Stavovi prema tuberkulozi i izvori informacija o tuberkulozi: studija bolesnika u izvanbolničkim sredinama u Splitu, Hrvatska

Attitudes towards tuberculosis may have severe impact on individuals and their families as well as on the effectiveness of tuberculosis control programs. The purpose of this study was to describe these attitudes and explore the sources of tuberculosis information available to the general population in Croatia through a cross-sectional survey based on structured questionnaire using convenience sampling among 386 subjects aged 18 years and over. Data were stratified by sex, age groups, educational background, personal monthly income and contact with tuberculosis patient. Being near to a tuberculosis patient would be uncomfortable for 39.9% of respondents and 26.4% of subjects would avoid any contact. If they were sick of tuberculosis, 9.6% of respondents would keep it from the society. Less than 10% of study subjects would be ashamed of their own or potential tuberculosis in their family. Almost twice less subjects with high education would hide the disease (p=0.049), or be ashamed if sick in comparison with less educated respondents (p=0.036). The subjects who were not in contact were less likely to feel uncomfortable about being near to a tuberculosis patient (p=0.042). As the source of tuberculosis information, 61% of the subjects reported TV, radio and journals. Internet was the least used source (13.2%). The subjects in contact received information from the family or friends (p=0.025), while those without contact were informed through mass media (p<0.001). Study results revealed high stigma-generating attitudes towards tuberculosis. The strong potential of mass media capable of reaching different population groups should be used as part of the stigma-reduction strategies.Stavovi prema tuberkulozi mogu snažno utjecati na bolesnike i članove njihovih obitelji, kao i na učinkovitost nacionalnih programa za borbu protiv tuberkuloze. Ovim se istraživanjem željelo istražiti stavove o tuberkulozi kao i izvore informacija o tuberkulozi dostupnih općoj populaciji u Hrvatskoj. Podatci su se prikupili presječnim istraživanjem slučajno odabranih 386 osoba starijih od 18 godina, a stratificirali su se prema spolu, dobnim skupinama, stupnju obrazovanja, prosječnom mjesečnom prihodu te kontaktu s oboljelim od tuberkuloze. U blizini oboljelog od tuberkuloze neugodno bi se osjećalo 39,9% ispitanika, a 26,4% anketiranih bi izbjegavalo svaki kontakt. Da obole od tuberkuloze, 9,6% ispitanika bi krilo svoju bolest od okoline. Manje od 10% ispitanika sramilo bi se svoje bolesti ili bolesti unutar svoje okoline. Skoro dva puta manje ispitanika s visokim obrazovanjem bi skrivalo bolest (p=0,049) ili bi se sramilo u usporedbi s manje obrazovanim ispitanicima (p=0,036). Ispitanici koji dosad nisu bili u kontaktu s tuberkuloznim bolesnikom manje bi se osjećali neugodno ako bi bili u njegovoj blizini (p=0,042). Kao izvor informacija o tuberkulozi 61% ispitanika navelo je televiziju, radio i novine. Internet je bio najmanje spomenut izvor (13,2%). Ispitanici koji su bili u kontaktu s tuberkuloznim bolesnikom informacije su primili od obitelji ili prijatelja (p=0,025), dok su se ispitanici koji nisu bili u kontaktu obavještavali preko sredstava javnog priopćavanja (p<0,001). Ovo istraživanje je pokazalo stavove o tuberkulozi koji doprinose stigmatizaciji tuberkuloznih bolesnika. Jaki potencijal sredstava javnog priopćavanja koja su dostupna različitim skupinama unutar opće populacije treba se primjereno iskoristiti kao dio strategije za smanjenje stigme

Gaps in Tuberculosis Knowledge among Primary Health Care Physicians in Croatia: Epidemiological Study

