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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in April

S a l m o n e l l o s i s. A slight increase of incidence is observed in April (142:134),  but this was less than in April last year (157). No significant clusters. 

T o x i i n f e c t i o   a l i m e n t a r is (food poisoning). Number of cases registered in April is lower than in previous month (540:663) but significantly higher than in April last year (302). Clusters are seen in Virovitica (31), Novi Zagreb (43) and Zagreb Pescenica (36).

D y s e n t e r i a   b a c i l l a r i s. Low incidence pattern continues with only 2 cases registered in April (both in Zagreb Dubrava). In April last year 1 case was reported.

H e p a t i t i s    A (epidemic jaundice). Low incidence with 2 cases reported in April, 1 in March and 3 in April last year.

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

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

H F R S  (hemorrhagic fever with renal syndrome).  There were 4 cases registered in April (Vinkovci, Rijeka, Zagreb Maksimir and Novi Zagreb) which is slightly more than in March (1) and April last year (2).

I n f l u e n z a. Incidence decreased further in April (2164:19934). The total of 53613 cases was registered in current outbreak, until the end of April.

•      No reports in April from:

Opatija, Buzet, Gracac, Pag, Drnis, Vis, Lastovo and Ludbreg. Total: 8 out of 113 epidemiological districts.

•      Epidemic outbreaks

Following outbreaks were reported in April:

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

Porec - Q fever in a village among persons exposed to sheep from a sheep farm. Between 21.1. and 14.2. 2008. there were 7 diseased. Infection was confirmed in sheep.

Dubrovnik – streptococcosis (sore throat & scarlatina) in a kindergarten. Between 20.1. and 5.2. 2008 there were 5 diseased and 13 more infected symptomless persons out of 32 exposed.

Pula – streptoccosis (sore throat & scarlatina) in a kindergarten with 7 diseased out of 72 exposed between 11.2. and 25.2. 2008.

Vukovar – salmonella food poisoning (S. enteritidis) in a family on 23.3. 2008 with 4 disesed  (all members). Vehicle epidemiologically: home made French salad and/or chocolate cake. No food samples left for analyses.

Vukovar – gastroenterocolitis after a birthday party, starting on 25.3. 2008 with the total of 13 diseased out of 33 exposed persons. Causative agent not found, microbiological examinations negative. Vehicle epidemiologically: home made sweets and cakes, kept  outside refrigerator for several days before eating.

Biograd – gastroenteritis in an institution for rehabilitation. Between 4.4. and 10.4. 2008 there were 32 diseased out of 171 exposed persons. Mode of spread: contact and via droplets. Causative agent nod found, bacteriological examinations, as well as tests for adeno and rota  viruses turned negative.

Rovinj – gastroenteritis in a kindergarten. Between 15.4. and 17.4. 2008 there were 18 cases registered (children and staff). Causative agent not found, microbiological examinations negative. Mode of spread epidemiologically: contact and partly alimentary, but vehicle not detected with certainty.

NEWS AND COMMENTS

•       Symposium on immunization in Zagreb

In April this year, a scientific symposium with international participation dedicated to immunization took place in the Zagreb Westin hotel. The meeting was organized by the Croatian national institute of public health under the motto: The vaccination, from individual protection to disease eradication. The meeting attracted great attention, and more than 650 vaccination professionals from all over Croatia participated in: pediatricians, epidemiologists, family doctors, school medicine doctors, infectologists, immunologists, vaccinologists, others, also nurses engaged in vaccination, all of them contributing substantially, in their own domain, to the present  excellent results of  the national mass immunization Program.

For this meeting the organizers have selected following topics:

• Overview of the results (excellent) of systematic long year implementation of national Program of mass immunization in Croatia

• Presentation of changes in the new Program of vaccination for 2008 (see also ENEWS   3/2008).

• Analysis and comparison of various existing five –component  vaccines

• Vaccination and autoimmune diseases

 Above topics were presented by experts of the Croatian national institute of public health

• Presentation of British experiences in the use of  five-component vaccine  DTaP-  IPV-Hib, with five pertussis antigens. The presentation was given by a guest expert   from  the  British Public health agency (PHA)

• Acellular pertussis vaccines, Swedish experiences. Lecture presented by a guest   from Sweden, expert in childhood vacination.

It was decided to organize similar meetings each year.

•       ECDC experts visited the Epidemiology service of

the Croatian national institute of public health

This April, the Service for epidemiology of communicable diseases of the Croatian national institute of public health was visited by a group of epidemiological experts from the European Center for disease control and prevention (ECDC) from Stockholm as a part of their visit to Croatia (also Ministry of health, Drug agency and Transfusiology institute) dedicated to communicable diseases surveillance and control, all in the frame of current process of Croatia's accession to the European union and integration of  the Croatian system of communicable diseases surveillance and control into the EU system. Few small differences diagnosed at the bilateral analytical screening in 2006. have been eliminated meanwhile by adoption of the new national Communicable disease protection act in 2007 (see ENEWS 7/2007) and by publishing the Case definitions, compatible with EU case definitions (see ENEWS 5 and 11/2007),  so a mutual  compatibility is now complete.

The esteemed guests were acquainted with doctors epidemiologists and with work of the Epidemiology service of the Croatian national institute of public health and also with the Institute Microbiology service and its public health referent laboratories for influenza, salmonellae, measles etc. They also visited other parts of the Institute and got a picture of the entire scope of this supreme national public health institution. They also wanted to meet doctors epidemiologists and their teams in some of primary, filed epidemiology units, so they visited the HE outpost Zagreb Centar of the Public health institute of the City of Zagreb. During the visit several future activities were agreed on: connection of the Epidemiology service of the Croatian national institute of public health to EU communicable disease surveillance networks,  participation in the work of editorial board of the EU journal Eurosurveillance, joint scientific meetings etc. It can be said that Croatia becomes integrated into communicable disease surveillance network of the EU.

•       Helminthiasis in Croatia 2007

Every year we present here an overview of recorded agents of the disease group, routinely monitored as helminthiasis. The total of 292  cases were registered in 2007 in Croatia. The causative agent was determined in the majority of them (246). The table below shows, which species of Plathelminthes and Nematoda genera had been diagnosed. 

Table 1.  Causative agents of helminthiasis in Croatia  2007

Like in previous years (see ENEWS 10/2007) Enterobius vermicularis (pinworm, or small children worm) is ranking first, and the diseased are mainly children (Table 2). In one example, a 6 years old child, triple infestation was diagnosed: with Enterobius, Trichuris and a dwarf tapeworm Hymenolepis nana. 

Table 2.  Age of patients with enterobiasis

COMMUNICABLE DISEASES IN CROATIA                         April 2008

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