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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in May

S a l m o n e l l o s i s.  Incidence raised in May (385:125) and is slightly higher than in May last year (332). Cluster is seen in Pozega (91; see Epidemic outbreaks).

D y s e n t r i a   b a c i l l a r i s. There were no cases registered in May.

H e p a t i t i s  A (epidemic jaundice). Low incidence pattern continues: May: 2, Apr: 2, May 2005:2.

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

R u b e l l a. No cases in May, due to systematic vaccination.

V a r i c e l l a (chicken pox). Number of cases is higher in May than in April (2775:2154). Intensity is higher than last year,  when in May 1608 cases had been recorded.

M e n i n g i t i s   e p i d e m i c a. There were 5 sporadic cases in May which is similar to previous month (4) and last May (5).

S y p h i l i s. In May there were 5 diseased recorded which is somewhat higher than in April (2), while no cases had been recorded in May last year.

M a l a r i a. One case (imported; Nigeria) was registered in Rijeka.

L y m e   b o r r e l i o s i s. Seasonal increase if incidence is visible (21:4), intensity higher than in May last year (17).

n      No reports in May from: Delnice, Imotski and Lastovo. Total: 3 out of 113 epidemiological districts.

n      Epidemic outbreaks

        Following outbreaks were reported in May:

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

Osijek – legionellosis in two families, epidemiologically linked through  their participation in a birthday party in same family house. Between 18.2. and 6.3. 2006 there were 4 diseased registered and 4 more asymptomatic cases (serologically) out of 16 exposed. First, working diagnosis in diseased was psittacosis (because of clinical picture and positive anamnesis – a parrot in a house). But all tests for psittacosis were negative, while further examination revealed legionellosis. However legionella was not found in any watter sample taken in suspected house, so mode of acquiring remaines unclear.

Cakovec – salmonella food poisoning (S. infantis) on 24.3. 2006. There were 18 diseased in a group eating the meal obtained from a catering facility. Vehicle epidemiologically: ground meat steak with eggs (Stephanie). Epidemiological investigation revealed four healthy salmonella carriers  among  kitchen staff.

Cakovec – acute gastroenteritis in a home for elderly people, starting 10.4. 2006. Causative agent not found, all examinations for pathogenic bacteria, rota virus and adenovirs negative. Test for calici (noro) virus not done. But, as norovirus outbreak occurs in vicinity (see below) at the same time, this outbreak could also be of the same etiology.

Pula – salmonella food poisoning (S. enteritidis) in a hotel. Between 16.4. and 20.4. 2006 there were 44 diseased out of ca 400 exposed persons. Vehicle not found with certainty, several dishes suspected. Source not found. Kitchen staff salmonella negative.

Cakovec - acute gastroenteritis in a hospital affecting two hospital wards. Causative agent: noro virus (Norwalk agens) of genogroup 2. Between 17.4. and 2.5. 2006 the total of 40 cases were registered (patients and staff). Mode of spread: contact and via aerosol at vomiting.

Slavonski Brod – salmonella food poisoning  (S. enteritidis) in a family on 18.4. 2006. All 9 members turned ill after eating home made cream cakes (proven salmonella positive). Favorizing factor: cakes kept more than one day outside refrigerator before consuming.

Sisak – salmonella food poisoning (S. enteritidis) after family celebration 19.4. 2006. There were 7 diseases out of 19 exposed persons. Vehicle epidemiologically: home made cream cakes, found salmonella positive. Eggs are suspected but not examined.

Umag – food poisoning 24.4.2006 in a group of tourists eating shells in a restaurant. Total of 10 diseased registered. Microbiological tests for salmonella and  shigella negative. Beside other possible causes (vibriones, viruses etc. which were not examined), a possibility exist that this was a case of DSP poisoning (diarrhetic shellfish poison), as DSP was found in few shellfish samples from that area during routine testing in Oceanographic institute in Split.

Pula – salmonella food poisoning (S. enteritidis) in a refugee shelter. Between 26.4. and 10.5. 2006 there were 19 diseased (inhabitants and personnel) out of 183 exposed. Vehicle not found with certainty because of slow progression and low intensity of the outbreak.

Pozega – salmonella food poisoning (S. enteritidis) after huge wedding banquet on 30.4. 2006. There were 86 diseased out of cca 550 participants. Some  guests came from other parts of the country, some also from abroad. So they turned ill and asked for medical help when returned home. Vehicle epidemiologically and microbiologically: cold, cooked chicken meat. Fresh chicken meat samples not left for analyses. All other numerous meals, backed meat, cakes etc. turned salmonella negative. During epidemiological investigation after outbreak, several persons participating in food preparation were found salmonella positive, but they also ate incriminated food. Favorizing factors: participants brought ingredients for meals (meat, eggs, vegetable etc) on their own from several uncontrolled sources, and have also engaged persons for food preparation, while object (restaurant)  only rented the space (hall, kitchen) and utilities.

Novi Zagreb – food poisoning in a home for elderly people on 6.5. 2006. The total of 60 diseased inhabitants and 5 employed persons were recorded out of cca 450 exposed. Causative agent: Clostridium perfringens. Vehicle epidemiologically: bean salad

Cakovec – outbreak of acute gastroenteritis caused by noro-virus in persons eating ice cream form the same pastry shop, starting on 14.5. 2006. There were 125 diseased registered. Norwalk/noro virus was detected in patients (all other microbiological examinations negative), but not in ice cream samples.

NEWS AND COMMENTS

n      Bacterial meningitis etiology 2005.

Bacterial, purulent meningitis cases other than meningococcal are monitored separately. In 2005 there were 79 such cases reported, which is about equal compared to previous years (2003: 79, 2004: 62). A causative agent was registered in 40 of these cases. The table shows the spectrum and proportions of causal agents of purulent meningitis actual in Croatia in 2005.

n      Deceased from communicable diseases in Croatia in 2005.

Fatal outcome of communicable disease today is far les frequent than in the past, but still occurring in spite of advanced treatment possibilities. The number of deaths depends on severity of disease and possibilities of treatment, but also on the frequency of cases. So all measures that can eliminate some diseases from  population, for instance vaccination or good sanitation, can also lower that number. The table below, as every year, shows diseases and numbers of death cases registered in Croatia in 2005.

Tuberculosis is ranking first, as in previous years, followed by pneumonia, both predominantly in elderly persons. A slight difference to previous years is in slightly increased number of deaths from meingococcal and other bacterial meningitides.

COMMUNICABLE DISEASES IN CROATIA              May 2006