High level of tuberculosis (TB) knowledge among physicians is important in order to achieve high case-finding and efficient case-management. Few attempts on how to measure physicians’ TB knowledge and understanding of national TB guidelines in middle-TB incidence countries such as Croatia have been reported. Related surveys were carried out mostly in high or low incidence countries. The aim of this study was to investigate TB knowledge among general practitioners (GPs) and paediatricians in Split and Dalmatian County, Croatia and need for TB education through cross-sectional survey based on anonymous questionnaire sent to all of them and completed by 160 (60.8%) subjects. Although the median percentage of correct responses was not low (70.3%), several areas of concern were revealed. Particularly low knowledge about normal breathing as usual physical chest examination finding in pulmonary TB (43.1%), proper drugs combination in initial phase of treatment (35%), and duration of treatment (61.9%) were found. Need for education in TB control was reported in 87.9% of physicians. TB knowledge score was obtained by the number of correct answers to 14 selected questions and it was 8.18 ± 1.84. Scores according to years of experience, number of treated TB patients and need for education, were not different from each other. Higher score was correlated with paediatricians (p=0.025) and familiarity with existence of National guidelines (p=0.002). This study showed gaps in knowledge among physicians being the cornerstone of TB control in Croatia. Given that the most successful intervention in TB control is early detection and early and appropriate treatment, efforts should be done to increase TB knowledge. Majority of participants were willing to take a part in education. This could be a good starting point for organisation of education activities as one of the approaches to reduce tuberculosis burden in middle incidence countries

Epidemiološke osobitosti tuberkuloze na području Splitsko-dalmatinske županije (TB Diagnosis Department)

Tuberkuloza, jedna od najstarijih bolesti ljudskog roda, i danas, u trećem tisućljeću liječnicima predstavlja veliki izazov. To je bolest posebne patogeneze i kompleksne imunologije što je i razlogom nepostojanja adekvatnog dijagnostičkog testa i što cjepivo nema potpunu učinkovitost. Sve su to aspekti na kojima znanstvenici intezivno rade. Tuberkuloza danas u svijetu je povezana s HIV-infekcijom, siromaštvom, beskućništvom, ovisnosti o drogi i alkoholu, rezistencijom i multirezistencijom na antitubekulotike, bolestima moderne civilizacije poput malignoma, dijabetesa, bubrežne insuficijencije i sl., te sa sve većom pojavnosti u starijim dobnim skupinama u vremenu kad se produžava očekivano trajanje života.  Prema podatcima Svjetske zdravstvene organizacije, tuberkuloza je i dalje veliki globalni problem. Smatra se da godišnje skoro 9 milijuna oboli od tuberkuloze, a skoro 2   milijuna umre. U vrijeme otkrića uzročnika (1882. g. M. tuberculosis otkrio je dr Robert Koch) zaražen je bio svaki sedmi čovjek na svijetu, a danas je to svaki treći, dakle ukupno dvije milijarde ljudi.Prema podatcima Registra tuberkuloze HZJZ-a, u Hrvatskoj je broj novooboljelih u regresiji od 50-tih godina prošlog stoljeća, kad se bilježilo preko 20 000 novooboljelih godišnje. Prema istim podatcima, u Hrvatskoj je u 2004. g. zabilježeno 1297 novooboljelih

Epidemiological patterns of tuberculosis in Split-Dalmatia County, 2003.-2016.

