ENGLISH LANGUAGE ISSUE *  ELECTRONIC VERSION

COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in May

S a l m o n e l l o s i s. Incidence increased in  May (196:142), but the intensity is lower than in May last year. No significant clusters.

M o r b i l l i (measles).  Four cases reported in May (Velika Gorica 1, Sesvete 2 , Trnje 1) all unvaccinated and all epidemiologically linked to the initial case, a  child exposed to measles abroad.

R u b e l l a. In May 1 case was reported from Zagreb Centar, not virologically confirmed

M e n i n g i t i s   e p i d e m i c a. Number of cases is higher in May  than in April (9:5) also higher than in May last year (6). Small cluster is seen on Zagreb area (Pescenica 1, Sesvete 1, Susedgrad 1)

L e g i o n e l l o s i s. There were 3 cases in May, all on Zagreb area  (Dubrava 1, Maksimir 1, Medvescak 1) but not epidemiologically linked. No cases has been recorded in April neither in last May.

L y m e   b o r r e l i o s i s. Incidence raised according to the season (25:9) but it was slightly lower than in  May last year (36).

I n f l u e n z a. Seasonal outbreak faded in May. Only 75 cases were recorded. In May last year incidence was still significantly high (626).       

•      No reports in May from:

Dvor, Glina, Kostajnica, Petrinja, Topusko, Makarska, Vis, Vrgorac, Lastovo and Metkovic. Total: 10 out of 113 epidemiological districts.

•      Epidemic outbreaks

Following outbreaks were reported in May:

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

Dubrovnik – varicella in a kindergarten. Total of 22 diseased out of 114 were registered between 21.1. and 30.3 2008.

Opatija – head lice in en elementary school. On 15.2. 2008 there were 10 infested out of 300 exposed persons.

Kutina – head lice in a psychiatric hospital ward. On 17.2. 2008 there were 21 infested detected out of 26 exposed patients.

Rijeka – family outbreak of salmonellosis (S. enteritidis) on 17.3. 2008, with 3 diseased (entire family) eating home made cakes. No samples left for analyses.

Novi Zagreb – salmonellas in a family (S. enteritidis) starting on 12.4. 2008. There were 3 diseased out of 4 family members. Vehicle epidemiologically: home made cakes with eggs.

Rab – head lice in a kindergarten, with the total of 12 infested out of 69 exposed on 11.4. 2008.

Novi Zagreb – megalerythema in an elementary school. Between 20.4. and 5.5. 2008 there were 5 diseased out of 250 exposed pupils. Mode of spread: via droplets.

Pula – Q fever affecting visitors and owners of a sport terrain on a family farm dealing among other with sheep breding. Since the beginning of April up to 20.4. 2008. there were 8 diseased out of 40 exposed persons. Coxiella burnetii infection found in sheep, but in a relatively low proportion.

Novi Zagreb – gastroenteritis of unknown etiology (all tests negative) in a group of  cadet members of a basketball club. Between 24.4. and 27.4. 2008 there were 6 diseased out of 12 exposed. Mode of spread: probably alimentary, but food responsible was not determined.

Zlatar Bistrica – salmonellosis (S. enteritidis) on 28.4. 2008 after a family banquet held in a restaurant, but using food and meals prepared at home and brought to the restaurant saloon. There were 12 diseased out of 38 exposed persons. Vehicle epidemiologically: backed young pork and/or cake. No samples left for analyses.

Pula – enterocolitis of unresolved etiology (microbiological examinations negative) in a social institution starting on 15.5.2008. There were 14 diseased registered.

Krapina – histamine food poisoning. On 23.5. 2008. two persons got ill after eating tuna sandwiches bought in a fast food kiosk. In tuna samples examined (canned, imported), increased amounts of histamine were detected (400 mg/kg).

NEWS AND COMMENTS

•       Listeriosis in Croatia

Lysteria monocytogenes, a gram positive bacteria, is a ubiquitous microorganism which could be found in soil, water and elsewhere in environment, but also very frequently in the enteral tract of various animals and humans. If human food is somehow contaminated with Listeriae, they can be ingested but in the majority of cases no clinical difficulties occur. Sometimes, a diareal syndrome can emerge, but much more serious illness could be expected in persons with low  resistance to infections i.e. very young (newborns) or very old or immunocompromised. In such examples Listeriae  can pass the enteral tract and enter blood and tissues, causing septic, meningeal or encephalitic illness and  symptoms. Additionally infection in pregnancy can cause fetal illness and abortion. Such severe forms of listeriosis are fortunately rare. But anyhow, in order to eliminate risks to persons with lowered resistance, all over the world and in Croatia too, all possible measures to minimize the possibilities of Listeria presence on or in the food, are applied. It is important to remind that proper thermic treatment (cooking, backing etc.) destroys Listeriae. So in practice, usually raw food or poorly thermically processed food is responsible for disease in humans, for instance dried meat, some sorts of vet soft cheeses, etc. Risks are increased by the fact that Listeriae can multiply even in refrigerator i.e. at refrigerator temperatures (+4^oC).

There are reports in the world about outbreaks of listeriosis, beside usual sporadic isolated cases. Such outbreaks in groups of especially susceptible persons like homes for elderly, can easily results with some fatal cases. In Croatia there were no such outbreaks until now, owing to generally high standards in food industry, There were no outbreaks due to industrially produced food at all, for many years,  due to proper meat processing, systematic milk pasteurization, strict control of milk products manufacturing etc. It is understandable that hygienic food handling in the kitchen is also important, thorough washing of fruits and vegetable, cooking and backing, wise use of refrigerators etc.

Last year the entity of listeriosis entered the list of notifiable diseases in Croatia (see ENEWS 10/2007). But even before Listeriae were registered as etiological agents in reported cases of bacterial meningitis and encephalitis. Based on those data here some basic epidemiological features of listeriosis in Croatia are presented.

Table 1 Listeriosis (encephalitis & meningitis) cases  in Croatia 1998 - 2007

It can be noticed that the number of cases is low, which is also observed in other countries.

Graph 1  Age and sex distribution of listeriosis cases in  Croatia 2003 – 2007 cumulative

Graph 2  Seasonal distribution of listeriosis, Croatia 2003 - 2007 cumulative

COMMUNICABLE DISEASES IN CROATIA                         May 2008

Last change - 25.05.2009 - Posljednja promjena