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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in November

S a l m o n e l l o s i s. As expected for the season, the incidence decreased further (508:730), being somewhat lower than in November last year (547). Clusters are seen in Rijeka (44), Pula (25), Zagreb Dubrava (29), Susedgrad (26), Tresnjevka (34) and Novi Zagreb (34).

D y s e n t e r i a   b a c i l l a r i s. In November 3 sporadic cases were reported, which is similar to previous month (0) and November last year (1).

H e p a t i t i s   A (epidemic jaundice). Low incidence pattern continues: Oct: 1, Nov: 1, November last year : 7.

M o r b i l l i  (measles). One case reported in November from Korcula (in a foreign tourist) not virologically confirmed. Anyhow, the incidence remains exceptionally low, due to systematic vaccination.

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

V a r i c e l l a (chicken pox). Regular seasonal increase is observed (1042: 394). The intensity is higher than in November last year (792).

P a r o t i t i s   e p i d e m i c a  (mumps). Owing to vaccination, the incidence decreased substantially. There were only 3 cases registered in November (6 in previous month, 11 in last November).

L e g i o n e l l o s i s. There were 59 cases registered in November, 55 of them from Pregrada, belonging to the outbreak occurring in March 2006 in a social institution for adults (see Epidemic outbreaks, ENEWS 4/2006).

n      No reports in November from:

Cazma, Dvor, Opatija, Senj, Obrovac, Vis, Lastovo, and Zagreb Trnje. Total: 8 out of 113 epidemiological districts.

n      Epidemic outbreaks

        Following outbreaks were reported in November:

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

Zagreb Crnomerec - gastroenteritis in a kindergarten. Between 29.5. and 11.6. 2006 there were 7 diseased out of 26 exposed children. Causative agent: rota virus. Mode of spread mainly by contact.

Metkovic – family outbreak of salmonellosis (S. enteritidis) on 3.8.2006. There were 6 diseased out of 7 family members. Vehicle epidemiologically: home made cake with eggs, not microbiologically examined.

Opatija – salmonella food poisoning (S. enteritidis) in a group eating home made cake with fresh egg cream, starting on 29.8. 2006. There were 7 diseased out of 13 exposed. Source not found. Eggs were salmonella negative.       

Karlovac – gastroenterocolitis of unknown etiology (bacteriological examinations negative; viral etiology possible) in a small town and its vicinity.  Between 13. 9. and 3. 10. 2006 there were 29 cases registered out of ca 2000 potentially exposed inhabitants. Source and mode of spread not certain. Local,  uncontrolled water supply system was suspected but spatial distribution of cases had not supported this assumption: part of diseased supplied from another,  safe,  water pipe system. So the main mode of spread in this slowly developing outbreak, could be by contact.

Crikvenica – salmonella food poisoning (S. enteritidis) in a hotel, discovered retrospectively at regular health checking for staff members,  when 3 of them have been found salmonella carriers. A further inquiry revealed the total of 13 diseased persons  (guests and staff) out of 800 exposed, between 22.9. and 30.9. 2006. Symptoms rather mild and short lasting. Source and vehicle not found. Epidemiological investigation discovered few more asymptomatic salmonella carriers among kitchen staff. However, salmonella was isolated  also from eggs and from frozen chicken meat  samples taken from the kitchen.

Zagreb Tresnjevka – gastroenterocolitis in a kindergarten. Between 18.10. and 22.10. 2006. the total of 11 diseased out of 60 were recorded. Causative agent: noro (Norwalk, calici) virus, found in 6 diseased (single positive findings for rota and adeno virus respectively). Bacteriological examinations negative. Mode of spread probably  by contact.

Rijeka – enterocolitis among staff members of a health care institution. Between 20.10. and 24. 10. 2006 there were 6 diseased out of 13 exposed. Causative agent: Campylobacter spp. Vehicle epidemiologically: panned chicken, brought from a  neighboring restaurant as a hot meal. Microbiological examinations of incriminated meat tuned negative however.

NEWS AND COMMENTS

n      Head lice, a repeating problem

Every autumn one can hear people talking, that head lice in children are frequent as never before. The reason for that impression lies in the fact that frequency was as usual low in the summer, increasing again in the autumn, while a similar situation from the last year had already been forgotten. In fact, the lice situation has been about the same in recent years (Graph 1).

Graph 1    Pediculosis capitis in Croatia

The graph shows that the highest incidence was registered in 1993. However health workers remember even higher incidence in the mid seventies, but at that time there was no systematic notification; it started in Croatia in 1992. Basing on available data from regular individual notifications, here we present a review of recent epidemiological features of head lice in Croatia and, in the second part, a few practical guidelines for lice elimination. Graph 2 shows characteristic seasonal dynamics of head lice incidence with a regular summer minimum. This because of less favorable possibilities for transmission (light clothing, no caps, no shawls) combined with long summer school vacation, while the winter maximum usually includes a short transitory decrease, caused by winter vacations.

Graph 2     Pediculosis capitis; seasonal distribution

The age distribution (Graph 3) shows that most affected are preschool and elementary school age groups, while incidence sharply decreases after 14 years of age, although registered in all ages.

The female sex is much more affected than male (Graph 4), probably because of  longer hair in females, where lice are more prone to attach and are more difficult to detect.  

 The importance of head lice and how to eliminate them

Head lice infestation often causes some negative social reactions, but in fact this condition is not necessarily connected with poor body and household hygiene. Head lice can easily resist usual hair washing as their eggs (nits) are not thus destroyed. So, if someone is not expecting lice, they can pass unnoticed until itching and scratching cause skin lesions. As caring for children, mothers could be easily affected too, but it could be any other person in close contact.

Fortunately head lice do not transmit any human infection, opposite to body lice. Nevertheless, everybody wishes to get rid of lice as soon as possible. There are various remedies on the market aimed at lice removal. However the goal is often not achieved, and lice persist. As an active ingredient in anti-lice preparates, several types of insecticides are used. A reason for treatment failure lies in the fact that insecticide promptly eliminate adult lice, but are much less effective against their eggs (nits). In practice even those preparations announced to be effective against nits can fail, and new generation of young lice can emerge keeping the cycle alive.

In order to avoid that, a main point is to assure after initial treatment the insecticide presence at the moment when all young lice already came from eggs, but still before their sexual maturity and ability to produce new eggs. Respecting the lice (Pediculs humanus var. capitis) biology cycle, this time period should be ten days. So, to be fully effective, at least two treatment acts should be used 10 days apart.  For instance: insecticide applied to hair (head) in the afternoon, left over night and then hair is washed,  after ten days: repeating same procedure. The efficacy is increased by rinsing hair after washing in a warm acidic water which helps to eliminate nits using a dense comb, and also by visual detection of nits on hair and eliminating them. Complete or radical haircut is not necessary. Predilection places, where nits are most probable to be found are: the top of the head, the occipital region, and behind ears.

The described two - step procedure can be applied exclusively to an infested person (child), especially if lice are detected early, but better to all family members at the same time. If  lice somewhere became widely spread, for instance in a child collective (after a physician, epidemiologist examined the collective and confirmed high infestation rate) the same two-step procedure should be applied simultaneously to all children members of the collective, also to their family members (previous explanatory meeting necessary) and (depending the type of collective) also to the staff. This will help to eliminate lice and lice troubles for a longer period, but, as it is obvious from a common global experience, not completely or forever.

COMMUNICABLE DISEASES IN CROATIA                    November 2006