Cilj ovoga istraživanja bio je prikazati epidemiološke karakteristike tuberkuloze u Splitsko-dalmatinskoj županiji u razdoblju od 2003. do 2016. godine. Retrospektivno smo analizirali sve tuberkulozne bolesnike prijavljene Službi za epidemiologiju Nastavnog zavoda za javno zdravstvo Splitsko-dalmatinske županije od 2003. do 2016. godine, što ukupno čini 926 ispitanika. Rezultati su pokazali da županijska incidencija tuberkuloze kontinuirano pada te sa zadnjom zabilježenom stopom od 8,6/100 000 pripada područjima niske incidencije. Iako su na početku najviše stope bile zabilježene u zaobalju, a najniže na otocima, tijekom posljednjih 6 godina (2011. – 2016.) došlo je do izjednačavanja stopa u zaobalju i na otocima (najviše zbog izraženog pada stopa u zaobalju), a najniže su postale u priobalju. Stope incidencije rastu s porastom dobi. Muškarci obolijevaju dvostruko češće od žena. Najčešća lokalizacija tuberkuloze su pluća (85,1% oboljelih). Bakteriološki potvrđenih tuberkuloza bilo je 71,92%. Ukupno 40,82% bolesnika imalo je mikroskopski pozitivne iskašljaje, što ih čini najzaraznijim tuberkuloznim bolesnicima. Rezistencija je zabilježena u 4,35% slučajeva i najčešće se radilo o monorezistenciji na izoniazid. Zabilježena su dva slučaja multirezistentne tuberkuloze. Rezultati ovoga istraživanja pokazuju da je epidemiološka situacija povezana s tuberkulozom u Splitsko-dalmatinskoj županiji pod nadzorom. Kontinuirani pad stopa incidencije pokazuje da smo na dobrom putu, ali bez obzira na povoljne epidemiološke prilike, protutuberkulozne aktivnosti treba nastaviti provoditi kako su zakonski zadane, jer bilo kakvi propusti mogu uništiti sve dosad postignute uspjehe.The purpose of this study was to describe the epidemiological patterns of tuberculosis (TB) in SplitDalmatia County in the period 2003-2016. We did a retrospective analysis of all tuberculosis patients registered by the county\u27s Public Health Institute in the period 2003-2016, which included 926 tuberculosis patients. The results showed a continuous decrease in the incidence rates with the last reported rate of 8,6/100,000. This shows that the county became a low-incidence region. Even though the incidence rates were the highest in the hinterland and the lowest on the islands at the beginning of this study, during the last 6 years (2011-2016) the incidence rates in the hinterland and on the islands have become almost equal (mostly due to significant decrease of the incidence rates in the hinterland) while the incidence rates at the coastline have become the lowest. The incidence rates increase with age. Men are almost twice as likely to suffer from tuberculosis than women. Pulmonary tuberculosis is by far the most common presentation of the disease (85.10% of all examined patients). Bacteriologically confirmed tuberculosis has been found in 71.92% of the cases. In total, 40.82% of the patients were sputum smear-positive, which means they were highly contagious. Anti-tuberculosis drug resistance was found in 4.35% of all cases and it was mostly monoresistance, most often to isoniazide. Only two cases of multidrug-resistant tuberculosis have been notified. The results confirmed that the epidemiological situation regarding tuberculosis in Split-Dalmatia County is favorable. Nevertheless, we should continue to be vigilant and work intensely on the implementation and strengthening of anti-tuberculosis measures in order to eliminate tuberculosis as a public health problem

Pandemic influenza A (H1N1) 2009. in Split-Dalmatia County in seasons 2009/2010 and 2010/2011

