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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in February

S a l m o n e l l o s i s. Incidence is lower in February as expected for the season (108:156). Last year the number was higher (140). No significant clusters.

H e p a t i t i s  A (epidemic jaundice). Low incidence with 2 cases reported in February similar to  previous month (3). This was less than in February last year (9).

P e r t u s s i s  (whooping cough). Low incidence owing to systematic vaccination continues. There were 9 cases registered in February, 7 in January, 3 in last February. No clusters.

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

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

Q   f e v e r.  Number of cases is higher in February than in previous month (8:1) according to the season. Cases cluster in Drniš (7). In  February last year 1 case was reported.

T u l a r e m i a. There were 2 cases in February, both in Sisak. No cases recorded  in January neither in February last year.

H F R S  (hemorrhagic fever with renal syndrome). There were 4 cases reported,  3 of them from the Zagreb area (Medveščak, Sesvete, Trešnjevka). In January there were 2 cases, 1 case in February last year.

I n f l u e n z a. Incidence raises quickly in February, typically for influenza (29350:2162), but in February last year the number was significantly higher (53546).

•      No reports in February from:

Vis, Vrgorac, Lastovo and Velika Gorica. Total: 4 out of 113 epidemiological districts.

•      Epidemic outbreaks

        Following outbreaks were reported in February:

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

Dubrovnik – salmonellosis in a family  (S. enteritidis) on 3.8. 2007. There were 2 cases registered out of 4 exposed. Vehicle epidemiologically: home made cream- cakes, not microbiologically examined.

Dubrovnik – salmonella food poisoning in a family (S. enteritidis) with 4 diseased out of 5 family members on 20.8. 2007. Vehicle epidemiologically: paned chicken, not microbiologically examined.

Djakovo – salmonella food poisoning (S. enteritidis) in a family on 9.9. 2007. with 16 diseased members out of 18 exposed. Vehicle epidemiologically: home made cream cakes, not examined microbiologically.

Dubrovnik – small salmonellosis outbreak (S. enteritidis) among one hotel staff,  discovered on 29.9. 2007,  when routine quality control of dishes prepared in a hotel found  S. enteritids in a pasta sample. Aimed health check of all employed in the kitchen, revealed two infected persons (one with enteral symptoms). Owing to this and other measures, no cases occurred among hotel gests.

Dubrovnik – family outbreak of salmonellsis (S. enteritidis) on 1.10. 2007, with 2 diseased out of 3 members. Vehicle epidemiologically: home made cake.

Dubrovnik – salmonellosis in a family (S. enteritidis) starting on 9.10.2007. Both family members got ill. Vehicle epidemiologically: fried eggs.

Velika Gorica - pneumonia in an elementary school,  starting 15.10. 2007. There were 30 diseased out of 300 exposed until the end of December. Causative agent: Mycoplasma pneumoniae

Velika Gorica – enterocolitis after family celebration on 15.10. 2007. Causative agent not found, microbiological examinations negative. Mode of spread: very probably  alimentary, but vehicle not detected. There were 4 diseased out of 11 exposed persons. 

Opatija – gastroenteritis in a kindergarten. Causative agent: noro virus. Between 22.10. and 5.11. 2007 there were 20 diseased out of 420 exposed. Mode of spread: contact.

Dubrovnik – small cluster of salmonellosis (S. enteritidis) discovered at regular health check of kitchen staff of one hotel. On 25.10.2007 there were 2 salmonella positive persons out of 29. Retrospectively a paned chicken meal could be suspected as the  common vehicle.   

Vinkovci – salmonellosis in a family (S. enteritidis) on 11.11. 2007 after a family dinner. There were 8 diseased out of 10 exposed persons. Vehicle epidemiologically: panned chicken, not microbiologically examined.

Opatija  - gastroenterocolitis in a hospital starting 5.12. 2007. The total of 40 cases were registered (patients and staff). Causative agent: noro virus. Mode of spread not certain.

