INFECTIOUS DISEASE EPIDEMIOLOGY SERVICE
(Ministry of Health’s Reference Centre for Epidemiology)
- Head, Prof. Dr Ira Gjenero-Margan

Organised by Croatian Academy of Medical Sciences, by Croatian Medical Association’s Croatian Society for Urogenital Infections and by Fran Mihaljevic Infectious Disease Clinic, the Seventh Symposium on Sexually Transmitted Diseases and Urogential Infections (Slavko Schönwald Symposium) with international participation was sponsored by the Ministry of Health and Social Welfare of the Republic of Croatia.  It took place in Opatija on 10-13 April 2005.  The attendance comprised professionals from 13 societies belonging to Croatian Medical Association; from CNIPH, there were seven professionals presenting six lectures and three posters.

Borislav Aleraj, MSc gave a keynote lecture on the topic “Sexually Transmitted Diseases in Croatia in 2004” basing himself on the figures (preliminary data) regularly monitored for Croatia by this Service.  During 2004 and up to this point in 2005, epidemiologic state of these diseases showed no substantial change.  Low gonorrhoea and syphilis incidence trends held (23, respectively 47 diseased in 2004).  The incidence of HIV/AIDS (11 diseased and 37 new HIV infections) was relatively low; despite being relatively high the incidence of chlamydial infection stayed unchanged (905).  This situation was assessed as being relatively favourable and deriving from intensive systematic work on the implementation of all measures in health and outside this sector.

On 25-27 April, Bernard Kaic, MSc attended in Skopje, Macedonia, a WHO sub regional conference for member states of the Dubrovnik Charter on the subject of strengthening of national systems for infectious disease monitoring.  The Conference concluded that each country should assess its infectious disease monitoring system to identify its weaknesses.  A joint report with a proposal of activities in need of improvement would be drafted and forwarded to the WHO.  This is also useful because acceding EU member states must pass a quality assessment by the EU experts.  Only after fulfilling all conditions, they will be allowed to join the Union.  Therefore, in undertaking the evaluation we will definitely take account both of the EU and WHO criteria while, of course, primarily meeting own needs for an efficient operation of the system enabling it to make a timely detection of infectious diseases and permit a timely and adequate intervention.

Along with some 20 European experts, Dr Aleksandar Simunovic attended in Copenhagen on 28-29 April a WHO Meeting for the Development of Instructional Packages and Curricula for the Surveillance of Tuberculosis.  The existing directions were analysed and new ones proposed for the forthcoming half‑year period.  The focus of the Meeting was on collaboration needs in multiresistant tuberculosis and HIV surveillance among the HIV‑positive population.  There was also a debate on the methodology of new educational techniques.

CHRONIC MASS DISEASE EPIDEMIOLOGY DEPARTMENT
- Head, Pr Vlasta Hrabak-Zerjavic, MD, MSc

The Sixth Symposium of the Croatian Society for Radiological Protection was held at Stubicke Toplice on 18‑20 April 2005.  Within the Symposium’s ‘Biological Effects of Radiation’ section, Ariana Znaor, MSc presented a lecture “Incidence of Chromosomal Aberration as a Biomarker for Cancer Development Risk”.

The head of Service attended a Meeting of National Focal Points on the European Strategy for Noncommunicable Diseases in Copenhagen on 28-30 April 2005.  They emphasised that chronic noncommunicable diseases pose a heavy burden on the European Region, causing, according to the 2002 estimates, 86% of all deaths and 77% of the disease burden.  A significant portion of these diseases being linked to preventable risk factors, it was concluded that a comprehensive strategy for their prevention and control should be developed in line with the 2004 decision of the WHO Regional Office for Europe.  Pr V. Hrabak-Zerjavic was appointed a member of an 8‑member Working Group with the charge to create a draft European strategy for noncommunicable diseases. 

To stress the importance of the role of health workers in controlling the smoking epidemic, this year’s World No Smoking Day (May 31), will be marked by the slogan ‘Health Professionals against Tobacco – Action and Answers’.

SOCIAL MEDICINE SERVICE

- Head, Pr Urelija Rodin, MD, MSc

CNIPH was a sponsor of The Fourth Conference on Computerised Business (e‑biz2005 – link at address http://www.case.hr/e-biz2005) that was organised by the Croatian Chamber of Economy in Opatija on 4-6 April 2005.  With a lecture, “Medical Data and Patient Security and Privacy” Pr R. Stevanovic, ScD, head of Primary Health Care Department, took part in it for CNIPH.

At the Symposium on Sexually Transmitted Diseases, Pr R. Stevanovic delivered a paper authored by him and A. Stanic, A. Jovanovic, M. Merzal, I. Gluhak and M. Petrovcic named ‘Ways of Solving STD and Urinary Infection Problems in Primary Health Care’.  Figures on detected STDs permit the conclusion that in 2003 on average at least 5.6% of the insured aged 15‑64 years were diseased with these illnesses.  A survey conducted at four family physician offices uncovered several major problem items in work with the STD patients in Primary Health Care Service.  These ranged from transfer into the charge of another physician, to difficulty treating both sexual partners, to inconsistent epidemiologic data etc.  It emphasised the following improvement possibilities: better working conditions, linkage into project teams, standardised data and information, result and outcome measurement, change in the culture of the whole organisation.  Pr R. Stevanovic and Dr I. Pristas were also co‑authors of the following papers, “Incidence, Diagnosis and Treatment of Chlamydial and HPV Genital Infections at the Office of a Chosen Family Physician” and “Incidence, Diagnosis and Treatment of Chlamydial and HPV Genital Infections at the Office of a Chosen Gynaecologist”.

