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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

•    Communicable disease case notification in October

S a l m o n e l l o s i s.  Incidence decreases further (300:365) being lower than in October last year (556). Clusters are seen in Koprivnica (13), Rijeka (20), Cakovec (18), Varazdin (16), Velika Gorica (15) and Novi Zagreb (21).

A n g i n a   s t r e p t o c  o c c i c a  (streptococcal sore throat).  Number of cases raised as expected for the season (587:424),  intensity somewhat higher than in October last year. 

T e t a n u s. One case was reported in October from Solin: an old unvaccinated person.

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

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

S y p h i l i s. There were 3 cases reported in October, equal to the previous month and October last year.

T B E (tick born meningoencephalitis).  In October 9 cases were reported which was slightly more than in September (6) and also more than in October last year (2).

I n f l u e n z a. Number of new pandemic influenza cases registered in October (334) is similar to previous month (377).

C a m p y l o b a c t e r i o s i s.  Incidence is lower in October than in September (131:144). Small clusters are found in Rijeka (13) and Sibenik (16).

•      No reports in October from:

Otocac, Umag, Hvar, Vis and Lastovo. Total: 5 out of 113 epidemiological districts.

•      Epidemic outbreaks

Following outbreaks were reported in October:

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

Opatija – salmonellosis (S. entertidis) among consumers of cream cakes from a pastry shop. Between 12.6. 2009 and 20.7. 2009 there were 3 cases detected. Cakes were not microbiologically examined.

Umag – hepatitis A. Between 20.8. and 21. 9. 2009,  3 cases were registered, two in children from the same family and one in a young  adult epidemiologically not linked. Source not found with certainty. In the adult case, possible vehicle could be a meal of sea shells, but no other cases connected with shell consumption were registered,  shells however not microbiologically examined.

Petrinja – salmonellosis (S. coeln) in an institution. Between 21.8 .and 3.9. 2009 there were 43 diseased. Source not found. Vehicle not detected,  Several meals during several days could be responsible.

Umag – salmonellosis (S. thompson) among pizzeria guests eating different meals (pizza with ham, backed pasta etc). There were  6 diseased between 28.8. and 10.9. 2009. Epidemiological investigation pointed to possible secondary manual contamination of a small proportion of  total  meals served.

Beli Manastir – food poisoning after a birthday party on 30.8. 2009. There were 5 diseased. Vehicle epidemiologically and microbiologically: baked lamb meat, backed pork meat, home made cakes, all found Staphylococcus aureus positive.

Biograd – acute gastroenteritis in a group of children on school excursion. Between 23.9. and 24.9.2009 there were 49 diseased out of 75 exposed. Causative agent not found, possibly a virus, as laboratory tests for pathogenic bacteria, rota and adenoviruses were negative. Source probably a member of the group  arriving already sick with gastroenteritis. Mode of spread: contact,  party probably aerogenic.

NEWS AND COMMENTS

•       Development of flu pandemic

Limited, relatively low incidence intensity continued during September and October. However in first weeks of November, at the time of writing this article,  numbers of cases started to rise significantly announcing full influenza outbreak wave, typical for a cold season. In such a situation, by the decision of  the central Pandemic headquarters,  additional amounts of antivirals were distributed all over the country,  to the primary health care doctors level. This increase was also the reason to switch from individual reporting to usual weekly cumulative reporting of all influenza cases.

In next weeks further increase is expected, as well as increased numbers of  persons needed hospital and intensive care treatment. This points to the importance of optimal organization of entire health care service,  to  treat the majority of patients in the primary care sawing thus hospital capacities for patients that need hospital treatment,  either  for flu or becouse of any other disease. 

This approach implies contact with a family doctor or pediatrician for all diseased with signs of flu, allowing doctors to make proper assessment and diagnosis and decide if patient can stay at home or needs hospitalization. Home treatment however should assure all necessary therapies including antivirals. Regarding antivirals it is known that they act best if applied early, in first days of illness. But it turned out,  that they are also approved later, especially in characteristic situations of sudden worsening after initial improvement. The WHO stresses the importance of energic combined treatment including antivirals in such cases. So patients themselves as well as health care personnel should be aware and notice the important signs of worsening. Here is an  excerpt from the WHO guidelines on this problem.

"...Clinicians, patients and those providing home based care need to be alert to danger signs that can signal progression to mere severe diseases. As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in a person with confirmed or suspected H1N1 infection.

* shortness of breath, either during physical activity or while resting

* difficulty in  breathing

* turning blue

* bloody or colloured sputum

* chest pain

* altered mental status

* high fever that persists beyond 3 days

* low blood pressure.

In children danger signs include fast or difficult breathing, lack of alertness, difficulty in weaking up, and little or no desire to play... "

From the WHO: Recommended use of antivirals, Pandemic (H1N1)2009 briefing note 8, 21.8.2009

•       Weekly influenza reporting

Currently weekly cumulative reporting of all influenza cases from all doctors diagnosing flu all over the country  is in place (see previous article). However, to gain a fast  insight into pandemic development,  additional preliminary reporting on weekly basis from a county level is temporarily retained, replacing previous daily county zero reports introduced since the pandemic phase 5 in April. It should be remembered that age groups were slightly changed this summer, to fit the WHO-ECDC age groups used in the EuroFlu network. In the course of this winter the ordinary seasonal flu wave is expected too. This will not change weekly reporting i.e. reporting will bi only one, containing all clinical influenza cases (confirmed cases included) regardless the type or subtype of influenza virus as the majority of clinical cases will remained etiologically unresolved. The relative proportions of circulating types or subtypes of viral strains will be assessed (extrapolated) from the observed structure of viral strains among laboratory confirmed cases,  as it is done every influenza season.

•       Encephalitis etiology,  Croatia 2004-2008

Usually, some 50 cases of encephalitis/meningoencephalitis are reported per year in Croatia, TBE recorded separately. _The etiology however remains mainly unresolved. In the last five years (2004-2008) the total of 246 cases were registered. A causative agent was diagnosed in 26 of them (10%). These cases were scattered through the year (Table1)

Table 1

Elderly persons were more presented (Table 2), males equal to females (13)

Table 2  Encephalitis, age distribution, Croatia 2004-2008

Causative agents diagnosed are shown in the Table 3.

Table 3  Encephalitis  etiology Croatia 2004 - 2008

Herpes virus is ranking first, followed by Listeria.
Rare cases caused by parasites (Taenia) can be expected.

COMMUNICABLE DISEASES IN CROATIA               October 2009

Last change - 15.12.2009 - Posljednja promjena