Opatija – enterocolitis in an elementary school. Causative agent not found, all tests negative. Mode of spread: contact. There were10 diseased out of 350 pupils,  between  11.12. and 13. 12. 2007.

Pula - gastroenteritis in a hospital. Causative agent: noro virus. Between 13.12. 2007. and 9.1. 2008. there were 113 cases (patients and staff). Mode of spread by contact and via droplets.

Opatija – gastroenteritis in a hotel, caused by noro virus. Between 14.12. 2007 and 17. 12 .2007 there were 20 cases (guests and staff) out of 550 exposed.  Mode of spread epidemiologically: alimentary and by contact. Possible vehicle: fresh cabbage salad and/or dried fruit.

Labin – enterocolitis in a home for elderly people. Between 5.1. and 22.1. 2008. there were 21 diseased out of 81 exposed persons. Causative agent: rota virus. Mode of spread: contact.

Zagreb Sesvete – acute respiratory disease (influenza like) among pupils in an elementary school starting on 1.2. 2008. At that day 11 out of 30 pupils got ill with fever and malaise. Causative agent not found. The illness was short lasting, only for one day. Mode of spread:  most probably respiratory.

NEWS AND COMMENTS

•       Influenza, current outbreak development

Graph 1.  Influenza in Croatia 2008.

Seasonal increase of incidence continued in February as expected. Until the end of the month there were 31512 cases reported. This was however significantly less than in same period last year (53590). The National influenza center laboratory at the Croatian national institute of public health has detected virus influenzae A/H1N!/ and B among patients from the current outbreak.

•       Pneumonia, etiology in 2007

In 2007 there were 5431 cases of pneumonia registered in Croatia, excluding pneumonia cases in Q fever or psittacosis, which are registered within the respective entities. As usual, in the majority of cases, an etiological agent was not determined. This information is available for 72 cases, similarly to previous years. Although being only fragmentary, these data still can give us some insight into the current structure and relative shares of pneumonia agents in the country. The table shows types of  microbial agents, as well as their frequency

Table 1 Causative agents of pneumonia in Croatia 2007

•       International workshop on salmonellae and food born diseases in Warsaw

Between 25^th. and 29^th of February 2008. in Warsaw (Poland) an international advanced course dedicated to salmonellae and food born diseases took place. It was held in the historical building of a host, the  National institute of hygiene /public health (Panstwowy Zaklad Hygieni). Beside the hosts, meeting was organized by several important international bodies, among them WHO European office, European network of veterinary and public health institutions Vet Med Net,  WHO project GSS (Global Salm-Surv), ECDC (EPIET), CDC Atlanta (USA), Danish food institute etc. 

Such specialized meetings had been organized biannually for more than ten years now. At the beginning,  only salmonelloses were covered,  and only microbiologists were the participants. Later on, epidemiologist were invited to participate too, and scope was widened to other food born diseases. This year, meeting become even more interdisciplinary, involving also veterinarian experts. So, four Croatia representatives attended the course, two veterinary doctors, and two medical doctors from the Croatian national institute of public health: an epidemiologist from the Service for epidemiology of communicable diseases and a microbiologist from the National salmonella centre. During the meeting they have presented one epidemiological analytical report: Noroviral outbreaks in Croatia, and one microbiological topic dedicated to salmonella detection and identification in Croatia, entitled Something new and something old about Salmonellae.

    Between many useful and interesting details from the meeting, here a short information about worldwide salmonella surveillance, the WHO project called Global Salm Surv (GSS). It consists itself from two main parts: first is a system of quality assurance and improvement for diagnostic laboratories, called EQUAS, and the second is a  worldwide data base for salmonellae, supplied with data from all relevant laboratories and national influenza centers in the World,  including Croatian ones. More information can be found on the web address: www.who.int/salmsurv

COMMUNICABLE DISEASES IN CROATIA                         February 2008

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