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

· Infectious Disease Epidemiology Department

Croatian Medical Association’s Epidemiologic Society held its 55^th Regular Meeting 16 December at CNIPH. Attended by 94 epidemiologists, it heard 15 reports on the activity of epidemiologists.
Passed by the minister of health, Obligatory Immunisation Schedule for 2004 was distributed to all vaccinators during December. 

In the last week of 2003, the finding of an influenza A-type infection among the Zagreb children’s population was confirmed (by direct immunfluorescence). Thus, we find that influenza has arrived in Croatia, as anticipated. 

During December, measle case clustering was observed, cautioning us that high immunisation coverage is essential, if transmission of the measles virus in the population is to be prevented. 
 

· Chronic Mass Disease Epidemiology Department

The Department staff has attended the 55^th Regular Meeting of Croatian Medical Association’s Epidemiologic Society. Pr Vlasta Hrabak-Zerjavic, MSc, gave a presentation entitled “Epidemiologic account of cerebrovascular disease risk factors”. Dr Maja Silobrcic﷓Radic presented “An Epidemiologic Account of Suicides in Croatia”. 

Service head Pr Vlasta Hrabak-Zerjavic, MSc, attended the Symposium on acute coronary heart syndrome in females and its risks. As an invited lecturer, she presented the paper “Epidemiology of female coronary heart disease in Croatia” at the opening of a new cardiovascular disease institute, cateterization laboratory, and heart electrophysiology department for the occasion of the 200th anniversary of the Sveti Duh General Hospital.

 

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

On 22 October-2 November 2003, three CNIPH representatives (Pr Urelija Rodin, MSc, Dr Verica Kralj, and Dr Zrinka Petrovic) attended the 2nd ADEPT Course (Accession-oriented Dutch European Proficiency Training) titled “Public Health in the European Union” and organized by the Netherlands School of Public & Occupational Health under the auspices of the Dutch Ministry of Foreign Affairs. The countries due to join the EU in 2004, and EU candidate countries (Croatia, Bulgaria, Romania and Turkey) attended there. Covered by the Course were the three segments of public health the EU had set as priorities for its members in the period 2003-08: harmonisation of health indicators and health information, the early warning system associated with various health hazards (from bioterrorism and ecologic catastrophes to the occurrence of emerging diseases characterized by rapid spread) and health determinants. In addition to the exchange of information and present experience with public health administration in relation to EU priorities, also held were role﷓playing workshops aimed at enabling the acquisition of certain skills needed in public health (conducting negotiations, decision-making process, dealing with the “offer and demand” in public health projects). Course takers were able to visit the Dutch Commission on Public Health at the Council of Ministers and the European Commission premises in Brussels to get an insight into the working of the bodies at the European Commission.

As a national coordinator of the European Network of Health Promotion Schools project, Pr Marina Kuzman, ScD, attended its Budapest meeting 12-16 November 2003. It was devoted to an evaluation of the project and development of international indicators that would be applicable to all countries in the assessment of health promotion effectiveness and to the delivery of health promotion in schools.

MICROBIOLOGY SERVICE
Head, Dr Vera Katalinic-Jankovic

Although quality assessment of the operation in foreign public health microbiology laboratories, including external quality assessment, has been more intensive in the 1980s, work quality control, laboratory certification and accreditation is in trend again. CNIPH has been conscious of the existence of quality control and of the need to introduce it in microbiology. Thus in 1983, a group of CNIPH’s microbiologists published a booklet titled “Provjera kvalitete u mikrobiologiji” (carrying out quality control in microbiology), followed two years later by the Bacteriologic Diagnosis of Tuberculosis Laboratory voluntarily joining the German network of controlled TB laboratories. In time, the Reference Laboratory for Mycobacteria at Borstel; Germany, became a supranational laboratory of the WHO. In this way, it preserved the control function of national reference laboratories for mycobacteria in a number of countries, Croatia included. As a result, the good quality of our laboratory’s operation was confirmed, and it became certified. This has enabled the use of the same strains in national quality assessment runs at other TB laboratories in Croatia by checking methods for the determination of strain sensitivity to antituberculars. Bacteriologic Diagnosis of Tuberculosis Laboratory, CNIPH, has been running such assessments for eight years now. 

