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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in April

S a l m o n e l l o s i s. Incidence in April is similar to the previous month  (157:154). The only cluster is seen in Rijeka (25).

D y s e n t e r i a    b a c i l l a r i s. Only one case reported in April.

P e r t u s s i s   (whooping cough). Low incidence observed  in April (6), similar to March (8), owing to systematic vaccination.

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

R u b e l l a. There were 18 cases reported in April from Dubrovnik (see ENEWS 3/2007), all in unvaccinated persons. Last year 1 case has been reported in April.

Q   f e v e r. In April 5 cases were reported, like in previous month (3), slightly less than in April last year (11).

L e i s h m a n i a s i s. One imported case (Asia) was reported in April from Zagreb Maksimir.

I n f l u e n z a. Current outbreak faded in April, but  still 1787 cases were reported. This gives a total of 108916 cases since the beginning of the year (outbreak).

•      No reports in April from:

Solin, Lastovo and Ploce. Total: 3 out of 113 epidemiological districts.

•      Epidemic outbreaks

        Following outbreaks were reported in April:

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

Labin – bronchopneumonia. Between 12.1. and 1.4. 2007 there were 150 cases registered in the town and its surrounding. Causative agent: Mycoplasma pneumoniae. The age of patients ranged from the kindergarten age to the oldest  ages. 

Vinkovci – viral gastroenteritis in a home for elderly persons. Causative agent: noro virus. Between 21.1. and 12.2. 2007 the total of 95 cases were recorded out of 395 exposed persons. Mode of spread: mainly by contact. 

Opatija – viral gastroenterits in a pupils home. There were 20 diseased out of 350 exposed. Causative agent: noro virus. Mode of spread: mainly by  contact. 

Koprivnica – salmonellosis (S. enteritidis) after a birthday party on 11.3. 2007. All  17 exposed persons turned ill. Vehicle epidemiologically: home made fruit cake. Source probably among persons preparing the cake; salmonella carriage discovered. 

Zagreb Centar – acute gastroenteritis in a home for elderly persons. Between 12.3. and 20.3. 2007 there were 26 diseased out of 645 exposed persons. Causative agent: noro virus. Mode of spread by contact and partly aerogenic.

NEWS AND COMMENTS

•      Human antirabic treatment in Croatia 2006

Establishing the indication for immunological antirabic treatment in persons exposed to rabid animals or to animals possibly rabid, counts among particularly delicate tasks of doctors epidemiologists, being aware that without adequate antirabic treatment, rabies, if emerged, is practically hundred percent lethal. This important part of medical work is performed in the so called antirabic stations, organized within the epidemiology services in the institutes of public health of all counties and in the public health institute of the City of Zagreb where the Reference center for rabies is active. Basing on regular annual reports of all antirabic stations in Croatia (27 of them) we are giving here as usual (see ENEWS 10/2006) a digested overview  of the situation in the last year.

During the year 2006 the total of 5247 persons have asked for medical help in some of our antirabic stations, because of potentially risky incident or contact with  animals. After thorough medical examination and detailed anamnesis in 1501 persons (27,4 % of examined) an indication for immunological antirabic treatment was established. This was more than in last few years (2004: 1220, 2005: 1375) and reflects a certain deterioration of the situation, in spite of efforts to achieve better control of dogs and stray dogs. Namely, the highest portion of all treated cases in 2006 (see Table 1) occurred after exposure to a dog (938), either of an unknown owner, or escaped after incident leaving its vaccinal status unknown. So in spite of high vaccination coverage of dogs in the country and only few rabid dogs diagnosed yearly, the antirabic protection for injured persons was unavoidable. The Table 1 also shows that considerable number of persons had been exposed to rabid domestic cattle (cows, sheep) and treated. This reminds us that domestic unvaccinated animals living near, or in a natural, wild life environment, can be infected by rabies, and more caution is needed when dealing with such animals if they are ill.

Table 1   Animals causing human antirabic treatment in 2006.

The Table 2 gives the anatomic localization of injuries in treated persons.

Table 2

In 1501 treated persons 64 (4.2%) had received vaccine and hyperimmune globulin (HRIG), the rest (1473) received the vaccine only. All treated persons stayed well. There were no human rabies cases in Croatia since 1964 owing to good vaccination coverage of dogs, as well as to the expert work of doctors epidemiologists on human postexposure prophylaxis.

At the end it should be stressed again, that better control over dogs, especially a better care of owners for these beautiful animals known as  "man best friends", could reduce present number of very probably unnecessary but unavoidable postexposure treatments, and also reduce unwanted dog bite injuries of people.   

COMMUNICABLE DISEASES IN CROATIA                    April 2007

Last change - 15.11.2007 - Posljednja promjena