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CROATIAN NATIONAL INSTITUTE OF PUBLIC HEALTH

EPIDEMIOLOGY UNIT 

ROCKEFELLEROVA 7 
10000 ZAGREB 

REPUBLIC OF CROATIA

ISSN 1334-6733

- NEWS AND COMMENTS

- COMMUNICABLE DISEASES IN CROATIA


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2009

MARCH

Nº 3

ENGLISH LANGUAGE ISSUE *  ELECTRONIC VERSION

COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

    Communicable disease case notification in March

S a l m o n e l l o s i s. Low incidence is seen as expected for the season (March 148: February: 167) but slightly higher than in March last year  (134). Small clusters are seen in Osijek (14) and Sibenik (27).

M o r b i l l i  (measles). One case reported in March from Velika Gorica, in an unvaccinated person.

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

M e n i n g i t i s   e p i d e m i c a. There were 7 diseases in March, like in previous month (6), slightly more than in March last year (4).

E n c e p h a l i t i sCases in March are more frequent than in February (10:6) and  in March last year (5), but scattered.

A I D S . There were 4 reports in March covering several previous months.

T r i c h i n e l l o s i s. The disease was registered also in March, but with less cases than in February (8:19). Majority of cases was in Splitsko-dalmatinska county (Sinj: 2, Split: 3). In March last year there were no cases.

M a l a r i a. One imported case (Papua New Guinea) was reported from Zagreb Tresnjevka in March.  

L e g i o n e l l o s i s. Incidence was  equal to previous month (3:4), while 1 case had been reported in Mach last year.

P n e u m o n i a. Incidence raised in March (762:724) being significantly higher than in March last year (567).

I n f l u e n z a. Intensity dropped in March (22570:3359), but still was high. The total of  497165 cases were registered in Croatia in 2009 up to the end of March, which was about equal to previous year.

      No reports in March from:

Makarska and Lastovo. Total: (only) 2 out of 113 epidemiological districts.

      Epidemic outbreaks

Following outbreaks were reported in March:

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

Sinj – trichinellosis in a family. Between 25. 12. 2008 and 28.2. 2009 there were  8 diseased among the  family members and their friends, all eating own home made dried pork products. Trichinella was found in meat samples.

Vinkovci – trichinellosis in an family on 15.1. 2009. There were 13 diseased after consumption of own home made dried pork products. Trichinella found in meat samples  

Dugo Selo – viral gastroenteritis caused by noro virus in a home for mentally disabled  persons. Between 16.1. and 4.2. 2009 there were 35 diseased out of 346 exposed. Mode of spread: contact.

Djakovo – trichinellosis in a family. Between 21.1. and 2.2. 2009 there were 3 diseased out of 5 members, eating own home made dried meat products,  made from a mixture of pork and wild boar meat.  Trichinella found in samples examined.

Pozega – viral gastroenteritis caused by noro virus in a home for elderly persons, starting on 4.2. 2009. Total of 33 cases was registered . Mode of spread: contact

Krk – viral gastroenteritis  caused by noro virus in a home for elderly. Between 12.2. and 21.2. 2009 a total of 47 diseased out of 184 exposed was recorded.

Sisak – gastroenteritis in an home for elderly persons starting on 16.2. 2009. Causative agent not found, laboratory examinations negative. There were 6 diseased out of 30 exposed. Mode of spread: contact.

Zadar – cluster of 2 cases of supposed septicemic meningococal disease starting simultaneously on 24. and 25. 2. 2009 in two children of a family. Neisseria meningitidis of serogroup B was found only in nasal swab of one child and not in its blood culture, while in other child all samples were negative, possibly because of previous antibiotic treatment. No other pathogens detected. Source not found.

Labin – viral gastroenteritis (noro virus) in a health institution. There were 24 diseased persons between 26.2. and 9.3. 2009.  Mode of spread: contact.

Sibenik – streptococcosis (sore throat and scarlet fever) in a kindergarten. Between 1.3. and 16.3. 2009 there were 4 diseased out of 25 group members.


