EPIDEMIOLOGY OF HEPATITIS C VIRAL INFECTION

SAŽETAK Virusni hepatitis C zarazna je bolest uzrokovana hepatotropnim hepatitis C virusom (HCV) iz porodice Flaviviridae. Otkriće virusa razjasnilo je etiologiju najvećega dijela poslijetransfuzijskih non-A, non-B hepatitisa dotad nepoznata uzroka, te je ustanovljeno da se virus najčešće prenosi krvlju i krvnim pripravcima parenteralno. Koliko je poznato, inficirane su osobe jedini “rezervoar” virusa i izvor su infekcije za druge ljude. HCV infekcija jedan je od najtežih javnozdravstvenih problema današnjice. Procjenjuje se da je više od 170 milijuna ljudi u svijetu zaraženo tim virusom, većina njih kronično. Kronična infekcija u velikoga broja oboljelih dovodi do razvoja ozbiljnih komplikacija, uključujući zatajenje jetrene funkcije, razvoj ciroze jetre, te hepatocelularnoga karcinoma (HCC). Prevalencija HCV infekcije, od otkrića virusa kao uzročnoga agensa bolesti do danas, bitno je promijenjena zahvaljujući ponajprije rutinskome testiranju krvi dobrovoljnih davatelja na infekciju hepatitis C virusom. Općeprihvaćeno je da je danas najvažniji rizični čimbenik koji pridonosi širenju infekcije hepatitis C virusom, unutarvensko uzimanje droga.ABSTRACT Viral hepatitis C is infectious disease caused by hepatotropic hepatitis C virus (HCV) belonging to family Flaviviridae. The discovery of the virus has clarify the ethiology of the major part of post-transfusion non-A non-B hepatitis of unknown origin. It was determined that the virus was mainly transmitted by blood and its products by parenteral route of transmission. HCVinfected people are the only known reservoir of the virus and the source of infection for others. HCV infection is one of the most important public health problems today. It was estimated that more than 170 million individuals are infected with HCV worldvwide, most of them chronically. Chronic infection in significant proportion leads to the development of serious complications that include liver function failure, the cirrhosis development and hepatocellular carcinoma (HCC). The prevalence of HCV infection has significantly changed since the dicovery of virus as ethiological agent of the disease primarily owing to routine testing of blood from volunteer donors on the presence of HCV infection. Today is generally accepted that the most important risk factor that contributes to the spread of HCV infection is illegal use of intravenous drugs

Rabies and rabies postexposure prophylaxis in the Primorje-Gorski Kotar County from 1986 to 2021

