ENGLISH LANGUAGE ISSUE *  ELECTRONIC VERSION

COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in December

S a l m o n e l l o s i s. Incidence is somewhat lower than in November (399:547) which is slightly more than n December last year (302). No significant clusters.

H e p a t i t i s   A  (epidemic jaundice). There were more cases in December than in November (11:7) as expected for the season. This was not much different from the last December (6). Small cluster is seen in Zagreb Pescenica (5). The diseased were children living in some suburban settlements with insufficient sanitation.

P e r t u s s i s (whooping cough). In December only 9 sporadic cases were reported, owing to systematic vaccination. This was less than in December last year (21).

M o r b i l l i  (measles). No cases in December owing to vaccination

R u b e l l a. One suspect case reported from Ploce. However virological and epidemiological examination discarded rubella: child was previously vaccinated and had had only  IgG positive finding.

P a r o t i t i s   e p i d e m i c a (mumps). Number is equal to previous month (11), slightly higher than in  December last year (6). No clusters

L e p t o s p i r o s i s. There were still 29 cases registered in December (32 in November) which was more than in December last year (7). Cases cluster in Djakovo (7)

B o t u l i s m u s. One isolated case is registered in December in Sinj. Patient was exposed abroad, eating there home made mushrooms preserved in oil.

n      No reports in December from: Cazma, Delnice, Drnis, Lastovo. Total: 4 out of 113 epidemiological districts.

n      Epidemic outbreaks

         Following outbreaks were reported in December:

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

Dubrovnik - mumps in the town and its surrounding. There were 87 cases registered between 10.5. and 1.9. 2005. The age of diseased: between 20 and 35 years, all unvaccinated, as that cohort had been not covered with the vaccination program. Place of exposure epidemiologically:  few public places and events visited by majority of diseased.

Rijeka - salmonella food poisoning (S. enteritidis) in a kindergarten starting on 11.5. 2005. there were 13 diseased out of 73 exposed. Vehicle epidemiologically: scrambled eggs and lasagna.

Dubrovnik - family outbreak of salmonellosis (S. group B) on 20.6. 2005. with 2 diseased out of 5 exposed family members. Vehicle epidemiologically: fried eggs, not microbiologically examined.

Dubrovnik - family cluster of enterocolitis with 4 diseased between 13.7. and 17.7. 2005. Vehicle probably the cake bought in a pastry shop. Cake samples not examined. In one of diseased Yersinia enterocolitica was isolated.

Dubrovnik - salmonella food poisoning (S. enteritidis) after a birthday party with 6 diseased on 15.8. 2005. Vehicle epidemiologically: cake from a pastry shop. Cake samples positive on enteral bacteria but not on salmonella..

Opatija - mononucleosis in a kindergarten. Between 20.8. and 15.9. 2005. there were 4 cases registered out of 150 exposed.

Dubrovnik - family cluster of acute enterocolitis on 8.9. 2005. with 2 diseased (one with hemorrhagic diarrheal syndrome) after eating cakes from a pastry shop. Causative agent probably Campylobacter spp. found in one of diseased. No cakes left for analyses.

Djakovo - leptospirosis in a village, after the flood (see ENEWS no 11/2005)  Between 6.9. and 21.9. 2005. there were 10 diseased. Causative agent most probably Leptospira int. s.v. ballum, showing highest antibody titers among several other positive serovars in patients examined. 

Dubrovnik - head lice in several elementary schools. Between September and November 2005  following separate clusters were discovered and treated: 22.09: 9 cases out of 175; 23.09: 11 cases out of 161, 04.10: 4 cases out of 50, 12.10: 7 cases out of 58,  03.11: 13 cases out of 100 exposed.

Dubrovnik - food poisoning in a family most probably caused by salmonella (S. enteritids), with all 4 members ill. Vehicle not found. Salmonella found only in one of diseased.

Rijeka - acute gastroenteritis in a kindergarten. Between 14.10. and 18.10. 2005 there were 11 diseased (2 hospitalized) among 107 children. Causative agent: Rota virus. Mode of spread: most probably by contact, but aerogenic spread could also had some role.

Rab - bronchopneumonia among preschool and school children. Between 24.10. and 22.12. 2005 there were 23 cases registered. Causative agent: Mycoplasma pneumoniae

Dubrovnik - small family cluster of salmonellosis (S. enteritidis) starting 5.11. 2005, discovered during regular health check in one symptomless family member employed as a food handler. Total of 3 cases out of 4 family members were detected; only one (a child) hawing clinical symptoms. Vehicle and place of exposure not certain. Attendance at a wedding banquet is suspected.

