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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in February

S a l m o n e l l o s i s. Rather low intensity observed as expected for the season. There were less cases reported than previous month (138:175), also less than in February last year (163). The only cluster is seen in Rijeka (30).

D y s e n t e r i a  b a c i l l a r i s.  Very low and sporadic incidence pattern continues in February with only 1 case registered,  similarly to January (1) and February last year (0).

P e r t u s s i s (whooping cough). Owing to systematic vaccination only 3 sporadic cases were reported in February,  which was similar to previous month (0) but lower than in February last year (21).

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

R u b e l l a. No cases in February owing to mass immunization.

V a r i c e l l a (chickenpox) seasonal increase  is observed (2420:2325) but in February last year the intensity was somewhat higher (2507).

A I D S. Five reports in February refer to the several previous month period.

L e g i o n e l l o s i s. There were 3 cases reported in February (Slavonski Brod, Petrinja, Zagreb Dubrava) which does not differ from previous month (3) and last February (1).

P n e u m o n i a. Number of reported cases in February (583) is similar to previous month (595), but visibly lower than in February last year (1083).

I n f l u e n z a. There were 5 cases reported in February, but without virological  confirmation. At that time last year, the outbreak was already fully developed with 17219 cases registered in February.
 

n      No reports in February from Vrgorac;  only one of 113 epidemiological districts.

n      Epidemic outbreaks

        Following outbreaks were reported in February:

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

Dubrovnik - varicella among school children on an island. Between 20.8. 2005. and 21.11. 2005 there were 78 diseased.

Slavonski Brod - trichinellosis in group of persons eating home made pork meat and products. There were 24 diseased out of 40 exposed persons between 29.11. 2005 and beginning of January 2006. Trichinella was found in meat samples.

Ludbreg - enterocolitis in a kindergarten. Between 19.1. and 26.1. 2006 there were 10 cases out of 60 exposed. Causative agent not found, laboratory examinations negative. Mode of spread: contact, possibly partly via droplets.

New Zagreb - salmonellosis (S. enteritidis) on 3.2. 2006 among group of factory workers, with 8 diseased out of 100 exposed. Some meal from factory canteen is suspected, but could not been determined.

NEWS AND COMMENTS

n      Regularity of reporting in 2005.

During 2005 the total of 24 different epidemiological districts out of 113 were absent from national communicable diseases surveillance system on monthly level. The majority of them were absent only for one month (this is the median value). Such absences are typical for those epidemiological districts where no complete epidemiologic team is established, so work can sometimes depend on one person, that can for instance get ill. From month to month between 1 and 8 epidemiological districts were missing, or 5 in average (exactly 4,5), which is 3.9% all districts.

Epidemiological districts with occasional absence were from 8 different counties, while in other 13 counties there were no missing districts during the entire year.

Generally such a picture of regularity of reporting can be assessed as rather good, as more than 95% all districts were presented et any moment, giving reliable basis for accurate assessment of epidemiological situation in the country. However  the aim should be, that no districts could be found without data in monthly surveillance.

n      Salmonellosis outbreaks in Croatia in 2005.

        There were 64 outbreaks of salmonellosis registered in Croatia in 2005. Like previous years, Salmonella enteritidis was the most important in causing outbreaks.

Table 1

The table 2 shows where those outbreaks occurred. It can be seen that the majority occurs in families after everyday meals, so small numbers of diseased are involved. Potentially more important became recently very popular mass wedding banquets. Great numbers of guests are usually present (exposed), while food preparation often has the characteristics of household nonprofessional cooking.

Table 2

Only few outbreaks occurred in public food facilities like restaurants, pastry shops, hotels etc.: in a hotel only one. There were no incidents caused by industrially manufactured food of food products. This suggests that current national system of public food security works well. Epidemiological investigation, performed regularly in every outbreak, had determined 60 different meals and dishes as epidemiologically responsible vehicles, in some cases more than one meal. However in a certain number of cases it was not possible to point to any particular meal among many meals served or no meal could be determined at all, usually when outbreak was detected late.

Table 3

In 20 different food samples taken in outbreaks investigated, salmonella was microbiologically confirmed (table 4)

Table 4

Basing on epidemiological investigation data, the main causes of salmonellosis outbreaks in 2005 were classical ones: handling food in unhygienic conditions,  insufficient thermic treatment, leaving outside refrigerator too long, rewarming etc.

The determination of a source of infection and answering how salmonella came into particular incriminated food (primary or secondary contamination)  was not possible in the majority of cases. In this respect it is important that, there were no positive findings from fresh meat of any kind examined, which puts a good light on overall microbiological safety of meat. In 5 outbreaks fresh eggs were found salmonella positive. Also in 5 outbreaks, salmonella carriers (usually with symptoms) among the kitchen staff had been epidemiologically related to particular outbreak. Much more positive food handlers were found during investigations, but  it was not possible to distinguish if this was a preexisitng condition, or just a consequence of eating incriminated meal as other diseased. The above data suggest that both, the care for microbiological safety of food of animal origin and the care for kitchen staff health regarding enteral infections are important and useful parts of the whole, complex foodborn diseases prevention and control system in place in the country.

COMMUNICABLE DISEASES IN CROATIA              February 2006