Epidemiology unit

S a l m o n e l l o s i s. Incidence decreased further as expected for the winter season (262:508). Intensity was higher last year (399). The only cluster is seen in Rijeka (42).

H e p a t i t i s A (epidemic jaundice). Low intensity pattern continues with only 2 cases in December (1 in November).

M e n i n g i t i s e p i d e m i c a. There were 3 sporadic cases registered in December, which is similar to previous month (2) and slightly less than in December last year (7).

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

R u b e l l a. No cases in December owing to mass vaccination.

V a r i c e l l a (chicken pox). Incidence increases significantly as expected for the season (1,499:1,042). Intensity is similar to December last year (1,450).

P a r o t i t i s e p i d e m i c a (mumps). Only one case reported in December (3 in October), slightly less than in December last year (11) as a result of systematic immunization program.

P n e u m o n i a. Number of cases reported in December is lower than in October (318:366) and also significantly lower than in December last year (680).

• No reports in December from:

Grubisno Polje, Pregrada and Zagreb Trnje. Total: 3 out of 113 epidemiological districts.

• Epidemic outbreaks

Following outbreaks were reported in December:

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

Sibenik - salmonella food poisoning (S. senfetenberg) among persons consuming roasted pork meat from a restaurant shop. Salmonella found in meat samples. Epidemiological investigation suggests that source was probably among staff members contaminating meat secondarily by manipulation. Between 22.8. and 1.11.2006. there were 12 diseased and 49 symptomless carriers detected out of cca 250 exposed persons.

Dubrovnik - salmonellosis (S. enteritidis) in a family, starting on 11.9.2006. with 3 diseased out of 6 exposed members. Vehicle epidemiologically: home made cakes and paned chicken, not microbiologically examined.

Dubrovnik - salmonella food poisoning (S. enteritidis) in a family on 29.9.2006. There were 2 cases out of 5 exposed members. Vehicle epidemiologically: roasted chicken.

Trogir - acute gastroenteritis in an institution for mentally ill adult persons. Causative agent: noro-virus (Norwalk a.). Between 9.11. and 16.11.2006. there were 29 diseased out of 166 exposed persons. Mode of spread mainly by contact.

Sisak - acute gastroenterits in a hospital ward. Causative agent: noro-virus (Norwalk). Between 24.11. and 27.11.2006. there were 12 diseased out of 30 exposed persons (patients and staff). Mode of spread: mainly contact.

NEWS AND COMMENTS

• Meeting of the Croatian epidemiological society

In the historical amphitheater hall of the Croatian national institute of public health in Zagreb, the 61st winter scientific meeting of the Croatian epidemiological society of the Croatian medical association took place, on December 8th 2006. There were 90 doctors epidemiologists and other interested professionals from all over Croatia attending the meeting, including guests, tuberculosis control experts from Slovenia.

During the meeting 20 lectures were presented and discussed. These were:

Man as a vector of communicable diseases
Introduction to immunity assessment problems in tuberculosis
Slovenian experiences in new tuberculosis immunity assessment tests and the revue of current tuberculosis situation in Slovenia.
Matra project: monitoring of bacterial antibiotic resistence
Legionellosis in a poultry farm
Hemolytic uremic syndrome caused by Echerichia coli O11 (EHEC)
Possibilities for immunological prevention of gynecological cancer through immunization against HPV infection.
Information about recently developed Gardasil vaccine against HPV infection
Media and epidemiologists in a frame of evidence based medicine
New initiatives for improved functioning of epidemiological services
Register of diabetes patients: Krodiab; registration through the Internet
Cardiovascular AIDS
Prostatic cancer epidemiologic features in Osječko-baranjska county
Epidemiologic characteristics of road traffic accidents in Croatia and in the World
European strategy for chronic mass diseases prevention and control, a revue
Mass occurrence of mayfly insects (Ephemeroptera) in Zadar in summer 2005
Rabies in Kutina district in autumn 2005; revue of control measures
Mediterranean spotted fever in northern Dalmatia
Typhoid fever in a vaccinated person

Sharing of impressions and friendly discussions continued over dinner in the town. Some pictures taken during the meeting can be seen at the web-address of the Epidemiology service of the Croatian national institute of public health: http://www.hzjz.hr/epidemiologija/strucni_sastanak_slike_06.htm.

• Cancer incidence in Croatia, a new annual book

At the end of 2006 a new (29th in the row) annual publication of the Cancer registry of the Service for epidemiology of chronic mass diseases of the Croatian national institute of public health has been released. The book contains latest available data i.e. for the year 2004 and includes incidence figures by cancer site, by stage, by age and sex, by place of residence etc, also in a form of standardized rates which can help for comparisons.

Here we usually excerpt some interesting details from the valuable content of this annual book. This time some data from the Table 7 of the book derived from this long term register, about relative survival by various cancer sites for Croatia in latest available period (1994-1998). This can give an insight into the efficacy of health measures against cancer conducted. A term "relative survival" means that really observed survival percentages, have been corrected by taking into account expected survival, basing on life expectancy tables published by the Croatian State institute of statistic. The following two tables are referring data for a number of important cancer sites for males and females respectively, presented as a 5-year survival in percentages.

