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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in August

S a l m o n e l l o s i s. Incidence declined in August comparing to previous month (651:729) but  this was more than in August last year. Small clusters are seen in Koprivnica (20), Slavonski Brod (20), Pula (20),  Zadar (21), Varaždin (26), Zagreb Črnomerec (27), Dubrava (31), Novi Zagreb (33), Susedgrad (28) and Sesvete (21).

D y s e n t e r i a   b a c i l l a r i s. Low incidence pattern continues with 3 sporadic cases registered in August (1 in July, 1 in last August).

T e t a n u s. One case in August in Zabok; an old unvaccinated woman.

M o r b i l l i  (measles). One imported case  reported  in August from Brač. 

R u b e l l a. No cases in August.

V a r i c e l l a  (chickenpox). Number of cases is much lower than in previous month as expected for the season (475:1495) This was also less than in August last year (734).

P a r o t i t i s   e p i d e m i c a (mumps). There were 21 cases reported in August as a continuation of cluster from previous month (see ENEWS 7/2005) with 40 cases registered. The diseased were mainly younger adults not covered with vaccination program still not immune through a naturaly contracted disease because of very low parotitis incidence achieved by systematic vaccination (shift to older age).

M e n i n g i t i s   v i r o s a (aseptic). Usual summer increase is detected (52:39). The number is higher than in last August (40).  Small clusters in Sisak (5) and Zadar (6).

T i c k   b o r n   m e n i n g o e n c e p h a l i t i s (TBE). A slight increase is observed in August (8:6), incidence similar to August last year (8).

n      No reports in August from: Novalja, Imotski, Vis and Lastovo. total: 4 out of 113 epidemiological districts.

n      Epidemic outbreaks

         Following outbreaks were reported in August:

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

Rijeka - hepatitis A in children living in a suburban area with insufficient sanitation. Between 28.12. 2994. and 8.8. 2005 there were 5 cases registered. Mode of spread: contact.      

Knin - family outbreak of tuberculosis with 5 affected between 21.3. and 10.7. 2005. Source not found. The first patient was a family member having spastic paraparesis. Contact tracing revealed two cases among close relatives living currently in other parts of the country.

Cres-Losinj - food poisoning in an auto-camp on 21.5. 2005. There were 9 diseased out of 13 exposed. Vehicle epidemiologically: grilled sausages, which were not microbiologically examined.

Rijeka - family outbreak of salmonellosis (S. enteritidis) starting on 22.5. 2005. with all 4 members getting ill after consuming grilled ground meat purchased in a butchers shop. Salmonella not found in raw meat samples however.

Rijeka - family outbreak of salmonellosis (S. enteritidis) starting on 3.6. 2005. with all 6 members getting ill. Vehicle: home made tiramisu sweet. Salmonella found in tiramisu samples.

Vinkovci - salmonella food poisoning (S. enteritidis) after a wedding celebration on 20.6. 2005. There were 11 cases out of 100 exposed. Vehicle epidemiologically: wedding cake. However, cake samples turned salmonella negative.

Garešnica - salmonella food poisoning (S. enteritidis) after a wedding banquet on 3.7. 2005. There were 80 diseased registered out of c/a 240 exposed persons. Vehicle epidemiologically: home made cakes and sweets. Salmonella was found in cake samples, in fresh eggs used for cake confectioning and on several pieces of kitchen equipment.

Ludbreg - salmonella food poisoning (S. enteritidis) in a family on 10.7. 2005. Vehicle epidemiologically: home made cake, no samples left for analyses. There were 6 diseased out of 12 exposed persons. Source not found with certainty.

Zagreb Črnomerec - salmonella food poisoning (S. enteritidis) in a group of young sportsmen accommodated in an hotel on 21.7. 2005. There were 9 diseased. Source not found. Vehicle not certain. Epidemiological investigation did not find salmonella in hotel staff neither in food samples.

Zadar – salmonella food poisoning (S. enteritidis) on a family gathering 5.8. 2005. There were 11 diseased out of 15 exposed. Vehicle: home made cream cakes. Salmonella was found in eggs used for cakes, but also in well water used for water melon cooling.

Krk - acute gastroenterocolitis in a children summer resort. Causative agent not found, laboratory examinations negative; viral etiology possible. Between 5.8. and 19.8. 2005. there were 67 diseased out of 174. Mode of spread most probably combined: by contact and via droplets.

NEWS AND COMMENTS

n      Epidemiologists meet to discuss influenza surveillance

Croatian national institute of public health. The purpose of meeting was to define the main activities of influenza surveillance this season, including possible new pandemic influenza. In this respect relevant parts of the National pandemic influenza preparedness plan were discussed and analyzed. The main elements of epidemiological surveillance of influenza agreed are:

a) to establish active sentinel network  in all Counties and City of Zagreb in order to notice clusters of febrile illness similar to influenza. In that network a certain number of medical practitioners, like GPs or school hygiene doctors etc. should be included as well as representatives of  schools and public institutions which can easily notice cases of unusual absenteeism.

b) if (when) such a cluster is detected, doctors epidemiologists from institutes of public health are expected to go to the field in order to visit a certain number of typical patients within the cluster. Cases in very early stage of illness i. e. 1-2 days since onset with high fever should be preferred because of best possibilities for finding viruses in upper respiratory tract and pharynx The swab samples will be taken and transferred in transport (Hanks) medium to the National influenza center at the Croatian national institute of public health for virus isolation attempt. The swab samples should be accompanied with the first patients blood sample and subsequently with second (pair) sample taken two to four weeks latter, for serological etiological diagnostics.

c) National influenza laboratory routinely identifies type of virus (A or B) using rapid monoclonal antibody tests, and further a viral subtype through isolation on cell cultures (MDCK) and embrionated eggs, using a sequence of heminaglutination inhibition tests (for instance: A/H1N1/New Caledonia), also avian H5N1. Viral isolates are sent to the reference laboratory in London (one of 4 world reference centers for human influenza viruses) for confirmation, and also as our contribution to WHO global influenza virus surveillance program, essential for a determination of most apropriate vaccinal viruses.

d) when the Laboratory gets first positive isolates,  the Epidemiology service of the Croatian national institute of public health will release a written announcement that influenza outbreak is at start, accompanied with usual recommendation for switching from individual reporting of influenza syndrome during interepidemic period of the year, to weekly cumulative reporting.

e) once the outbreak started, close epidemiological monitoring of epidemic development will provide important information about the age structure, severity of clinical picture, mortality, information whether vaccinated person get ill etc, essential for outbreak forecasting and decisions about adequate measures.

n      Marburg hemorrhagic fever in Angola, update

The World health organization weekly bulletin Weekly epidemiological record N^o 35 of September 2^nd 2005 reports about recent developments of epidemiological situation in Angola regarding Marburg fever (see ENEWS N^o 4/2005). The total cumulative number of cases until 13.7.2005.  reached the figure of 374 out of which 329 patients had died (88%). Laboratory confirmation was obtained for 158 cases. The last case occurred on 21.7. 2005. Measures are continuing.    

COMMUNICABLE DISEASES IN CROATIA                      August  2005