ENGLISH LANGUAGE ISSUE *  ELECTRONIC VERSION

COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in September

S a l m o n e l l o s i s.  An increase of incidence was observed in September (924:651), but similar situation existed in September last year (929). Highest numbers are seen in Rijeka (84), Čakovec (80) and Novi Zagreb (70).

H e p a t i t i s  A (epidemic jaundice). Low incidence situation continues with 5 cases registered (2 in August, 1 in last September). 

M o r b i l l i  (measles). No cases in September.

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

V a r i c e l l a  (chickenpox). Incidence decreased further (370:475) as expected for the period of seasonal minimum. In last September there were slightly more cases (402).

P a r o t i t i s    e p i d e m i c a (mumps).  After two months of increased incidence (see ENEWS N^o 7 and 8 /2005) the number in September returned to low levels (6:21) similarly to September last year (8).

L e p t o s p i r o s i s. Number of cases is higher than in August (13:4) and also higher than in  September last year (7). No significant clusters.

M a l a r i a. In September 1 case was reported from Rijeka (import).

L e i s h m a n i a s i s.  There were 2 cases recorded in September, both in Ploče.

L e g i o n e l l o s i s. 4 sporadic ceases were reported in September, similarly to August (1) and last September (3).

n      No reports in September from: Topusko and Lastovo, i.e. 2 out of 113 epidemiological districts.

n      Epidemic outbreaks

         Following outbreaks were reported in September:

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

Dubrovnik – varicella in few kindergartens during the first half of the year. Between 16.1. and 27.6. 2005 there were 92 diseased out of 424. Favorizing factor: overcrowding.

Rijeka – salmonellosis (S. enteritidis) in a kindergarten. Between 24.6. and 30.6. 2005. there were 12 cases out of 15 exposed in one children group. Vehicle not found. All other groups ate the same food and had no difficulties.

Karlovac – family outbreak of salmonellosis (S. enteritidis) after a panned cheese meal on 25.7.2005. All 4 family members got ill.

Karlovac – salmonella food poisoning in a family (S. enteritidis) starting on 31.7. 2005 and  with 3 diseased out of 4. Wehicle epidemiologically: cream cakes eaten in a hotel at the sea coast.   

Osijek – salmonella food poisoning after a social club celebration 31.7. 2005. with total of 9 diseased out of 23 exposed persons. Vehicle: home made ice cream. Salmonella found in ice cream samples, as well as in fresh eggs used for ice cream preparation.

Šibenik – salmonella food poisoning (S. enteritidis) after family meal on 2.8. 2005. There were 6 diseased out of 13 exposed. Source probably a person participating in food preparations suffering from enteric disturbances for several days (subsequently found salmonella-positive). No food left for analyses. Samples of eggs used in food preparation were found salmonella positive. May be that person mentioned became infected eating those eggs few days earlier.

Šibenik – salmonella food poisoning (S. oranienburg) in a family. Source and vehicle not found. Between 4.8. and 15.9. there were  4 diseased out of 6 family members.

Šibenik – salmonella food poisoning (S. enteritidis) among persons eating cakes from same pastry shop. Between 6.8. and 7.9. there were 4 cases registered. Cake samples  were found salmonella positive.

Rijeka – salmonella food poisoning among crew of a foreign ship. Between 13.8. and 2.9. 2005 there were 6 diseased out of 110 persons on board. Source probably a member of kitchen staff, found salmonella positive. Vehicle not certain, fish and rise meal is suspected, but no samples were examined.

Sisak – gastroenteritis in 6 persons having their holidays together in an auto-camp on Biograd area. Outbreak started on 20.8. still during vacations, while the rest of cases occurred after returning home. Source and mode of spread not found. Causative agent: Escherichia coli.

Jastrebarsko – salmonella food poisoning (S. newport) on 23.8. 2005 in a group of people eating green figs. Figs were however previously washed in a turbid water of local water pipe network, which was out of use at that time, because of the flood. All 5 exposed  persons got ill.

Varaždin – salmonellosis in a family (S. enteritidis) caused by home made cream cakes on 28.8. 2005. Five members got ill. Cream cakes were not microbiologically examined.

Sisak – salmonella food poisoning (S. enteritidis) in a group of school children on their trip abroad. Between 29.8. and 7.9. 2005 there were 5 diseased out of 120 participants (first cases occurred during the trip and the rest after returning home). Vehicle not found.

NEWS AND COMMENTS

n      Human antirabic treatment in Croatia in 2004

     As usual here we are presenting a digested annual report about antirabic treatment of persons exposed to rabies risk during 2004, based on annual reports of all antirabic units in Croatia (25 of them). This delicate and responsible medical work was done by doctors epidemiologists working in institutes of public health, which antirabic stations are a part of.

    In 2004 the total of 5668 persons asked for medical help after they had experienced some risky contact with animals found to be rabid or suspected to be rabid. After a thorough anamnesis and clinical examination, including necessary wound toilette, in 1220 cases the indication for a post exposure antirabic immunological treatment was established. This was somewhat less than in previous year (see ENEWS No 5/ 2004). The majority (1147) received the vaccine only, while 73 (5,9%) had received a vaccine and HRIG (rabies hyper immune gamaglobuline). The table bellow shows the distribution of injuries/contacts causing antirabic treatment by an anatomic localization.

Table 1

Animal species responsible for antirabic treatment in 2004 are given on the Table 2.

Table 2

Dogs are still ranking first, mostly dogs without owner's control i.e. of unknown owner. This reminds us once more of the necessity of better care for our pets, esteemed often  as "mans best friends". It can also be seen that the rat bite poses a regular (and justified) indication for antirabic treatment here, as few years ago a rabid rat had been detected. Treatment is also given in cases of exposure to bats  (although bat rabies was not detected in Croatia till now). Having in mind that the most dangerous is exposure to canide animals, it should be noted that there were few cases of exposure to wolf. Such situations could become more frequent if wolf population increased under current measures of wolf protection. People should than be aware of  such situations and behave with necessary  caution.

At the end it should be said that in 2004. none of treated persons turned ill with rabies, and there were no human rabies cases in the country at all. The last autochtonous case  was registered in 1964.

COMMUNICABLE DISEASES IN CROATIA                      September  2005