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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in October

S a l m o n e l l o s i s.   Incidence decreases according to the season (375:413). Intensity is lower than in October last year (730).  Small clusters exist in Rijeka (16), Ivanec (13), Zagreb Dubrava (15), Pescenica (13), Sesvete (16), Tresnjevka (15) and Novi Zagreb (23).

H e p a t i t i s   A (epidemic jaundice). Only 2 sporadic cases in October, similar to the last year (1).

P e r t u s s i s (whooping cough). Low incidence situation, with sporadic cases continues (Sep: 21, Oct: 11, Oct. 2006: 6).

M o r b i l l i  (measles). No cases in October

R u b e l l a. No cases in October.

M e n i n g i t i s   e p i d e m i c a. There were 3 sporadic cases in October, which was similar to previous month (1) and to October last year (3).

M e n i n g i t i s   v i r o s a (aseptic). In October a slight increases was observed (90:83) contrary to a seasonal expectations. Last year there were less cases registered (56). Cluster is seen in Split (15, some cases from previous months).

L e p t o s p i r o s i s. There were 16 cases in October, slightly more than in September (10), and also more than in October last year (4). Small cluster is seen on the Karlovac area: Karlovac (7), Duga Resa (2).

M a l a r i a. Two imported (Nigeria, Guinea) cases reported in October from Rijeka (1) and Zadar (1).

•      No reports in October from:

No reports in October from: Garesnica, Korenica, Otocac, Sibenik, Lastovo, Jastrebarsko and Zapresic. Total: 7 out of 113 epidemiological districts.

•      Epidemic outbreaks

        Following outbreaks were reported in October:

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

Rijeka – aseptic meningitis in the town and the surrounding, starting on 1.5 2007. Until 30.9. 2007 the total of 69 cases were recorded. Causative agent: enterovirus ECHO 30.

Dubrovnik – lambliasis in a family, discovered on regular health check in family member working as a food handler, and subsequently in one more family member. No cases found on the working place.

Dubrovnik – salmonellosis (S. enteritidis) among persons working in a bakery, discovered on regular health check in one staff member. Subsequent epidemiological investigation discovers one more asymptomatic salmonella carrier among staff. Vehicle retrospectively: probably fried chicken meal.

Dubrovnik – salmonellosis (S. enteritidis) in a home for children. Vehicle epidemiologically: homemade birthday cake called "soccer playground", brought to the home for a birthday celebration. Between 16.6. and 31.8. 2007 there were 9 diseased out of 28 exposed persons. Source not found. No samples left for analyses.

Ogulin – salmonella food poisoning (S. tosamanga) in a family on 28.7. 2007, with one diseased person and 4 more infected without symptoms, out of 7 exposed members.  Vehicle epidemiologically: chicken meat, not microbiologically examined.

Sinj – salmonella food poisoning (S. napoli) after family celebration on 19.8.2007. There were 5 diseased out of 30 exposed persons. Vehicle epidemiologically: home made cakes. Eggs examination negative for salmonella, however.

Beli Manastir – scombrotoxysm in persons eating fried mackerel fish, purchased in a shop. There were 3 registered cases. Elevated histamine levels were found in fish samples. A storage at inadequate temperature allowed histamine production in fish meat.

Zargeb Trešnjevka salmonellosis (S. enteritidis) in a kindergarten, starting on 20.9.2007. There were 9 diseased out of 26 exposed children. Vehicle not found with certainty. A birthday cake brought to the kindergarten was suspected, but  samples turned salmonella negative. Kindergarten staff who also ate the incriminated cake has stayed well.

Trogir – salmonella food poisoning (S. enteritidis) in a kindergarten on 20.9. 2007. There were 7  cases recorded out of 25 exposed. Vehicle epidemiologically: milk prepared in a vessel, previously used for mixing raw eggs, and probably not properly washed. Only children in the afternoon shift turned ill.  Source not found. Milk samples negative for salmonella, as well as stool samples of the staff.

