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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in April

S a l m o n e l l o s i s. Incidence dropped further in April (121:148), and was lower than in April last year (142). No significant clusters.

T e t a n u s. One case reported from Bjelovar, in an old unvaccinated person.

M o r b i l l i (measles). One imported case registered in Zagreb Centar in a visiting stranger.

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

M e n i n g i t i s    e p i d e m i c a. There were 8 diseased in April, which is similar to previous month (7) and  slightly more than in April last year (5).

S y p h i l i s. In April more cases were reported than in March (6:1). This was  also more than in April last year (1). Cases cluster in Zagreb area (5).

Q   f e v e r.  There were 3 cases reported in April: Metkovic (2), Pag (1).

L e g i o n e l l o s i s. Number is higher in April than in March (10:4; see Epidemic outbreaks).  Last year there were no cases in April. 

I n f l u e n z a. Number in April dropped  substantially (4176: 22570) and outbreak practically expired.

•      No reports in April from:

Gracac, Vis Lastovo and Ludbreg. Total: 4 out of 113 epidemiological districts.

•      Epidemic outbreaks

Following outbreaks were reported in April:

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

Dubrovnik – head lice in an elementary school class. On 22.9. 2008. there were 4 cases found among 23 class members.

Dubrovnik – head lice in another elementary school. On 16.10.2008. there were 6 infested out of 127 exposed pupils.

Dubrovnik – head lice in an elementary school class. There were 4 infested found out of 49 exposed  on 26.11. 2008.

Dubrovnik – streptococcal sore throat in a kindergarten,  with 7 diseased out of 24 exposed between 15.1. and 4.2. 2009.

Porec – legionellosis. Between 20.1. and 4.2. 2009 the total of 19 cases were registered among persons attending World Handball Championship matches in a newly built city sports hall. Epidemiological investigation revealed the Legionella pneumophila serogroup 1 presence in hot water in the hall. Beside domestic people 6 diseased were from abroad.

Dubrovnik – small family outbreak of salmonella food poisoning. (S. group B) with 2 diseased  between 25.1. and 20.2. 2009. Vehicle epidemiologically: home made cake, not microbiologically examined.

Sibenik – gastroenteritis in a home for elderly. Causative agent: noro virus. Between 1.2. and 9.2. 2009. there were 9 diseased out of 40 exposed persons. Mode of spread: contact.

Varazdin – trichinellosis in a family on 8.2. 2009. There were 5 diseased out of 8 members, eating insufficiently thermically processed meat or tasting raw meat mixture for sausages of their own swine. Trichinella found in meat samples.

New  Zagreb – gastroenteritis in a home for elderly people on 10.2. 2009. Causative agent: rota virus. There were 56 diseased out of 320 exposed persons. Mode of spread most probably alimentary (but vehicle not detected) and  subsequently by contact.

Dubrovnik – salmonellosis (S. gorup C) discovered at regular health check in a person working with food on 13.2. 2009. Epidemiological investigation revealed retrospectively 2 more cases in its family. Source and vehicle not detected.

Pula – viral gastroenteritis (noro virus) in a hospital. Between 21.2. and 20.3. 2009. there were 80 diseased (patients and staff). Mode of spread: contact.

Novi Zagreb – viral gastroenteritis caused by noro virus in an institution of closed type. Between 7.3. and 17.3. 2009 a total of 52 diseased was registered. Source unknown. Mode of spread: contact and partly alimentary (vehicle not detected however).

Dubrovnik – head lice in an elementary school. On 13.3. 2009. there were 5 infested out of 93 exposed children.

Sibenik – scarlet fever in a kindergarten. Between 23.3. and 28.3. 2009 there were 3 diseased children in the group of 24.

Dubrovnik – head lice in an elementary school class. On 23.3. 2009. there were 3 infested detected out of 41exposed pupils.

Opatija – histamine poisoning after a fish (anchovy) meal in a small restaurant. There were 5 cases registered. No fish left for analyses.

Novi Marof – enterocolitis in a kindergarten. Causative agent: rota virus. Between 31.3. and 17.4. 2009 there were 18 diseased out of 23 exposed children. Mode of spread: contact.

Varazdin – gastroenteritis on unknown etiology (examinations negative) in an institution of closed type starting on 10.4. 2009. There were 35 cases recorded. Mode of spread: contact.

NEWS AND COMMENTS

•       Campylobacteriosis in Croatia.

According to the new Communicable disease law (Official gazette No 79/2007) campylobacteriosis was added to the reportable diseases list.  Before that,  this infection was registered within reportable entities (syndromes) of enterocolitis and food poisoning, with causative agent mentioned in appropriate field on standard report form. This change was introduced in order to be aligned with EU legislature (see ENEWS no 10/2007). After necessary adaptations of existing software, the entity of campylobacteriosis is reported and regularly registered and  processes since the  beginning of 2009. In that period,  i.e. up to the end of April, a  total of  229 cases were recorded, males and females rather equally presented (M: 119, F: 110). The table is giving their age structure.

It can be seen that like in other frequent enteral infections, the youngest age is most affected,  especially up to second birthday.

•       Emergence of new influenza

At the end of April 2009 the World health organization informed, that in some areas of United States of America and Mexico,  clusters of diseases  were recorded caused by a new,  previously undetected influenza virus strain A/H1N1/, so different from earlier strains,  that it was not subtypable by standard test kits. In only few days  basing on all information gathered,  it was concluded that this could be a new pandemic influenza strain. Soon, already  on 26.4.2009 the World health organization announced that after several years of pandemic alert phase 3,  the situation changed to phase 4,  characterized by sustained interhuman transmission, and very soon after that,  in the same month on 30.4. 2009 announced that phase 5 started,  reflecting wide spread of new influenza virus.  All countries of the world,  Croatia too,  are following this new situation carefully, and basing on WHO guidelines, introducing  measures for early detection,  optimal treatment and possible mitigation of disease spread.

In this new situation, the work on National pandemic influenza headquarters was intensified and several measures were established in Croatia:

No restriction in international traffic,  according to the WHO position

To persons entering Croatia from abroad, written information is given,  advising that if somebody comes from a country where new influenza is frequent and falls ill with fever  within 7 days since arrival, should contact the ambulance service or by own transportation (avoiding public transportation) visit  the nearest hospital infectology ward. If infectologists there cannot exclude influenza, they will treat this patient properly including antivirals, while field epidemiologists visit patients close family contacts and offer them antiviral postexposure treatment. Meanwhile, patients sample is sent and tested in the National influenza center laboratory of  the Croatian national institute of public health. Medication is stopped if virology result turns negative.

This initial tactics will be applied since significant spread of the disease within the country and then  turned to tactics stated in the National plan and WHO guidelines, where the majority of diseased is treated in primary health care and at home  and only severe cases (defined by the Plan) are hospitalized, the postexposure prophylaxis is not applied systematically any more, and the greatest portion of  antivirals stockpile is aimed to diseased persons. The Croatian plan however foresees the preexposure chemoprophylaxis for some vital services in order to maintain regular life, basing on epidemiological assessments of the situation and possible benefits expected.

As the phase 5 has been announced, special daily zero reporting of influenza cases from all over the country was introduced In Croatia, beside all other regular reporting channels.

Up to now no cases of new influenza were detected in Croatia.

COMMUNICABLE DISEASES IN CROATIA              April 2009

Last change - 12.08.2009 - Posljednja promjena