INFECTIOUS DISEASE EPIDEMIOLOGY SERVICE
(Croatian Ministry of Health Reference Centre for Epidemiology)
- Head, Assist. Prof. Ira Gjenero-Margan, MD, DSc

Because of the current measles outbreak, all health facilities have been sent a circular instructing them how to deal with measles cases.  Briefly, it reminds them of the obligation to phone in their reports of every case of measles to the Epidemiological Service.  This is to enable the epidemiologists to make through immunological survey a timely identification of possibly nonimmunised patient contacts and protect them with either vaccine or immunoglobulin, depending on the situation. By emergency import through the Ministry of Health, we have ensured certain amounts of the 16%-human immunoglobulin for intramuscular administration.

During the past two months, some 60 people in Zagreb became ill with measles.  Among the patients, there are four physicians, two nurses, one carer and one orderly. Most of these health workers developed the disease at the beginning of the outbreak. This has prompted us to write the circular addressed to all health institutions in Croatia, requesting them to check the vaccinal status of their personnel and obliging them to immunise any health worker aged up to 35 years who was not vaccinated in the childhood for any reason whatever.

The epidemic not being over yet, we urge health institutions to follow this instruction unless they have already done so. 

We also remind everyone concerned of the Ministry of Health instruction to report promptly to the Epidemiology Service any grouping of respiratory disease cases, as well as of diseases with cause unknown.

The recent months saw a multiplication of courses on the theme of vaccination. These are given by individuals who have no insight into the implementation of immunisation schedules, trends of the diseases against which vaccines are administered, side‑effects of vaccination or other elements the knowledge of which is necessary to understanding the Immunisation Schedule.  Lecturers with only a partial insight into Immunisation Schedule, and whose daily run of activity mostly does not even include vaccinations, may unwittingly provide inaccurate facts about immunisation and the Schedule itself.  All vaccinators who, as part of their work, do a noble and remarkably useful duty of immunising children and adults are meritorius health workers who have contributed to successful overcoming of immunisable diseases. When in doubt on any point from the Immunisation Schedule, they should turn for advice to their county institute of public health’s epidemiology service, it having a legal obligation to supervise the implementation of Immunisation Schedule in its area.  Of course, the Infectious Disease Epidemiology Service, CNIPH, is at the disposal of all collaborators on Schedule implementation.
 

CHRONIC MASS DISEASE EPIDEMIOLOGY DEPARTMENT

- Head, Pr Vlasta Hrabak-Zerjavic, MD, MSc

Pr Vlasta Hrabak-Zerjavic, MD, MSc and Dr Maja Silobrcic attended on 12 January a symposium at the Croatian Medical Association at the invitation of Croatian Society for Clinical Psychiatry. The theme of the invited lecture was “Epidemiological account of mental diseases and disorders in Croatia”.  It reviewed mental disease trends in hospital morbidity; trends of mental diseases recorded in General Medical Service, indicators on schizophrenia from the Psychoses Registry.  A separate account presented the leading public health problems in this area (schizophrenia, alcohol dependency, depressive disorders, reaction to severe stress, PTSD included).  Other data presented came from the Suicides Registry.  A comparative analysis involved suicides committed in Croatia and those in a selection of other European countries.  In conclusion, the illustrated mental health care measures related to the currently valid Health Care Plan and Programme.  The proposal following a lively debate was for the co‑operation between the Society and CNIPH to continue.  An initiative was taken to set up a Working Party on Psychiatric Epidemiology.  Consequently, it was proposed that the Society’s experts should be consultants in the drawing up of a new Mental Health Care Measure Plan and Programme.

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

Organised by Croatian Society for Perinatal Medicine, Eleventh Conference on Perinatal Mortality took place at Croatian Medical Association on 17 January 2004.  First, several reports illustrated the trends of basic national perinatal care indicators, and those at several bigger maternity hospitals. Then a debate on measures for continuing advancement of infant care and improvements to the existing records on infant morbidity followed.  Conference Proceedings have appeared in a supplement to the “Gynaecologia et Perinatalogia” journal, issued conjointly by Croatian Society of Perinatal Medicine and CNIPH.   That of CNIPH in publishing a thematic issue of the journal and the long-standing independent participation of Dr Urelija Rodin in the workings of the Conference show joint action with the clinical practice to be the best approach to solving the perinatal care problems. 

