Epidemija Zika virusne infekcije

Virus Zika je flavivirus kojeg primarno prenose komarci iz roda Aedes, za koje je karakteristično da su aktivni danju, od izlaska do zalaska sunca. Kompetentni vektori su Ae.aegypti i Ae.albopictus (tigrasti komarac), dok se ostali komarci iz roda Aedes  smatraju potencijalnim vektorima. Virus Zika može se prenijeti i transplacentarno ili tijekom porođaja zaražene majke, te spolnim putem. Zika virus je detektiran u krvi, urinu i slini tijekom akutne faze bolesti. Zika virusna RNA može biti prisutna u sjemenoj tekućini najmanje dva mjeseca nakon oporavka od Zika virusne infekcije. Postoji potencijalni rizik prijenosa Zika virusa zaraženom krvlju i transfuzijskim pripravcima te doniranjem sjemena davatelja povratnika iz rizičnog područja. Ne postoji cjepivo ili mogućnost kemoprofilakse infekcije

Epidemija Zika virusne infekcije

Virus Zika je flavivirus kojeg primarno prenose komarci iz roda Aedes, za koje je karakteristično da su aktivni danju, od izlaska do zalaska sunca. Kompetentni vektori su Ae.aegypti i Ae.albopictus (tigrasti komarac), dok se ostali komarci iz roda Aedes  smatraju potencijalnim vektorima. Virus Zika može se prenijeti i transplacentarno ili tijekom porođaja zaražene majke, te spolnim putem. Zika virus je detektiran u krvi, urinu i slini tijekom akutne faze bolesti. Zika virusna RNA može biti prisutna u sjemenoj tekućini najmanje dva mjeseca nakon oporavka od Zika virusne infekcije. Postoji potencijalni rizik prijenosa Zika virusa zaraženom krvlju i transfuzijskim pripravcima te doniranjem sjemena davatelja povratnika iz rizičnog područja. Ne postoji cjepivo ili mogućnost kemoprofilakse infekcije

Međunarodna suradnja na području nadzora i kontrole zaraznih bolesti

Zarazne bolesti kao i moguće prijetnje vezane uz zarazne bolesti ne poznaju granice. Danas kad je prisutan intenzivan međunarodni promet ljudi i roba, očekivan je brži i jednostavniji prijenos i širenje već nam poznatih zaraznih bolesti, no također i pojava novih zaraznih bolesti. Time se postavljaju novi izazovi u sprečavanju i suzbijanju zaraznih bolesti, što je prepoznato od strane kako međunarodnih stručnih i znanstvenih institucija, tako i od domaćih.Sprečavanje i suzbijanje zaraznih bolesti predstavlja javnozdravstveni prioritet u Europi (Direktiva Europskog parlamenta iz 1998. Godine, br. 2/19/98/EC), kako u zakonodavstvu Europske unije, tako i u dokumentima Europske regije Svjetske zdravstvene organizacije (WHO Grottaferatta 2000 Consensus Meeting on Surveillance of Infectious Diseases, Lyon 2002. Natural and intentional epidemic risks in Europe: Strengthening alert mechanism). Ovo je područje prioritet i u zakonodavstvu Republike Hrvatske, a rad i organizacija Službe za epidemiologiju Hrvatskog zavoda za javno zdravstvo utvrđeni su Zakonom o zdravstvenoj zaštiti i Zakonom o zaštiti pučanstva od zaraznih bolesti te drugim zakonskim aktima. Služba za epidemiologiju sa Službom za mikrobiologiju čini dio europske mreže epidemiološkog nadzora nad zaraznim bolestima

Nacionalni programi prevencije zaraznih i nezaraznih bolesti

Javnozdravstveni cilj programa prevencije kako zaraznih tako i nezaraznih bolesti jest prevenirati bolest, smanjiti njezinu incidenciju i smrtnost, a posljedično tome unaprijediti zdravlje pojedinca i populacije u cjelini. Republika Hrvatska se pokretanjem i provođenjem programa prevencije svrstala u skupinu zemalja koje aktivno brinu o zdravlju svog stanovništva. Dobro koncipirani programi temelj su zdravstvene zaštite, oni su dugoročno gledano najučinkovitije i najjeftinije sredstvo u borbi protiv navedenih bolest

