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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in July

S a l m o n e l l o s i s. Incidence raised in July (729:504), being significantly higher than in July last year (515). Cases cluster in Rijeka (50), Zabok (33), Zagreb Dubrava (35), Maksimir (40), Trešnjevka (36), Novi Zagreb (35).

H e p a t i t i s  A (epidemic jaundice).  Low intensity continues: July: 9, June: 5 similarly to July last year (7). The majority was registered on Zagreb area (6).

P a r o t i t i s    e p i d e m i c a (mumps). There were 40 cases registered in July which is similar to the June figure (31). The majority of cases are from Dubrovnik (34) where outbreak continued among young unvaccinated adults (see ENEWS 6/2005).

M e n i n g i t i s    v i r o s a (aseptic). Number of cases is higher in July (39:4) as expected for the season, also slightly higher than last year (29).  No significant clusters.

M a l a r i a. One imported (Tanzania) case reported form Zagreb Medveščak.

T B E (tick born encephalitis). There were slightly more cases in July than in June (6:1) which is less than in July last year (13).

L y m e   b o r r e l i o s i s. Incidence raised as expected (41:28) but, like in TBE, not as much as in last July (60).

n      No cases reported in July from: Gracac, Obrovac, Drnis, Imotski, Makarska and Lastovo. Total: 6 out of 113 epidemiological districts

n      Epidemic outbreaks

         Following outbreaks were reported in July:

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

Sinj - salmonella food poisoning (S. enteritidis) starting on 8.1. 2005 after a birthdays party with 9 diseased. Vehicle epidemiologically: home made cake, not investigated microbiologically.

Rijeka - family outbreak of salmonella food poisoning (S. enteritidis) with 3 diseased between 21.3. and 31.3. 2005. Source and vehicle not found.

Rovinj - salmonella food poisoning (S. enteritidis)  in a family on 16.5. 2005. There were 4 diseased out of 5 persons eating soup with egg and cream, prepared in the morning and consumed  in the afternoon.

Sibenik - salmonella food poisoning (S. enteritidis) on birthday banquet.  24.5. 2005. there were 7 diseased out of 30 exposed persons. Vehicle epidemiologically: home made cream cakes, No cakes left for microbiological analyses.

Sibenik - salmonellosis (S. enteritidis) via ice cream from a pastry shop. Between 28.5. and 8.7. 2005. there were 10 cases registered. Epidemiological investigation revealed two salmonella carries among  staff. Salmonella was also found in ice cream and cake samples.

Sibenik - salmonella food poisoning (S. enteritidis) in a group returning from school excursion. Between 28.5. and 20.6. 2005 there were 13 diseased out of 69 exposed children and teachers. Vehicle epidemiologically: roasted chicken in a restaurant.

Krizevci - salmonella food poisoning (S. enteritidis) on 29.5. 2005. among participants of a wedding celebration. Vehicle epidemiologically: grilled meat and/or roasted chicken. Total of 6 diseased registered out of 300 guests. Microbiological examinations of food samples turned negative, secondary,  manual contamination is suspected.

Karlovac - salmonella food poisoning (S. enteritidis) in a family starting 1.6. 2005. with 2 cases out of 4 family members. Vehicle epidemiologically: home made cakes with fresh egg cream.

Zadar – food poisoning on a birthday party. Etiology not  found (examinations in patients all negative). There were 7 diseased out of 13 exposed on 12.6.2005. Vehicle epidemiologically: birthday cake, found contaminated with Staphylococcus aureus and enterobacteriacea.

Vinkovci – salmonella food poisoning (S. enteritidis)  in a family on 15.6. 2005 after eating home made cream cakes. All 5 exposed persons got ill.

Zabok – salmonella food poisoning (S. enteritidis) on 18.6. 2005 among persons participating in an private celebration and eating home made cakes. There were 12 diseased and 21 more symptomless carriers out of  80 exposed persons. Source not found.

Zadar – staphylococcal food poisoning in a holiday resort on 29.6. 2005. There were 19 diseased out of 40 exposed. Vehicle epidemiologically: cake and omelet. Epidemiological investigation revealed Staphylococcus aureus carriership among kitchen staff.

Sibenik – salmonella food poisoning (S. enteritidis) in a restaurant starting 1.7. 2005. with a total of 4 diseased out of 30 exposed persons. Vehicle epidemiologically: tiramisu sweet.

Slunj – acute gastroenterocolitis in a group of auto camp guests starting on 20.7. 2005. Causative agent not found, all microbiological examinations in patients negative. There were 10 cases out of 40 members of the group. At the same time other 1800 guests were well. The group used to cook own meals. Incriminated meal epidemiologically: pasta with eggs and cheese.

NEWS AND COMMENTS

n      Avian flu, development of human vaccine

      In the situation when the avian influenza virus of A/H5N1/ type, circulating in poultry in several Far East countries, recently also in Russia and Kazakhstan, is suspected as a most real candidate for new human pandemic causative agent, efforts are made to develop an adequate vaccine for humans, in case that  predicted although unwanted virus change really occurs. Activities are coordinated through the World health organization. Basing on information available on the Internet site of the WHO (www.who.int/influenza) here we give some interesting details about vaccine development.

       Currently the WHO chose few viral strains as possible prototype vaccinal strains suitable for vaccine production. These are genetically recombined strains obtained on the basis of A/H5N1/ virus isolated from infected humans. Three strains are mentioned: A/Hong Kong/213/03, A/Vietnam/1194/04 and A/Vietnam/1230/04. Some vaccine producers already conducted experimental production. First clinical testing on humans with those experimental vaccines were also done. The results showed that rather high concentrations of antigen were necessary for an adequate seroconversion, this having impact on total potential capacities of vaccine production. Certain vaccine adjuvants are expected to overcome this problem, as well as possible alternative intradermal application of vaccine. With previously solved those and some other existing problems of vaccine production, a mass production is planed only if and when present viral characteristics would change towards feared pandemic potentials. This because of  fact, that this production necessary would diminish capacities for production of "regular " seasonal influenza vaccine, which, by all means is very important tool in avoiding high numbers of diseased and deceased from influenza each season. In the next article actual proposed composition of influenza vaccine for 2005/2006 winter season on the northern hemisphere is given.

n      Influenza vaccine composition for winter season 2005/2006

        In spite of the fact that much attention is paid to recent developments in avian influenza situation as well as to possible other new pandemic influenza viral strains, regular global surveillance network data gave the elements for routine prognosis for this winter season. Basing on the Weekly epidemiological record N^o 8/2005 and internet site www.who.int/influenza, optimal vaccine composition this year should be as follows:

           A/H1N1/New Caledonia like

           A H3N2/ California  like

           B/Shanghai  like,

with an additional note that for component B, vaccinal strains B/Shanghai, B/Jingsu and B/Jilin are adequate, while for A/California vaccinal strain A/H3N2/New York fits best.

n         Enteroviruses in circulation in Croatia, summer 2005

       The reference laboratory for enteral viruses at the Virology service of the Croatian national institute of public health refers that this summer circulation of enteroviruses was moderate. Dominant isolate from patients specimens was Coxsackie A9 virus. Viruses ECHO 18, ECHO 22, ECHO 25 and ECHO 30 were also detected.

COMMUNICABLE DISEASES IN CROATIA                      July 2005