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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in July

S a l m o n e l l o s i s. Incidence raised in July according to the season (432:262) but this was less than in July last year (557). Clusters are seen in Požega (15), Karlovac (16), Zadar (16), Ploče (20), Velika Gorica (24) and Novi Zagreb (19).

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

R u b e l l a.  Only 2 cases reported in July.

M e n i n g i t i s   v i r o s a (aseptic). Number of cases is increased according to the season (80:68) but intensity is lower than last year (99).

Q   f e v e r. There were 12 diseased in July which is slightly more than in June (7) and also more than in July last year (2). Reports came from Senj (4), Poreč (2) and Sinj (6).

T r i c h i n e l l o s i s. In July there were 5 cases reported, all from Virovitica (see Epidemic outbreaks).  No cases registered in July last year .

M a l a r i a. In July, 2 imported cases were reported (Split 1, Zagreb Črnomerec 1).

P s i t t a c o s i s (ornithosis) There were 6 diseased registered in July, mainly in Split (4) and Solin (12).

H F R S  (hemorrhagic fever with renal syndrome). Incidence is  slightly higher in July than in June (11:2) which is also more than in July last year (0).  Cases are scattered and solitary. The only small cluster is seen in Slavonski Brod (5).

L y m e   b o r r e l i o s i s. Seasonal increase is registered in July (53:40) but not reaching a last July level (81).

•      No reports in July from:

Garesnica, Rijeka, Pag, Knin, Makarska and Vis. Total: 6 out of 113 epidemiological districts.

•      Epidemic outbreaks

        Following outbreaks were reported in July:

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

Ploce – salmonellosis (S. enteritidis ) in a restaurant. Between 6.5. and 30.5. 2007 there were 19 diseased in three separate groups of guests having their family celebrations there and 7 more diseased eating food left after these meals outside the restaurant. Total: 26 diseased out of 69 exposed persons. Vehicle epidemiologically and microbiologically: backed lamb meat (salmonella proven in meat samples). Epidemiological investigation suggests that meat was secondarily contaminated by manipulation. Source not found with certainty.

Pazin – enterocolitis in a hospital. Between 23.5. and 27.5. 2007 the total of 9 diseased (patients and staff) out of 26 exposed were registered. Causative agent not found, all microbiological examinations negative. Source not found.

Virovitica – trichinellosis in a family after consumption of infested meat of own domestic swine. Between 8.6. and 2.7. 2007 there were 5 cases registered. They all tasted a raw meat mixture for sausages, while 5 others ate the well backed meat and stayed well. Fresh meat was nod tested before processing. However epidemiological and microbiological investigation after the onset of outbreak, revealed Trichinella in meat samples.

Pozega – family outbreak of salmonellosis (S. enteritidis) on 11.6. 2007 with 3 diseased out of 4 exposed persons. Vehicle: home made ice cream. No samples left for analyses. Source not found.

Zagreb Sesvete – salmonella food poisoning (S. enteritidis) in a family on 11.6. 2007. Vehicle: cream cakes brought to home from a pastry shop from another town. All 5 exposed family members got ill. The only one that has not tasted the  cream cakes stayed well. No samples left for analyses.

Nova Gradiska – salmonellosis (S. enteritidis) on a family celebration 15.6. 2007. There were 7 diseased out of 20 exposed persons. Vehicle epidemiologically: home made cakes, not microbiologically examined. Favorizing factor: keeping cakes for several hours outside the refrigerator.

Zagreb Centar – salmonellosis (S. enteritidis) among people eating sandwiches, bought  in a kiosk selling sandwiches prepared on the other side of the town, and delivered to the kiosk. There were 9 diseased recorded. Salmonella was found in sandwich samples (sandwich with paned cheese).  No salmonella carriers discovered among staff. Source not found.

Sisak – salmonella food poisoning (S. enteritidis) after a wedding banquet on 20.6. 2007. There were 14 diseased out of cca 280 guests. Vehicle epidemiologically: paned chicken and turkey meat. Source not discovered.