Crikvenica – viral gastroenteritis in group of school children in a holiday center. Between 24.9. and 28.9. 2007. there were 47 diseased out of 220 exposed. Causative agent probably: adenovirus, which was found in one diseased pupil (only this one sample was examined), while other microbiological examinations (more samples) turned negative. Source not found. Mode of spread probably: contact and via droplets.

NEWS AND COMMENTS

•      New disease entities added to the list in new Communicable disease control act

The recently published new Communicable diseases control act (OG 79/2007; see ENEWS 7/2007) gives a list of notifiable diseases. The list looks familiar, as it does not differ much from the list from the old Act from 1992. However it is important to point to certain novelties on the list. First, several new entities are introduced (amoebiasis, fascioliasis etc), in addition, diseases already notifiable by special decisions adopted after 1992 (vCJD,  SARS etc) are added. Further, added are entities that are now defined differently than before i.e. by a causative agent (campylobacteriosis, listeriosis etc) and not as a clinical syndrome (enterocolitis or similar) with a causative agent mentioned. A similar approach already existed for salmonellosis. Some of new diseases on the list were already voluntarily reported in practice (lambliasis etc.).

Newly introduced diseases (entities) to be reported regularly beside all other diseases on the list, according to the law are listed below.

Amoebiasis

Acute flaccid paralysis (AFP)

Sepsis, bacterial

EHEC-caused illness  

Erlichiosis

Fascioliasis

Haemophilus influenzae type b – invasive disease

Streptococcus pneumoniae (pneumoccocus) – invasive disease

Yersiniosis

Campylobacteriosis

Cryptosporidiosis

Lambliasis

Listeriosis

Lymphogranuloma venereum

Typhus murinus

SARS

Viral gastroenteritis

Creutzfeldt – Jakob disease (CJD and vCJD)

Because of those changes, it should be necessary to adapt the software programs used for notification or  monitoring of communicable diseases in all segments of the national health service.

It should be mentioned that the reporting  of any disease from the list should follow the Case definitions, currently available on-line on the web site of the Epidemiology service of the Croatian national institute of public health (www.hzjz.hr/epidemiologija.htm), and soon also in a  printed form as a booklet which will be distributed to all doctors dealing with communicable diseases in the country.

•      Causative agents of helminthiasis in 2006.

In 2006, the  total of 362 helminthiasis cases were reported in Croatia. This is less than previous year, being the lowest point in current downward incidence trend (see EV 5/2004) reflecting overall improvements of basic hygienic conditions in the country.

Graph 1 Helminthiasis in Croatia 2000 – 2006

In 271 cases a parasite species was noted in the report. The distribution and proportions can be seen in the table beloww. 

It can be seen that Enterobius ranks first, followed by Ascaris infestations, while all other agents are rare and sporadic.

•      Completeness of reporting in 2006

A completeness of reporting communicable diseases is constantly monitored and evaluated. At the national level disease trends are monitored down to a field level, i.e. level of epidemiological districts, each covered with a field epidemiology team. There are 113 epidemiological districts in the country. From the table below it can be seen, that only few epidemiological districts were absent from the notification system per a month, while the majority, over 95 %, was constantly participating, giving thus a reliable insight into epidemiological situation in the country. In the majority, their absence was registered in only one month (18 districts), while one remote scarcely inhabited island district has been absent for 10 months. The table shows that total number of absent districts varied from 1 to 8 per month in which 30 different districts were registered.

Table 1. Epidemiological districts without reports per month, 2006.

On average, that was 4,8 or 5 districts per month, which is 4,4% of all districts in average. Such a proportion seems to be stable through the years (see ENEWS No 2/2006). However, the goal which asks for constant active work of epidemiology services on connecting all parts of health care system in active communicable diseases reporting, is that no empty columns are seen in any month.

COMMUNICABLE DISEASES IN CROATIA                         October 2007

Last change - 15.11.2007 - Posljednja promjena