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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in August

S a l m o n e l l o s i s. Number of cases in August is lower than in July (398:491). Last year the situation was similar (381). Largest cluster is seen in Pula (49).

T e t a n u s. There was 1 case reported in August from Zadar, in an old unvaccinated person.

M o r b i l l i (measles). No reports in August.

R u b e l l a. No reports in August.

V a r i c e l l a (chicken pox). Incidence dropped (431:1380) reaching usual seasonal minimum.

M e n i n g i t i s   v i r o s a (aseptic). Incidence is increasing as expected for the season (53:24), intensity somewhat higher than in August last year (36).

A I D S. In August 6 cases were reported,  referring to last six months.

M a l a r i a. One imported cases (Nigeria) was reported in August from Zagreb Mdevescak.

T B E (tick born encephalitis). There were more cases reported in August than in July (14:5) as expected. In August last year there were 8 cases registered.

I n f l u e n z a. In August 86 cases were reported, outside of usual season. As it is already known,  that was new pandemic flu AH1N12009 pdm. Cases are mostly imported.  (see ENEWS 4/2009 and 7/2009).

•      No reports in August from:

Krizevci, Vojnic, Opatija, Benkovac, Biograd, Makarska, Vis and Lastovo. Total: 8 out of 113 epidemiological districts.

•      Epidemic outbreaks

Following outbreaks were reported in August:

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

Dubrovnik – head lice in kindergartens. Between 12.1. and 7.4. 2009 there were 11 infested among 165 children on three different places.

Dubrovnik – salmonellosis (Salmonella of B group) on 13.3. 2009. There were 5 diseased out of 6 family members after a meal of paned chicken. No samples left for analyses.

Dubrovnik – family outbreak of salmonellosis (S. enteritidis) starting on 13.4. 2009 with 5 diseased out of 6 members. Vehicle epidemiologically: home made cake. Samples not examined.

Sibenik – influenza AH1N1/2009 in a group of school children returning from their 7- day trip abroad. Between 11.7. and 21.7. 2009 there were 62 diseased out of 150 exposed participants.

Gracac – food poisining on a wedding party 2.8.2009. Causative agent: Staphylococcus aureus. Total of 35 cases were registered out of 300 wedding guests. S. aureus was confirmed in several backed meat samples as well as in few cake samples. All meals were prepared by the participants themselves. Meat was backed a day before wedding  and kept outside refrigerator until the next day. Source probably a person engaged in food preparations found to have a supurative wound on the hand finger.

NEWS AND COMMENTS

•       Pandemic flu in Croatia,  phase of delay

Pandemic flu came to Croatia at the beginning of July 2009 (see ENEWS 7/2009). This triggered the activation of appropriate parts of the National preparedness plan, i.e. delaying phase. Main measures of this phase are:

No restriction in international travel, either at entry nor regarding departure to any part of the world. However advice for travelers was released saying that it is wise to postpone a trip if ill with fever (at exit or before entry) and to seek medical advice and help (in accordance with WHO recommendations).

On all international points of entry to Croatia, a written information for travelers advised them that anybody experiencing respiratory disease with fever in 7 days since entering Croatia, should visit a nearest infectology hospital ward for diagnostics and treatment including antiviral drugs.

For this reason as well as for needs of postexposure prophylaxis of contacts, an amount of antiviral drugs was promptly distributed to the field,  to all Counties,  from the central stock.

Every case of suspected pandemic flu was processed by the following algorithm: Information about the patient was promptly sent (by phone) at any time  to a doctor-epidemiologist on duty at the Epidemiology service of the Croatian national institute of public health. He(she) promptly informs a field epidemiologist (county institute of public health), who pays a home visit, detects persons in close  (family) contact with the patient and offers them postexposure antiviral prophylaxis.

Respiratory samples from all patients are sent to Virology laboratory of the National influenza center at the Croatian national institute of public health. Tests were performed regardless of the working time and results reported promptly by phone to central national Epidemiology service of the CNIPH. Epidemiology service passes  all results promptly by phone to clinicians who sent the samples, as a help in diagnosis and treatment (written test results came later in usual manner). This enabled that at any time complete overview of current epidemiological situation was possible at national level, necessary for all significant decisions of the central pandemic headquarters. Close family contacts under chemoprophylaxis could continue their duties and normal life, with reduced possibilities of transmitting and spreading the infection.

The main purpose and aim of this phase,  was to enter the cold season at as low as possible level of flu, which could influence the main outbreak intensity. The results were favorable:

Mostly imported cases were registered (in persons coming from abroad already infected) as a natural consequence of uninterrupted international movement of people mainly tourists, with only small number of domestic cases which was  very probably a consequence of the fact that nt one of close contacts of virologically confirmed pandemic flu cases, that received antiviral chemprophylaxis, got the disease. There were no tertiary cases.     

All diseased were treated optimally and recovered fully. There were no fatal cases.

However, with an increasing number of cases, such a tactic obviously become more difficult or impossible to perform. Then the next phase takes place i.e. phase of mitigation of pandemic impact, lasting in fact, in one way or another,  through the entire pandemic wave (waves). A heavy weight of measures is transferred mainly to diseased persons. The majority of patients are treated at their family doctors i.e. in primary health care (like in seasonal flu outbreaks) and only seriously ill patients or patients with underlying chronic diseases, are hospitalized in order to save a part  of hospital capacities for patients  with other diseases, particularly those vitally endangered.

Beside that, measures for preservation of function of entire health care system under the  pressure of mass morbidity as well as for maintenance of vital social functions possibly compromised by a mass morbidity, are applied. The majority of antiviral drugs are reserved for treatment of (seriously) ill flu patients, systematic postexposure prophylaxis is abandoned. Virological tests are not performed (understandably) in all patients, but only if the result is clinically important (differential diagnosis, guiding a proper therapy), or on the other hand is epidemiologically important for instance to clarify etiology of influenza like clusters. In addition, a planed virological sampling will be performed during the entire pandemic wave to give the information about potential and possible changes of viral characteristics (virulence, resistance etc). During this entire phase, the planed stepwise vaccination of population is performed too.

Daily information on newly discovered and confirmed pandemic flu cases in Croatia is published, since the first cases untill now, on the web site of the Croatian national institute of public health: www.hzjz.hr, along with relevant information and guidelines for citizens and health workers.
 

•       Salmonellae in circulation in 2008

Basing on individual salmonellosis case reports, which in 2008 numbered 3664, here we are giving an overview of detected serovariants (Table).

Table 1  Salmonella serovariants in salmonellosis patients in Croatia 2008.

Salmonella enteritidis was most prominent, like in previous years.

COMMUNICABLE DISEASES IN CROATIA               August 2009

Last change - 28.10.2009 - Posljednja promjena