Influenca je dobro poznata virusna zarazna bolest koja se, gotovo svake godine, pojavljuje epidemijski, a povremeno i u pandemijskom obliku. Cilj ovoga rada je pružiti kratki pregled aktivnosti u vezi s pojavom pandemijske influence A(H1N1)2009. u sezonama 2009./2010. i 2010./2011. i njihove epidemiološke osobitosti na području Splitsko-dalmatinske županije (SDŽ). Retrospektivno smo analizirali tjedne zbirne prijave obolijevanja-smrti od influence koje su prikupljane u Službi za epidemiologiju Nastavnoga zavoda za javno zdravstvo Splitsko-dalmatinske županije (NZJZ SDŽ) u razdoblju sezone influence 2009./2010. i 2010./2011. Na području SDŽ prvi slučaj influence izazvan pandemijskim virusom influence A(H1N1)2009., zabilježen je 3. srpnja 2009. Od tada do ožujka 2010. prijavljena su 5676 bolesnika od influence (stopa incidencije 122,4/10.000). Umrla su tri bolesnika (smrtnost 0,05%). Pandemijski virus A(H1N1)2009. nastavio je, kao sezonski virus, cirkulirati među stanovništvom u jesen i zimu 2010/2011., pa je došlo do ponovne pojave povećanog obolijevanja. U razdoblju prosinac 2010. – travanj 2011. prijavljeno je 7468 bolesnika (stopa incidencije 161,1/10.000), a umrlo ih je pet (smrtnost 0,07%). Kod svih umrlih dokazan je pandemijski virus influence A(H1N1)2009. Stopa hospitalizacije u sezoni 2009./2010. iznosila je 5,7/10.000, a u sezoni 2010./2011. 7,9/10.000 stanovnika.Influenza is a well-known viral infectious disease that occurs almost every year epidemically, becoming occasionally pandemic. The aim of this study is to provide an overview of the epidemiological characteristics and activities related to the appearance of pandemic Influenza A(H1N1)2009 during the 2009/2010 and 2010/2011 seasons in the Split-Dalmatia County (SDC), Croatia. We retrospectively analysed the weekly influenza related illness/death mandatory reports, which were collected in the Department of Epidemiology of the Teaching Institute of Public Health, Split-Dalmatia County during the influenza season 2009/2010 and 2010/2011. In the Split-Dalmatia County (SDC), the first influenza case caused by an infection with the pandemic influenza A virus (H1N1)2009 was reported on 3 July, 2009. From then till the end of March 2010, during the pandemic period, 5676 patients suffering from influenza were reported (incidence rate 122.4/10,000). Three patients deceased (case fatality rate 0.05%). Pandemic influenza A virus (H1N1)2009 continued to circulate as a seasonal virus among the population during autumn and winter 2010/2011 with a recurrence of influenza morbidity. In the December 2010 – April 2011 period there were 7,468 patients reported (incidence rate 161.1/10,000) with five deceased (case fatality rate 0.07%). The pandemic influenza A(H1N1) 2009 virus was confirmed in all deceased patients. The hospitalisation rate during the 2009/2010 season was 5.7 to 10,000, while during the 2010/2011 season it was 7.9 per 10,000 inhabitans

Even in the third millennium with an old friend: issues in the interpretation of tuberculin skin test results

Stremeći prema niskoj incidenciji, a u konačnici i eliminaciji tuberkuloze potrebno je intezivno sudjelovati u mjerama suzbijanja i sprječavanja tuberkuloze, primarno kroz rano otkrivanje i liječenje oboljelih, a zatim i kroz traženje kontakata tuberkuloznih bolesnika. Stoga identificiranje osoba s latentnom tuberkuloznom infekcijom, njihovo liječenje ili adekvatni nadzor, postaje nezaobilazna odrednica nacionalne strategije nadzora nad tuberkulozom. Trenutno su dva testa u uporabi za otkrivanje latentne tuberkulozne infekcije: tuberkulinski test i test otpuštanja gama interferona. Bez obzira što se dugo upotrebljava, još uvijek postoje brojne nejasnoće u tumačenju rezultata tuberkulinskoga testa, naročito u populaciji poput naše, koja je cijepljena Bacillus Calmette-Guerin cjepivom. Uz to postoje dvojbe oko tumačenja rezultata ponovljenih testiranja za otkrivanje nove infekcije u rizičnim skupinama, kao što su inicijalno tuberkulin-negativni kontakti tuberkuloznoga bolesnika. Stoga je cilj ovoga preglednoga rada pružiti smjernice za pravilnu interpretaciju rezultata tuberkulinskoga testiranja s posebnim osvrtom na konverziju, razloge lažno pozitivnih i lažno negativnih rezultata, buster fenomen, kriterije za razlikovanje konverzije od buster fenomena, promjene tuberkulinske reakcije zbog varijabilnosti u rezultatima testiranja, reverziju, testiranje trudnica, te buster efekt tuberkulinskog testiranja na testove otpuštanja gama interferona.As countries approach the low incidence of tuberculosis burden and subsequently its elimination phase, intensive efforts should be undertaken. Along with the most successful intervention in tuberculosis control, which is early detection and early treatment of tuberculosis patients, the importance of detection and treatment of latent tuberculosis infection and emergence of groups at particularly high risk of tuberculosis are gradually increasing. There are currently two tests used to detect latent tuberculosis infection: tuberculin skin test and interferon-gamma release assays. Although tuberculin skin tests have been used for decades, the interpretation of the results is not easy, especially in a population which has been vaccinated with Bacillus Calmette-Guerin vaccine. Particular problems have arisen with the use of repeated tuberculin tests to detect new infection in high-risk population such as initially tuberculin-negative contacts of tuberculosis patients. The aim of this review is to provide guidance for the proper interpretation of tuberculin test results, with special emphasis on conversion, reasons for false positive and false negative results, buster phenomenon, criteria for distinguishing conversion from buster phenomenon, changes in tuberculin reactions due to variability in test results, reversion, testing of pregnant women and buster effect of tuberculin test on interferon-gamma release

