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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in January

S a l m o n e l l o s i s.  Low, winter incidence pattern continues in January, with 236 diseased (262 in last month), however the intensity was even lower in January last year (175). Small clusters are seen in Varazdin (13) and Novi Zagreb (29). 

H e p a t i t i s  A (epidemic jaundice). There were 5 cases in January all from Pozega (see Epidemic outbreaks).

P e r t u s s i s  (whooping cough). Slightly more cases were reported in January than in previous month (9:4), while no cases had occurred in January last year. Majority of cases are registered on the Zagreb area (6), but not connected.

M e n i n g i t i s   e p i d e m i c a. There were 3 sporadic cases reported in January, just like previous month and similar to last January figure (6).

S y p h i l i s. In January there were 8 diseased, which was slightly more than in previous month (3) and similar to January last year (6). Small cluster is observed in Zagreb Tresnjevka (5).

M a l a r i a.  One imported case (Congo) is reported in January from Slunj.

I n f l u e n z a. The seasonal influenza outbreak started in January, with the total of 334 cases registered until the end of month.

•      No reports in January from:

Pag, Makarska, Solin, Vis and Lastovo. Total: 5 out of 113 epidemiological districts.

•      Epidemic outbreaks

        Following outbreaks were reported in January:

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

Dubrovnik – scabies in a family, with 4 infested members out of 6, on 18.7. 2006. Infestation occurred while visiting their relatives in a neighboring country.

Dubrovnik – salmonellosis (Salmonella of B group) in a family. There were 2 cases out of 5 members between 3.10. and 25.10. 2006. Source not clear.

Zagreb Susedgrad – gastroenteritis in a kindergarten center. Causative agent: noro (Norwalk) virus. Between 13. 10. and 15.10. 2006. there were 120 diseased in 7 different locations, out of 550 exposed. Mode of spread: most probably  alimentary, but incriminated food was not detected.

Dubrovnik – salmonella food poisoning (S. enteritidis) on 15.10. 2006 after family celebration held in a restaurant. There were 3 diseased persons out of 25 exposed. Vehicle epidemiologically: tiramisu sweet and/or fish pâté, not microbiologically examined.

Dubrovnik – head lice in a kindergarten with 3 cases out of 59 group members on 3.11. 2006.

Kutina – hospital outbreak of gastroenteritis. Between 19.11. and 17. 12. 2006 there were 76 diseased out of 250 exposed persons. Causative agent: noro (Norwalk) virus. Mode of spread probably combined: by contact and alimentary.

Zagreb Crnomerec – enterocolitis in a hospital ward. Between 26.11. and 14. 12. 2006 there were 13 diseased. Causative agent most probably noro (Norwalk) virus, being found in one patient while all other microbiological examinations turned negative (bacteria, rota, adeno).

Dubrovnik – head lice in an elementary school, with 3 cases detected among 40 class mates on 3.12. 2006.

Pozega - hepatitis A in a family. Between 6. 12. 2006. and 12. 1. 2007. there were 5 diseased. Mode of spread: contact.

Dubrovnik – head lice in an elementary school. On 9. 12. 2006 there were 16 infested out of 77 exposed pupils.

Slavonski Brod – acute gastroenteritis (noro (Norwalk) virus) among meat industry workers. Mode of spread: alimentary. Incriminated meal epidemiologically: fresh cabbage salad. Between 11.12. and 14. 12. 2006 there were 28 diseased out of 150 exposed workers. Comprehensive measures were applied to prevent possible spread through fresh meat products distribution.

Sibenik – psittacosis in a family that recently bought a parrot. There were 2 cases between the end of December 2006 and January 26th 2007. The incriminated parrot  escaped somehow and was not examined. Other birds in the pet shop  turned negative for Chlamydia psittacii.

Zagreb Centar - viral gastroenteritis (noro virus (Norwalk)) in a home for elderly people. Between 2.1. and 22.1. 2007 there were 11 diseased out of 18 exposed. Mode of spread: mainly contact.

Petrinja – outbreak of illness characterized by vomiting and lack of enteral symptoms, starting on 8.12. 2007 in a group of scouts having their vacancies in a field house. There were 13 diseased out of 34 exposed persons. Causative agent not found as diseased and other members have left for their homes. Mode of spread: probably mostly by contact. Epidemiological investigation did not point to any food or meal. Certain hygienic defects found in the kitchen, including local water supply, are put under repair.  

NEWS AND COMMENTS

•      Workshop on new International health regulations in Opatija

On 21^st of January 2007 a workshop dedicated to the new WHO International health regulations was organized in Opatija by the Croatian national institute of public Health and the Ministry of health and social welfare of Croatia, supported by the World health organization. A guest speaker, who presented this important document, soon replacing the old one dating from 1969, was a high WHO representative Dr Roberta Adraghetti. Epidemiologists from all over the country, working in filed epidemiology units, in county institutes of public health and in Croatian national institute of public health, together with state border sanitary inspectors, attended the meeting. Those two services deal, in their everyday work,  with international travelers and international traffic, implementing thus international health regulations. Beside the central lecture given by the esteemed guest, short reports on role of epidemiologists and border sanitary inspectors in Croatia, in regard to the International health regulations were presented by an epidemiologist from Croatian national institute of public health, appointed as a national IHR focal point, and by a head of state border sanitary inspection of the Ministry of health and social welfare.

Discussion touched all important parts of IHR, in order too asses if Croatia had all necessary prerequisites for its implementation. These are so called core capacities that should enable every country to detect diseases promptly, to establish the etiology by use of diagnostic laboratories, to treat all patients properly and to be able to respond to health threats and control the disease spread within the country and also to prevent international spread. Three levels of health care services are essential to facilitate this work, i.e.: primary (field) level, intermediary level, and national (central) level. Croatia has such an organization of healthcare cervices, including specialized epidemiological services for disease control within the institutes of public health, organized also at three levels: field epidemiology units, county institutes of public health and Croatian national institute of public health. Further,  within the national health care system all four recquired segments are developed: surveillance, diagnostics, treatment and diseases control. For the information exchange between the WHO and each state party, the new IHR establishes a function of national IHR focal point. In Croatia, this role was appointed by the Ministry of health and social welfare to a doctor epidemiologist of the Epidemiology service of the Croatian national institute of public health. Finally, a general requirement the IHR is posing to all countries: to constantly improve health care possibilities and also to improve technical and hygienic conditions important for the international traffic in ports, airports, ground crossings, traffic vessels, combined with skilled professionals in this sector, all in order to achieve high goals of the IHR, to prevent international spread of diseases, without unnecessary interference with international traffic and trade today being more intensive than ever. The conclusion was, that Croatia is ready for implementation of the new IHR.

Some pictures taken during the meeting, can be seen on the web-address of the Epidemiology service of the Croatian national institute of public health: http://www.hzjz.hr/epidemiologija/sastanak_slike_0701.htm .

Influenza wave arrived in the second half of January.  The National influenza center, at the Microbiology service of the Croatian national institute of public health detected virus influenzae A, in first patients´ samples. Further determination in progress.

COMMUNICABLE DISEASES IN CROATIA                    January 2007

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