Pregled rada Antirabične stanice u Zagrebu u razdoblju od 1980. do 2005. godine (An Overview of the Work of the Antirabies Station in Zagreb 1980 -2005)

U Antirabičnoj stanici Zavoda za javno zdravstvo grada Zagreba, u razdoblju od 1980. do 2005. godine ukupno je pregledano 35754 pacijenata, od čega je 8977 odnosno 25,11% cijepljeno protiv bjesnoće. Od tog broja, 7661 ih je primilo samo antirabično cjepivo, a 1316 kombinaciju cjepiva i humanog antirabičnog imunoglobulina (HRIG). Distribucija zadanih ozljeda po učestalosti ugriza je slijedeća: donji ekstremiteti, gornji ekstremiteti, multiple ozljede, šaka i prsti, glava i vrat, te trup. Osobe koje su primile antirabičnu zaštitu, najčešće su bile ugrižene od pasa (65,32%); lisica (13,45%); mačaka (13,04%) i glodavaca (4,23%), te potom drugih vrsta životinja (3,96%). Zastupljenost životinjskih vrsta u ukupnom broju pregledanih i obrađenih pacijenata je slijedeća: pas (84,52%); mačka (6,97%); lisica (3,96%);glodavci (1,62%) te ostale vrste životinja (2,93%)

Pregled rada Antirabične stanice u Zagrebu u razdoblju od 1980. do 2005. godine (An Overview of the Work of the Antirabies Station in Zagreb 1980 -2005)

U Antirabičnoj stanici Zavoda za javno zdravstvo grada Zagreba, u razdoblju od 1980. do 2005. godine ukupno je pregledano 35754 pacijenata, od čega je 8977 odnosno 25,11% cijepljeno protiv bjesnoće. Od tog broja, 7661 ih je primilo samo antirabično cjepivo, a 1316 kombinaciju cjepiva i humanog antirabičnog imunoglobulina (HRIG). Distribucija zadanih ozljeda po učestalosti ugriza je slijedeća: donji ekstremiteti, gornji ekstremiteti, multiple ozljede, šaka i prsti, glava i vrat, te trup. Osobe koje su primile antirabičnu zaštitu, najčešće su bile ugrižene od pasa (65,32%); lisica (13,45%); mačaka (13,04%) i glodavaca (4,23%), te potom drugih vrsta životinja (3,96%). Zastupljenost životinjskih vrsta u ukupnom broju pregledanih i obrađenih pacijenata je slijedeća: pas (84,52%); mačka (6,97%); lisica (3,96%);glodavci (1,62%) te ostale vrste životinja (2,93%)

IZ ARHIVE ANTIRABIČNE AMBULANTE GRADA ZAGREBA: HOSPITALIZIRANE OSOBE ZBOG UGRIZA ŽIVOTINJA U RAZDOBLJU OD 1995. DO 2006. GODINE

Aim: In the Zagreb Antirabies Clinic, which operates within the Reference Center for Rabies at Andrija Štampar Teaching Institute of Public Health in Zagreb, in the period from 1995 to 2006, there were 12 380 patients examined for injuries infl icted by animals, of which 147 (1.18%) were hospitalized in various Zagreb departments and hospitals due wound severity. Methods: Data were retrospectively collected from the offi cial patient registry of the Zagreb Antirabies Clinic. Results: Hospitalized patients were in an age range from 1 to 81 years, 63 (42.86%) were adults, and 84 (57.14%) children aged 1 to 16 years; among adults, there were 28 (44.44%) men and 35 (55.56%) women, while among children there were 45 (53.57%) boys and 39 (46.43%) girls. Discussion: Concerning animals involved in the incidents which led to hospitalization, dogs were by far the most frequent species, recorded in 74.82% of cases; other animals were, in the order of frequency, cats, rats, a pig and a donkey. The dogs of known owners were represented five times more often than stray dogs. Conclusion: There was no statistically significant difference in the frequency of hospitalization between children and adults, while dogs were significantly more likely to inflict injuries that ended in hospitalization than other animals, and patients were more often hospitalized after head and neck injuries or multiple injuries than due to injuries to limbs or hands and fingers.Cilj: U antirabičnoj ambulanti Referentnog centra za bjesnoću pri Nastavnom zavodu za javno zdravstvo „Dr. Andrija Štampar “ u Zagrebu u razdoblju od 1995. do 2006. godine ukupno je zbog ugriza životinja pregledano 12.380 bolesnika, od kojih je 147 (1,18%) hospitalizirano u bolnicama i klinikama grada Zagreba. Metode: Rezultati su prikupljeni retrospektivno iz službenog registra antirabične ambulante u Zagrebu. Rezultati: Hospitalizirani bolesnici bili su u dobnom rasponu od 1 do 81 godine, 63 (4,86%) odrasle osobe i 84 (57,14%) djece u dobi od 1 do 16 godina; od odraslih bilo je 28 (44,44%) muškaraca i 35 (55,56%) žena, a od djece 45 (53,57%) dječaka i 39 (46,43%) djevojčica. Rasprava: Od životinja koje su sudjelovale u incidentima koji su doveli do hospitalizacije psi su bili daleko najviše zastupljena vrsta (74,82% slučajeva), dok su ostale životinje po redu učestalosti bile mačke, štakori, svinja i magarac. Psi poznatih vlasnika bili su zastupljeni pet puta češće od pasa lutalica. Zaključak: Nema statistički značajne razlike u učestalosti hospitalizacije između djece i odraslih, dok su psi statistički značajno češće nanosili ozljede koje su završile hospitalizacijom u odnosu na druge životinje, a bolesnici su bili češće hospitalizirani nakon ozljeda glave i vrata ili višestrukih ozljeda nego zbog ozljeda udova ili šake i prstiju

