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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in November

S a l m o n e l l o s i s. Incidence decreased further as expected for the season (415 : 470), but  the intensity was higher than in November last year (374). The only cluster is seen in Pula (50).

V a r i c e l l a  (chicken pox). Usual seasonal increase of incidence started in November (902:408), but did not reach the level of last November (1223).

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

R  u b e l l a. No cases in November.

P a r o t i t i s  e p i d e m i c a (mumps). Low incidence, owing to systematic vaccination is observed, with 6 sporadic cases in November, 7 in October, 3 in November last year.

A I D S. There were 10 cases reported in November, cumulated through the last six months.

M a l a r i a. One imported case (Sudan) was reported from Samobor.

•      No reports in November from:

Topusko, Korenica, Gracac, Makarska, Vis, Lastovo and Ivanic-Grad. Total: 10 out of 113 epidemiological districts.

•      Epidemic outbreaks

Following outbreaks were reported in November:

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

Dubrovnik – cariership of salmonella (group B) in a member of kitchen staff of a hotel at regular health check on 25.4. 2008. Epidemiological anamnesis revealed that this person has visited some countries in the Far East and got ill there with an enteral disease after chicken meat meal. Rest of the staff negative for salmonella.

Dubrovnik – histamine food poisoning in two foreign tourists on 20.5. 2008. after consumption of tuna meat  in a restaurant.

Djakovo – salmonella food poisoning (S. enteritidis) after a birthday party. Between 24.5. and 4.6. 2008 there were 7 diseased out of 59 exposed persons. Vehicle epidemiologically: cake with strawberries bought in a restaurant in another county. Cake samples turned salmonella negative, however.

Dubrovnik – salmonella food poisoning (S. eteritidis) among hotel staff. Between 2.6. and 29.6. 2008. there were 4 diseased registered among kitchen and storage staff. Vehicle not found.

Rab – chlamydial eye infection in a family. There were 5 cases registered out of 6. Only one member (a child) was manifestly ill, at first in June and, after treatment, again in July and in August. Then, the family members were screened and 5 were found positive on 21.8. 2008, but without eye simptoms. After simultaneous treatment, all members turned negative. Mode of spread not found with certainty (see next outbreak ).

Rab – family outbreak of chlamydial conjunctivitis starting 21.8. 2008, when one member (child) turned ill. Investigation within family members, discovered 3 simptomless cases out of 7. Similarly to previous outbreak mode of spread not found, neither these two families were epidemiologically linked. However both families live in the same littoral place, so possible mode of acquiring for children might be bathing on the same sand beach near the village.

Pula - salmonella food poisoning (S. enteritidis) on a ship, during the test voyage starting on 16.9.2008. There were 53 cases registered out of 180 exposed persons. Vehicle epidemiologically: tartar sauce with mayonnaise, made in the  ship kitchen. Kitchen staff was screened for carriage and few positives found. Egg used for mayonnaise were suspected but not microbiologically examined.

Pula – salmonella food poisoning (S. enteritidis) on 22.9. 2008 in a group of sportsmen soon after their return from a voyage abroad. There were 6 diseased out of 20 exposed. Vehicle epidemiologically: paned chicken with mayonnaise eaten in a local restaurant during the trip.

Pozega – acute gastroenteritis in a hospital. Causative agent: noro virus. Between 6.10. and 17.10 2008 there were 33 diseased. Mode of spread: contact.

Pozega – gastroenteritis in a closed institution. Causative agent: noro virus, Between 19.10. and 25.10. 2008 there were 22 cases registered. Mode of spread: contact.

Zapresic – salmonella food poisoning (S. enteritidis) in a hospital. There were 16 diseased out of 108 exposed persons, between 12.11. and 15.11. 2008. Vehicle not found. Source not certain.

NEWS AND COMMENTS

•       ECDC & WHO pandemic influenza expert group  visiting Croatia

At the end of September, according to previous agreements and plan, a combined ECDC - WHO expert group visited Croatia in order to analyze, together with domestic experts, the state of preparedness for possible new pandemic of influenza. Such analytical visits have already been done in all EU countries, and a number of other countries.

The purpose is to identify good elements in each country plan which then can be implemented in other countries if they found it appropriate, as well as to detect certain challenges that ask for further efforts and development. During four days of the visit, the guests met high representatives of the Ministry of health and social welfare, representatives of other ministries involved in the national plan, also veterinary experts at the Veterinary directorate of the Ministry of agriculture, fishery and rural development. Further, a visit to Infective diseases clinical hospital in Zagreb was organized. A considerable amount of time was dedicated to discussions with experts epidemiologists of the Epidemiology service of the Croatian national institute of public health, where center of national influenza surveillance network is placed, and which experts actually created and proposed National plan, adopted by the government, so all details were exhaustingly discussed. The laboratory of National influenza center of the Croatian national institute of public health was also visited. Beside analysis of preparedness at a national level, attention was aimed also to local, i.e. county level. In this respect Bjelovarsko bilogorska county which completed preparatory activities as well as all other counties, according to the national plan. The meeting was organized there with the representatives of county interdisciplinary headquarters, county officials, representatives of county hospital, county public health institute, family doctors and media, dedicated to all planning details important for a successful answer to possible new pandemic.

At he end of the visit, a joint preliminary analysis was done and presented and discussed at the Ministry of health and social welfare. Currently final version is  jointly prepared. One of points from analysis and report was the decision to organize an exercise in 2009 aimed to test those parts of the National plan, that are less checked  or practiced through everyday work on outbreak surveillance and control in the country.

Knowing that all parts of health system are important and vital for an optimal response to pandemic problems as well as many segments outside the health system, here in the epidemiological journal, the role of epidemiologists, epidemiology services and institutes of public health will be stressed, especially in planning, coordination and assistance in implementation of measures, in early detection and surveillance of influenza outbreaks (pandemic), in communication with the people and the  media, as well as it was the case in organization and realization of the visit described, both on national and county level.

This is also an opportunity to remind all health care workers, that our National preparedness plan for possible pandemic influenza, pointing how each particular segment is involved, is available at the web site of the Ministry of health and social welfare (www.mzss.hr/hr/ministarstvo/strategije_i_planovi).

•       Leptospirosis in 2008

In 2008 leptospirosis intensity in Croatia was lower than in the previous year. Until the end of November the total of 21 cases were registered, while 62 had been recorded in previous year.

Table 1  Leptospirosis in Croatia 2008 (until end of November)

The laboratory for leptospira diagnostics of the Croatian national institute of public health has detected by immunologic techniques in patients´ sera the following serologic variants of Leptospira interrogans circulating in 2008.

Table 2   Leptospirae in circulation 2008

COMMUNICABLE DISEASES IN CROATIA                        November 2008

Last change - 25.05.2009 - Posljednja promjena