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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in January

S a l m o n e l l o s i s. Relatively low intensity continues as expected for the season (156).  In January last year there were more cases recorded (236). Small clusters are seen in Rijeka (13) and Sibenik (12).

H e p a t i t i s  A. (epidemic jaundice). Low incidence pattern continues with 3 reported cases in January, similarly to January last year (5).

H e p a t i t i s  B. Number of cases in January (16) is similar to previous month (15),  slightly higher than in January last year (9).  Small cluster is present on Zagreb area (Crnomerec 1, Dubrava 1, Novi Zagreb 1, Pescenica 1).

T e t a n u s. There were two cases registered in January (Djurdjevac, Kastela) both in old unvaccinated persons.

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

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

P a r o t i t i s   e p i d e m i c a (mumps). Number in January equals the previous one (9), which is  also about equal to January last year (8).

T r i c h i n e l l o s i s. One case reported from Nasice.

I n f l u e n z a. Influenza arrived in the last days of 2007 (see ENEWS  12/2007) which was earlier than last year. In January 2008 there were 2162 cases reported.

•      No reports in January from:

Otocac, Drnis, Makarska and Lastovo. Total: 4 out of 113 epidemiological districts.

•      Epidemic outbreaks

        Following outbreaks were reported in January:

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

Pozega – viral conjunctivitis among patients of an ophthalmologic outpatient clinic. Causative agent: adenovirus. Between 18.9. and 17.12. 2007 there were 27 cases registered in patients (majority) and their family contacts (few). Exact circumstances of spread not discovered. Enhanced disinfection and strict aseptic practices stopped the outbreak however. 

Dugo Selo – family outbreak of salmonellosis (S. enteritidis) starting  on 11.11. 2007.  All 4 members turned ill. Vehicle epidemiologically: beefsteak tartar with home made mayonnaise, not  microbiologically examined.

Beli Manastir – staphylococcal food poisoning on 15.11. 2007. Vehicle: backed young pork meat bought in a kiosk. Stapylocoocus aureus found in meat samples and in nasal samples of the kiosk staff.

Virovitica – salmonella food poisoning (S. enteritidis) after family celebration. Between 25.11. and 10.12. 2007 there were 9 diseased out of 14 exposed. Vehicle epidemiologically: home memade cakes called "ice cubes", not microbiologically examined.

Senj – viral gastroenteritis in a town. Between 8.12. and 19.12. 2007 there were 140 diseased. Causative agent: noro virus. Mode of spread not completely  determined  (partly by contact ). A local water pipe system was suspected but  the case spatial distribution did not fit,  as well as water examination results.

Zagreb Centar -  viral gastroenteritis in a home for elderly persons. Causative agent: noro virus. Between 14.12. and 24.12. 2007 total of 98 diseased were recorded. Mode of spread: contact

Sisak – food poisoning of unknown etiology (laboratory examinations negative) in a family on 20.12. 2007. All 4 members turned ill. Vehicle epidemiologically: backed lamb meat, left from previous day. Meat samples not examined.

Vukovar – salmonella food poisoning (S. enteritidis)  in a family on 1.1. 2008 after consuming home made French salad,  with 4 diseased. No samples left for analyses.

Pula – viral gastroenteritis in a group of young sportsmen settled in a hotel. Causative agent: noro virus. Between 6.1. and 10.1. 2008. there were 14 diseased out of 41 group members. At the same time no cases recorded among other numerous hotel guests. Mode of spread: contact and via droplets. Source: most probably one of group members.

NEWS AND COMMENTS

•       Malaria in Croatia 2007

Malaria is eradicated in Croatia, the last autochtonous case recorded in 1954. Afterwards, only imported cases are registered in persons traveling or working abroad in some of malaric regions of the world. Registered numbers of cases however include only those,  that had turned ill (and asked for medical help) after their return to Croatia. Cases of malaria in Croatian citizens treated somewhere else in the world,  are not  routinely traced or registered.

In 2007 the number of malaria cases (all imported) registered in Croatia was 8,  which is abut equal to previous year (6, see ENEWS 2/2007 ). Some data about the patients: type of malaric plasmodium, country were patients were most probably exposed,   information about chemoprophylaxis are presented in the table.

Table 1       Malaria cases in Croatia 2007

It should be noted that information about chemoprophylaxis and antimalarial drugs used was obtained  from patients during the interview,  so could be incorrect.   

Anyhow it can be seen that all cases in 2007 acquired malaria in Africa. The majority were professionals working in a malaric country,  two patients were working on an oil platform,  only one was a sailor. Similar distribution was noticed last year,  but few years ago, situation was usually different, with the majority of cases being sailors. All diseased were successfully cured.

•       Regularity of communicable diseases reporting in 2007

A prompt and regular reporting on communicable disease cases is the basis for successful disease control. So a quality of reporting, its speed, completeness and geographical representativeness are constantly monitored and evaluated. A part of usual annual analysis of regularity and representativeness of reporting in Croatia for the year 2007 is presented here. Comparing to previous year (see ENEWS 10/2007) the situation is similar. The table below is giving numbers of epidemiological districts missing from the system in a particular month of the last year. As there are altogether  113 epidemiological districts in Croatia, it comes out that in average 6 districts or 5.3%  were absent per month, which, if looked from opposite side means that 95% all districts had been presented constantly in the national notification network system which can be assessed as rather good.

Table 1 Regularity of reporting in 2007

During the year, 33 different districts had been registered missing, mainly (28) for only one or two times (months). Beside usual notes in the monthly ENEWS, this annual revue will be sent to each epidemiological district regarded, to help local epidemiological teams and other colleagues doctors to succeed in achieving the general goal with no epidemiological district absent during the year at all.

•       Influenza 2008

Influenza outbreak developed during January. Total of 2162 cases were reported.

Graph 1 Influenza in Croatia, January 2008

The dominant viral agent in January was influenza virus type A/H1N1/, according to findings of the National influenza center of the Croatian national institute of public health.

COMMUNICABLE DISEASES IN CROATIA                         January 2008

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