Table 1 MALES

Site	Relative 5-year survival %
Liver	14
Acute myeloid leukemia	16
Esophagus	17
Gall bladder	24
Lung	25
Acute lymphatic leukemia	27
Ventriculus	28
Chronic myeloid leukemia	37
Bones	43
Non-Hodgkin lymphoma	46
Colon	49
Soft tissues	51
Melanoma	54
Pharynx	55
Kidney	56
Morbus Hodgkin	61
Chronic lymphatic leukemia	62
Prostata	65
Urinary bladder	75
Thyroid gland	82
Testis	85
All sites	40

Table 2 FEMALES

Site	Relative 5-year survival %
Liver	11
Acute lymphatic leukemia	16
Acute myeloid leukemia	19
Gall bladder	20
Lung	23
Esophagus	24
Ventriculus	29
Chronic. myeloid leukemia.	37
Ovarium	46
Bones	47
Non Hodgkin lymphoma	49
Colon	50
Chronic lymphatic leukemia	64
Larynx	65
Kidney	65
Melanoma	66
Soft tissues	69
Collum uteri	74
Breast	75
Morbus Hodgkin	76
Urinary bladder	76
Corpus uteri	83
Thyroid gland	93
All sites	57

It can be seen, that in spite all treatment and early detection or existing preventive measures, some sites appear to have very small chances for recovery, in worst cases not much more than ten percent survived after 5 years since diagnosis had been set. At the same time in some other sites, results and prognoses are much better, with round 90 % persons surviving 5 years. Some of the most malignant are: the liver cancer, cancer of the gall bladder and lung cancer. A proper treatment combined in some cases with early detection measures or with disease natural course itself, give the best survival chances to persons diseased with thyroid gland cancer, with Ca uteri, breast cancer, prostatic cancer and carcinoma of testis. In the majority of sites and in general too, survival chances for females are better than for males. Table 7 in the book also gives the comparisons to corresponding European data, from which it can be concluded that there is practically no difference in this respect.

Data about the book

Title: Incidencija raka u Hrvatskoj / Cancer incidence in Croatia 2004, bilingual: Croatian and English, 41 pages, 14 composed tabled signed by numbers 1 - 7 and sub-numbers, 9 charts and drawings. Format: 20 x 28 cm. Editor: Croatian national institute of public health, Zagreb, 2006.

COMMUNICABLE DISEASES IN CROATIA December 2006

Salmonellosis	262
Food poisoning	429
Enterocolitis	556
Disenteria bacillaris	1
Hepatitis A	2
Hepatitis B	28
Hepatitis C	14
Hepatitis vir. non identified	1
Angina streptococcica	699
Scarlatina	196
Morbilli	0
Rubella	0
Pertussis	4
Varicella	1499
Parotitis epidemica	1
Meningitis epidemica	3
Meningitis virosa	14
Encephalitis	1
Leptospirosis	5
Mononucleosis infectiosa	100
Erysipelas	76
Tuberculosis	88
Gonorrhoea	1
Syphilis	3
Echinococcosis	2
Scabies	46
Toxoplasmosis	5
Psittacosis	1
HFRS	2
Meningitis bacterial	2
Legionellosis	1
Enterovirosis	41
Pediculosis	45
Pneumonia	318
Herpes zoster	272
Lyme borreliosis	12
Chlamydiasis	49
Helminthiasis	34

CONTENTS OF THE EPIDEMIOLOGICAL NEWS IN 2006

Epidemiological comments	N^oENEWS
Malaria in Croatia 2005	1
Avian flu in humans, current situation	1
Salmonellosis outbreaks in Croatia 2005	2
Pneumonia, etiology in 2005.	3
Influenza	3, 4
Influenza, vaccine composition for the 2006/2007 season	9
Effects of systematic vaccination against hepatitis B in Croatia	3
AIDS in Croatia 2005	4
New handbook for HIV counseling	4
Bacterial meningitis; etiology 2005	5
Deceased of communicable diseases in Croatia in 2005	5
Human antirabic treatment in Croatia 2005	6
Aseptic meningitis in summer 2006	7
Helminthiasis in Croatia 2005	7
Legionellosis, sampling and interpretation of test results	8
Foodborn outbreaks in Croatia, etiology in 2005	9
Cases definitions on the web	10
Scabies in Croatia	10
Salmonellae in circulation in October	10
Head lice, repeating problem	11
Cancer incidence in Croatia, new annual book	12

Work and problems of epidemiological services	N^oENEWS
Completeness of reporting in 2005	2
New handbook for HIV counseling	4
Meeting of the Croatian epidemiological society of CMA, Murter	6
Meeting of the Croatian epidemiological society of CMA, Zagreb	12
Case definitions on the web	10

Graphs and pictures	N^oENEWS
Hepatitis B in 15-19 age group in Croatia	3
Influenza in Croatia in 2006, by epidemiological weeks	4
AIDS in Croatia by years	4
Aseptic meningitis in Croatia 2005 and 2006 by weeks	7
Scabies in Croatia by years	10
Scabies, seasonal dynamics	10
Scabies, sex and age distribution	10
Head lice in Croatia by years	11
Head lice, seasonal dynamics	11
Head lice, sex and age distribution	11

Permanent titles

Individual case notification dynamics in Croatia (commentary)

Epidemiological districts without notifications

Epidemic outbreaks reported in current month

Communicable diseases notified in current month (numeric table)

Last change - 20/02/2007 - Posljednja promjena