Year three, no. 3 - March 2003 

Director’s introduction
Marijan Erceg, MD, MSc

In connection with the appearance in some countries of severe acute respiratory syndrome (SARS), an atypical pneumonia of still unknown cause, WHO has proclaimed a state of higher readiness. At CNIPH, Disease Prevention Headquarters has proposed to the ministry of health special protective measures against the introduction of this disease into Croatia. They consist in intensified epidemiologic surveillance of travellers in international traffic. Epidemiological services of county public institutes have been put on heightened alert. All health institutions have been familiarized with the appearance of SARS, disease recognition criteria, patient handling measures and with the obligation to report SARS suspects. 

Wih regard to the war in Iraq, all health institutions have been requested to be on the lookout for unusual diseases, poisonings or deaths and urged to report them early.

Assistant Prof. Marija Strnad, MD, MPH, PhD, deputy general manager

Already traditional, 22 March (Narcissus Day) was devoted this year again to breast cancer patients all over Croatia. The funds raised this year by narcissus sales are earmarked for early breast cancer prevention. In advance of the day a forum was held on March 20 in Zagreb at the European Home with Prof. Dr. R. Sabol (“Tradition: the Narcissus Day”), Prof. Dr. I. Drinkovic (Mobile Mammographs Project) and Assist. Prof. Dr. Marija Strnad (“Incidence of Breast Cancer in Croatia”) as lecturers. 

The Second Congress of Croatian Senological Society with International Participation, Senology 2003 is taking place at Cavtat on 4-8 June 2003. Information is available by contacting www.dubrovnik-senologija2003.com. 

Assistant Professor Slobodan Lang, MD, and DSc, deputy director

Regular preparations for the First Croatian Congress on Preventive Medicine and Health Promotion continue. These areas are important to Croatia for three basic reasons: (i) our lagging behind developed countries both in length of life and in years of health, (ii) our facing very significant health problems (bioterrorism, cardiovascular diseases, malignant diseases, new diseases), unhealthy life style (smoking, alcoholism, drugs, violence), insufficient health promotion (healthy nutrition, physical activity, stress reduction); problem of maintenance, control and protection of the environment, water, food as well as ageing of the population, (iii) th fact that healthy food and medical tourism are a strategic segment for the development of Croatian economy. By organizing the Congress we accept responsibility for the development of health policy in Croatia. Other activities are a resumption of the run of county institutes of public health and starting a run of CNIPH's departments.

EPIDEMIOLOGY SERVICE (Ministry of Health Reference Centre for Epidemiology) Head, Pr Vlasta Hrabak-Zerjavic, MD, MSc

· Infectious Disease Epidemiology Department

By 31 March there were reports of 27,719 cases of influenza in Croatia. The Virology Department did the subtyping showing the involvement of A/H3N2/Panama/2007/99-like, AH1N1/New Caledonia/20/99-like as well as of the B types whose antigens are contained in influenza vaccine used this season. Consequently, the immunized individuals are protected from these subtypes.

The Q-fever epidemic in Dalmatia referred to in the previous issue of “News” is dying down. 

In mid-February 2003, a clustering of unknown disease manifested as atypical pneumonia was observed to occur in Hong Kong and Vietnam. By the middle of March it had spread to several South East Asian countries and Canada. Recognizing in the disease an international health hazard and to enable the timely recognition and prevention of its spread, WHO issued a recommendation on 15 March urging intensified health surveillance of the travellers coming from the countries reporting cases of “severe acute respiratory syndrome” (SARS). China had the biggest cluster of SARS suspects, the majority of the diseased in Hong Kong were concentrated in a part of a residential quarter and in view of SARS having an unclear route of transmission, the latest WHO warning urged the travellers who intended to travel to Hong Kong or to the Chinese province Guangdong to postpone their trip unless it was essential. This relates to the travellers entering these parts of China, not those in transit at the existing international airports in those areas. By 31 March, 13 countries officially had 1550 cases of SARS with 54 deaths (source: WHO). Not a single case of SARS was reported in Croatia. According to the latest WHO reports, there is diminishing reporting of human metapneumovirus (discovered two years ago in children with respiratory symptoms in Australia and considered until recently the prime “candidate” for this syndrome) in this connection. This is due to a growing body of laboratory information pointing to coronavirus. More details about this syndrome can be found on the Infectious Disease Epidemiology Department's web pages. 

· Chronic Mass Disease Epidemiology Department

The Sixth Session of the International Negotiation Body for Framework Conference on Tobacco Control took place 17-28 February in Geneva. The last two days Pr Vlasta Hrabak﷓Zerjavic, MD, MSc, attended there as a member of the Ministry of Health Appointed Commission on Combating Smoking. The Conference was prepared as an international instrument devised to effectively protect human health from the deleterious effects of smoking. After extensive debate and elaboration, the agreed text of the Convention was referred for adoption to the World Health Assembly scheduled for May 2003.

