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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in July

S a l m o n e l l o s i s. Incidence raised significantly in July (557:309), but not as much as in July last year (729). Clusters are seen in Opatija (27), Rijeka (36), Split (26), Zagreb Dubrava (22), Maksimir (23) and Novi Zagreb (25).

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

R u b e l l a. No cases, owing to vaccination.

M e n i n g i t i s  e p i d e m i c a.  There were 8 cases registered in July, which is more than in June (1), but similar to July last year (7).

M e n i n g i t i s  v i r o s a (aseptic). Seasonal increase is observed (99:23), intensity  higher than in last July (39; see: News and comments).

S y p h i l i s. In July there were 6 diseased, which is similar to June (5) and slightly higher than in July last year (2).

A I D S. In July 11 cases were reported, occurring since the beginning of the year.

L y m e   b o r r e l i o s i s. In July, seasonal increase of this tick-born disease continued (81:43) with intensity higher than in last July (41).

n      No reports in July from: Sibenik, Makarska, Vis, Lastovo and Jastrebarsko. Total: 5 out of 113 epidemiological districts.

n      Epidemic outbreaks

        Following outbreaks were reported in July:

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

Opatija – salmonella food poisoning (S. enteritidis) in a hotel, but only among hotel staff,  eating a meal of bean and pasta with pieces of  meatloaf left from the day before. Between 23.5. and 30.5. 2006 there were 17 diseased.

Sinj – acute gastroenteritis after a meal during school excursion,  starting 30. 5.2006. Total of 60 cases were registered out of 200 exposed. Causative agent: noro-virus. Mode of spread most probably alimentary, by food or by water from local uncontrolled well. Epidemiological investigation revealed one person who participated in food preparation as  noro-virus positive.

Opatija – food poisoning on 31.5. 2006. in a group of workers having their daily warm meal in a restaurant. Causative agent: Clostridium perfringens. Vehicle epidemiologically: probably fat (liquid) got from meat backing added to various dishes for several days. But, microbiological examinations turned negative.

Split – family outbreak of salmonellosis (S. enteritidis) on 10.6. 2006. All 9 members got ill after eating homemade cake with cream, kept outside refrigerator for one day. Eggs (domestic) used for cake were found  salmonella positive.

Sibenik – salmonellosis (S. enteritidis) in a family, starting on 17.6. 2006  with 9 diseased out of 18 exposed. Source not found. Vehicle epidemiologically: homemade cream cakes.

Zupanja – salmonella food poisoning (S. enteritidis) in a family 18.6.2006. There were 5 diseased out of 6 exposed persons. Vehicle epidemiologically: home made ice cream or/and cheese, eaten by all. Source probably a person who prepared food having enteric illness.

Rovinj – salmonella food poisoning (S. enteritidis) on 21.6. 2006. Source not found. Vehicle epidemiologically: homemade cake. There were 5 diseased out of 6 exposed family members.

Brac – salmonellosis (S. enteritidis) in a hotel starting on 30.6. 2006 with total of 15 cases registered  (guests and staff) eating a sweet  made from eggs, called "paradizet" (Schneenockerln). Microbiological examination of eggs turned negative.

Pula – acute gastroenteritis in a group of preschool children having their vacancies in a camp. Causative agent not found, bacteriological and virological examinations negative. Source: probably a group member getting ill on day after arrival. Mode of spread: contact and by aerosol. Between 2.7. and 4.7. 2006 there were 31 diseased (children and teachers) out of 51 exposed.

Split – salmonella food poisoning (S. enteritidis) in a family on 2.7. 2006, with 6 diseased. Vehicle epidemiologically: sweet from eggs called "paradižet" (Schneenockerln) not microbiologically examined. Source not found.

Hvar – enterocolitis in a children summer resort on 7.7. 2006. There were 27 diseased out of 175 exposed. Causative agent not found; microbiological examinations negative. Source not found. Mode of spread: most probably alimentary, but incriminated food could not be determined.

Sisak – salmonella food poisoning (S. enteritidis) on a birthday party. Between 9.7. and 11.7. 2006. there were 6 diseased out of 16 persons exposed. Vehicle epidemiologically: home made birthday cake. Person who made the cake, has suffered from enteric disturbances for several days.

NEWS AND COMMENTS

n      Meningitis virosa (aseptic) in summer 2006.

This summer, the incidence of aseptic viral meningitis (usually most frequent in the summer, affecting predominantly younger ages) seems to be higher than previous year, with the total of 245 cases reported until mid of August (moment of writing this article), while 120 cases had been recorded in the same period last year.  Basing on the report of the Laboratory for enteric viruses of the Croatian national institute of public health, this summer a dominant agent is enterovirus ECHO 18. Beside this, few isolates of ECHO 7, ECHO 30, Coxsackie B4 and Coxsackie B3 viruses were registered. Current development suggests that this year however will not become a so called epidemic year, which can be seen every ten on more years producing thousands of diseased (last one was 1998 with ca 4000 cases) and that this year figure could be expected to fall within the range seen in last five years (table).

Table 1.  Meningitis virosa (aseptic) in Croatia 2000 - 2006

*2006: up to 18.8.

Graph 1. Aseptic meningitis in Croatia 2005 and 2006, by epidemiologcal week

n      Helminthiasis in Croatia 2005.

A spectrum and relative portions of helminthic agents in Croatia generally do not vary much from year to year with clear dominance of enterobius and ascaris worms. In 2005 there were 471 cases of helminthiasis recorded. The causative agent was noted in the majority of them (339 or 72%). The table is presenting  agents registered.

As lambliasis does not belong to helminthes, that parasitosis is not formally notifiable. But physicians usually report lambliasis cases too. Last year 36 cases were recorded. Lambliasis shows different age distribution than ascariasis or enterobiasis. The later are most frequent in youngest age group (0 -9), while lambliasis affects young, adult (working) population segment (20-49).

Generally the incidence of helminthiasis is decreasing recently, showing the lowest figure in 2005 (see ENEWS 5/2005).

COMMUNICABLE DISEASES IN CROATIA                         July 2006