ENGLISH LANGUAGE ISSUE *  ELECTRONIC VERSION

COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in March

S a l m o n e l l o s i s. In March there were less cases than in February (111:163). No significant clusters.

H e p a t i t i s   A (epidemic jaundice). A low incidence pattern continues (Feb.:2, Mar.:8). No clusters.

A n g i n a     s t r e p t o c o c c i c a (streptococcal sore throat). There were less cases reported in March than in February (767:858), which is significantly less than March last year (1446). Highest numbers are recorded in Slavonski Brod (30), Sisak (59), Zagreb Susedgrad (37) and New Zagreb (56).

M e n i n g i t i s  e p i d e m i c a. Number of cases is slightly higher than in February (10:5) and also higher than March last year (6). Cases are sporadic and not connected. Since the beginning of the year the total of 19 cases were reported, which is roughly equal to (or slightly less than) the same period last year (20).

A I D S. Seven case reports in March were cumulated through last five months.

M a l a r i a. One imported case in Split.

P n e u m o n i a. Number of cases recorded in March is similar to previous month (1010:1083), but higher than in March last year (674).

I n f l u e n z a. Incidence rapidly raises in March (84006 : 17219) being far above the last year March figure (9400). In fact, this month more ceases were recorded then in entire last year outbreak.

n      No reports in March from: Lastovo; only one out of 113 epidemiological districts.

n      Epidemic outbreaks

         Following outbreaks were reported in March:

Note: in all outbreaks mentioned here, epidemiological investigation and all necessary measures were undertaken, preventing thus other potential cases.

Sinj - brucellosis in a village among persons dealing with goats and sheep (animals found infected by veterinary examination). Vehicle not found. There were 5 cases out of 28 exposed between 2.5. and 15.7. 2004.

Nova Gradiška - pertussis among preschool and school children in few villages. Between 5.12. 2004 and 15.2. 2005 there were 15 cases registered. However the attempt  for microbiological confirmation i.e. Bordetella isolation turned negative.

Zagreb Peščenica - hepatitis A in a family starting 15.12. 2004 with 4 diseased children. They were most probably exposed on a family celebration (wedding) held in a neighboring country. Source not found. Mode of spread: contact or via food.

Sisak - streptococcal sore throat in a social institution for children. Between 1.2. and 18.2. 2005 there were 19 diseased (children and staff) out of 70 exposed.

Zagreb Črnomerec - gastroenterocolitis in a pediatric hospital ward. Between 13.2. and 30.3. 2005 there were 25 diseased. Causative agent: Rota virus. Source found with certainty. Mode of spread mainly by contact.

Dubrovnik - head lice in an elementary school. There were 8 infested among 100 exposed on 18.2. 2005.

Dubrovnik - head lice in another elementary school (see above) with 12 infested out of 103 exposed on 22.2.2005.

Krk - enterocolitis in an elementary school with 16 diseased between 9.3. and 17. 3. 2005. Etiology unclear (microbiological examinations negative). Mode of spread: alimentary. Vehicle epidemiologically: ham and eggs.

NEWS AND COMMENTS

n      Influenza

         Current influenza outbreak developed greatly, reached its peak and declined in March, showing an intensity visibly higher than last year. The graph below shows influenza incidence trends by epidemiological weeks this year compared with pervious one.

n      II. Encephalitis, etiology

In the majority of encephalitis cases reported (40 - 70 per year) the etiology is not detected.  A microbial causative agent is known in some 8 % all cases, i.e. between 0 and 7 per year. Spectrum of identified causative agents in encephalitis cases between 1996 and first trimester of 2005 is shown in the table below. 

Varicella-zoster virus is ranking first (roughly 2 cases per year), followed by Herpes simplex tip 1 virus, Listeria monocytogoenes, Borrelia burgddorferi etc. Although not representative (but only available data) these data can in some extent indicate the etiologic structure in the rest of encephalitis cases in which etiology was not found, as well as relative proportions of causative agents hawing in mind  that first in rank varicella-zoster virus is absent in middle age, differing thus from overall age distribution pattern of all encephalitis cases together (see graph)  

As usual for CNS infections males prevail among encephalitis cases with known etiology (23:14). This ratio is equal to sex ratio in all encephalitis cases.

Out of 37 cases with etiology determined 4 patients died. In them encephalitis was caused by the following microbial agents: Varicella-zoster virus (herpes zoster disease), Influenza virus, Herpes simplex virus and Staphylococcus sciuri.

COMMUNICABLE DISEASES IN CROATIA                                March  2005