Cilj: Prikazati karakteristike antirabične zaštite koja se provodi u antirabičnoj ambulanti Epidemiološkog odjela Rijeka Nastavnog zavoda za javno zdravstvo Primorsko-goranske županije u razdoblju od 1986. do 2021. godine. Ispitanici i metode: U istraživanju su korišteni podatci antirabičnih anketa koje su dio godišnjeg izvješća koje se dostavlja Referentnom centru Ministarstva zdravstva za bjesnoću. Osobe koje su obrađivane i koje su primile antirabičnu zaštitu (imunoprofilaksu – postekspozicijsko cijepljenje protiv bjesnoće s humanim antirabičnim imunoglobulinom ili bez njega) najvećim su udjelom stanovnici Primorsko-goranske županije, odnosno grada Rijeke. Rezultati: U antirabičnoj ambulanti od 1986. do 2021. godine utvrđen je trend smanjivanja broja pregledanih osoba (y= -6,9+304, R2=0,78; p<0,05), s 263 na 50 osoba. Broj osoba koje su primile antirabičnu zaštitu u promatranome se periodu povećao (y=0,95+19, R2=0,24; p<0,05). U navedenome vremenskom razdoblju pregledano je 7.678 osoba, od kojih je 1.318 (17,2%) primilo imunoprofilaksu. Imunizirano je 42,3% (558/1.318) osoba ženskoga spola i 57,7% osoba muškoga spola (760/1.318). Najveći broj osoba imuniziran je zbog ozljede, ogrebotine, kontakta od nepoznate, uginule, odlutale, ubijene ili divlje životinje (N=1005) (grupa C) te zbog ozljede, ogrebotine i kontakta sa životinjom pozitivnom na bjesnoću (N=155) (grupa A). Osobe su najčešće imunizirane zbog ozljede, ogrebotine i kontakta sa psom (752/1318; 61,4%). Godine 2011. zabilježena je posljednja osoba koja je imunizirana zbog kontakta s dokazano bijesnom životinjom. Zaključak: U 35 godina rada antirabične ambulante na području grada Rijeke nije zabilježena bjesnoća u ljudi, što se pripisuje učinkovitim mjerama antirabične zaštite. Multidisciplinarni pristup pokazao se najučinkovitijim u smanjenju pobola od bjesnoće u životinja te posljedično sprječavanju pojave bjesnoće u ljudi na području Primorsko-goranske županije i Republike Hrvatske. Međutim, neizostavno mjesto u prevenciji bjesnoće u ljudi i dalje ima antirabična imunoprofilaksa.Aim: To present the characteristics of rabies preventive measures at the Antirabies Clinic at the Epidemiological Department of the Teaching Institute for Public Health Rijeka, Primorje-Gorski Kotar County, in the period from 1986 to 2021. Respondents and methods: In this study, data from anti-rabies surveys included in the annual reports submitted to the Ministry of Health Rabies Reference Center were used. Persons who received antirabies protection (immunoprophylaxis – vaccination against rabies with or without human rabies immunoglobulin) were mostly residents of the Primorje-Gorski Kotar County, dominantly from the city of Rijeka and its surroundings. Results: In the period from 1986 to 2021, a decreasing trend in the number of examined persons at the Antirabies Clinic was determined (y=–6.9+304, R2=0.78; p<0.05), from 263 to 50 persons. During the study period the number of people who received protection against rabies increased (y=0.95+19, R2=0.24; p<0.05).In this period 7678 persons were examined, out of which 1318 received immunoprophylaxis(17.2%). A total of 42.3% of females(558/1318) and 57.7% of males (760/1318) were immunized. Most people were vaccinated because of scratches, contacts from unknown, dead, stray, killed or wild animals (N=1005) (group C), or because of scratches and contacts with an animal tested positive for rabies (N=155) (group A). People were most often treated with antirabies treatment due to scratches or contact with a dog (752/1318; 57.1%). In 2011, the last person to receive antirabies treatment due to the contact with an animal tested positive for rabies was recorded. Conclusion: In 35 years of operation of the Antirabies Clinic in Rijeka, no rabies cases have been recorded in humans, which can be attributed to effective antirabies protection measures. The multidisciplinary approach has proven to be the most effective in reducing the incidence of rabies in animals and consequently preventing the occurrence of rabies in humans from the Primorje-Gorski Kotar County and the Republic of Croatia. However, human anti-rabies immunoprophylaxis still plays an indispensable role in the prevention of rabies

Epidemiological Study of Visual Functions – Refractive Errors, Macular Degeneration and Glaucoma in Children in the Karst Area of Opatija

Authors of earlier studies examined the epidemiological characteristics of certain eye diseases: age-related macular degeneration (AMD), refractive errors and glaucoma in the area of Primorsko-goranska County (the island of Rab, Novi Vinodolski and Delnice). It was found that the occurrence of AMD is most common on the island of Rab, followed by Novi Vinodolski and it is least common in Gorski Kotar. This fact is associated with the intensity of solar radiation in the UV-A and UV-B fi elds. The highest percentage of the occurrence of glaucoma was also identifi ed on the island of Rab. In comparison to this study, it was found that in the karst area of Opatija (Mune, Brgud, Žejane, Brešca, Zvoneće, Pasjak, Šapjane and Zaluki) there is a very high incidence of glaucoma (27% suspected and 7% diagnosed glaucoma) within the indigenous population. Glaucoma does not appear among children whose parents migrated to the karst area of Opatija. Refractive errors are far less common among children of indigenous population than among the children whose parents migrated to this area. The occurrence of AMD was not found in any child that was born and lives in this area, regardless of whether their parents are indigenous or not. This statement is very important because it confi rms author’s earlier statement which claims that at low exposure to solar UV-A and UV-B there is no occurrence of AMD