IZ ARHIVE ANTIRABIČNE AMBULANTE GRADA ZAGREBA: HOSPITALIZIRANE OSOBE ZBOG UGRIZA ŽIVOTINJA U RAZDOBLJU OD 1995. DO 2006. GODINE

Aim: In the Zagreb Antirabies Clinic, which operates within the Reference Center for Rabies at Andrija Štampar Teaching Institute of Public Health in Zagreb, in the period from 1995 to 2006, there were 12 380 patients examined for injuries infl icted by animals, of which 147 (1.18%) were hospitalized in various Zagreb departments and hospitals due wound severity. Methods: Data were retrospectively collected from the offi cial patient registry of the Zagreb Antirabies Clinic. Results: Hospitalized patients were in an age range from 1 to 81 years, 63 (42.86%) were adults, and 84 (57.14%) children aged 1 to 16 years; among adults, there were 28 (44.44%) men and 35 (55.56%) women, while among children there were 45 (53.57%) boys and 39 (46.43%) girls. Discussion: Concerning animals involved in the incidents which led to hospitalization, dogs were by far the most frequent species, recorded in 74.82% of cases; other animals were, in the order of frequency, cats, rats, a pig and a donkey. The dogs of known owners were represented five times more often than stray dogs. Conclusion: There was no statistically significant difference in the frequency of hospitalization between children and adults, while dogs were significantly more likely to inflict injuries that ended in hospitalization than other animals, and patients were more often hospitalized after head and neck injuries or multiple injuries than due to injuries to limbs or hands and fingers.Cilj: U antirabičnoj ambulanti Referentnog centra za bjesnoću pri Nastavnom zavodu za javno zdravstvo „Dr. Andrija Štampar “ u Zagrebu u razdoblju od 1995. do 2006. godine ukupno je zbog ugriza životinja pregledano 12.380 bolesnika, od kojih je 147 (1,18%) hospitalizirano u bolnicama i klinikama grada Zagreba. Metode: Rezultati su prikupljeni retrospektivno iz službenog registra antirabične ambulante u Zagrebu. Rezultati: Hospitalizirani bolesnici bili su u dobnom rasponu od 1 do 81 godine, 63 (4,86%) odrasle osobe i 84 (57,14%) djece u dobi od 1 do 16 godina; od odraslih bilo je 28 (44,44%) muškaraca i 35 (55,56%) žena, a od djece 45 (53,57%) dječaka i 39 (46,43%) djevojčica. Rasprava: Od životinja koje su sudjelovale u incidentima koji su doveli do hospitalizacije psi su bili daleko najviše zastupljena vrsta (74,82% slučajeva), dok su ostale životinje po redu učestalosti bile mačke, štakori, svinja i magarac. Psi poznatih vlasnika bili su zastupljeni pet puta češće od pasa lutalica. Zaključak: Nema statistički značajne razlike u učestalosti hospitalizacije između djece i odraslih, dok su psi statistički značajno češće nanosili ozljede koje su završile hospitalizacijom u odnosu na druge životinje, a bolesnici su bili češće hospitalizirani nakon ozljeda glave i vrata ili višestrukih ozljeda nego zbog ozljeda udova ili šake i prstiju

