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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in March

S a l m o n e l l o s i s. Incidence raised in March (134:108), but  to a lower level than in March last year (154). The only cluster is in Karlovac (24).

T o x i i n f e c t i o  a l i m e n t a r i s (food poisoning). There were 610 cases reported in March, which was somewhat more than in previous month (549) and much more than in March last year (465).  Cases cluster in Slavonski Brod (70) and Zadar (53).

P e r t u s s i s  (whooping cough). Low incidence situation, owing to vaccination, continues. In March 9 cases were reported same as in February, similar to March last year (8). Small cluster is seen in Pregrada (4).

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

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

Q  f e v e r. In March, 8 cases were reported just like previous month. In March last year few cases less had been registered (3).

H F R S (hemorrhagic fever with renal syndrome). After 4 cases in February only 1 case was reported in March,  same as in March last year (1).

I n f l u e n z a. There were 19934 cases reported in March, which is less than in February (29350) and significantly less than in March last year (5339).

•      No reports in March from:

Otocac, Vis, Lastovo. Total: (only) 3 out of 113 epidemiological districts.

•      Epidemic outbreaks

        Following outbreaks were reported in March:

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

Dubrovnik - noro-viral gastroenteritis in a hospital. Between 29.12. 2007. and 16.1.2008. there were 26 diseased (patients and staff). Mode of spread: contact.

Zagreb Centar -  gastroenteritis in a home for elderly people with 39 diseased between 11.2. and 1.3. 2008. Causative agent: rota virus. Mode of spread: contact and aerogenic. Source not found.

Zagreb Susedgrad – gastroenteritis in a psychiatric hospital with 20 diseased between 19.2. and 29.2. 2008. Mode of spread mostly by contact, partly via droplets. Causative agent not found, bacteriological and virological examinations negative.

Slavonski Brod - noro-viral gastroenteritis in a home for elderly persons starting on 21.2. 2008. There were 62 diseased out of 280 exposed persons. Mode of spread: contact

Slavonski Brod - enterocolitis in a group of workers eating their warm meal brought from a near restaurant on 28.2. 2008. There were 22 diseased out of 28 exposed, all from the same afternoon shift. Vehicle epidemiologically: pasta Bolognese and fresh cabbage salad. Causative agent not certain, possibly norovirus (found in one sample out of 13 tested), along with single positive detections of Escherichia coli and Campylobacter. Tests for Salmonellae, Shigellae,  rota and adeno-viruses were performed in all diseased,  and all turned negative.

Sisak - gastroenteritis in a home for elderly. Between 3.3. and 21.3. 2008 the total of 38 cases out of 231 exposed persons were recorded. Causative agent: rota virus. Mode of spread: contact.

NEWS AND COMMENTS

•       Changes in national Program of mass vaccination in 2008

In 2008 national Program of mass immunization in Croatia got several important changes. After hepatitis B vaccination was introduced in newborns last year, the total number of separate parenteral interventions (i.e. vaccine applications) in infant age (first year of life) raised to six: BCG, hepatitis B, Hib, DiTePer and Polio-IPV. Thus, in 2008 for the first time, a new five-component vaccine against diphtheria, tetanus, pertussis, Hib invasive disaease and poliomyelitis was introduced and number of separate parenteral interventions lowered to three: BCG, hepatitis B and 5-valent vaccine DTaP-Hib-IPV. Related to this change, but also due to favorable epidemiological situation (i.e. stabile eradication) of poliomyelitis in the country, in all primary vaccinations as well as in revaccination, an inactivated polio vaccine (IPV) was scheduled, i.e. live oral polio vaccine (OPV) abandoned.

The introduction of new five-component vaccine mentioned, caused that DTwP vaccine used very successfully up to now since1959 (with 98% incidence reduction of pertussis, total elimination (eradication) of diphtheria and complete elimination of tetanus in the entire vaccine covered population (only few cases in very old unvaccinated persons) is now abandoned.

One more point to remind: vaccination of persons with 60 years of age against tetanus now represents a booster (only one dose instead of previous three) because current cohort had been covered in childhood, while in previous years 60-years cohorts were not covered by the national vaccination program, introducing tetanus vaccination in 1955.

•       Bacterial meningitis etiology in 2007

Beside viral (serous) meningitis and meningococcal meningitis that are monitored separately, bacterial meningitis other than meningococcal is also on the reporting list in Croatia. In previous year, 2007, there were 55 such cases registered The etiology i.e. causative agent was found roughly in a half (29), which is similar to previous years. The table beneath shows which were these agents as well as their relative shares.

Table 1    Causative agents of purulent meningitis in Croatia 2007

The next table is giving the age distribution of the most frequent pneumococcal meningitis.

Table 2    Age of patients with pneumococcal meningitis in 2007 

It can be seen that the majority of cases occurs in adults.

COMMUNICABLE DISEASES IN CROATIA                         March 2008

Last change - 25.05.2009 - Posljednja promjena