EPIDEMIOLOGY OF VIRAL HEPATITIS

Hrvatska je zemlja niske prevalencije virusnih hepatitisa A, B i C, hepatitis D se u Hrvatskoj ne javlja, a hepatitis E se javlja tek sporadično. S obzirom da je zahvaljujući poboljšanim uvjetima života i higijenskim uvjetima hepatitis A sveden na sporadičnu bolest, najčešći uzročnici virusnih hepatitisa u Hrvatskoj su hepatitis B i C. Uvođenje obveznog cijepljenja školske djece protiv hepatitisa B 1999. godine dovelo je do pada incidencije te bolesti u Hrvatskoj, s najvećim učinkom na adolescente i mlade odrasle osobe i može se očekivati daljnji pad njene incidencije i prevalencije. Incidencija hepatitisa C je također u blagom opadanju. Unatoč relativno povoljnoj situaciji u vezi s virusnim hepatitisima, hepatitis B i C i dalje su važan javnozdravstveni problem s obzirom da procjenjujemo da je oko 25 tisuća osoba u Hrvatskoj kronično zaraženo virusom hepatitisa B, a oko 40 tisuća virusom hepatitisa C.Understanding the country-specific epidemiology of disease, which may vary greatly among countries, is crucial for identifying the most appropriate preventive and control measures. An overview of the local epidemiology of viral hepatitis in Croatia is given in this paper. The overall prevalence of hepatitis B in Croatia is low (less than 2% HBsAg carriers in the general population). Hepatitis B incidence and prevalence began to decline significantly following the introduction of universal hepatitis B vaccination in 1999. Information on HBsAg seroprevalence is derived from routine testing of certain subpopulations (pregnant women, blood donors) and seroprevalence studies mostly targeted at high-risk populations. Universal childhood vaccination against hepatitis B remains the main preventive measure. We recommend testing for immunity one to two months after the third dose of hepatitis B vaccine for health-care workers. The incidence and prevalence of hepatitis C have also been declining in the general population. The main preventive measures are ensuring safety of blood products, prevention of drug abuse, and harm reduction programs for intravenous drug users. Hepatitis A incidence has declined dramatically since fifty years ago, when thousands of cases were reported annually. In the last five years, an average of twenty cases have been reported per year. The reduction of hepatitis A is a consequence of improved personal and community hygiene and sanitation. Hepatitis D has not been reported in Croatia. The risk of hepatitis D will get to be even smaller as the proportion of population vaccinated against hepatitis B builds up. Hepatitis E is reported only sporadically in Croatia, mostly in persons occupationally in contact with pigs and in travelers to endemic countries. In conclusion, Croatia is a low prevalence country for hepatitides A, B and C. Hepatitis D has not been reported to occur in Croatia and there are only sporadic cases of hepatitis E. Since hepatitis A is a rare disease occurring sporadically, which is a consequence of improved sanitation and hygiene, hepatitides B and C are the main causes of viral hepatitis in Croatia. The introduction of universal mandatory hepatitis B vaccination of schoolchildren in 1999 resulted in a decrease in the incidence of hepatitis B, which is most pronounced in adolescents and young adults, and further decrease in the incidence and prevalence is expected as the pool of susceptible individuals decreases through vaccination. The incidence of hepatitis C is decreasing as well. In spite of a relatively favorable epidemiological situation, hepatitis B and C are still a significant public health burden with an estimated 25,000 persons chronically infected with HBV and about 40,000 persons chronically infected with HCV in Croatia

Influenza vaccine effectiveness against influenza A subtypes in Europe: Results from the 2021-2022 I-MOVE primary care multicentre study