SOCIAL MEDICINE SERVICE
Head, Pr Marina Kuzman, MD, MSc

On 19 April 2003, there was a meeting of school medicine heads from county institutes of public health and the Management Board of the Croatian Society for School and University Health. With from 2003 on, preventive care for full-time students being the school health domain, the meeting defined a card for monitoring, reporting and creating a database on general medical examinations for the student population. Discussions that also dealt with the possibilities and limitations of pupil drug testing adopted the attitude that this test does not meet population screening preconditions and is thus not to be considered suitable for mass application in a population. 
Organized by the International Commission for Occupational Diseases (ICOH), the 27th World Congress on Industrial Medicine was held 23-28 February 2003 at Iguasso Falls, at the tri-border point between Argentina, Brazil and Paraguay. It assembled 4500 occupational health professionals from all over the world. The main topic addressed “challenge to equality in work safety and work health” was common to 12 introductory papers, 23 round table sessions, 75 symposia, 50 oral communication sections (with 512 papers) and 324 posters. Croatia was represented by three oral communications and two posters. They were “History of occupational health in Croatia” (presented in the History of Industrial Medicine Group by Pr Vlasta Deckovic-Vukres, DSc), “Retrospective analysis of industrial injuries in chemical industry with special reference to older workers” presented by Pr Danica Barkovic, DSc from DINA-Omišalj in the Ageing and Work Group, and “The effects of exposure to low levels of lead on the quality human semen” by Dr Spomenka Telisman from IMI in the Occupational Toxicology Group. Both posters appeared in the Respiratory Disorders Group, with Professor Eugenija Zuskin presenting one titled “Respiratory funtion in tobacco industry workers” and Azra Hursidic﷓Radulovic, MSc, “Effects of length of exposure to irritants on lung ventilation function”. 
Exactly 100 years after the first congress that was held in Milan and founded the present ICOH, the 28th Congress of Industrial Medicine is to take place there in August 2006. 

MICROBIOLOGY SERVICE
Head, Dr Vera Katalinic-Jankovic

We were surprised this year by the late start of the influenza outbreak. Its first case reports came in on 21 February, almost a month's delay on our 10-year average. According to our virological indicators, we are in the sixth week of the epidemic, with the number of positive samples still rising. In view of the situation arising from acute respiratory syndrome (SARS), we used test reagents for A/H5N1/, the so-called “bird influenza”, all findings being negative for the present. As initially the media incriminated paramyxoviruses for the SARS syndrome, initially the attention in Croatia was also on these organisms. They are routinely tested for at the Virology Department; the tests showed parainfluenza type 1, 2 and 3 viruses to be in circulation in our population.  

HEALTH ECOLOGY SERVICE
Head, Krunoslav Capak, MD, MSc

A visit to the British institutions (York) concerned with pesticides took place on 23﷓28 February as part of the EU Cards 2001 assistance programme “Strategy of development capacity building in the area of plant health - Programme Preparation Facility”. D. Kipcic, MSc, visited on the part of CNIPH. The run covered familiarisation with pesticide problems ranging from legislation to food pesticide level determinations, to so-called pesticide dossiers, namely complete pesticide data sheets required for their registration and marketing. It is a demanding and extensive operation involving large staff (200 employed at the Pesticide Safety Directorate and 650 in the Central Scientific Laboratory) and well equipped laboratories. 
Organized by the firm Korunic d.o.o. and sponsored by the health, agriculture and forestry, and environmental protection and physical planning ministries, a conference on “Disinfection, Desinsection and Deratization and ZUPP 2003 – Focus on Professionalism” was held in Poreč on 11-14 April 2003. This year too some 200 interdisciplinary professionals for this area attended there. On the part of CNIPH Krunoslav Capak, MD, MSc, presented a lecture “The influence of climatic change on transmitted infectious diseases”. 

The 29th Symposium of Health Ecologists with International Participation will be held at the Borik Hotel in Zadar 9-11 April 2003. It is organized by CNIPH and Croatian Pharmaceutical Society's Medical Ecology Chapter. Health via Food and Medicinal Plants is the subject of this traditional gathering. The symposium is intended for the professionals and scientists concerned with medical ecology and public health, public health lawmakers intent on protecting the environment from environmental noxa, analysts examining the influence of environmental factors on human health, inspectorates and others with interest in this area. There will be lectures and posters dealing with the subjects of uses of vegetable preparations, and of food and nutrition, undesirable food ingredients, pesticide and metal residues in various foodstuffs, legislation and analytical methods.