ENGLISH LANGUAGE ISSUE *  ELECTRONIC VERSION

COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in October

S a l m o n e l l o s i s. Intensity is similar or slightly higher than previous month (730:719), which is less than in October last year (865). Significant clusters are seen in Rijeka (44), Dubrovnik (33), Zagreb Tresnjevka (33), Novi Zagreb (40).

H e p a t i t i s   A (epidemic jaundice). Very low incidence pattern continues in October, with only one case reported. There were 2 cases in previous month, one  last October.

T e t a n u s. One case in Virovitica in an old unvaccinated person.

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

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

M e n i n g i t i s   e p i d e m i c a . There were 3 scattered cases in October, similarly to September (4). In October last year one case was recorded.

G o n o r r h o e a. In October 4 cases were reported, 3 of them linked together: a mother and her newborn twins developing gonorrhoic conjunctivitis after birth. In October last year, a similar, low, incidence value was registered (3).

M a l a r i a. One imported case (Cameroon) registered in Rijeka.

L e g i o n e l l o s i s. Incidence raised slightly in October (11:6), being also higher than in October last year (1). Cases are not linked, however.

n      No reports in October from: Pula, Makarska, Solin, Vis, Lastovo and Zagreb Trnje. Total: 6 out of 113 epidemiological districts.

n      Epidemic outbreaks

        Following outbreaks were reported in October:

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

Rijeka – non-specific gastroenteritis (tests for pathogenic bacteria, viruses and parasites negative) in a group of filed workers. They used water from and uncontrolled well for several days while working. Well water analysis revealed a massive faecal contamination. Between 12.7. and 17.7. 2006 the total of 23 cases recorded.

Sibenik – tuberculosis in a social institution. There were 4 diseased between 11.4. and 6.10.2006.

Pozega – salmonellosis (S. enteritidis) after a wedding party, organized in an object  offering only space and cooking facilities, while guest provide and prepare food by themselves (see also ENEWS 5/2006). Total of 28 diseased out of 450 exposed guests were recorded. Vehicle epidemiologically: panned chicken, probably  contaminated by manipulation (relatively small number of cases).  Source not found. No food or ingredients left for analyses. Epidemiological investigation revealed asymptomatic carriership among persons involved in food preparation.

Rijeka – salmonellosis (S. enteritidis) in a family, with 4 diseases out of 5 family members between 24.9. and 27.9.2006. Vehicle: homemade cream cakes. Outbreak was discovered retrospectively, after regular heath check of a family member employed as food handler.

Pozega – gastroenteritis of unknown etiology (examinations negative) in a group of persons eating cake bought in a pastry shop. Salmonella enteritidis was detected in cake samples, which suggests that this was the causative agent in diseased. Between 25.9. and 2.10. 2006 there were 6 diseased out of 10 exposed persons. Pastry shop staff negative for salmonella, however.

Zagreb Tresnjevka – mild gastroenteritis in an elementary school, starting 26.9. 2006. Tests for pathogenic bacteria, Adeno viruses and Rota viruses negative. In one patient Noro-virus was found, so this could be a causative agent. Mode of spread not certain, probably by contact and partly aerogenic. The total of 74 diseased pupils and 5 diseased teachers were registered.

Pozega – family outbreak of salmonellosis (S. virchow) on 2.10.2006 with 3 diseased out of 4 members. Vehicle epidemiologically: panned chicken, not microbiologically examined.

NEWS AND COMMENTS

n      Case definitions on the web

This summer, a set of new case definitions for notifiable diseases has been published on the web-site of the Epidemiology service of the Croatian national institute of public health – Reference center for epidemiology of the Ministry of health and social welfare. As Croatia is currently in a process of accessing the European Union, these definitions are in compliance with the corresponding European definitions as given in legal documents of the European Union (Commission).

At the Internet adress: www.hzjz.hr/epidemiologija/definicije_zb.pdf all physicians in primary heath care, polyclinic care and in hospitals dealing with communicable diseases and participating in communicable disease reporting can look at definitions and use them.    

Certain number of diseases notifiable in Croatia which are not among those published, will be prepared soon and then published on the same web-address.

The purpose of case definitions is to help and equalize routine reporting, and  to enable better comparability between countries.

In Croatia, communicable disease notification is regulated by the Communi-cable disease control act, and the Ordinance on communicable disease notification. In these documents, the diseases have their definitions too: they are defined by a diagnosis in the Latin and Croatian languages (supposing that diagnosis is made by a medical doctor following all professional criteria) but still with specially prescribed certain necessary diagnostic steps.

The same principle is applied in the Case definition collection published on the web, but these definitions are somewhat larger, with digested clinical description, followed by a set of necessary diagnostic steps and criteria (clinical, laboratory, epidemiological) to enable assessing one of the three possible levels of case definition: possible, probable or confirmed.

It should be stressed that in Croatia, basing on current legislature, cases are reported in 24 hours time, upon a clinical diagnosis (syndromic approach) which usually represents a probable or possible case, as postulated in the Case definitions, but with simultaneous further steps toward etiological diagnosis (obligatory for a number of diseases from the list) necessary for achieving a confirmed case (etiological approach), or sometimes to cancel or modify a previous clinical diagnosis. The rationale for the first mentioned reporting phase is in early detection of disease trends and rapid response actions, while the second phase enables exact insight and epidemiological analyses and also approves measures taken.

A general criterion for decision to notify a case, as explained in the national legislature, as well as in recently published case definitions, is the presence of illness, not an asymptomatic carriership nor a simple finding of some microorganism. However, this is modified in some epidemiologically important examples, when asymptomatic carriership is to be reported (Salmonella tiphy carriership, HBsAg positivity etc.)

All case definitions will also be published also in printed version,  to be on disposition to all health workers in their everyday work.

n      Scabies in Croatia

Parasitic disease of  scabies goes along with a low hygienic standard and a low overall standard of living. In Croatia it shows a favorable downward trend, reflecting substantial changes and improvements in this field  (Graph 1). 

Graph 1 Scabies in Croatia - annual incidence

As it could be expected, this disease is less frequent in the summer, when hygiene maintenance is easiest (Graph 2).

Graph 2 Scabies - seasonal dynamic /cumulative 2001-2005/

Graph 3   Scabies - sex distribution /cumulative 2001-2005/

Females are slightly more affected by scabies than males (Graph 3). The incidence is highest in childhood and youth, lower in adults, and again increased in the oldest age group (Graph 4).

Graph 4   Scabies  - age distribution /cumulative 2001-2005/

n      Salmonellae in circulation in October in Croatia

During October, in individual salmonellosis case notifications, the following salmonella  serovars were recorded.

COMMUNICABLE DISEASES IN CROATIA                         October 2006