Mortality Characteristics of Two Populations in the Northern Mediterranean (Croatia) in the Period 1960–2012: An Ecological Study

In the second half of the 20th century, the town of Bakar (Primorje-Gorski Kotar County, Croatia), where a coking plant was operational 1978–1994, experienced intensive industrialisation. The town of Mali Lošinj (Primorje-Gorski Kotar County, Croatia) in this period based its economy on non-industrial sectors. The study goal was comparing mortality characteristics of these populations in the northern Mediterranean for 1960–2012. An ecological study design was used. Data were analysed for 1960–2012 for the deceased with recorded place of residence in the study area. Data on the deceased for 1960–1993 were taken from death reports, for 1994–2012 from digital archives of the Teaching Institute of Public Health, Primorje-Gorski Kotar County. Data on causes of death for 1960–1994 were recoded to the three-digit code of underlying cause of death according to the International Classification of Diseases (ICD–10). Among studied populations significant difference was found among the causes of deaths coded within ICD–10 chapters: neoplasms (particularly stomach carcinoma), mental and behavioural disorders and diseases of the respiratory system (particularly chronic obstructive pulmonary disease, (COPD)). Increase in mortality from neoplasms, increase in respiratory diseases for the area exposed to industrial pollution, also stomach carcinoma and COPD particularly in the town Bakar require further research

Vaccine Regulations in Croatia

In this paper legal prerequisites for vaccine licensure in Croatia are discussed. The Croatian legislation concerning vaccine licensing, marketing authorisation and utilization is reviewed. The procedures for including a vaccine into the Mandatory Childhood Vaccination Programme are also discussed with focus on Human papillomavirus (HPV) vaccines. Non-obligatory vaccination recommendations are given when according to professional opinion; vaccination is beneficial for the vaccinee. There is little doubt that HPV vaccines should be recommended for preadolescent girls in Croatia. However, reaching a decision on its possible introduction into the Childhood Vaccination Programme will require careful consideration of the larger picture and a comparison of the cost-effectiveness of a mandatory vaccination against other competing public health priorities

Tick-Borne Encephalitis Due to Consumption of Raw Goat Milk, Gorski kotar, 2019: Clinical Case Reports

Virus krpeljnog meningoencefalitisa (KME) najčešći je uzročnik infekcija središnjeg živčanog sustava u endemskim područjima srednje Europe. Radi se o prirodno žarišnoj zoonozi, čiji rezervoar čine šumski glodavci, domaće i divlje životinje, a čovjek se zarazi prigodno, ubodom inficiranog krpelja. U posljednje je vrijeme sve više izvješća o epidemijama KME povezanih s konzumacijom svježeg mlijeka i mliječnih proizvoda. Cilj je rada prikazati kliničke značajke i tijek bolesti kod oboljelih od KME u tijeku grupiranja u Primorsko- goranskoj županiji (lipanj 2019. godine), povezanog s konzumacijom nepasteriziranog kozjeg mlijeka iz istog izvora. Tri su bolesnika hospitalizirana s kliničkom slikom meningitisa, a kod dvoje se infekcija prezentirala kao febrilna bolest s mijalgijama i općom slabošću. Kod svih je bolesnika infekcija potvrđena serološkom obradom. Niti jedan bolesnik nije bio cijepljen protiv KME niti je imao podatak o ugrizu krpelja. Ovim radom želimo ukazati na zdravstvene opasnosti prehrambenih navika konzumiranja sirovog mlijeka koje u današnje vrijeme postaje sve popularnije, osobito među zagovornicima „zdrave hrane“.Tick-borne encephalitis (TBE) is the most common central nervous system (CNS) infection in the endemic areas of Central Europe. TBE is a zoonosis whose reservoir are forest rodents, and other mammals and vectors are Ixodes ticks. Humans become infected through a tick bite, but recently many TBE outbreaks after consumption of unpasteurized milk and dairy products from infected livestock have been described. The aim of this study was to analyze clinical characteristics of five TBE cases who were infected after consumption of unpasteurized goat milk and dairy products from a small family farm in Primorje-Gorski Kotar County (June 2019). Tree patients developed CNS infection while two had febrile illness. None of the infected patients reported a history of a tick-bite or were vaccinated against TBE. The infection was confirmed by detection of TBE specific antibodies. Since "healthy" lifestyle that encourages consumption of raw milk and dairy products is increasingly fashionable, we would like to point out the importance of pasteurizing or boiling milk before the consumption

