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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in September

S a l m o n e l l o s i s.  Incidence in September was similar to previous month (Aug: 398, Sep: 365), lower than in September last year.  Small clusters exist in Osijek (18), Rijeka (22) and Novi Zagreb (24).

H e p a t i t i s    A (epidemic jaundice). In a generally favorable low incidence situation 6 cases were reported in September, none in August. In September last year  there were 5 cases.

P e r t u s s i s (whooping cough). There were 17 reported cases in September, slightly more than in August (11), also more than in September last year (5). Majority of cases is on the Zagreb area (12).

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

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

M e n i n g i t i s     v i r o s a  (aseptic). Number of cases raised further in September (74:53) being higher than in September last year (38), due to a cluster in Pozega (30).

Q   f e v e r.  There were 3 cases reported in September (Pazin 1, Split 2). In September last year there were 2 cases.

L y m e   b o r r e l i o s i s. Number of reports dropped compared to previous month (47:86) to a level lower than in September last year (65).

I n f l u e n z a. In September 377 cases of new pandemic flu were reported, mainly imported i.e. in groups of graduate secondary school students (pupils) after their return from traditional 7-days trip abroad.   

•      No reports in September from:

Obrovac, Drnis,  Sibenik,  Solin, Vis,  Vrgorac and  Novi Marof. Total: 7 out of 113 epidemiological districts.

•      Epidemic outbreaks

Following outbreaks were reported in September:

Note: in all outbreaks presented here the epidemiology service conducted epidemiological investigation and applied measures preventing thus further spread and more cases.

Dubrovnik – streptococcal sore throat in a kindergarten starting 13.5.2009 with a total of 18 diseased registered.

Dubrovnik – salmonellosis cluster (Salmonella of C group) detected at a regular health check in a group of food handlers on 22.5.2009. Two cases were registered: one asymptomatic, another hawing enteral disturbances few days ago. Possible vehicle epidemiologically:  roasted chicken .

Dubrovnik – family outbreak of salmonellosis (S. enteritidis) on 1.6.2009 after consumption of home made cream cakes (not microbiologically examined). All 3 members turned ill.

Dugo Selo – salmonellosis in a family (S. enteritidis) starting on 23.7.2009. with 3 cases registered out of 5 family members. Vehicle epidemiologically: home made cakes with eggs (not microbiologically examined).

Krapina – salmonellosis  (S. enteritidis) in a family starting 15.8.2009. There were 11 diseased,  all of them exposed to home made cream cakes. Salmonella was found in cake samples and also in panned chicken served. However epidemiological investigation points to cakes, as the 4 other, non exposed participants  stayed well.  Eggs were purchased in a shop. So egg samples  were taken from the shop and were found  Salmonella – positive. All amounts of eggs of the  same batch were promptly withdrawn from the market.

Crikvenica – febrile gastroenterits in a group of sportsmen settled in a hotel. There were 15 diseased between 26.8. and 28.6.2009.  Causative agent possibly noro virus found in one of diseased and in two kitchen/restaurant staff members. During investigation Salmonella enteritidis was also detected (one symptomless staff member). Examinations of meals and kitchen facilities were salmonella negative. Short duration suggests possible alimentary mode but vehicle was not found.

NEWS AND COMMENTS

•       Human antirabic treatment in Croatia in 2008

As every year, here we are presenting a short overview of a very important part of the routine epidemiological work i. e. the treatment of persons exposed to rabid or possibly rabid animals. This specialist medical procedure is performed in the so called antirabic stations within the epidemiology services of institutes of public health in all counties, a total of 27 units at present. Basing on their regular annual reports here a cumulative for Croatia is given.

In 2008 a total of 5666 persons had visited one of our antirabic stations. After a physical examination and thorough anamnesis, doctors epidemiologists decided that in 1726 of them immunologic antirabic treatment was indicated. All those persons received a vaccine, while a part (135 patients or 7,8%) had received hyperimmune gamaglobuline along with the vaccine. The Table 1 shows anatomic localization of injuries that asked for antirabic treatment.