In contrast to our 10-year averages, this year influenza appeared a month earlier. We recorded the first cases on 24 December, accompanied by an unusually very high number of positive samples in the first days of the epidemic. Because our National Centre for Influenza of the WHO identified the first cases as belonging to the type A, manifested this year in Europe and elsewhere as a new virus strain A/H3N2/Fujian/411/2002, a larger epidemic might be awaiting us this season. 

HEALTH ECOLOGY SERVICE
Head, Krunoslav Capak, MD, MSc

As part of the preparations for the Fourth Ministerial Conference on Environment and Health to be held in Budapest 23-25 June 2004, and Ad Hoc Working Group for drawing up CEHAPE (Children’s Environment and Health Action Plan), political document to be adopted and signed by ministers of health and environment, has been set up. The Third Meeting of the Ad Hoc Working Group for CEHAPE took place in Brussels 15 and 16 December 2003, with Dr Zrinka Petrovic taking part there as our national representative. The Meeting discussed CEHAPE, the ministerial document and a Table of Activities, covering a number of actions proposed to protect children’s health from 14 environmental risk factors, which actions in the course of the Meeting were adopted with minor amendments. Priority objectives agreed for CEHAPE in the ministerial document were ensuring access to wholesome water for all children, safe environment, out- and indoor air purity, child protection from noxious physical, biological and chemical agents, and the creation of a national plan for the environment and health of children by the year 2005. In January 2004, the Ministerial Declaration will be debated in Turkey.

A new regulation coming out in the Official Journal of the Republic of Croatia 197/03 called, “Object of Common Use Health Safety Regulation” was drawn up at CNIPH’s Object of Common Use and Medical Device Department. Though unchanged in name, it contains some essential amendments. The Regulation now covers vessels, utensils, equipment and devices for the preparation and manufacture of cosmetic products, packaging for objects of common use (cosmetics and disinfectants), children’s toys, cosmetic products, cleansing agents, tobacco, tobacco products and smoking utensils, as well as certain objects and agents coming in use into direct contact with the skin and mucus. It no longer includes the objects of common use that in utilisation made direct contact with foods. The latter are covered by a special regulation that has also been written at CNIPH and is in the process of harmonisation at the Croatian Ministry of Agriculture. The requirements stipulated in the new Regulation have undergone maximum harmonisation with the relevant EU demands. For this area, recent formulations of such demands are, unfortunately, scarce. An essential amendment is the introduction of a new concept “special purpose cosmetics” meaning preparations (often of vegetable origin) that are applied to the skin and other parts of the human body. Unlike standard cosmetics, their action is systemic, use precise and special, and their expiry period limited. Consequently, they are subject to registration with the ministry of health-appointed commission on special-purpose cosmetics. In part, this product group coincides with the former “semimedical preparations” or so-called “medicinal cosmetics”. On the market, the number of such preparations has been increasing. Since 1997, they have not been governed by any regulation whatsoever. In consequence, they are not controlled! 
The next amendment relates to disinfectants. This group now also includes the pesticides for household pets and ornamental houseplants. The third amendment requires the process of registration with and approval from the Ministry of Health Commission on Toxins prior to the first launching on the market of agents designed for use as disinfectants. This stipulation concerns the form of the preparation, method of its use and, in this connection, the concentration of active substance. 

The Regulation includes a list of 14 ingredients that are allowed, banned or allowed under restrictions for individual groups of the objects of common use covered (by mistake their names were not printed together with the rest of the Regulation). However, they will be named in one of the next issues of the Official Journal of the Republic of Croatia. The new regulation part of this chapter was prepared by Vjera Haberle, MSc.