Background: In 2021-2022, influenza A viruses dominated in Europe. The I-MOVE primary care network conducted a multicentre test-negative study to measure influenza vaccine effectiveness (VE). Methods: Primary care practitioners collected information on patients presenting with acute respiratory infection. Cases were influenza A(H3N2) or A(H1N1)pdm09 RT-PCR positive, and controls were influenza virus negative. We calculated VE using logistic regression, adjusting for study site, age, sex, onset date, and presence of chronic conditions. Results: Between week 40 2021 and week 20 2022, we included over 11 000 patients of whom 253 and 1595 were positive for influenza A(H1N1)pdm09 and A(H3N2), respectively. Overall VE against influenza A(H1N1)pdm09 was 75% (95% CI: 43-89) and 81% (95% CI: 45-93) among those aged 15-64 years. Overall VE against influenza A(H3N2) was 29% (95% CI: 12-42) and 25% (95% CI: -41 to 61), 33% (95% CI: 14-49), and 26% (95% CI: -22 to 55) among those aged 0-14, 15-64, and over 65 years, respectively. The A(H3N2) VE among the influenza vaccination target group was 20% (95% CI: -6 to 39). All 53 sequenced A(H1N1)pdm09 viruses belonged to clade 6B.1A.5a.1. Among 410 sequenced influenza A(H3N2) viruses, all but eight belonged to clade 3C.2a1b.2a.2. Discussion: Despite antigenic mismatch between vaccine and circulating strains for influenza A(H3N2) and A(H1N1)pdm09, 2021-2022 VE estimates against circulating influenza A(H1N1)pdm09 were the highest within the I-MOVE network since the 2009 influenza pandemic. VE against A(H3N2) was lower than A(H1N1)pdm09, but at least one in five individuals vaccinated against influenza were protected against presentation to primary care with laboratory-confirmed influenza.This project has received funding from the European Centre for Disease Prevention and Control with in the framework contract ECDC/2018/029.S

Immunisation of migrants in EU/EEA countries: Policies and practices

In recent years various EU/EEA countries have experienced an influx of migrants from low and middle-income countries. In 2018, the “Vaccine European New Integrated Collaboration Effort (VENICE)” survey group conducted a survey among 30 EU/EEA countries to investigate immunisation policies and practices targeting irregular migrants, refugees and asylum seekers (later called “migrants” in this report). Twenty-nine countries participated in the survey. Twenty-eight countries reported having national policies targeting children/adolescent and adult migrants, however vaccinations offered to adult migrants are limited to specific conditions in seven countries. All the vaccinations included in the National Immunisation Programme (NIP) are offered to children/adolescents in 27/28 countries and to adults in 13/28 countries. In the 15 countries offering only certain vaccinations to adults, priority is given to diphtheria-tetanus, measles-mumps-rubella and polio vaccinations. Information about the vaccines given to child/adolescent migrants is recorded in 22 countries and to adult migrants in 19 countries with a large variation in recording methods found across countries. Individual and aggregated data are reportedly not shared with other centres/institutions in 13 and 15 countries, respectively. Twenty countries reported not collecting data on vaccination uptake among migrants; only three countries have these data at the national level. Procedures to guarantee migrants’ access to vaccinations at the community level are available in 13 countries. In conclusion, although diversified, strategies for migrant vaccination are in place in all countries except for one, and the strategies are generally in line with international recommendations. Efforts are needed to strengthen partnerships and implement initiatives across countries of origin, transit and destination to develop and better share documentation in order to guarantee a completion of vaccination series and to avoid unnecessary re-vaccination. Development of migrant-friendly strategies to facilitate migrants' access to vaccination and collection of vaccination uptake data among migrants is needed to meet existing gaps

Measles outbreak in Dubrovnik-Neretva County, Croatia, May to June 2018

In May 2018, measles was introduced in the Dubrovnik region by an adult who recently travelled to Kosovo*. Control measures and an outbreak investigation were implemented: 15 epidemiologically-linked cases met the outbreak case definition of a visitor/resident of Dubrovnik-Neretva County with laboratory-confirmed measles and symptom onset beginning on May 19. New cases were identified through hospitals and primary care physicians. Throat swabs, urine and/or serum samples were collected from outbreak cases. RT-PCR detection of viral RNA and IgM/IgG was used to confirm infection. The median age of cases was 33 years, with one 8 month-old infant. Vaccination status was unknown for 9 cases, three were unvaccinated, one case had history of one dose and two cases reported receiving two doses of measles-containing vaccine. There were 11 hospitalisations and one person developed pneumonia. Control teams undertook an extensive search of contacts and implemented a range of control measures. Despite the outbreak occurring at the beginning of the summer tourism season, it was contained and did not spread to neighbouring regions. With continuing measles transmission in Europe, even small outbreaks create a burden on the health system in countries which have eliminated measles, and illustrate the importance of maintaining high immunisation coverag

Low 2018/19 vaccine effectiveness against influenza A(H3N2) among 15-64-year-olds in Europe: exploration by birth cohort