NEWS AND COMMENTS

       Influenza

The development of current seasonal influenza wave is presented on the following graph.

Graph 1  Influenza in Croatia 2009 by weeks

It can be seen that intensity goes down in March. The laboratory of the National influenza center of the Croatian national institute of public health has detected viruses A/H3 N2/ and B circulating among diseased up to the end of March.

       Food-born outbreaks in Croatia 2006 – 2008

Food is essential for human life. However, beside its vital positive role food may sometimes cause some infective diseases. Some of these infections belong to a zoonosis (anthropozoonosis) group i.e. they are shared by animals and humans, like salmonelloses, campylobacteriosis etc. So people can be exposed by eating food originating from infected animals, or through meals secondarily contaminated from infected animals or infected humans. Some exclusively human diseases can be also transmitted by food in cases when ingredients or meals were contaminated for instance  by salmonella Typhi, staphylococci, noroviruses etc.

Having in mind the paramount importance of food, in all societies and countries, in Croatia too multi-level security systems are organized, starting from a level of production, through the inspection supervision to medicine measures of epidemiological prevention and control.

Registered outbreaks of food born diseases in Croatia in last three years (2006-2008) are given in the table. The data show that the complex system mentioned aimed to secure high food safety, is working well in Croatia, giving generally fairly safe food for everyone.

Table 1      Food born outbreaks in Croatia 2006 – 2008

disease/causative agent

No outbreaks

Salmonellosis

125

Gastroenteritis/toxiinfectio alimentaris, un identified

18

Gastroenteritis, Noro virus

7

Gastroenteritis, Rota virus

1

Toxiinfectio alimentaris, Clostridium perfringens

4

Toxiinfectio alimentaris, Staphylococcus  aureus

6

Toxiinfectio alimentaris, Vibrio parahaemoythicus

1

Enterocolitis, unidentified

3

Campylobacteriosis

2

Trichinellosis

6

Histamine poisoning

7

Shelfish poisoning (DSP) ?**

1

Brucellosis

1

**possible, not proven

It can be seen in the table, that salmonellosis outbreaks are most frequent. However it should be stressed that a vast majority of these outbreaks is occurring in families after domestic meals, involving small numbers of exposed and diseased. Only few outbreaks were registered in public restaurants, hotels etc. High frequency of salmonellosis is understandable having in mind that salmonellae are widely spread through the living world: in fishes, amphibia, reptiles, birds and mammals, including humans.

Foodborn noro viral outbreaks are also registered. Here it should be noted,  that only a minority of all noroviral outbreaks are foodborn i.e are mainly spread  by contact, via droplets or possibly aerogenic (see ENEWS 2/2007).

Trichinellosis has recently been substantially suppressed to low numbers and few small family outbreaks, owing to systematic veterinary measures as well as to preventive and prompt control activities of epidemiology service.

There were no outbreaks in the whole period caused by the industrially manufactured food.


COMMUNICABLE DISEASES IN CROATIA              March 2009

Salmonellosis

148

Food poisoning

549

Enterocolitis

671

Hepatitis B

14

Hepatitis C

15

Hepatitis vir. non identified

2

Angina streptococcica

1210

Scarlatina

632

Pertussis

4

Morbilli

1

Rubella

0

Varicella

2627

Parotitis epidemica

8

Meningitis epidemica

7

Meningitis virosa

4

Encephalitis

10

Leptospirosis

2

Mononucleosis infectiosa

  145

Erysipelas

 97

Tuberculosis

108

Syphilis

1

AIDS

4

Q fever

1

Trichinellosis

8

Echinococcosis

1

Malaria

1

Scabies

44

Toxoplasmosis

3

Anthrax

1

HFRS

1

TBE

1

Meningitis bacterial

3

Legionellosis

4

Enterovirosis

  45

Pediculosis

48

Pneumonia

769

Herpes zoster

337

Lyme borreliosis

7

Inluenza

22570

Chlamydiasis

30

Helminthiasis

24

Sepsis

6

Yersiniosis

3

Campylobacteriosis

80

Giardiasis

18

Gastroenteritis, viral

84

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