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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in July

S a l m o n e l l o s i s. Incidence raised (491:276) as expected for the season). There were less cases in July last year (381). Clusters are seen in Split (36), Samobor (21), Novi Zagreb (43), and Zagreb Tresnjevka (44).

D y s e n t e r i a   b a c i l l a r i s. Low incidence pattern continues  with only 2 sporadic cases registered in July  (June: 0, last July: 0).

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

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

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

M e n i n g i t i s   v i r o s a (aseptic).  In July a slight seasonal increase of incidence is registered (24:19), while in July last year more cases were reported (36).

L e i s h m a n i a s i s   c u t a n e a. In July 1 report from Omiš. This fits the usual very low incidence pattern of leishmaniasis in Croatia (June: 0, last July: 0).

H F R S. There were 3 cases reported in July (Slatina, Virovitica, Sisak) which is similar to previous month (1) and to July last year (6).

L e g i o n e l l o s i s. In July 3 sporadic cases were reported (Petrinja, Novi Zagreb, Sesvete), which was not much different from previous month (0) and the last year (1).

L y m e   b o r r e l i o s i s. Significant seasonal increase of incidence registered in July (112: 58) following tick activity season. However in July last year there were less diseased recorded (80). Cases cluster on Zagreb area with highest numbers in Dubrava (10),  Novi Zagreb (13) and Trešnjevka (14).

•      No reports in July from:

Garesnica, Opatija,  Novalja, Buzet, Gracac, Makarska, Vis and Lastovo. Total: 8 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 – viral gastroenteritis (noro virus) in a hospital ward. Between 8.1. and 12.1. 2009 there were 15 diseased (patients and staff). Source probably the  patient with enteral symptoms at admission.

Split – salmonellosis (S. enteritidis) on the city area, with the total of 106 cases registered between 14.5 and 24.5. 2009. Patients were all epidemiologically linked to the consumption of cakes produced in a large pastry shop.  Epidemiological investigation revealed several salmonella carriers among the staff.  However all cake samples examined turned slamonella negative.  

Pregrada – salmonellosis (S. enteritidis) among guests of a country tourism facility on 24.5. 2009. Wehicle epidemiologically: deer goulash with bread noodles, not left for analyses. Salmonella found on kitchen surfaces. 

Beli Manastir – salmonella food poisoning  (S. enteritidis) after a wedding banquet on 24.5. 2009. There were 9 diseased out of 200 guests. Vehicle epidemiologically: home made wedding cake most probably secondarily manually contaminated by some of persons engaged in the kitchen, found subsequently salmonella positive and reporting enteric illness few days ago. 

Opatija -  viral gastroenteritis (noro virus) in a hotel.  Between 9.6. and 14.6. 2009 there were 30 diseased  (guests and staff) out of cca 200 exposed persons. Mode of spread: contact. Outbreak started after arrival of few guests already diseases with an enteral disease.

Delnice – gastroenteritis of unresolved etiology (laboratory examinations negative)  15.6. 2009 in a group of sportsmen settled in a hotel. Total of 14 diseased were registered. Source not found, mode of spread not found. Local water supply suspected but not examined.

Slavonski Brod – salmonella food poisoning (S. enteritidis) in a family starting on 16.6. 2009. There were 7 diseases (all members). Vehicle epidemiologically: paned bread. Source not found. Food and ingrediences not examined.

Pula – viral gastroenteritis (noro virus) among staff of  an auto camp. There were 9 diseased between 23.6. and 24.6. 2009. Mode of spread probably by food,  but vehicle not found. At the same time same meals were eaten by a great number of camp guests  with no cases.

Zagreb Sesvete – pandemic flu H1N1 2009 in a group of school children returning from their 7 days trip abroad. There were 21 diseased between 5.7 .and 14.7. 2009. 

NEWS AND COMMENTS

•       Fulfillment of national mass vaccination Program in Croatia in 2008

Successful implementation of mass vaccination Program is of the highest importance in order to maintain and to improve the state oh health of the population. Thus the results of this very difficult work of health services are particularly interesting.  Basing on regular annual reports of all doctors vaccinators in the country  which are all recorded and analyzed in the Epidemiology service of the Croatian national institute of public health,  here a digested annual report for Croatia as a whole is presented.

Table 1 Primary vaccination coverage Croatia

It can be seen that  coverage levels for all vaccinations are very good i.e. very high, exceeding obligatory levels of 95% for measles and of 90% for all other vaccinations.

These data correspond well with case notification data showing very low or zero incidence of diseases covered by vaccination.

The only part standing out from this excellent picture is vaccination of 60 years old persons against tetanus, which never, since its introduction had reached a desired level of 90%, in 2008 being even lower than before. This should be corrected with increased efforts of all the involved, to better reach this segment of population by enhanced promotion and information for grown-up people, many of whom still think that vaccination is something for children. The importance of this vaccination lies in the fact that there is no herd immunity effect in tetanus and that this disease is still highly fatal. The only case registered in 2008 had unfortunately a lethal outcome.

•       Etiology of helminthiasis in Croatia 2008.

Helminthiasis still shows a considerably high incidence affecting mainly children, in spite of the fact that incidence trend goes visibly downward, like in other diseases of low hygienic standard.

Table 1 Helminthiasis in Croatia 1999- 2008

Graph 1 Helminthiasis in Croatia

In 264 registered cases in 2008 the majority had the causative agent noted. The table is showing which parasites were diagnosed.

Table 2  Agents of helminthiais,  Croatia 2008.

As in previous years (see ENEWS 4/2008) Enterobius vermicularis is ranking first,  followed by Ascaris lumbricoides. Tapeworm infestations are rare. A curiosity were 3 registered cases of the largest human parasite Taenia saginata (cattle tapeworm). 

COMMUNICABLE DISEASES IN CROATIA              July 2009

Last change - 15.10.2009 - Posljednja promjena