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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in June

S a l m o n e l l o s i s. Incidence raised in June as expected (332:196). Intensity is higher than in June last year (262).

H e p a t i t i s   A  (epidemic jaundice). There were 4 cases recorded in June, 3 of them in Ivanic Grad. In June last year 1 cases was reported.

M o r b i I l i  (measles). Number of reports raised in June (42:4) as a reflex of a small outbreak on Zagreb and Slavonski Brod area. All diseases are epidemiologically linked (see News and comments)

M e n i n g i t i s   v i r o s a (aseptic). Slight seasonal increase of incidence is observed (16:13). but in June last year the intensity was much higher (68). No significant clusters.

S y p h i l i s. There were 7 cases reported in June, which is slightly more than in previous month (2) and also mere than in June last year (3).

M a l a r i a. Two  cases reported in June (Karlovac, Dugo Selo) both imported (Ethiopia, Cameroon).

K a l a   a z a r. One case reported from Split

B r u c c e l l o s i s. There were 5 cases reported in June, all from Karlovac,  while there were no reports in previous month neither in June last year. Cases are imported i.e. linked to a stay in, or to food consumption originating from, a neighboring country

H F R S  (hemorrhagic fever with renal syndrome). In June expected seasonal increase observed (11:4). Cases cluster in Delnice (4) and Rijeka (4). In June last year 2 cases were reported.

L y m e   b o r r e l i o s i s. Incidence raised as expected for the season (81:25). In s June there were less cases of this tick born disease (49).

•      No reports in June from:

Drnis, Makarska, Vis and Ploce. Total: 4 out of 113 epidemiological districts.

•      Epidemic outbreaks

Following outbreaks were reported in June:

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

Dubrovnik -  streptococcal sore throat in a kindergarten with 19 diseased out of 119 exposed between 17.10 and 18.12. 2007.

Dubrovnik - streptococcal sore throat in a kindergarten (another) with 13 diseased out of 52 exposed between 30.10. and 14.11. 2007.

Dubrovnik - streptoccocal sore throat in a kindergarten (another) with 4 cases registered out of 11 exposed between 13.12. and 31.12. 2007.

Dubrovnik - streptococcal sore throat  in a kindergarten (another). Between 24.1. and 1.4. 2008  there were 30 diseased out of 186 exposed.

Dubrovnik - streptoccocal sore throat in a kindergarten (another) with 7 diseased out of 101 exposed children between 1.3. and 1.4. 2008.

Zagreb Susedgrad - small cluster of meningococcal disease in a big kindergarten. Between 10. 4. and 18.4. 2008. there were 3 cases registered out of 300 exposed children. Causative agent: Neisseria meningitidis  of serogoup B, clinical picture relatively mild. Wide control activities were undertaken by the epidemiology service

Pula - salmonella food poisoning (S. enteritidis) in a family on 29.4. 2008. There were 4 diseased, all eating home made French salad with home made mayonnaise.

Samobor - salmonellosis (S. enteritids) in a pastry shop starting on 31.4. 2008. There were 19 diseases registered. Vehicle epidemiologically tiramisu sweet. Microbiological examination of tiramisu samples negative for salmonella but  increased counts of Enterobacteriacea were found.

Slavonski Brod - measles. Since the beginning of May until 31^st of May 2008 there were 19 diseased, all epidemiologically linked. Diseased were mostly  members of a large family (children and young adults), living partly abroad, and had not been vaccinated there. In current outbreak all susceptible family contacts were covered with vaccination.

Editorial comment: this outbreak is directly linked to outbreak in Zagreb and surrounding (see News and comments).

Split – family outbreak of salmonellosis (S. enteritidis) on 9.5. 2008. All 5 family members got ill after a fried eggs meal. Eggs were not microbiologically examined

Split – salmonella food poisoning (S. enteritidis) after family celebration on 9.5. 2008. There were 25 diseased out of 25 exposed persons. Vehicle epidemiologically  home made cakes with eggs. Eggs were bought in the same shop as in the above outbreak. Salmonella found in cake samples. Eggs were not microbiologically examined.

Cakovec – gastroenteritis in a kindergarten. Causative agent not found, microbiological examinations on pathogenic enteral bacteria, rota and adeno viruses turned negative. Between 6.5 and 18.5. 2008. there were 30 diseased out of 200 exposed.

Trogir – salmonella food poisoning (S. enteritidis) after family dinner held in a restaurant on 19.5. 2008. There were 35 diseased out of 74 exposed persons. Vehicle epidemiologically: French salad prepared in the restaurant. Salmonella was found in kitchen staff and also in eggs (used in mayonnaise for French salad)

Zupanja – gastroenteritis in a family. Between 19.5. and 25.5. 2008. there were 9 diseases out of 13 exposed. Causative agent not found. Microbiological examinations negative. Mode of spread most probably alimentary. Vehicle epidemiologically: fresh salad handled by hands (some of persons working in the kitchen suffered from enteric disturbances) and/or drink with water from a house well.

Ivanec – enterocolitis on unknown etiology (microbioloigcal examinations negative) in a group of forestry workers, with total of 12 diseased out of 20 exposed between 10.6. and 14. 6. 2008. Mode of spread probably alimentary, but vehicle not determined with certainty.

Varazdin - head lice in a kindergarten with 27 infested on 12.6. 2008.

NEWS AND COMMENTS

•       Measles in Croatia 2008

In the previous month (May), first cases of measles after more than two years of a zero incidence in Croatia were registered (see ENEWS 5/2008) followed by an increase in June. Such a favorable situation was a consequence of systematic mass vaccination and constantly high vaccination coverage of cca 95%. However at such excellently high coverage, a certain number of persons is obviously left unvaccinated and non immune. So, from time to time it could happen that cases of measles still occur usually after exposure somewhere outside the country, as well as small clusters or outbreaks of cases if more unvaccinated persons are found themselves around such individual measles cases. Such a situation with gathering of unvaccinated persons could be expected, among other possibilities, in the health care or hospital environment. So, in various countries of the word with high vaccination coverage and low measles incidence, hospital i.e. nosocomial measles outbreaks were recorded. The same experience is also ours from the last measles outbreak in 2003/2004 (see ENEWS 1/2004) as well as in the current outbreak 2008. Namely, one of persons that contracted the disease in a contact with the first case (child: see ENEWS 5/2008), previously unvaccinated because of migrant type of life, with a lot of time spent abroad, by chance needed a hospital treatment at the same time. This caused infection of a number of persons from Zagreb area, getting into contact with the diseased, while visiting hospital or outpatient clinic (measles are highly contagious) and several health care workers were affected too. At the same time the disease emerged among relatives of the first case, living in Slavonski Brod area also being unvaccinated because of their migrant type of life with long stays abroad.

It is a standard practice here that epidemiology service promptly acts in each measles case, performing an inquiry in the home or vicinity of diseased to detect possible other cases and send them to proper treatment with isolation, and to vaccinate everyone in contact, who is not vaccinated or without vaccination record. This can prevent the spread of diseases and is useful also for the future as vaccination coverage is improved. This procedure was carried out fully in this case too, and the outbreak was stopped at the numbers lower than in the outbreak four years ago.

It should be mentioned that this event, triggered by an imported measles case, occurs at the same time when outbreaks of measles were registered in several European countries, in some of them with more than thousand diseased.

Table 1 Measles in Croatia 1998 – 2008 (up to  end of June 2008)

*  import, child, tourist from non European country, virologically not confirmed

** 2008 up to the end of June

COMMUNICABLE DISEASES IN CROATIA                         June 2008

Last change - 25.05.2009 - Posljednja promjena