At the Twelfth Congress on Family Medicine, organised by Croatian Society for Family Medicine and taking place on 28-30 April in Zadar, R. Stevanovic, ScD presented four papers and Dr I. Pristas 3.

SCHOOL HEALTH SERVICE

- Head, Pr Marina Kuzman, MD, ScD

In a keynote speech at the Opatija Symposium on Sexually Transmitted Diseases and Urogenital Infections authored by herself, B. Tomic and D. Matanic, Pr Marina Kuzman dealt with the topic “Public Health Importance of Sexually Transmitted Infections”.  In 2003, local gynaecological clinics in Croatia reported 5,398 chlamydial, 753 genital herpes and 22,133 trichomoniasis infections.  Health consumption of diagnostic services and that of inflammatory disease of pelvic organ treatment amounted to HRK14,304,506.  It was stressed that not only work with female adolescents within the regular curriculum, but also through available and accessible health services was conducive to a reduction in STD incidence and prevalence.  Speaking for a group of authors (M. Kuzman, I. Pavic Simetin, S. Fabijanic, I. Pejnovic Franelic), Dr Ivana Pavic Simetin presented the paper “Interdisciplinary Approach as a Necessity in Sex Education of Children and Youths:  The Status and Role of School Health Teams”.  Based on CNIPH figures for the health educational and guidance activity of school health teams and according to the Health Care Measure Plan and Programme, the authors reviewed school health activity in the areas of child and youth health and sex education.  These activities, funded by mandatory health insurance through interaction with the educational sector, ensure a systematic and regular provision of health or sex education of all Croatian pupils and schools.

ADDICTION PREVENTION SERVICE

Acting Head, Pr Marina Kuzman, MD, ScD

MICROBIOLOGY SERVICE
- Head, Prof. Dr Gordana Mlinaric-Galinovic

The paper “Inflammatory Cells and Bacteriologic Diagnosis of Female Lower Genital Tract Infections” authored by B. Hunjak, MSc, and co‑authored by Drs. S. Ljubin‑Sternak and Z. Persic from the Microbiology Service and by R. Stevanovic, ScD, from the Social Medicine Service was presented at the Symposium on Sexually Transmitted Diseases (STDs)  in Opatija.  It noted that infections due to the group B beta‑haemolytic streptococcus and to the Chlamydia trachomatis bacterium are more often also accompanied by a finding of inflammatory cells, i.e., polymorphonuclear leukocytes (PMNs).  In female lower genital tract infections, Ureaplasma urealyticum was the most commonly demonstrated causative agent of infection (25%).  Since the sequelae of STDs, whose incidence is on a steady rise, are avoidable by prevention, the Symposium was partly devoted to the problem of educating younger age groups of the population and to increasing their awareness.  In spite of Croatia still experiencing the problem of nonuniform STD reporting, it registers a steady rise in chlamydial infections.  As regards genital chlamydiasis and gonococcal infections, they are detected in ever‑younger age groups. 

Organised by Biomedika (a German-Austrian firm), Borrelia Workshop took place in Maribor, Slovenia, on 19 April 2005, with Drs Z. Persic and D. Karlovic‑Martinkovic taking part for CNIPH.  The Workshop’s lecturers were German, Austrian and Slovenian professionals and scientists who introduced conferees to the advances in the antigenic structure of Borrelia, and to the production and use of new antigens produced by the recombinant technique designed to improve the indirect diagnosis of Borrelia.  New ELISA and Western blot tests are already using new antigens, with which they improve the serologic diagnosis of borreliosis.  Introduced at the Seminar was the xMAP technology on a Luminex 100 device for quantitative and qualitative determinations of antibodies to Borrelia and other agents in patient sera.  The technique allows of doing 9,600 tests in a matter of two hours.  For its rapidity, sensitivity and specificity, it is regarded a must in future serological diagnostics.

ENVIRONMENTAL HEALTH SERVICE

- Head, Krunoslav Capak, MD, MSc

There was a meeting of all environmental health services from county public health institutes on 26 April 2005.  Presented to it was “POZIP” (an electronic program linking accredited laboratories to enable their information exchanges, as well as real‑time reporting and monitoring of the health safety of food, drinking water and consumer goods).  The debate related to its acceptability as a program that is unique to all certified laboratories. It is a proposed information program to network all environmental health services, and designed to be an integral part of the “Environment and Health” information system, respectively of the future Croatian public health information system.

Another important subject of the meeting was the role of public health institutes in implementing the HACCP system in Croatia.  This was exemplified by the practice of the Primorsko-Goranska County Public Health Institute.  Their representatives agreed that manpower structure and staff jobs as well as the analytical capacity made public health institutions ideal providers of the HACCP education and implementers of this system.  They also accepted the view that the institutes should participate to the extent allowed by Hygienic‑Epidemiologic and Health Ecology Service capacities.  Because a regulation whereby to assign the roles connected with the HACCP introduction is in preparation, it is necessary for the Ministry of Health and Social Welfare and members of the appointed committee to take up representing the interests of the institutes.  Needed too is the laying down of minimum requirements for the adviser making HACCP plans.  Raising the level of awareness of this topic is essential.  The first step towards this goal will be CNIPH organising a conference in collaboration with the Primorsko-Goranska County Public Health Institute to address the theoretical and practical aspects of the introduction of the HACCP system.