ENGLISH LANGUAGE ISSUE *  ELECTRONIC VERSION

COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in April

S a l m o n e l l o s i s. Less cases were registered in April than in March (125:142), or in April last year (196). Cluster is seen in Slavonski Brod (13).

H e p a t i t  i s   A (epidemic jaundice). Low incidence situation continues with only 2 cases reported in April. Last year figure was slightly higher (7).  No clusters.

P e r t u s s i s (whooping cough). In April there were 9 cases, which was similar to previous month (8) and April last year (10). Cases were not microbiologically confirmed however.

M o r b i l l i (measles). No cases in April, due to vaccination

R u b e l l a . One case reported from Pakrac, not confirmed.

M e n i n g i t i s   e p i d e m i c a.  There were 4 cases registered in April, which was somewhat more than in March (2) but less than April last year (8). 

Q   f e v e r. More cases in April than in March (11:2). Small cluster registered in Sinj (7).

L e g i o n e l l o s i s. There were 7  cases reported in April (Osijek: 3, Djakovo: 3). This was slightly more than in March (3) and also more than in last April (1).

I n f l u e n z a. Incidence raised in April as expected for the season (620:197) but with an intensity far lower than last year, when 9,054 cases had been registered in the same month.

n      No reports in April from: Garesnica, Grubisno Polje, Otocac, and Lastovo. Total: 4 out of 113 epidemiological districts.

n      Epidemic outbreaks

        Following outbreaks were reported in April:

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

Osijek – trichinellosis in a village. Between 1.1. and 16.2.2006. there were 11 diseased in two connected families, eating own home made dried pork meat sausages. Trichinella found in sausage samples. Family processed three animals, but only two had been submitted to trichinelloscopy.

Osijek – legionnaires diseases in a family starting at the beginning of February. One member was manifestly ill, while 3 more were found serologically positive, though healthy. Mode of acquiring of the disease not found. Possibility exists, that house well had been contaminated with stagnant water from the house central heating system while adding water from the well into it. 

Pregrada – legionnaires disease in a social institution for elderly people. There were 55 diseases out of 510 exposed. Mode of spread: warm water supply system, i.e. watery aerosol at showering and washing. Epidemiological investigation detected several favorizing factors like drowned hydrants after recent flood, too low temperature of warm water, communication with stagnant fire-plug water. Outbreak  successfully stopped.

Varazdin – gastroenterocolitis in an institution for medical rehabilitation, caused by calici (Norwalk) virus, genogroup 2. Between 6.2. and 19.3.2006. there were 71 diseased out of ca 2000 exposed persons. Mode of spread most probably by contact.

Krapina – streptococcal disease (sore throat & scarlet fever) in an elementary school class. Between 25.2. and 25.3.2006. there were 7 cases out of 31.

Drnis/Sibenik – gastroenteritis in a group of  Sibenik speleologists after their return from Drniš area excursion. Causative agent not found, microbiological examinations negative. Epidemiological inquiry suggests that drink of water from a local river was the cause. River water  found microbiologically contaminated.

Sisak – head lice in an elementary school. On 30.2.2006. there were 63 infested out of 193 pupils present.

Slavonski Brod - salmonella food poisoning (S. enteritis) on a family party, on 5.4.2006. There were 3 diseased out of 4 family members. Vehicle epidemiologically and microbiologically: cream cakes and fruit cake bought abroad.

NEWS AND COMMENTS

n      Influenza

Current influenza outbreak develops itself rather unexpectedly. Up to end of April only 854 cases were registered. This is incomparably lower than last year  with 110,570 cases (!) in the same period. Graph below shows influenza reports by epidemiological weeks in 2006. in Croatia, up to end of April.

The distribution of these cases by month, shows clusters at the beginning and at the end of the year. This was greatly a consequence of Mycoplasma pneumoniae activity which last year had an activity higher than usual.

n      AIDS in Croatia 2005

In 2005. sixteen new cases of AIDS were registered in Croatia. This was slightly more than in previous year, but within limits already seen (graph).

The majority of them belong to some of well-known high risk groups, but their relative structure differs from the overall structure of all cumulative cases characterized by domination of male homo/bisexual persons. Namely, in 2005. first place is occupied by heterosexual promiscuous persons (exposed mainly abroad). Further, a small (3 cases) but potentially important portion of the category unknown is worth mentioning, because this year figure is the higher than before, and, if this was correctly classified, suggested transmission outside known risk groups i.e. in overall population. So it would be necessary to watch carefully the further development, and react on time with properly aimed control measures in order  to preserve present fairly favorable situation.

Table 1                                                                          AIDS in Croatia 1986-2005

Since 1986. in Croatia there were 239 cases of AIDS. The table above shows the case structure by a mode of acquiring disease.

n    New manual for HIV counseling

      At the end of 2005. a new manual for doctors working on counseling in centers for anonymous voluntary HIV testing and counseling  (VTC) was published. At present ten such centers are working in Croatia. The manual was written by a group of epidemiologists from the Communicable disease epidemiology department of the Croatian national institute of public health, with collaboration of an epidemiologist from the Institute of public health of Primorsko goranska county and an expert lawyer. Beside other, the booklet contains the following chapters:

• Basic counseling skills,

• Organization of centers for voluntary anonymous testing and counseling in Croatia,

• Data collecting and keeping,

• Testing algorithms in VTC,

• Assuring confidentiality,

• Informed consent,

• Working abilities of HIV infected persons,

• Ethical and legal questions,

• Infective waist disposal, etc.

Information about the book: Title: Manual for HIV counseling and testing. Language: Croatian. Editor: The Croatian national institute of public health, Zagreb, 2005. Edition: 30 copies. Format: 26 x 18 cm, 105 pages. As the book is aimed for doctors epidemiologists working in counseling centers, the edition is small. But, some parts of the book could be interesting for all epidemiologists, so everybody interested can contact the editor for excerpts or separates of particular parts of the manual.

COMMUNICABLE DISEASES IN CROATIA              April 2006

*not confirmed