Epidemiološka obilježja HIV-om zaraženih muškaraca : doktorski rad

CILJ ISTRAŽIVANJA Prije točno tri desetljeća opisani su prvi slučajevi HIV-infekcije i AIDS-a i to unutar populacije muškaraca koji imaju spolne odnose s drugim muškarcima (MSM). Od tada do današnjeg dana MSM-populacija je i dalje populacija pod visokim rizikom za HIV-infekciju. MSM-ovi se značajno razlikuju po epidemiološkim karakteristikama od ostalih grupa rizika. Unutar MSM-ova postoji populacija koja ima posebno povećan rizik od HIV-infekcije. Cilj je ovog rada otkriti čimbenike povećanog rizika ili grupu obilježja koja povećavaju rizik od HIV-infekcije u MSM-populaciji. Uz to, MSMpopulacija razlikuje se od sredine do sredine te je važno ustanoviti koji su ključni čimbenici rizika koji uvjetuju da dođe do zaraze. ISPITANICI I METODE Ispitanici su muškarci koji imaju spolne odnose s muškarcima, a regrutirani su iz opće populacije i među HIV-pozitivnim pacijentima. Ukupno je 296 ispitanika. Ispitanici su anketirani anonimno i dobrovoljno. Iz grupe ispitanika kreirane su dvije grupe: ispitivana grupa-slučajevi koju čine HIV-pozitivni MSM-ovi, i kontrola koju čini grupa HIVnegativnih MSM-ova. Obrađivani su po epidemiološkim obilježjima kao dob, mjesto rođenja, stručna sprema, zvanje i zanimanje, boravak u inozemstvu. Opisana su rizična ponašanja vezana uz HIV-infekciju: seksualno ponašanje, seksualna opredijeljenost, broj partnera, korištenje kondoma, učestalost analnih, odnosno oralnih spolnih odnosa, ovisnosti i druge karakteristike. Provela se case-control studija u kojoj su testirane razlike unutar obje grupe po relevantnim epidemiološkim obilježjima. REZULTATI U ovom radu potvrđena je hipoteza da se HIV-pozitivni MSM-ovi doista razlikuju od HIV-negativnih MSM-ova, odnosno od ostale MSM-populacije. Kao prvo, HIVpozitivni MSM-ovi imaju značajno veći broj partnera (prema Mann-Whitney U 4483,5, p<0.001). Što je veći broj partnera, veća je mogućnost da partner bude HIV-pozitivan i da prenese HIV-infekciju. HIV-pozitivni MSM-ovi značajno su češće imali odnos sa strancem (OR 2,54, 95% CI 1,34-4,84). Osobe koje su imale odnos sa strancem 2,36 puta su u većem riziku da se zaraze HIV-om od onih koji nisu imali kontakt sa strancem. HIV-pozitivni MSM-ovi u anamnezi češće navode obolijevanje od spolno prenosivih bolesti, prije negoli su postali HIV-pozitivni, za razliku od MSM-ova koji nisu zaraženi HIV-om (45,9% : 11,1%, odnosno OR 6,79, 95% CI 3,49-13,19). HIV-pozitivni MSM-ovi značajno su češće zaraženi hepatitisom B (OR 6,58, 95% CI 1,86-23,30), gonorejom (OR 3,24, 95% CI 1,13-9,34), sifilisom (OR 17,74, 95% CI 3,43-122,87) i genitalnim herpesom (OR18,39, 95% CI 2,03-424,70). Osobe koje su u anamnezi imale sifilis, imaju 9,35 puta veću mogućnost da se zaraze i HIV-om. HIV-pozitivni MSM-ovi imaju značajno češće partnere istoga, znači muškog spola (OR 2,64, 95% CI 1,34 - 5,21). HIV-pozitivni MSM-ovi značajno češće koriste kondom pri analnom nego pri oralnom odnosu (OR 3,59 a 95% CI 1,67-7,79). ZAKLJUČAK Rezultati ovog istraživanja koristit će se u budućim preventivnim aktivnostima usmjerenim prema populaciji MSM-ova, kao posebno rizičnoj populaciji za HIV-infekciju. Važno je daljnje praćenje ove populacije, kao i određene intervencije, kako bi se smanjila mogućnost zaraze HIV-infekcijom, a samim time smanjila njihova stigmatizacija i marginalizacija.OBJECTIVES Exactly three decades ago first cases of HIV infection and AIDS were described, this within the population of men who have sexual