Rodent Bites in the City of Zagreb and Zagreb County in 2007

Glodavci imaju važnu ulogu u širenju zaraznih bolesti ljudi i domaćih životinja. Oni su rezervoari ili prijenosnici čitavog niza uzročnika zaraznih bolesti čovjeka kao što su: kuga, virusne hemoragijske groznice, virusne hemoragijske groznice s bubrežnim sindromom, leptospiroza, tularemija, salmoneloza, trihineloza, bolest štakorskog ugriza, Sodoku, bjesnoća itd. U ovome radu prikazani su ugrizi glodavaca na području grada Zagreba i Zagrebačke županije u 2007. godini. Od 811 pacijenata, koji su poradi ugriza od raznovrsnih životinja tijekom 2007. godine pregledani u antirabičnoj ambulanti Zavoda za javno zdravstvo grada Zagreba, zabilježena su 24 slučaja ugriza glodavaca, što čini 2,96% svih ugriza. Od tog broja,13 ugriza ili 54,17% otpada na štakora, a ostatak na ugrize drugih vrsta glodavaca (voluharica, kućni miš, vjeverica, puh i kunić). Zbog tih je ugriza antirabičnim cjepivom bez humanog antirabičnog globulina (HRIG-a) cijepljeno 18 pacijenata (75 %), dok šest preostalih nije (25 %). Premda su cijepljeni protiv bjesnoće, troje pacijenata iz drugih županija (Zadarske, Sisačko-moslavačke i Karlovačke) nisu uvršteni u ovaj prikaz. Navedeni pacijenti su, naime, u antirabičnu ambulantu došli samo zbog nastavka primanja antirabične zaštite, koja je započeta u njihovim županijama. Radilo se o ugrizima od po jednog štakora, puha te kućnog miša; tako da ukupni broj ugrizenih pacijenata prikazanih u ovome radu iznosi 21. Protiv bjesnoće je cijepljeno svih 12 pacijenata ugrizenih od štakora, te po jedan pacijent ugrizen od puha, voluharice i vjeverice. Od šestoro necijepljenih pacijenata, tri su bila ugrizena od kućnog miša, dva od puha te jedan od kunića. Od svih navedenih glodavaca, na bjesnoću su pretražena samo potonja dva puha. Pretrage su završene s negativnim rezultatom, a obavljene su u Laboratoriju za bjesnoću i opću virologiju Hrvatskog veterinarskog instituta u Zagrebu. Dobna raspodjela pacijenata bila je sljedeća: devetoro muških osoba u dobi od 21 do 81 godine, sedmoro ženskih osoba od 31 do 70 godine te petoro djece od 4 do 15 godina. Anatomska lokalizacija zadanih ozljeda bila je sljedeća: na prvome mjestu su šaka i prsti u 15 slučajeva (71,43%), a potom slijede donji ekstremiteti, gornji ekstremiteti, glava i lice sa po dva slučaja. Područna raspodjela pacijenata bila je slijedeća: 13 ugrizenih osoba potjecalo je iz Zagrebačke županije, a osam s područja grada Zagreba.Rodents have a very important role in spreading infectious diseases in humans and domestic animals. They are reservoirs or vectors for many causative agents of infectious diseases in humans such as: plague, viral haemorrhagic fevers, viral haemorrhagic fever with nephrotic syndrome, leptospirosis, tularemia, salmonellosis, trichinellosis, rat bite fever, Sodoku, rabies etc. This paper gives an overview of rodent bites in the city of Zagreb and Zagreb county in 2007. During 2007, among 811 examined patients in the Antirabies ambulance of the Zagreb Institute of Public Health, 24 were cases of rodent bites, making up to 2.96% of the total number of bites. Within this number, rat was presented in 1.60 %, and other types of rodents with the remaining 1.36% (vole, mice, squirell, dormice and rabbit). Of the 24 bite cases mentioned above, 18 patients (75 %) received rabies post-exposure prophylaxis (PEP) without HRIG, while 6 patients (25 %) remained without treatment. Three patients from other counties (Zadarska, Sisačko-moslavačka and Karlovačka) came to Antirabies ambulance of the Zagreb Institute of Public Health due to continuing antirabies treatment, and were not included in this paper. They have been bitten by a rat, dormouse and a housemouse. The total number of patients bitten by rodents was 21, and they are included in this paper. All 12 patients bitten by rat were vaccinated against rabies, followed by patients bitten by dormouse, a vole and a squirrel. Of the animals that bit 6 unvaccinated patients, two dormice were tested at the Croatian Veterinary Institute and proved negative to Slika 1. Prijava i pregled ugriza Figure 1. Registration of rodent bites rabies. Three persons bitten by house mice, and one person bitten by home rabbit were not vaccinated against rabies. Patients were grouped by age as follows: 9 male persons from 21 to 81 years, 7 female persons from 31 to 70 years and 5 children from 4 to 15 years. The anatomic localisation of the wounds was as follows: fist and fingers – 15 cases (71.43%), lower limbs, upper limbs, head and face with two cases each. Geographical distribution was as follows: 13 bites in the Zagreb county and 8 in the the city of Zagreb

