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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in August

S a l m o n e l l o s i s. Number of cases registered in August is lower than in July (386:432) and also lower than in August last year. The only cluster is seen in Rijeka (43).

T e t a n u s. Two cases in August, both in old unvaccinated persons.

P e r t u s s i s (whooping cough). In August the incidence is slightly higher than in July (14:10), also higher than in August last year (5). The only small cluster is in Novska (4).

M e n i n g i t i s   v i r o s a (aseptic). Incidence raises in August (132:80) as expected for the season, but the intensity is lower than August last year (158). Cases cluster in Rijeka (56).

T i c k   b o r n   m e n i n g o e n c e p h a l i t i s (TBE). There were only 2 cases reported. In August last year incidence was somewhat higher (6).

L y m e   b o r r e l i o s i s. Incidence dropped in August (46:53) being lower than  last year (51).

M a l a r i a . One imported case is reported in August from Šibenik

H F R S. Incidence dropped (2:12) to the last August level (4).

•      No reports in August from:

Vukovar, Vojnic,  Opatija, Korenica, Buzet, Pazin, Solin, Vrgorac and Lastovo. Total: 9 out of 113 epidemiological districts.

•      Epidemic outbreaks

        Following outbreaks were reported in August:

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

Porec – Q fever. There were 3 cases registered between 27.5. and 2.6. 2007. Source not found with certainty. Two diseased are engaged in goat breeding.

Jastrebarsko – staphylococcal food poisoning on 30.7. 2007. There were 5 diseased out of 10 persons eating cakes left after a family celebration. Staphylococcus aureus  found in cake samples.

Dubrovnik – food poisoning on 11.6. 2007 in a group of school children on excursion. All diseased ate ice cream in the same pastry shop. Causative agent not found, stool samples negative for pathogenic bacteria. Ice cream samples negative on pathogenic  bacteria too, but  fecally contaminated.

Dubrovnik – rubella in the town and its vicinity. Between 8.1. and 11.5. 2007. there were 47 cases registered. In 27 rubella was confirmed by laboratory detection of  IgM antibodies in patients sera. The majority of diseases had not been vaccinated or without vaccination data. Only three patients were previously  vaccinated according to their medical documentation. The age of diseased: predominantly between 15 and 29 years.

Topusko – family outbreak of salmonellosis (Salmonella determined only to the species level) on 21.7. 2007. There were 6 diseased out of 9 family members. Vehicle epidemiologically: cheese (samples negative for salmonella) and fried fish, not microbiologically examined.

Pozega – family outbreak of salmonellosis (S. enteritidis). after a birthday party on 11.7. 2007. Two members got ill out of 7 exposed. Vehicle epidemiologically: home made birthday cake, not microbiologically examined.

Pozega – salmonella food poisoning (S. enteritidis) in a family on 29.7. 2007 with 3 diseased out of 4 family members. Vehicle epidemiologically and microbiologically: home made ice cream. Source not found with certainty.

Gospic – staphylococcal food poisoning on a wedding party on 11.8. 2007. There were 30 diseased out of 150 exposed persons. Vehicle epidemiologically and microbiologically: cakes, lamb meat, and young pork meat, all found positive for Staphylococcus aureus.

Zagreb Crnomerec – gastroenteritis among persons eating grilled minced meat  in a small restaurant. Between 25.7. and 28.7. 2007. there were 10 diseased. Causative agent not found, bacteriological examinations negative. Meat samples were not analyzed.

NEWS AND COMMENTS

•      Enteroviruses in circulation in summer 2007     

The Laboratory for enteral viruses of the Croatian national institute of public health, reports positive findings of  enteroviruses in  the  current  summer  period, i.e. between the mid of  May and mid of August 2007 (table). 

It can be seen that the most frequent was ECHO 30 virus, mostly in patients with aseptic meningitis, followed by the ECHO11.

•      Imported Dengue

At the beginning of August a young female tourist from Spain got ill with fever, soon after her arrival to a Dubrovnik hotel.  She was admitted to the city hospital where it was learned that before arrival to Dubrovnik she has spent 6 months in India as a news reporter. Tests for malaria were negative as well as bacterial haemocultures and stool cultures. As she got petechial rush and showed prolonged blood clotting time (protrombine time) suspicion of the dengue was established.  The patient arrived to Dubrovnik soon after her return from India,  with her parents who did not go to India. They were healthy. As the clinical suspicion of dengue was established, this information was sent from the hospital to the local epidemiology service in the County institute of public  health,  who informed the national epidemiology unit at the Croatian national institute of public health too. Epidemiologists assessed the situation and decided to perform limited, aimed desinsection in and around the place of residence of the diseased person, because of a possibility (although small) that some Aedes albopictus mosquito could be around (recently Croatia had, like some other Mediterranean countries detected the presence of this imported species, capable of transmitting the dengue virus). The patient was transferred to the Infective disease clinic in Zagreb by the helicopter and ambulance car, which both were disinfected afterwards. Engaged staff used standard personal protection. Meanwhile in the Virological laboratory of the Croatian national institute of public health in Zagreb, preliminary  diagnosis of dengue fever was confirmed by the positive ELISA blood test. The same result was obtained from patient serum sample sent by the Infectology clinic to the laboratory in Slovenia. This, together with the clinical picture, suggests that an earlier attack of dengue might happen during her relatively long stay in India. As the patient condition was stable and the family expressed their wish to go home, infectologists gave their permission for appropriate transfer to the hospital in Spain. So, the next day an ambulance airplane, organized by the press association the diseased works for, transferred the patient and her parents from the Zagreb Airport to their home town in Spain.

•      Results of systematic testing of pregnant women for active hepatitis B infection in Croatia in 2006.

In 1999 systematic vaccination of school children against hepatitis B was introduced in Croatia. Same year, systematic testing of all pregnant women on active hepatitis B infection was started too, in order to protect their newborns against hepatitis B on time. Results of this important action on hepatitis B prevention in 2006 in Croatia are given in a table below, basing on annual reports of all maternity wards in the country.

It can be seen from the table that overall coverage is very high, over 99 % of all pregnant women. The percentage of HbsAg positives (prevalence) turned to be 0,35% in average,  which is similar to previous years, corresponding highly to the percentage of hepatitis B virus carriers found through routine voluntary blood donor testing, as presented by the Croatian institute for transfusiology. A total of 143 HBsAg positive mothers, gave birth to 147 live newborns, which all were timely protected by the vaccine and hyper immune gamaglobulin.

COMMUNICABLE DISEASES IN CROATIA                          August 2007

Last change - 15.11.2007 - Posljednja promjena