Split - salmonellosis (S. enteritidis) starting on 18.11.2005 in a group eating home made cake. There were 11 diseased out of 19 exposed persons. Cake was not microbiologically examined.

Rab - food poisoning in a group of voluntary blood donors. After organized blood taking they were offered with a meal of cooked dried pork ribs. A short-lasting afebrile diarrhea was the predominant symptom. There were 17 diseased out of 80 exposed persons. Causative agent: Clostridium perfringens, found in diseased,  while sanitary microbiological examination of dried ribs revealed the sulfite-reducing clostridia, and Staphylococcus aureus.

Varazdin - food poisoning of unknown etiology (microbiologcal examinations negative) in a kindergarten, starting on 1.12. 2005. There were 10 diseased (children and staff) out of 130 exposed persons. Vehicle epidemiologically: few meals: hot dog, ragu soup, pasta with cheese, but no pathogenic microorganisms  found in food samples. Additionally no cases occurred in other kindergartens in the town, eating food form the same central kitchen.

NEWS AND COMMENTS

n      Salmonellae in circulation in 2005

The Laboratory  for enteral pathogenic bacteria of the Microbiology service of the Croatian national institute of public health reports positive salmonella primoisolates in current year (see table). 

Like in earlier years Salmonella enteritidis clearly dominated in 2005.

n      New annual report of the Cancer registry

The Cancer Registry of the Epidemiology department for chronic mass diseases of the Croatian national institute of public health recently released its regular annual edition  titled  "Cancer incidence in Croatia" with data for 2003. Total of 40 pages contain 27 tables and 12 graphic presentations with bilingual commentary (Croatian and English). Data about cancer incidence by localization, age, sex, place of residence etc. are given. At the end of the book, there is an interesting revue of publications, articles, scientific research projects and lectures, using data from this important national Register during the year. Among all informations published in the book we are excerpting here some data from a table showing stage of cancer diseases at the moment of diagnosing, data about Ca uteri are chosen, which illustrates efficiency of early detection measures established in order to provide timely treatment. (see table).

The figures are rather favorable, as majority of cases had been detected (diagnosed) at stages 0 and 1. Anyhow, further efforts would be justified to reduce even more the numbers of cases diagnosed in advanced stages which leave  much less possibilities for a successful treatment and favorable outcome.

n   30 years of the Croatian epidemiological society of CMA

This year (2005.) the Croatian epidemiological society of the Croatian medical association, celebrates the 30th anniversary of existence and continuous fruitful work. The founding meeting occurred on June 24th 1975. in great hall of a historical building  of  the School of public health "dr. A. Stampar" of the Medical faculty of Zagreb and the Croatian national institute of public health, in the Rockefellerova street. The first president of the CES was one of most eminent epidemiologist Prof. dr. Zlatko Bencic. At the moment of founding 51 members were present. Today the Society has 192 members, mainly medical doctors specialist in epidemiology. During past 30 years the Society constantly tried to contribute to a continuous education and training of its members. In this purpose the total of 60 scientific meetings were organized (two each year) with more than 600 scientific and professional lectures presented, as well as tree successful epidemiological congresses, first one in Zadar in 1986, second in Split in 1999 and third one this year in Rovinj (see: ENEWS no 10/2005 and also ENEWS No 4/1999).

n     Respiratory viruses in circulation  in winter 2005

The Laboratory for respiratory viruses  and National influenza center of the Croatian national institute of public health informs about positive findings during November and December in specimens taken form patients with acute respiratory illness. Following viral agents were identified: Parainfluenza 1, Parainfluenza 3, Adenovirus and RS virus.
In all specimens analyzed so far, no influenza viruses were found.

COMMUNICABLE DISEASES IN CROATIA              December 2005

*  discarded; see  page 1, case notification

CONTENTS OF THE EPIDEMIOLOGICAL NEWS

IN 2005

Epidemiological comments                                                                       N^o ENEWS

Work and problems of epidemiology services

Graphs and pictures

Permanent titles

Individual case notification dynamics in Croatia (commentary)

Epidemiological districts without notifications

Epidemic outbreaks reported  in current month

Communicable diseases notified in current month (numeric table)