CHILDHOOD TUBERCULOSIS: AN ANCIENT DISEASE IN THE YOUNGEST GENERATION IN THE 21ST CENTURY FROM EPIDEMIOLOGICAL POINT OF VIEW

Tuberkuloza u djece je po svojim epidemiološkim i kliničkim osobitostima posebna bolest. Kako najveći dio djece ima mikroskopski negativne iskašljaje, smatralo se da oboljela djeca malo doprinose prijenosu bolesti. Stoga se tuberkulozi u djece pridavalo manje javnozdravstveno značenje te je uglavnom bila zanemarena u nacionalnim programima borbe protiv tuberkuloze. Kako tuberkuloza u djece obično nastane nakon brze progresije svježe infekcije, reflektira prijenos uzročnika i cirkulirajućih sojeva u populaciji pa je dobar indikator učinkovitosti nacionalnih programa. Neliječena je latentna infekcija među djecom izvor širenja bolesti u sljedećim generacijama. Prognoza rano otkrivene i pravilno liječene tuberkuloze je odlična pa se razvoj novih dijagnostičkih metoda i lijekova za tuberkulozu dječje dobi nameće kao nužnost. Pitanje učinkovitijeg cjepiva, koje bi se moglo koristiti i za zaštitu djece inficirane HIV-om, ostaje potrebom za kvalitetniju prevenciju na globalnoj razini. Što bolje implementiranje nove Stop TB Strategije, u čijoj se osnovi nalazi i strategija Directly Observed Treatment Short-Course (DOTS) značajno doprinosi smanjivanju globalne pojavnosti tuberkuloze u odraslih, a time štiti i djecu od infekcije i bolesti. Takve mjere trebaju biti praćene i poboljšavanjem općih uvjeta (prehrane, socioekonomskih uvjeta i nadzora nad čimbenicima okoliša) za bolji utjecaj na smanjivanje morbiditeta i mortaliteta od tuberkuloze u dječjoj dobi.Childhood tuberculosis (TB) has distinct epidemiological and clinical features. TB burden in children worldwide and in Croatia, the risk of infection and disease, as well as disease characteristics, sources of infection in children, diagnostic difficulties, impact of HIV on pediatric tuberculosis, limits of BCG- vaccine and program implications are discussed in this paper. Children younger than 15 years account for 15%-20% of global TB burden, which is often associated with severe TB-related morbidity and mortality. Childhood TB is rarely sputum-smear positive on microscopy. That is probably the reason for the lower priority traditionally given to children by TB control programs compared to that of adult disease. Young children are at a high risk of rapid progression from infection to disease, reflecting recent transmission rather than secondary reactivation. Therefore, the pediatric burden potentially provides a useful measure of current transmission within a community and it is a good indicator of the efficacy of TB control achieved in a particular community. Strict contact tracing and use of preventive chemotherapy is important to reduce TB-related suffering of children. Untreated latent TB infection in children provides the seed of the epidemic for the next generation. Evidence of an adult TB index case is a clue for diagnosis of childhood TB in low-endemic countries. Prognosis of early detected and properly treated TB is excellent. Consequently, new diagnostic methods and treatment options are an imperative. Among HIVcoinfected children, the optimal timing for highly active antiretroviral therapy initiation and drug combinations that have minimal interactions with anti-TB drugs need to be further explored. The most effective vaccine, suitable even for HIV-infected children, remains the need for successful prevention at the global level. The Stop TB Strategy, which builds on the previous Directly Observed Treatment Short-Course Strategy (DOTS) developed by the World Health Organization, has a critical role in reducing the worldwide burden of the disease and thus in protecting children from infection and disease. The management of children with TB should be in line with the Stop TB Strategy, taking into consideration the particular epidemiology and clinical presentation of TB in children. In addition to reducing the burden of adult TB, attention to childhood nutrition and improvement of socioeconomic conditions of communities is likely to have an impact on TB transmission to children

