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NEWS AND COMMENTS
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Chikungunya in Europe
According to the information from the European office of the WHO
(www.euro.who.int/surveillance/outbreaks/20070904_1)
and from the ECDC Eursurveillance bulletin (www.eurosurveillance.org/ew/2007/070906.asp)
this summer an outbreak of chikungunya fever, the disease not
common in Europe, occurred in Italy. During August and September
over 160 cases were diagnosed in few adjacent settlements.
Chikungunya fever
is a viral disease caused by a virus from the alphavirus group (Togaviridae
family), transmitted principally by the Aedes aegypti mosquito vectors
(not present in Croatia neither in Europe, ed. comment). Infection is
transmitted among humans, while a possible animal reservoir has not been
discovered up to now. However the recent spread in Italy was not found to be
connected with Aedes aegypti, but with another species i.e. Aedes
albopictus. This species, naturally living in Asia was, as it is known,
unintentionally introduced to Europe few years ago by international trade (first
detection was in Italy) and gradually spread to other Mediterranean countries
including Croatia (also to some northern European countries). At the moment, the
Aedes albopictus population density in Croatia is low.
Italian experts
responded to the outbreak with intensive control measures consisted of
desinsection in affected settlements including houses, so called house to house
tactics. The measures were successful and outbreak was put under control.
The main symptoms
of chikungunya are: fever accompanied with usual fever disturbances (headache,
photophobia etc), pronounced arthralgia and sometimes rush, rarely a mild,
petechial rush. The disease is self-limiting and usually passes in a few weeks.
There are no fatal cases well documented. However reports about fatal cases are
coming from some endemic countries where this disease is common and frequent
but overlapping with the epidemiologically similar, more severe disease of
dengue.
Prevention of chikungunya depends on systematic vector control combined with
measures against possible import of vector mosquitoes through international
trade and traffic by applying regular desinsection of vehicles and cargoes
coming from affected areas of the world, preventing at the same time some other
transmissible diseases like malaria.
Desinsection
measures and vector control can not prevent imported chikungunya cases in
persons coming to a country from affected areas and such events are registered
in Europe. Systematic overall and aimed vector control is expected to prevent or
restrict a spread of the disease within a country.
In Croatia
systematic desinsection is one of regular prophylactic measures prescribed by
the law. Described newly emerged situation in the neighboring country asks that
this practice should be continued as thoroughly as possible. In this scope the
Epidemiology service of the Croatian national institute of public health
promptly released a written guidelines for all counties and county epidemiology
services urging that in frame of their regular tasks which includes planning and
supervising of DDD activities and evaluation of the results, try to asses a
current state of DDD on their territories, to intensify efforts for further
complete implementation of planned measures and if some gaps were detected with
too dense populations of mosquitoes, to conduct necessary activities for the
correction. Parallelly the laboratory service was informed and necessary
laboratory diagnostic ingrediences have been made available. In a case that
chikungunya was diagnosed in some patient in the country, which is always
possible considering all numerous trips of our citizens abroad and even more
numerous foreign visits to the country (tourism, business etc.) the aimed
control measures should be applied i.e. restricted desinsection in the household
of the diseased person and premises in the house yard, also in the near
surrounding of the house, just as it is usually practiced in cases of imported
malaria or dengue fever (see ENEWS No 9/2007).
Up to now no
outbreaks resembling chikungunya were detected in Croatia.
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Case
definitions printed
As it was planned
and announced (see ENEWS No 5 and No 10/2007), at the
beginning of December (time of writing this number of ENEWS) the booklet called
Definicije zaraznih bolesti koje se prijavljuju (Engl: Case definitions of
notifiable communicable diseases) compiled by the group of experts of the
Epidemiology service of the Croatian national institute of public health,
aligned with similar WHO and EU case definitions, was published. The booklet is
already distributed to all Croatian counties (21) to be further distributed to
all doctors in the country dealing with communicable diseases and their
reporting.
Data about the
book:
Title: Definicije
bolesti koje se prijavljuju. Language: Croatian
Editor and
copyright: Croatian national institute of public health
Edition: 7000
copies
Format: 21 x 14
cm, 76 pages.
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Meeting of the Croatian epidemiological society of the CMA
Like every year,
at the beginning of December (7. 12. 2007.) a regular 63rd winter
scientific meeting (symposium) of the Croatian epidemiological society of the
Croatian medical association was organized in Zagreb. The meeting took place in
the large historical rounded hall (amphitheatre) of the Croatian national
institute of public health. More than 100 members of the Society, doctors
epidemiologists all over the Croatia and other interested, were present at the
meeting.
At the beginning a
new booklet with case definitions (see the above article) was officially
promoted.
In the scientific
part, two leading topics were presented: activities on implementation of the
National preparedness plan for possible pandemic influenza and second topic,
dedicated to recent problems with water supply in few new buildings in the city
of Zagreb.
In total 17
original scientific and professional lectures were presented and discussed:
·
Federico Grisogono Bartolacic,
a famous Renaissance doctor, cosmographer and scientist from Zadar
·
Assessment of current status of preparedness for possible pandemic influenza in
Croatia; results of an aimed inquiry
·
An example of good preparedness plan on the county level, from the Medjimurska
county
·
Novelties in indications for antiviral drugs in pandemic influenza; the
influence
on pandemic
planning
·
Problems of water supply in few new buildings in Zagreb; activities of health
ecology services
·
Activities of epidemiology service of the Institute of public health of the
City of Zagreb coping with problems of water supply in few newly constructed
buildings
in Zagreb
·
Cancer incidence in Croatia in 2005
·
New definition of myocardial infarct
·
Sick building syndrome
·
Reporting about antirabic treatment, questions about HRIG application; topics
arisen at the 2nd symposium on rabies
·
Register of persons with disabilities in Croatia
·
Role of epidemiologists in the development of a trauma–system in Croatia
·
CRODIAB, computerized diabetes data base; possibilities of analyses and
reporting
· Epidemiological
surveillance and guidance in routine preventive DDD measures implementation in
Zadar
·
Anthrax, actual also in the 21st century; report from village of
Bobovac
·
Acute gastroenteritis outbreak caused by noro – virus in a Zadar hospital
·
Experiences from the international course "Applied public health" in Netherlands
The list of topics
and themes, shows clearly the area of work of Croatian doctors specialized in
epidemiology, i.e. the field of communicable diseases, non-communicable or
chronic mass diseases, as well as the field of health ecology.
The discussion was
continued during friendly meeting at dinner in a restaurant in the town.
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