ENGLISH LANGUAGE ISSUE *  ELECTRONIC VERSION

COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in April

D y s e n t e r i a   b a c i l l a r i s. Low incidence situation continues: Mar: 2, Apr: 3, Apr. last year 2. No clusters. 

H e p a t i t i s  A (epidemic jaundice). Incidence is low. March: 8, April 7. A small cluster is seen in Rijeka (6). In April last year 1 case was reported.

M o r b i l l i  (measles). 1 case, not confirmed virologically, reported from Čakovec.

V a r i c e l l a (chicken pox). The incidence is decreasing (1536:2032) according to the season.

M e n i n g i t i s   e p i d e m i c a. In April, there were less reports than in March (8:10), cases not connected.

S y p h i l i s. Slightly more cases reported in April than in March (7:2), which is also more than in April last year (3). No clusters.

T u l a r e m i a. There were 3 cases reported in April, all from Sisak area. No cases in previous month, neither in April last year.

I n f l u e n z a. Within the current outbreak wave, which has reached its peak in previous month, steep decrease of incidence is observed in April (9054:84006).

n      No reports in April from: Knin, Kaštela, Vis and Lastovo. Total: 4, out of 113 epidemiological districts. 

n      Epidemic outbreaks

         Following outbreaks were reported in April:

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

Sisak - salmonella food poisoning (S. enteritidis) in three connected families on 29.3.2005. There were 5 diseased and 3 more symptomless carriers found  in 14 exposed persons. Vehicle epidemiologically: home made cakes and cooked ham. The epidemiological investigation revealed salmonella contamination in several samples: home made pasta, raw domestic eggs, home made cakes and cooked ham.

NEWS AND COMMENTS

n      Malaria in Croatia 2004

       In 2004. there were 8 cases of malaria registered in Croatia, which is equal to the previous year. All cases were imported i.e. patients have acquired the disease abroad in some of malaric regions of the world,  mostly as professionals working there. No autochtonnous malaria in Croatia recorded for 50 years now, owing to  large successful antimalarial campaign in late fourties and early fifties of the last century. As usual, here we are giving some data about these cases basing on information collected for each malaria case through special malaria case report form: country or area where malaria was most probably acquired, plasmodium species causing the disease, and chemoprophylaxis data.
 

 *immunochromatography assay

The patient N^o 1 could be classified as a possible case of resistance of P. falciparum to mefloquin, basing on anamnestic information that mefloquin prophylaxis was taken regularly and additional information that other drugs were used for subsequent hospital treatment.

n      Bacterial meningitis etiology in 2004

    Cases of bacterial meningitis (other than meningococcal) are monitored separately. In 2004. there were 62 such cases reported, which was slightly less than previous year (79). Etiologic causative agents are noted in 25 of them (40%) which was somewhat less than the average seen in previous years i.e. c/a 50% of bacterial meningitis cases with etiology determined.

 Etiology of bacterial meningitis in 2004

Streptococcus pneumoniae is ranking first this year. Further, it is worth noticing that only one single case of Hib meningitis was registered (a 69 years old women), suggesting that the most susceptible cohorts of infants and small children are already protected by systematic vaccination introduced recently.

n      Marburg virus disease in Angola

       According to WHO information published in the Weekly epidemiological record (numbers 12/25.03.05  - 17/29.04.05), during last several months Angola is experiencing severe outbreak of this exceptionally malignant disease and is  reporting more than 200 cases with the lethality over 90%. The most affected is a province of Uige. In spite of extensive engagement of the WHO and international experts the outbreak appeared not easy to control. Until the end of April according to the same source, situation was still delicate and potentially unstable.

      In this respect some precaution measures were established in Croatia. Persons coming from Angola at points of entry are routinely advised to monitor their body temperature daily and in case of a fever measuring over 38.3 ^oC they should contact a nearest epidemiology service, which is prepared to arrange the transfer of such person to adequate infectology hospital ward for further clarification and, if necessary, treatment and isolation. Till now one such case occurred, but Marburg haemorhagic fever was  excluded.

      Editorial note: Marburg disease (fever) belongs to a group of hemorrhagic viral tropical fevers. The causative agent, a virus of Filoviridae group is closely related to the Ebola fever virus. Till now outbreaks occurred rather rare and almost exclusively in Africa. An exception, which gave the name to this disease, was the outbreak in 1967, in the town of Marburg and at the same time in Frankfurt and Beograd, as a consequence of contact of laboratory workers with organs and tissues of African green monkeys (Ceriopithecus aethiops)* imported from Africa for the cell - culture production purposes. That year this virus was identified for the first time.

    The disease is transferred from manifestly ill persons to other persons in close contact with patients´ blood and secreta/excreta when virus can pass through damaged skin and probably through intact mucosa including genital mucosa (even in convalescence phase). So, main preventive measures, behind proper hand washing, are those that protect against the contact or droplet exposure (protective masks, gloves, goggles etc.) combined with all measures that avoid intrahospital  cross-infection i.e. asepsis and antisepsis, this being very important because of the experience that hospitally acquired infections occured frequently, in current outbreak too.
____

* it seems that African green monkeys are not the reservoirs of the virus but  susceptible victims of infection, while a real natural reservoir - most probably some rodent species is still undiscovered.

COMMUNICABLE DISEASES IN CROATIA                April  2005