Diseases caused by group A streptococci: burden and public health significance during the COVID-19 pandemic

Cilj: S pojavom bolesti COVID-19 primijetilo se smanjenje broja infekcija respiratornim patogenima, što je bilo najizraženije na početku pandemije. Cilj ovoga rada je prikaz pojavnosti neinvazivnih i invazivnih bolesti izazvanih streptokokom grupe A u Hrvatskoj tri godine prije (2017. – 2019.) i tijekom tri pandemijske godine (2020. – 2022.). Ispitanici i metode: U ovo retrospektivno istraživanje uključeni su svi bolesnici s dijagnozama streptokokne angine, šarlaha, erizipela, bakterijskog meningitisa i sepse prijavljeni u Registar zaraznih bolesti Hrvatskog zavoda za javno zdravstvo i sve epidemije izazvane streptokokom grupe A od 2017. do 2022. godine prijavljene Službi za epidemiologiju zaraznih bolesti Hrvatskog zavoda za javno zdravstvo. Rezultati: Uočen je značajno veći broj prijavljenih streptokoknih angina, šarlaha i erizipela prije pandemije u odnosu na tri pandemijske godine (p = 0,0086, p = 0,0276, p = 0,0017). Primjetna je izrazita sezonalnost kod streptokokne angine i šarlaha samo u pretpandemijsko doba. Kod angine se najveći broj oboljelih bilježio od rujna do prosinca (p = 0,0003), a kod šarlaha od siječnja do ožujka (p = 0,0039). Što se tiče bakterijske sepse i meningitisa uzrokovanih piogenim streptokokom, ne postoji značajna razlika u broju prijavljenih bolesnika u dva promatrana razdoblja. Zabilježeno je 35 epidemija streptokokne angine s 277 oboljelih te šest epidemija šarlaha s 51 oboljelom osobom. Najviše epidemija zabilježeno je u vrtićima (33 s 293 oboljelih), potom su zabilježene u obiteljima (šest s 20 oboljelih) te školama (dvije s 15 oboljelih) što je sukladno dominantnoj dobnoj distribuciji oboljelih. Zaključak: Zabilježen je manji broj streptokoknih infekcija tijekom tri pandemijske godine u odnosu na godine prije pandemije. Kako se smatra da je sa smanjenjem prakticiranja nefarmakoloških mjera prevencije širenja COVID-19 moguć porast broja oboljelih, treba nastaviti pažljivo i pouzdano nadzirati kretanje streptokokoza. S obzirom na mogućnost ozbiljnih oblika bolesti, važno je da se slučajevi šarlaha i streptokokne angine odmah liječe antibioticima kako bi se ograničilo daljnje širenje i smanjio rizik od potencijalnih komplikacija. Dominirajuća pojavnost epidemija u vrtićima upućuje na potrebu educiranja zaposlenika vrtića, pomnog nadzora pobola od strane vrtićkoga zdravstvenog osoblja te brzu komunikaciju s nadležnim epidemiologom. Kako se ove bolesti ne mogu prevenirati cijepljenjem, ostaju kontinuiranim izazovom i kliničarima i liječnicima preventivne medicine.Aim: With the emergence of COVID-19, a decrease in the number of infections with respiratory pathogens was observed, which was most pronounced at the beginning of the pandemic. The aim of this work is to present the incidence of non-invasive and invasive diseases caused by group A streptococcus in Croatia three years before (2017–2019) and during three pandemic years (2020–2022). Participants and methods: All patients registered in the Register of Infectious Diseases of the Croatian Institute of Public Health with the diagnosis of streptococcal pharyngitis, scarlet fever, erysipelas and bacterial meningitis, sepsis and all outbreaks caused by Streptococcus group A from 2017–2022 notified to the Infectious Diseases Epidemiology Division of the Croatian Institute of Public Health were included in this retrospective study. Results: A significantly higher number of reported streptococcal pharyngitis, scarlet fever and erysipelas was observed before the pandemic compared to the three pandemic years (p= 0.0086, p=0.0276, p=0.0017). A distinct seasonality was observed in streptococcal angina and scarlet fever only in the pre-pandemic era. With angina, the largest number of patients was recorded from September to December (p=0.0003), and with scarlet fever from January to March (p= 0.0039). Regarding bacterial sepsis and meningitis caused by this pathogen, there is no significant difference in the number of reported patients in the two observed periods. A total of 35 epidemics of streptococcal pharyngitis with 277 patients and six epidemics of scarlet fever with 51 patients were recorded. Most epidemics were recorded in kindergartens (33 with 293 patients), with outbreaks in families following (six with 20 patients) and schools (two with 15 patients), which is in accordance with the dominant age distribution of the patients. Conclusion: A lower number of streptococcal infections was recorded during the three pandemic years compared to the years before the pandemic. As it is considered that with a reduction in the practice of non-pharmacological measures to prevent the spread of COVID-19, an increase in the number of patients is possible, the burden of streptococci should be carefully and reliably monitored. Therefore, the burden of streptococci should be carefully and reliably monitored. Given the ossibility of serious forms of the disease, it is important that cases of scarlet fever and strep throat are treated immediately with antibiotics to limit further spread and reduce the risk of potential complications. Dominant occurrence of outbreaks in kindergartens points to the need for education of kindergarten employees, close monitoring of illnesses by the kindergarten health staff, and quick communication with the competent epidemiologist. As these diseases cannot be prevented by vaccination, they remain a continuous challenge for both clinicians and doctors of preventive medicine