relations with men (MSM). Since then until this day, the MSM population is still a population under heightened risk for HIV infection. The epidemiological characteristics of the MSM are significantly different form other groups under heightened risk of HIV infection. Among the MSM population, there is a population with particularly heightened risk of HIV infection. The aim of this research is to determine which risk factors or a group of characteristics heighten the risk of HIV infection among the MSM population. Aside from this, the MSM population differs from region to region and it is important to determine which key risk factors are conditions for the infection to occur. PATIENTS AND METHODS Respondents are men who have sexual relations with men and were recruited form the general population and among the HIV positive patients. There was a total of 296 respondents. The respondents were questioned anonymously and on a voluntary basis. From the total number of respondents two groups were defined: those MSM found to be of HIV positive status (patient group) and those MSM whose HIV status was negative (control group).The analysis was conducted having in mind epidemiological characteristics such as age, place of birth, education achieved, occupation, stay abroad. Risk behaviors related to HIV infection were described: sexual behavior, sexual orientation, the number of partners, condom use, frequency of anal and oral sexual relations, addictions and other characteristics. A case control study was conducted in which differences among both groups according to relevant epidemiological characteristics were tested. RESULTS This paper confirms the hypothesis that HIV positive MSM indeed differ from the HIV negative MSM, that is, from other MSM population. Firstly, the HIV positive MSM have a significantly higher number of partners (Mann-Whitney U 4483,5, p<0.001). The higher the number of partners, the higher the possibility that the partner is HIV positive and can transmit the infection. HIV positive MSM had sexual relations with persons from abroad significantly more often (OR 2,54, 95% CI 1,34-4,84). Persons who had sexual relations with a foreign citizens are under a 2,36 times higher risk of HIV infection in comparison to those who did not have sexual relations with a foreign citizen. The HIV positive persons more often state having sexually transmitted diseases in history prior to becoming HIV positive, unlike those MSM who are not HIV infected (45,9% : 11,1% that is, OR 6,79, 95% CI 3,49-13,19). The HIV positive MSM are significantly more often infected with hepatitis B (OR 6,58, 95% CI 1,86- 23,30), gonorrhea (OR 3,24, 95% CI 1,13-9,34), syphilis (OR 17,74, 95% CI 3,43- 122,87) and genital herpes (OR18,39, 95% CI 2,03-424,70). Persons with a history of syphilis have 9,35 times a higher chance of getting infected with HIV. The HIV positive MSM have partners of the same (male) sex significantly more often (OR 2,64, 95% CI 1,34 - 5,21). HIV positive MSM use condoms significantly more often at anal sexual intercourse than at oral sexual intercourse (OR 3,59 a 95% CI 1,67-7,79). CONCLUSION The results of this research will be used in future activities targeted towards the MSM population, as a population at a particular risk for HIV infection. A further monitoring of this population is important, as are particular interventions in order to decrease the possibility of HIV infection, and with it, the stigmatization and marginalization of this population