Sibenik – streptococcal sore throat among young guests of a camp. Between 22.6. and 22.7. 2007 there were 20 diseased out of 70 exposed persons. Mode of spread: via droplets among persons rather densely settled in the tents.

Pozega – salmonella food poisoning (S. enteritidis) in a family eating home made ice cream on 25.6. 2007. There were 9 diseased out of 12 exposed persons. No samples left for analyses. Source not found.

Zadar – salmonella food poisoning (S. enteritidis) on a village celebration. Between 30.6. and 3.7. 2007 total of 22 diseased were recorded. Vehicle epidemiologically: backed lamb, not microbiologically examined. Source not found.

NEWS AND COMMENTS

•      New communicable diseases control law

The Official gazette of the Republic of Croatia  No 79/2007, July 30th,  published the new Communicable diseases control law adopted recently by the Croatian parliament. Thus, after several years of preparations, the old law from 1992 was replaced. The new law is updated scientifically and organizationally where needed,  while those parts of the old law that have showed good results in the practice, contributing substantially to a present favorable situation in this field in the country, are kept and reaffirmed in the new law. We can shortly comment here, that the new law retains its basic spirit and philosophy, offering to all people in Croatia the possibility to enjoy health measures against communicable diseases (from vaccination, safe water and food to proper treatment), in order to assure individual health, but also to assure the protection to entire community. In this respect people are also obliged to undergo some of measures like antimicrobial treatment in some diseases, periodic health checks for certain professions like food handler etc. The list of notifiable diseases in the new law is now completely aligned to the European list (containing also some more diseases which are of specific national interest). The law as a whole, is in accordance to European legislation too. Also it gives a good basis for the fulfillment of the requests and tasks emerging from the new WHO International health regulations (IHR) entering into force this summer.

•      Results of mass vaccination in Croatia 2006

Systematic, planned mass vaccination is one of the most important and most successful preventive health measures in the population. It already succeeded to change dramatically a morbidity and mortality picture for some diseases, known in the past as horrible pests (variola, diphtheria, poliomyelitis), while today, most of the people do not know them, some not even by name. There ere several factors important for the success of vaccination: choice of best vaccines, skilled and professional application of the vaccine to individuals from particular carefully scheduled population age cohorts etc. Among the most important factors also counts a high vaccinal coverage, constant through the years. High density of immunized (immune) persons in the population can depress the causative agent circulation in some cases, and thus suppress diseases even further. For all vaccinations in the national program the level of coverage which is to be reached and hopefully exceeded, is 90%, while the limit for measles is 95%. This parameter  is monitored constantly in the Epidemiology service of the Croatian national institute of public health,  basing on regular annual reports of all doctors vaccinators from all counties, all over the country. Here we are presenting a part of the analysis of  the results for the year 2006 for the primary vaccination in  Croatia as a whole.

Table 1   Primary vaccination coverage in Croatia 2006

It can be seen from the table that in all vaccinations (except one: anaTE for adults) excellent, high coverage rates were achieved, and that the level was constant  through the years. It is worth mentioning that it was not easy to achieve in a dynamic everyday life situation (migrations, undercurrent illnesses, updating lists of newborns, timely distribution of vaccines etc). So all congratulations go to those, participating in the creation, preparations and implementation of the national Program. The only exception is the vaccination of 60-year cohort of adults against tetanus, introduced recently into the Program. Here the prescribed limit of 90% was not reached yet, which is unsatisfactory particularly because there is no herd immunity effects in tetanus and each person should be individually protected i.e. vaccinated. A reason for such result partly lies in the health services, but also in people themselves,  because they, especially elderly, are still not familiar with the fact that some overall vaccination is offered not only to children but also to adults. The epidemiology service which is appointed to coordinate and evaluate the Program implementation, is working on enhancing information to people and also to doctors, to improve this point  too.

COMMUNICABLE DISEASES IN CROATIA                          July 2007

Last change - 15.11.2007 - Posljednja promjena