Sexual Behaviour and Condom Use as a Protection against Sexually Transmitted Infections in Student Population

The aim of the study was to determine the differences in sexual behaviour and condom use as a protection against sexually transmitted infections (STI) between the first-year and the last-year students. Data were collected by filling anonymous and consented questionnaire in June of 2011 at University of Josip Juraj Strossmayer in Osijek, Croatia. Out of 857 students in the planned sample, 462 (53.9%) filled out the questionnaire, and 353/462 (76.4%) were sexually active. Data from sexually active students were processed and statistically significant results between first-year and the last-year students were presented. Studied sample consisted of 192/353 (54.4%) first-year students and 161/353 (45.6%) last-year students. Average age of sexual initiation for the first-year students was 17.28±1.29 years, a for the last-year students 18.45±2.14 years, and the difference is significant (Man-Whitney test=10335.00, p<0.01). First-year students have lower number of sexual partners (2=28.005, p<0.01), during relationship they had lower number of intercourses with the third person (2=17.947, p<0.01), and feel that lower number of their friends were already sexually active at the time of their own sexual initiation (2=18.350, p<0.01). First-year students more often inform their partners about existing or previous STI (2=14.476, p<0.01) and curiosity significantly influenced their decision regarding sexual initiation (2=8.689, p<0.05). First-year students more often used condom at their first sexual intercourse (2=7.275, p<0.01), and more rarely used withdrawal (2=6.380, p<0.05). At their last sexual intercourse, first-year students more often used any kind of protection (2=3.853, p<0.05),more often used condom (2=11.110, p<0.01) and withdrawal (2=5.156, p<0.05), and more rarely used contraceptive pills (2=4.405, p<0.05). First-year students more often use condom in a permanent relationship (2=13.384, p<0.05), and also plan to use it during following intercourse in the permanent relationship (2=17.575, p<0.01). Growing condom use and decreasing risky sexual behaviour among students, as well as other adolescents and young adults needs to be maintained. Youth should learn before sexual initiation that only correct condom use at every sexual intercourse protects them against STI and human immunodeficiency virus (HIV). Sexual education and STI/HIV prevention programmes, positive role of media (television) and civil organisations that communicate with the youth can help that. Such changes among adolescents and young adults should have to be seen in student population as well