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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in July

T y p h u s   a b d o m i n a l i s (typhoid fever). One case reported in July  from Solin. Case is imported, i. e. acquired abroad, during a several week long trip to Asia,  in an unvaccinated person.

S a l m o n e l l o s i s. Number raised in July, compared to June (381:332),  but this was less than in July last year (432). Significant clusters are seen in Rijeka (30) and Varazdin (36; see Epidemic outbreaks).

H e p a t i t i s   A (epidemic jaundice). Number of reports is equal to previous month (4), which is slightly more than in July last year (1). Cases are scattered.

T e t a n u s. One case reported in July from Vinkovci in an old unvaccinated female.

M o r b i l l i (measles). There were 5 more cases reported in July, connected to the cluster from previous month (see ENEWS 6/2008).

R u b e l l a. In July 1 case was reported (virologically confirmed) from Split. Patient was a young unvaccinated male, who acquired the disease while traveling abroad.

M e n i n g i t i s   v i r o s a (aseptic). Seasonal increase is observed (36:16), intensity lower than in July last year (80).

E n c e p h a l i t i s. There were 10 cases reported in July,  5 of them from Cakovec. Cases are not linked in time or location. In June 1 case was registered while in July last year there were 7 reports.

T B E  (tick born meningoencephalitis). Seasonal increase of activity is noticed as expected,  with 8 reported cases. No reports in previous month neither was in July last year.

H F R S  (hemorrhagic fever with renal syndrome). In July there were 6  sporadic cases reported, which is less than in June (11) and also less than in July last year (12). 

•      No reports in July from:

Novalja, Labin, Gracac, Kastela, Vis, Vrgorac, and Lastovo. Total: 7 out of 113 epidemiological districts.

•      Epidemic outbreaks

Following outbreaks were reported in July:

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

Rijeka - streptococcosis (sore throat &scarlatina) in a boarding school. Between beginning of May and 14.7. 2008 there were 15 diseased out of 28 exposed pupils.

Slavonski Brod - gastroenterocolitis in a hospital. Causative agent: noro virus. Between 19.5. and 28.5. 2008 there were 13 diseased (patients and staff) on two hospital wards. Mode of spread: contact.

Rijeka - salmonellosis (S. enteritidis) in a kindergarten, with 15 diseased between 2.6. and 20.6. 2008. Vehicle epidemiologically: home made cakes brought to the kindergarten. Epidemiological investigation revealed 3 salmonella positive members of a family that donated the cakes. However, family member  that actually prepared the cakes turned salmonella negative. 

Sisak - food poisoning after a wedding banquet on 29.6. 2008. There were 3 diseased out of 60 exposed persons. Causative agent not found, microbiological examinations in patients all turned negative. Vehicle epidemiologically: backed pork meat. In meat samples Stapylococcus aures was detected, so this could be a causative agent.

Varazdin - salmonella food poisoning (S. typhimurium) among participants of a fire brigade celebration on 30.6. 2008. There were 42 diseased out of 200 exposed persons. Vehicle epidemiologically: panned turkey and home made cakes brought from home to celebration. No samples left for analyses. Source not found.

Cres-Losinj - family outbreak of hepatitis A discovered on 7.7. when one family member turned manifestly ill. Afterwards 3 more family members were found recently infected serologically but without symptoms. mode and place of infection not found.

Pula - gastroenteritis  on unknown etiology in a group of foreign tourists. Between 10.7. and 12.7. 2008. there were 12 diseased out of 93 exposed persons. Mode of spread probably:  by a meal from a near restaurant, but exact vehicle not discovered.  Microbiological investigations of food from the restaurant  made after outbreak turned all negative.      

Sibenik - salmonella food poisoning (S. typhimurium) in a hotel on 12.7. 2008 with 27 cases registered (guests and staff) out of 225 exposed persons. Vehicle epidemiologically: cream cakes. Microbiological investigation of food left revealed more than one kind  of food contaminated with Salmonella: fried chicken, cream cakes, chocolate roulade, cake with cream, white cake and also fresh eggs used in sweets preparation. So it is assessed that outbreak was caused by secondary manual contamination of some food, combined with consumption of cakes made with primarily contaminated eggs, with additional improper food handling.