Table 1 Anatomic distribution of injuries,  Croatia 2008

On the Table 2, animals causing an indication for antirabic treatment are presented.

Table 2 Animals causing antirabic treatment in 2008.

This table, just like the previous year one, asks for a comment about rather high number of treatments caused by a dog, while the majority of dogs are actually vaccinated. But they are not always attended by their owners but left to move freely alone, so in the case of an accident the owner and vaccinal status often can not be established, and treatment unavoidable. So there is a reason for warning dog owners to care better for their pets (see ENEWS 9/2008). Further improvement of general situation asks for a reduction of intensity of sylvatic i.e. fox rabies, most conveniently by their systematic vaccination, reducing thus possibilities for exposure of other domestic animals like cattle, horses, sheep etc. while greasing or similar.

•      60^th  anniversary of  the National influenza center laboratory of the Croatian national institute of public health

In the year of new influenza pandemic, 60th anniversary of the influenza laboratory of the Virology department of the Central hygienic institute – today Croatian national institute of public health, the laboratory established  in 1949 in association with the Medical faculty Zagreb, is celebrated. In the next year, 1950, the first isolation of an influenza virus strain was made in the laboratory as one of the earliest such  achievements in the world. Since than, the laboratory constantly works on the field of influenza virus diagnostics, developing its methods, skills and excellence. In the year 1953 laboratory was proclaimed by the WHO as a National influenza center (NIC). Since then the laboratory regularly participate in the global influenza surveillance through the WHO influenza network FluNet, collaborating closely with the regional reference laboratory. All external quality controls last years resulted in 100% accurate findings. Recently the laboratory is also included in the FluNet –associated networks for Europe: EuroFlu (WHO) and EISN  (ECDC).

In the current pandemic which reached Croatia at the beginning of July, the laboratory performed a total of 700 tests, among which 250 had been fond i.e. confirmed positive. Today the Laboratory is capable to perform virus cultivation on eggs and cell cultures, identification with monoclonal antibodies (3 different methods) and detection and identification by the molecular techniques RT (real time) PCR (7 different methods), using highly selected ingredients (kits) in cooperation with reference laboratories and under constant external quality control.

•      Meeting on climate changes and human health

On 6^th and 7^th of September 2009 an international meeting dedicated to climate changes and health was organized in Stockholm by the ECDC Scientific advice unit (Croatian representative participating too). Beside other health consequences of possible further global warming, some communicable diseases could be expected too. This is not difficult to predict having in mind that currently,  very different climatic areas on Earth exist, giving potential for different communicable diseases, for instance tropical diseases. It could be assessed that in a situation of increased global temperature, diseases indirectly influenced by a lack of water or in opposite an excess of water (flooding) could be expected, as well as diseases depending on animal vectors and reservoirs and the changes in their spatial distribution and total number.

For doctors epidemiologists however, acting professionally on the protection of human health, the challenge is to assure that possible climatic changes and consecutive potential health risks, do not really became a harm for the people as an increased number of infectious or other diseases. Practical  experience shows, that risks of different climatic zones on Earth today can be fairly neutralized by appropriate preventive medical measures like vaccination, disinsection, deratization, chemoprophylaxis, water conditioning,  food safety measures and  health education giving people a  knowledge and skills for avoiding specific risks.

An effective answer to potential new threats caused by further climatic changes should be based on the continuous implementation of all well known and by the law prescribed measures of monitoring the environmental parameters, the drinking water quality, food quality, monitoring disease trends in humans and animals, as well as  on systematic implementation of various preventive measures. Among them particularly important  is the co called vector control aimed to keep mosquito and  phlebotome density at a low level, because even without climatic influences, but only because of intensive international trade and traffic, some infectious agent could appear here (chikungunya, malaria etc.) and could be spread by these vectors. Awareness of the importance of organized response to climatic changes and about health risks associated is present in the country. At the end of 2007 an international interdisciplinary symposium on this topic, was organized at the Infective disease teaching hospital, Zagreb.

COMMUNICABLE DISEASES IN CROATIA               September 2009

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