Provedba programa obaveznog cijepljenja na području Splitsko-dalmatinske županije (Running the compulsory immunisation programme)

Cijepljenje se pokazalo kao najučinkovitija mjera primarne prevencije zaraznih bolesti. Zahvaljujući cijepljenju svijet je eradicirao velike boginje, a Evropa je eliminirala difteriju i dječju paralizu.Prema podacima WHO-a u svijetu, na žalost, još uvijek umire preko milijun male djece od bolesti koje se mogu spriječiti cijepljenjem, kao što su ospice, hemofilus infekcije, hripavac, novorođenački tetanus i druge

Provedba programa obaveznog cijepljenja na području Splitsko-dalmatinske županije (Running the compulsory immunisation programme)

Cijepljenje se pokazalo kao najučinkovitija mjera primarne prevencije zaraznih bolesti. Zahvaljujući cijepljenju svijet je eradicirao velike boginje, a Evropa je eliminirala difteriju i dječju paralizu.Prema podacima WHO-a u svijetu, na žalost, još uvijek umire preko milijun male djece od bolesti koje se mogu spriječiti cijepljenjem, kao što su ospice, hemofilus infekcije, hripavac, novorođenački tetanus i druge

Smjernice Svjetske zdravstvene organizacije vezane uz cijepljenje (WHO statements regarding immunization)

Svjetska zdravstvena organizacija (SZO) objavljuje smjernice (guidelines, policy statements, position papers) vezane uz razne aspekte cijepljenja, sa svrhom obrazovanja  opće javnosti i zdravstvenih djelatnika, te osiguranja minimalne razine kvalitete rada u svim državama članicama.Na zemljama članicama je zadatak da se upoznaju sa smjernicama i prihvate one smjernice koje su u njihovim uvjetima prikladne. Obveze prihvaćanja smjernica nema, ali se očekuje da svi relevantni čimbenici u provedbi cijepljenja s njima budu upoznati i na temelju obaviještenosti odluče što će od predloženih smjernica prihvatiti, a što (uz valjane argumente) neće. Ovdje želimo ukratko prikazati nekoliko temeljnih smjernica SZO vezanih uz sigurnost primjene cjepiva, na koje se nedovoljno obraća pažnja, uz komentar o tome što smatramo potrebnim prihvatiti i ugraditi u nacionalne preporuke, pa čak i u pravila struke, a što smatramo neprikladnim za naše uvjete

Pandemic A(H1N1)2009 Influenza in the County of Split-Dalmatia in 2009/2010 and 2010/2011: Some Clinical and Epidemiological Characteristics