EPIDEMIOLOGICAL CHARACTERISTICS OF SALMONELLOSIS IN NEW ZAGREB DURING THE 1990-2009 PERIOD

U razdoblju od 1990. do 2009. godine Higijensko epidemiološkom odjelu Novi Zagreb prijavljeno je 58.268 zaraznih bolesti. Prijavljeno je 4.492 salmoneloza što čini 8%. Prosječna incidencija je 179 oboljelih na 100.000 stanovnika. Najviša incidencija je u djece do prve godine života (880/100.000). Najčešće izolirani serotip je Salmonella enteritidis (84%), zatim slijedi Salmonella typhimurium (7%), Salmonella virchow (3%) te Salmonella hadar (2%). Žene obolijevaju nešto češće od muškaraca. Odnos oboljelih žena i muškaraca je 1,2:1. Akutno kliconoštvo zabilježeno je kod 2.557 (57%) osoba, dok je kronično kliconoštvo bilo prisutno u 139 (3%) osoba. Za vrijeme trajanja kliconoštva obrađeno je 22.460 uzoraka stolica, što je u prosjeku 5 stolica po jednoj oboljeloj osobi. Hospitalizirano je 1.033 (23%) osoba, u prosjeku 7 dana, dok je 359 (8%) osoba boravilo u dnevnoj bolnici. Prijavljene su 3. 592 osobe (88,4%) sa simptomima bolesti, u 413 (9,3%) salmonela je otkrivena u obradi kontakata, a kod pregleda za sanitarnu knjižicu dokazano je kliconoštvo salmonele u 127 (2,3%) osoba. U 90% salmoneloza radilo se o sporadičnom obolijevanju, a u 10% se radilo o manjim epidemijama. Najčešći vehikulumi kod alimentarnih infekcija salmonelama su jaja (32%), kolači (10%) te piletina (10%).In Croatia, salmonellosis is the leading cause of bacterial foodborne diseases. The aim of the study was to determine the incidence of the disease, patient breakdown by age and sex, the most frequently isolated Salmonella serotypes, the length of carriership, and the most frequent source of infection. It was a retrospective analysis, and the sources of data were reports and epidemiological questionnaires administered to those affected with the disease. During the 1990-2009 period, 4492 cases of salmonellosis were reported in the New Zagreb area. The average incidence was 179/100,000. From 2004 onwards, salmonellosis has been on a decrease in Western Europe countries and the USA, whereas in Croatia it is still the leading cause of bacterial food poisoning. The highest incidence is recorded in children up to the age of 1 year (880/100,000), due to low immunity and a lower infective dose. In the observed period (1990-2009), the most frequently isolated serotype was Salmonella enteritidis (84%), followed by Salmonella typhimurium (7%), Salmonella virchow (3%) and Salmonella hadar (2%). There was a slight female predominance (F:M ratio 1.2:1) in salmonellosis cases. All persons affected with the disease are placed under sanitary surveillance including bacteriological control of the stool. Acute carriership was recorded in 2557 (57%) subjects, whereas stool excretion of Salmonella for more than 90 days (chronic carriership) was present in 139 subjects. In nine (0.2%) subjects, chronic carriership was observed for more than a year. During carriership, 22,460 stool samples were examined, i.e. 5 samples per patient on an average. A total of 1033 (23%) subjects were hospitalized for 7 days on an average, whereas 359 persons stayed in day hospital (1-2 days). Out of 3592 (88.4%) subjects with symptoms of the disease reported on their own, Salmonella was detected by the examination of contacts in 413 (9.3%) and carriership proven in 127 (2.3%) subjects examined for sanitary certificate (persons under sanitary surveillance due to the work with food). There were 90% of sporadic cases and 10% of small outbreaks. The most common source of infection were eggs (32%), poultry (10%) and pastry (10%). The outbreaks were mostly confined to the families. Salmonellosis is a major public health and economic problem, as well as an issue pertaining to veterinary and human medicine. The best and most efficient way to prevent the spread of infection by food is reduction of salmonellosis in animal population

Oral vaccination of foxes against rabies in the Republic of Croatia – how successful have we been so far?