IntroductionInfluenza A(H3N2) clades 3C.2a and 3C.3a co-circulated in Europe in 2018/19. Immunological imprinting by first childhood influenza infection may induce future birth cohort differences in vaccine effectiveness (VE).AimThe I-MOVE multicentre primary care test-negative study assessed 2018/19 influenza A(H3N2) VE by age and genetic subgroups to explore VE by birth cohort.MethodsWe measured VE against influenza A(H3N2) and (sub)clades. We stratified VE by usual age groups (0-14, 15-64, ≥ 65-years). To assess the imprint-regulated effect of vaccine (I-REV) hypothesis, we further stratified the middle-aged group, notably including 32-54-year-olds (1964-86) sharing potential childhood imprinting to serine at haemagglutinin position 159.ResultsInfluenza A(H3N2) VE among all ages was -1% (95% confidence interval (CI): -24 to 18) and 46% (95% CI: 8-68), -26% (95% CI: -66 to 4) and 20% (95% CI: -20 to 46) among 0-14, 15-64 and ≥ 65-year-olds, respectively. Among 15-64-year-olds, VE against clades 3C.2a1b and 3C.3a was 15% (95% CI: -34 to 50) and -74% (95% CI: -259 to 16), respectively. VE was -18% (95% CI: -140 to 41), -53% (95% CI: -131 to -2) and -12% (95% CI: -74 to 28) among 15-31-year-olds (1987-2003), 32-54-year-olds (1964-86) and 55-64-year-olds (1954-63), respectively.DiscussionThe lowest 2018/19 influenza A(H3N2) VE was against clade 3C.3a and among those born 1964-86, corresponding to the I-REV hypothesis. The low influenza A(H3N2) VE in 15-64-year-olds and the public health impact of the I-REV hypothesis warrant further study.We thank Dr Danuta Skowronski for detailed explanation of the I-REV hypothesis, shared discussions and helpful comments on our manuscript. We thank Pernille Jorgensen (WHO/Europe) for her continued support for the I-MOVE network over the years. We acknowledge the authors, originating and submitting laboratories of the sequences from GISAID's EpiFlu Database used for this study. All submitters of data may be contacted directly via the GISAID websitS

Low 2018/19 Vaccine Effectiveness against Influenza A(H3N2) among 15\textendash 64-Year-Olds in Europe: Exploration by Birth Cohort

International audienceIntroduction Influenza A(H3N2) clades 3C.2a and 3C.3a co-circulated in Europe in 2018/19. Immunological imprinting by first childhood influenza infection may induce future birth cohort differences in vaccine effectiveness (VE). Aim The I-MOVE multicentre primary care test-negative study assessed 2018/19 influenza A(H3N2) VE by age and genetic subgroups to explore VE by birth cohort. Methods We measured VE against influenza A(H3N2) and (sub)clades. We stratified VE by usual age groups (0\textendash 14, 15\textendash 64, ≥q\,65-years). To assess the imprint-regulated effect of vaccine (I-REV) hypothesis, we further stratified the middle-aged group, notably including 32\textendash 54-year-olds (1964\textendash 86) sharing potential childhood imprinting to serine at haemagglutinin position 159. Results Influenza A(H3N2) VE among all ages was -1% (95% confidence interval (CI): -24 to 18) and 46% (95% CI: 8\textendash 68), -26% (95% CI: -66 to 4) and 20% (95% CI: -20 to 46) among 0\textendash 14, 15\textendash 64 and ≥q\,65-year-olds, respectively. Among 15\textendash 64-year-olds, VE against clades 3C.2a1b and 3C.3a was 15% (95% CI: -34 to 50) and -74% (95% CI: -259 to 16), respectively. VE was -18% (95% CI: -140 to 41), -53% (95% CI: -131 to -2) and -12% (95% CI: -74 to 28) among 15\textendash 31-year-olds (1987\textendash 2003), 32\textendash 54-year-olds (1964\textendash 86) and 55\textendash 64-year-olds (1954\textendash 63), respectively. Discussion The lowest 2018/19 influenza A(H3N2) VE was against clade 3C.3a and among those born 1964\textendash 86, corresponding to the I-REV hypothesis. The low influenza A(H3N2) VE in 15\textendash 64-year-olds and the public health impact of the I-REV hypothesis warrant further study