Organised by the Affiliate HL7 (Health Level Seven) Croatia, a workshop named “Standard HL7 – its fundamentals and application in Croatian health” was held on 29 January 2004 at the Faculty of Electrical Engineering and Computing, Zagreb.  Its co-organisers were Croatian Society of Medical and Biological Engineering, Croatian Society for Medical Informatics, Faculty of Electrical Engineering and Computing, and Medical School, University of Zagreb.  The HL7 Croatia affiliate was established in 2001 since when it has seen to it that the international communication standard HL7 is applied in Croatia.   It is one of the 23 affiliates of the international HL7 Network.

Besides the themes tackled by the European directives and the conditions in Croatia with regard to standardisation in health, the Workshop dealt with the meaning, principles and methodology of HL7 based on the experience of domestic experts, including an account of  the first own solutions to the application on medical worksites.  Five members of the CNIPH staff attended the Workshop.

Predictably, the application of these standards may lead to cost reductions in computer‑supported health information systems owing to rational linkage and communication between individual system components.  This should contribute to its more economic operation and improvement in the quality of health care.

MICROBIOLOGY SERVICE
- Head, Dr Vera Katalinic-Jankovic

Not even in its fifth week, does this year’s influenza outbreak show a weakening in the intensity. The isolations and subtypings performed at our WHO National Centre for Influenza have shown that, so far, solely type A (H3N2) influenza virus has been involved.  The samples, coming from the diseased from different age groups, suggest that there is a clustering of a larger number of patients in younger age groups (up to 12 years of life).

In Croatia, influenza displays the chartacteristics of a widespread epidemic, because the patients recorded are from all its regions.  Not a single case of the type A “avian influenza” (H5N1) has been proved either so far in this season or in the tests done in previous years.  Occurrence of the latter influenza is still limited to Asian countries exclusively.

With the consent of the Andrija Stampar School of Public Health, CNIPH has been formally recognised as the WHO Collaborating Centre for Virology since autumn 2003.  In fact, for years our Virology Division staff has been collaborator of this Centre, the only one of its kind in Croatia.  Set up on 8 January 1967 at the Andrija Stampar School of Public Health, School of Medicine in Zagreb, it has undergone renovations regularly. Prof. Dr G. Mlinaric‑Galinovic has been the Centre leader since 1989.  A progress report on the past 4‑year period was submitted on 22 January 2004 to the head of the Laboratory Training and Support Division of Emerging and Other Communicable Disease Surveillance and Control, Dr D. Lavanchy, WHO, Geneva.

HEALTH ECOLOGY SERVICE
Head, Krunoslav Capak, MD, MSc

In collaboration with county public health institutes and with the support of the Ministry of Health and Social Welfare and of the Ministry of Education and Sport, the Nutritional Physiology Department has distributed a brochure “Prehrambene smjernice za djecu” (nutritional directives concerning children) to the primary schools all over Croatia under the Schedule for Prevention of Obesity in Schoolchildren’s Population.  Besides the brochure dissemination, also planned is a child education syllabus on proper diet for children attending classes 1 to 4 of primary schools.  It will be carried out in collaboration with county public health institutes, respectively local school health clinics in every county.

As part of the preparations for the Fourth Ministerial Conference on Environment and Health to take place in Budapest 23-25 June 2004, a preparatory meeting in Copenhagen was held on 29-30 January 2004. Our national representative Dr Zrinka Petrovic attended it.  The debate was about the contents of a declaration to sign in Budapest.  Having adopted the latest objections of signatory countries to the content of the Declaration, the Conference also debated what course it itself should take and how to organise itself. The preparatory meeting  also arrived at an agreement on whether all the ministers present from signatory countries would sign the political documents referred to (Ministerial Declaration, Ministerial Document), or whether  the Hungarian ministers of health and environmental protection should do so on their behalf.  It is expected that after signing the Ministerial Declaration and Ministerial Document: CEHAPE (Children’s Environment and Health Action Plan) at the intergovernmental meeting scheduled for 2007 the EU Member Countries and other signatory countries would report on a number of activities undertaken that are suggested by the Table of Activities for child protection.  It also debated what method signatory countries and World Health Organisation would use to monitor the execution of activities from the Table of Activities.  The status of CEHAPE Tables of Activity still being unresolved, the Fourth Intergovernmental Meeting on Malta due to take place in March 2004 should discuss whether the table in question would constitute an annex to the Ministerial Document or merely be a technical document.