NEWS AND COMMENTS

•       Activities to maintain current low density of populations of Aedes albopictus in Croatia

Before the main summer season, activities were undertaken to check and enhance if needed all measures aimed to maintain a low density of mosquitoes and similar vectors all over the country additionally motivated by a recent introduction of Aedes albopictus species.  Similar measures were implemented also last year, when some unfavorable epidemiological information about infections transmitted by this species came from some countries in the vicinity (see ENEWS 11/2007).

Upon the initiative of the Epidemiology service of the Croatian national institute of public health, meeting of an expert group of epidemiologists, entomologists, health ecology experts and disinsection (DDD) experts was organized. During the meeting annual report for the last year on realization  of  routine preventive DDD measures prescribed by law, was analyzed. This report was compiled by the Health ecology department of the Croatian national institute of public health, basing on reports from all county institutes of public health. It was assessed from the report,  that  routine measures of disinsection were generally well implemented over the country in respect of types of insecticide used, mode of work,  and frequency of treatments respectively. In some places where measures were not performed satisfactorily, necessary steps were initiated to correct the situation.

Further, the current situation regarding stability of the presence of Aedes albopicus was analyzed and concluded that since the first introduction a few years ago populations of a low density are persisting in southern parts of the country, while in northern continental part the winter seems to cut their continuity, in spite of repeated introductions by international trade and traffic detected, i.e. it seems that populations can not survive continental winter.

In July, one more quick telephone inquiry was performed by direct contact with all County institutes of public health in touristic areas. Information obtained was generally favorable i.e. mosquito density under control. It was agreed that situation should be continuously monitored and if somewhere the density increases, additional  aimed DDD measured are to be applied. Such urgent interventions were performed during this summer on few places.

Up till now no cases of vector diseases related to mosquito exposure were registered in Croatia.

•       Results of mass vaccination program in Croatia in 2007

Every year results of mass vaccination Program implementation are expected with interest. This because it is the most important and up to now most successful mass preventive medical intervention in the country. More than thousand of doctors vaccinators with their teams are participating in the program realization: general practitioners, pediatricians, neonatologists, school medicine doctors, epidemiologists etc. Beside direct vaccinators many more participants are contributing to the  Program success (or failure): those responsible for supply of best vaccines, their quality control and distribution all over the country, also the epidemiology services having a task of coordination of this complex work in the field, by planning, secondary distribution of vaccines to colleges vaccinators, monitoring implementation, evaluating  of results and issuing reports on vaccination coverage for each particular epidemiological district. Basing on these reports a general report for the entire country is compiled at the Epidemiology service of the Croatian national institute of public health.  The mass vaccination program covers wide population segments, from birth to 19 years of age and further to 60 years old cohorts. Vaccination is performed on several different parts of the health care system: neonatology wards, primary health care outpatient clinics for children and for adults, schools etc.

Having this in mind it is understandable that realization of national Program of mass immunization is really a complex and difficult task. This could be a reason for satisfaction, when one looks to the table below with very good coverage results in 2007 and previous years.

Table 1   Coverage by primary vaccination in Croatia in 2007

It is visible that all percentages are above the required level of 95% for measles and 90% for all other vaccinations, except for ana-Te vaccination of 60 years old cohort. This percentage should be actively improved in forthcoming years, because it is really a pity that someone dos not receive this excellent and long lasting vaccine and get tetanus which is still a highly lethal disease.

A proof that above data are real, can be fund in actual incidence figures for diseases included in the vaccination program, which can be checked also on the pages of this bulletin, and which are fairly favorable: total absence of diphtheria and poliomyelitis, very small numbers of cases of other vaccine covered diseases, including invasive forms of tuberculosis in childhood.

COMMUNICABLE DISEASES IN CROATIA                         July 2008

Last change - 25.05.2009 - Posljednja promjena