Pandemijski virus influence pojavio se u Hrvatskoj u srpnju 2009. godine i do sada je u dvije godine uzrokovao infekciju u više od 100.000 ljudi, od kojih je najmanje 86 (60 virološki dokazano) umrlo. U Splitsko-dalmatinskoj županiji oboljelo je 15.958 ljudi od čega je najmanje 8 umrlo (svi virološki dokazani). U Kliničkome bolničkom centru u Splitu liječena su 634 bolesnika što iznosi 3,97% od ukupno prijavljenih. U jedinici intenzivnog liječenja liječeno je 27 bolesnika (4,26% liječenih u bolnici), od čega je 8 umrlo (29,63%). Vrhunac epidemije 2009/2010. bio je od listopada do prosinca, a 2010/2011. u siječnju i veljači. Epidemija 2009/2010. počela je u srpnju,a epidemija 2010/2011. u prosincu. U svim pozitivnim obriscima nosa i ždrijela 2009/2010. metodom RT PCR i/ili DFA dokazan je virus A(H1N1)2009, dok je u sezoni 2010/2011. u 5 obrisaka dokazan virus tipa B, a u ostalih također virus A(H1N1)2009. Najviše hospitaliziranih u obje sezone bilo je u dobi od 30 do 64 godine, ali je bilo gotovo 10% više u sezoni 2009/2010. (39,85%) nego u sezoni 2010/2011. (30,16%). U sezoni 2010/2011. veći je broj hospitalizirane djece do 4 godine (25,5%) nego u sezoni 2009/2010. (18,04%) i starijih od 65 godina (21,74 prema 16,4%). Raspodjela prijavljenih epidemiološkoj službi učinjena je samo za 2010/2011. i najviše prijavljenih bilo je također u dobi od 30 do 64 godine (29,43%). U Klinici za infektologiju KBC-a Split u ove dvije sezone liječeno je 10 puta više bolesnika negoli je desetogodišnji prosjek liječenja bolesnika s influencom u ovoj klinici. U ovom članku prikazat ćemo neke kliničke i epidemiološke karakteristike bolesnika oboljelih od influence u Splitsko-dalmatinskoj županiji u sezonama 2009/2010. i 2010/2011.The pandemic influenza virus appeared in Croatia in July 2009, and over these two years it has caused infection in over 100,000 people, of whom at least 86 (60 virologically proven) died. In the County of Split-Dalmatia it affected 15,958 people, causing at least 8 deaths (all virologically proven). The number of hospitalized patients at the University Hospital Center Split was 634, or 3.97% of the total reported number. The number of patients treated at the Intensive Care Unit was 27 (4.26% treated in hospital), of whom 8 died (29.63%). The 2009/2010 epidemic reached its peak in the period from October to December, and that of 2010/2011 in January and February. The 2009/2010 epidemic began in July, and the 2010/2011 epidemic in December. Virus A (H1N1) 2009 was detected using the RT PCR and/or DFA method in all positive nose and throat swabs taken during the 2009/2010 epidemic, while in the season 2010/2011 type B virus was detected in 5 swabs, and virus A (H1N1) 2009 in others. Most hospitalized patients in both seasons were 30 - 64 years old, but there was almost 10% more patients in the season 2009/2010 (39.85%) than in the season 2010/2011 (30.16%). A larger number of hospitalized children under 4 years of age (25.5%) was recorded in the season 2010/2011 than in the season 2009/2010 (18.04%), as well as that of patients older than 65 years (21.74 vs. 16.4%). The distribution of total influenza cases reported to epidemiological services was done only for 2010/2011, and most patients were also 30 - 64 years old (29.43%). The number of patients treated at the Clinic for Infectious Diseases of the University Hospital Center Split over these two seasons was 10 times higher than the ten-year average of influenza patients treated at this clinic. In this article we will present some clinical and epidemiological characteristics of patients suffering from influenza in the County of Split-Dalmatia in 2009/2010 and 2010/2011

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

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

Measles cases in Split-Dalmatia County (a Croatian tourist region), in May–July 2019: outbreak report and lessons learnt

Background: Measles elimination was accomplished in Croatia in 2016. Split-Dalmatia County, with population of ca. 425 000 inhabitants, is among the most important Croatian tourist areas with numerous seasonal workers coming during summer months. In both 2018 and 2019, more than 3 million tourists visited this county. In 2000-2018, there were no measles cases in this county, or their number was low (1-3 cases per year). Methods: After measles was clinically suspected, all contacts were traced and contacted. Detection of specific IgM/IgG antibodies and real-time reverse transcription-polymerase chain reaction detection of viral RNA were used for laboratory confirmation. Sequencing and genotyping were performed for strains' molecular epidemiology analysis. Results: Six epidemiologically unlinked measles virus occurrences happened in Split-Dalmatia County in 15 May-19 July 2019. Causative viral strains belonged to genotypes B3 and D8. Four were single imported cases. Ten patients belonged to two separate clusters within domicile population. Multiple individual and public health measures were implemented. In total, 483 contacts were identified, 64.2% within healthcare system where two persons contracted the disease. Conclusions: Besides the importance of timely vaccination of children, the lessons learned from this outbreak point to the need of stricter implementation of other aspects of Croatian measles prevention programme, such as checking of vaccination status in early adulthood. Despite the fact that measles elimination within domicile population in this tourist region has been accomplished and maintained for years, continuous public health workers' efforts are still necessary for identification and diminishment of populational pockets of susceptibility