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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in November

S a l m o n e l l o s i s. Incidence is lower in November (547:865), as expected for the season; intensity similar to the last year (517). Cluster registered in Rijeka (63).

H e p a t i t i s  A. (epidemic jaundice). Low incidence pattern continues with 7 cases registered in November (9 in last November). Small cluster is seen in Bjelovar (3).

M o r b i l l i  (measles). No cases in November owing to systematic immunization.

R u b e l l a. No cases in November, owing to systematic immunization.

V a r i c e l l a  (chickenpox). After usual summer-autumn minimum, an increase of incidence is registered in November (792:426). However, in November last year more cases were recorded (1260).

L e p t o s p i r o s i s. There were more cases registered in November than in October (32:25) which was also more than in November last year (26). Small clusters are seen in Slavonski Brod (3), Petrinja (4), Karlovac (3) and Vojnic (3).

A I D S. There were 4 reports registered in November for cases occurring during last six months.

I n f l u e n z a. In the frame of national sentinel network for early detection of influenza,  1 isolated case of influenza syndrome was reported in November, but virologically not confirmed.

n      No reports in November from: Otocac, Drnis, Kastela, Lastovo and Metkovic. Total: 5 out of 113 epidemiological districts.

n      Epidemic outbreaks

         Following outbreaks were reported in November:

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

Novi Zagreb - salmonella food poisoning (S. enteritidis) among consumers of ice cream and cakes from a pastry shop, on 10.9. 2005. There were 16 diseased. Salmonella was found in cake samples. Source probably among staff (history of enteric disturbances and salmonella positivity).

Sibenik - food poisoning in a kindergarten, starting 22.9.2005. Causative agent not found; microbiological examinations negative. There were 6 diseased out of 23 members of one children group. Vehicle epidemiologically: ice cream, but microbiological examinations turned salmonella negative. So, secondary  contamination during manipulation is suspected.

Koprivnica - salmonella food poisoning (S. enteritidis) after a wedding banquet, 9.10.2005. There were 63 diseased out of 222 exposed persons. Vehicle: various meals and dishes: panned chicken, pork meat, roasted sausages, bean salad, French salad, backed fish, wedding cake, all found salmonella positive! Source not found. Epidemiological investigation revealed several mistakes in food handling.

Pula - salmonella food poisoning (S. enteritidis) on 15.10. 2005 after a group dinner in a restaurant. Total of 22 cases were recorded out of 130 exposed. Source probably among kitchen staff  (two persons salmonella positive) Salmonella was also found in samples of pasta with tuna and in boiled vegetable samples. 

Zagreb Centar - acute enterocolitis of unknown cause (microbiological examinations negative) in a group returning from pedestrian pilgrimage on 16.10. 2005. All 9 members of the group turned ill. Mode of acquiring most probably by drinking water from and uncontrolled forest well. Water samples showed massive fecal contamination.

Zadar - mushroom poisoning in a family with 4 diseased on 23.10.2005. No mushroom left for determination. Family declared that they did not know neither eat  that  mushrooms before (a classical mistake; one should gather and eat only mushrooms that are very well known to him/her).

Kutina - scabies in a home for elderly persons. On 25.10. 2005. there were 32 infested persons out of 63.

Zadar - salmonellosis (S. enteritidis) among crew of a fishing boat, starting 26.10. 2005 with 6 diseased (all hospitalized) out of 9 exposed. Vehicle epidemiologically: panned fish meal not microbiologically examined. Source not found.

Sisak - salmonellosis (S. enteritidis) 2.11. 2005 in a family, eating their own home made cream cakes. All 4 members turned ill. Source not found, no cakes left for analyses.

NEWS AND COMMENTS

n      Avian flu in humans, current situation

      Basing on recent reports of World health organization (www.who.int/CSR/en, dated 16.12. 2005.) at the moment of writing this article (mid of December) there were 139 cases of infection with H5N1 influenza virus (avian influenza) registered in humans, out of which 71 had died (51%). Distribution of cases is presented in following tables:

The current statistics is held since 2003 (see following table)

  *up to 16.12.05.

The second table shows that lethality decreases, most probably because of wider  coverage of persons infected. Except some cases occurring in very close contacts (health care workers, family members) which are still under thorough investigation, the vast majority of all registered human cases, had occurred in close and direct contact with poultry, sick with avian influenza. Until now, no sustained interhuman transmission occurred.

n      Deceased from communicable diseases in Croatia in 2004.

        Every year we are presenting a spectrum of communicable diseases capable to cause a lethal outcome. Here are the data for 2004. The total of 73 774 cases of notifiable communicable diseases were recorded in Croatia in 2004. Out of this number 71 had died, which gives a very small proportion of 0.009 %,  this owing to proper treatment and good accessibility of health services. Looking to the table bellow one can see that tuberculosis is still ranking first (see ENEWS N^o 8/2004) followed by pneumonia, both in elderly people. Other cases are rare, but still, and always, tragic and unwanted.

Further decrease in this segment of mortality can be achieved by even more successful therapy, but also through preventive and control measures, lowering overall incidence of certain diseases.

n   Leptospirosis

     This autumn, an increased incidence of leptospiroses was observed comparing to last year (92:63, in first 11 months). This was most probably a consequence of recent floods, forcing small terrestrial mammals (natural reservoirs of leptospirae) to concentrate themselves on a dry terrain, often near human dwellings, increasing thus possibilities for human infections.

Graph above is showing leptospirosis case reports by month, this and  previous year.

COMMUNICABLE DISEASES IN CROATIA              November 2005