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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in June

S a l m o n e l l o s i s. There were less cases registered in June than in May (309:387) which is also less than in June last year (504). Small clusters are seen in Virovitica (16), Ivanec (13), Varazdin (11), Zagreb Tresnjevka (23) and Novi Zagreb (16).

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

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

V a r i c e l l a (chicken pox). Incidence is decreasing (1860:2775) as expected for the season, but the intensity is somewhat higher than in last June (1762).

M e n i n g i t i s   v i r o s a (aseptic). Seasonal increase of incidence is observed (23:15), intensity higher than in June last year (4).

S y p h i l i s. Five sporadic cases were reported in June, similar to previous month (5) and to June last year (4).

M a l a r i a. One imported case (Tanzania) is reported in June from Zagreb Centar.

T i c k   b o r n   m e n i n g o e n c e p h a l i t i s (TBE). In June there were 4 cases  reported, all from well known enzootic/endemic areas. Last year 1 case was registered in June.

L y m e   b o r r e l i o s i s. Incidence raised further as expected (43:23). The intensity is slightly higher than in June last year (28).

C r e u t z f e l d t  J a k o b disease (CJD). One case registered in June in Čakovec. Investigation reveals, that it was not a case of new variant of this disease  (vCJD).

n      No reports in June from: Pakrac, Rovinj, Drnis, Sibenik, Makarska, Vis and Lastovo. Total: 7 out of 113 epidemiological districts.

n      Epidemic outbreaks

        Following outbreaks were reported in June:

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

Rab - food poisoning after family celebration on 8.5. 2006. Causative agent not found (microbiological examinations negative). There were 12 diseased out of 25 exposed persons. Vehicle not found as everyone tasted all meals served.

Porec - acute gastroenteritis in a hotel. Between 14.5. and 19.5. 2006 there were 20 diseased in a separate group of guests counting 50 persons, while all other 300 hotel guests stayed well, as well as the staff. Causative agent: calici (noro, Norwalk) virus, found in diseased. Mode of spread not clear, most probably mainly by contact within the group members.

Sibenik - salmonella food poisoning (S. coeln) in a family. Between 22.5 and 1.6. 2006 all 4 members turned ill. Source not found. Vehicle: backed pork meat bought in a meat-backing facility in the town. Salmonella was isolated from meat samples. Staff found salmonella negative.

Sibenik - salmonella food poisoning (S. enteritidis). Vehicle epidemiologically: home made cakes with cream. Source not found. Between 6.6. and 15.6. 2006 there were 9 diseased out of 23 exposed persons from few connected families.

NEWS AND COMMENTS

n      Human antirabic treatment in 2005

Basing on regular annual reports of all antirabic stations in the country (26) here we are presenting an overall report on antirabic treatment of exposed persons in Croatia in 2005. This delicate and highly specialistic work is done by medical doctors specialists in epidemiology working in antirabic stations which are the part of county institutes of public healh. In 2005. total of 5824 persons visited some of antirabic stations, because they had experienced possibly dangerous contact with some animal. After thorough anamnesis and examination, indication for immunologic antirabic treatment was established in 1375 patients (23,6%). This is somewhat more than in last year (1220; see ENEWS 9/2005). Vaccine and gamaglobuline (HRIG) was administered in 95 cases (6,9%), while 1280 patients had received vaccine only. The table bellow is giving information on anatomic localization of risky exposure in treated persons.

Table 1

The second table shows which animals caused antirabic treatment in 2005.

Table 2

The dog is on the first place as in previous years, mostly of unknown owners and left without supervision. Comparing to previous year, more persons exposed to fox were treated (111:58). Cases of exposure to bat (10) asked for treatment too, because of few cases of bat rabies in some countries of Europe, although rabies had not been detected in bats in Croatia.  In 2005 there was no exposure to wolfs.

At the end,  it should be stressed that all treated persons stayed well, and that there was no cases of human rabies in Croatia in 2005. The last autochthonous human rabies case was registered in 1964.

n      Meting of Croatian epidemiological society of CMA

On 9^th and 10^th of June 2006 a regular 60^th scientific meeting of the Croatian epidemiological society of the Croatian medical association took place in a town of Murter on the Murter island near Sibenik. The hosts of the meeting were epidemiologists and other members of the Institute of public health of the Sibensko -kninska county. Over 70 epidemiologists from all parts of  Croatia attended the meeting. The following topics and lectures were held on the meeting:

*      Evaluation of systematic immunization in the Sibensko kninska county

*      A memorial plate for an epidemiologist,  prim. dr. Miljenko Suic

*      Malignant diseases in children and young persons; situation in the Vukovarsko-srijemska county

*      Smoking habits in persons undergoing periodical health checking because of their work.

*      Aedes albopictus mosquito detected in Zadar area

*      Ftalate migration into non alcoholic refreshing drinks and mineral water from plastic emabalage

*      Systematic vaccination and  trends of vaccine preventable diseases in Croatia and Europe

*      Cold chain; WHO recommendations

*      Antirabic treatment in the  Primorsko goranska county

*      A case of martens bite,  an example of wrong procedure

*      Antirabic treatment in Nova Gradiška district

*      Epidemiology of invasive pneumococcal disease in Croatia; is diabetes an indication for immunization against pneumococcal disease

*      Legionellosis outbreak in a home for persons with psychic disorders

*      Family outbreak of tuberculosis; comment on epidemiology of tuberculosis in the Sibensko-kninska county.

*      Some organizational difficulties in hospitalization of TB patients with no health insurance

*      Atypic micobacteriosis; a case review

*      Evaluation of communicable disease reporting in 25 elected epidemiological districts in Croatia between 1979 and 2005

*      Zoonotic diseases in forestry workers in Nova Gradiska epidemiological district

*      Improvements in HIV/AIDS surveillance in Croatia

*      Outbreak of gastroenteritis caused by noro-virus in Medimurska county

*      Croatia in the European legionella network EWGLINET

*      Presentation of new set of case definitions for reportable communicable diseases

*      Presentation of annual monography Communicable diseases in Croatia in 2005

A part of the meeting was dedicated to actual problems of epidemiological services in Croatia, with suggestions for further improvements. Successful working schedule of the meeting, has been completed with exceptionally interesting trip to the Kornati archipelago.

COMMUNICABLE DISEASES IN CROATIA                         June 2006