Epidemiologija Hepatitis C Virusne Infekcije

Viral hepatitis C is infectious disease caused by hepatotropic hepatitis C virus (HCV) belonging to family Flaviviridae. The discovery of the virus has clarify the ethiology of the major part of post-transfusion non-A non-B hepatitis of unknown origin. It was determined that the virus was mainly transmitted by blood and its products by parenteral route of transmission. HCVinfected people are the only known reservoir of the virus and the source of infection for others. HCV infection is one of the most important public health problems today. It was estimated that more than 170 million individuals are infected with HCV worldvwide, most of them chronically. Chronic infection in significant proportion leads to the development of serious complications that include liver function failure, the cirrhosis development and hepatocellular carcinoma (HCC). The prevalence of HCV infection has significantly changed since the dicovery of virus as ethiological agent of the disease primarily owing to routine testing of blood from volunteer donors on the presence of HCV infection. Today is generally accepted that the most important risk factor that contributes to the spread of HCV infection is illegal use of intravenous drugs.Virusni hepatitis C zarazna je bolest uzrokovana hepatotropnim hepatitis C virusom (HCV) iz porodice Flaviviridae. Otkriće virusa razjasnilo je etiologiju najvećega dijela poslijetransfuzijskih non-A, non-B hepatitisa dotad nepoznata uzroka, te je ustanovljeno da se virus najčešće prenosi krvlju i krvnim pripravcima parenteralno. Koliko je poznato, inficirane su osobe jedini “rezervoar” virusa i izvor su infekcije za druge ljude. HCV infekcija jedan je od najtežih javnozdravstvenih problema današnjice. Procjenjuje se da je više od 170 milijuna ljudi u svijetu zaraženo tim virusom, većina njih kronično. Kronična infekcija u velikoga broja oboljelih dovodi do razvoja ozbiljnih komplikacija, uključujući zatajenje jetrene funkcije, razvoj ciroze jetre, te hepatocelularnoga karcinoma (HCC). Prevalencija HCV infekcije, od otkrića virusa kao uzročnoga agensa bolesti do danas, bitno je promijenjena zahvaljujući ponajprije rutinskome testiranju krvi dobrovoljnih davatelja na infekciju hepatitis C virusom. Općeprihvaćeno je da je danas najvažniji rizični čimbenik koji pridonosi širenju infekcije hepatitis C virusom, unutarvensko uzimanje droga

The Impact of the Natural Hazard Flooding in East Part of Croatia - Reducing Possible Consequences

Flooding is one of the most common natural hazards that produce substantial loss of life and property. Continuous, heavy rainfall with low pressure area affected a large area of Southeastern and Central Europe, resulted in extensive flooding in Croatia and neighboring countries. The paper presents a review of structural measures that were taken to cope with floods in some cities a long the Sava river in north-east part of Croatia (Slavonia).The aim of this study was to highlight the risks that may expand to major consequences after occurrence of a disaster of this magnitude. Due to many variables, health authorities pointed the potential health exposure risks (communicable diseases occurrence and spread)according to which recovery phase activities were taken. Flood risk management and post-disaster assessments has high level of development in flood-prone areas in Croatia

Coxiella burnetii (Q-fever) outbreak associated with non-occupational exposure in a semi-urban area of western Croatia in 2022

In March 2022, an outbreak of Q fever (Coxiella burnetii) with non-occupational exposure was confirmed in a semi-urban area in Čavle, Croatia. Veterinary and human epidemiological investigations were conducted to identify the source of the outbreak and to implement appropriate control measures. Three farms were settled next to each other near the homes of the first human cases at the end of the street. The closest farm was less than 500 meters away. These farms contained 161 adult sheep and goats. Among the animal samples analysed, all 16 goats (100%) and 24/50 sheep (48%) tested positive for C. burnetii IgM/IgG antibodies, phase I and II. One out of five sheeps' vaginal swabs were C. burnetti DNA positive. Human testing revealed 20 confirmed and three probable cases (9/23 pneumonia, 2/23 hepatitis, 21/23 fever), with three hospitalizations, and one death. Twenty-seven cases were discarded following negative laboratory results. The epidemiological investigation revealed airborne transmission as the most likely route of transmission. Multiple logistic regression analyses were used to evaluate risk factors for Q fever infection. Persons who were near the farms (≤750 m) (OR 4.5; 95% CI = 1.1–18.3) and lived in the nearest street to the farms had the highest risk of contracting Q fever (OR 3.7; 95% CI = 1.1–13.6). Decreased rainfall compared to monthly averages was recorded in the months prior to the outbreak with several days of strong wind in January preceding the outbreak. This was the largest Q fever outbreak in the county in the last 16 years, which was unexpected due to its location and non-occupational exposure. To stop the outbreak, numerous intensive biosecurity measures were implemented. The outbreak highlights the importance of urban development strategies to limit the number of animal housing near residential areas while providing regular biosecurity measures to prevent infections in livestock