Prema Svjetskoj zdravstvenoj organizaciji (SZO) svega su dvije uspješne metode eliminacije virusa bjesnoće u domaćih i divljih životinja. Prva je obavezno cijepljenje pasa protiv bjesnoće, koja u pravilu dovodi do eradikacije humanih slučajeva bjesnoće u pojedinoj zemlji, a druga je oralna vakcinacija lisica protiv bjesnoće, koja je najefikasnija metoda eradikacije virusa bjesnoće u prirodnim žarištima, s iznimkom u šišmiša. U Republici Hrvatskoj obavezno cijepljenje pasa protiv bjesnoće uvedeno je 1948. godine, što je dovelo do eradikacije urbane bjesnoće 2 godine kasnije. Do uvođenja oralne vakcinacije lisica protiv bjesnoće u Republici Hrvatskoj došlo je nešto više od 40 godina kasnije (početak 1991.), premda se ranije pokušavalo s povećanim izlovom lisica (ubijanjem, trovanjem, plinjenjem) te tzv. "jamarenjem" njihov broj držati na razini 4 lisice po 1 km2 ili manje. Prva akcija provođenja oralne vakcinacije (ORV) lisica protiv bjesnoće na području Republike Hrvatske započela je 1991. godine, a trajala je do 1996. godine, kada je zbog Domovinskog rata te nedostataka financijskih sredstava bila prekinuta. Drugi put se s ORV lisica krenulo 1998. godine, ali samo na području grada Zagreba i Zagrebačke županije, ali je i ta akcija bila prekinuta. Treći put s ORV lisica protiv bjesnoće započelo se 2010. godine, kada je izvršena samo jesenska akcija bacanja mamaka, da bi se s kompletne dvije akcije bacanja mamaka (u proljeće i jesen), krenulo od 2011. godine. Rezultati akcije od 2010. do 2015. godine, polučili su izvanredne rezultate: od 11,1% pozitivnih izolata bjesnoće u domaćih i divljih životinja u 2010. god, do 0% pozitivnih izolata bjesnoće u 2015. god. Zbog ovakvih rezultata Uprava za veterinarstvo i sigurnost hrane pri Ministarstvu poljoprivrede Republike Hrvatske planira Republiku Hrvatsku u 2018. godini proglasiti zemljom slobodnom od bjesnoće.According to the World Health Organisation (WHO), there are only two successful measures which lead towards the elimination of the rabies virus in domestic animals and wildlife. The first is a mandatory vaccination of the dogs against rabies, which has been proven effective in eliminating human rabies cases in particular countries, and the second is the oral vaccination (ORV) of foxes against rabies, which is the best method for the eradication of the rabies virus in natural habitats, with exception of bats. In the Republic of Croatia, the mandatory vaccination of dogs against rabies was initiated in 1948, and only two years later urban rabies was successfully eradicated. More than 40 years (1991) have passed until the programme of the ORV of foxes against rabies was introduced. Within that period, considerable efforts have been made to hunt foxes (culling, poisoning or gassing in fox dens), with the goal to keep the population of foxes on the level of 4 per 1 km2 or below. The programme of ORVof foxes against rabies in the Republic of Croatia started for the first time in 1991, and it lasted until 1996, when it was discontinued due to lack of financial resources and the War in Croatia. For the second time, it started again in 1998, but it covered only the city of Zagreb and Zagreb County, and it was discontinued for the same reasons as before. For the third time, ORVprogramme started in 2010, when the autumn campaign of dropping baits was performed, while in 2011 two actions of dropping baits (spring and autumn) were performed on the entire area of the Republic of Croatia. The results of the oral rabies vaccination (ORV) program targeting foxes in the period 2010 – 2015 were outstanding: while there were 11.1% positive rabies isolates in domestic animals and wildlife in 2010, this number by 2015 was reduced to 0%. Therefore, the Office for Veterinary Affairs and Food Safety at the Ministry of Agriculture of the Republic of Croatia plans to proclaim the Republic of Croatia a rabies-free country in the year 2018

Ugrizi i ozljede od majmuna u Antirabičnoj ambulanti grada Zagreba u 2014. godini

Travelling around the world and visiting distant places and countries (especially national parks, parks of nature, natural resorts, etc.) sometimes may result in animal bites and injuries from the species which are not usually represented as the source of human rabies cases, such as monkeys. In the last ten to fifteen years, monkey bites and injuries present an unpleasant experience and cause a lot of problems for travelers and tourists when travelling to India, Thailand, Indonesia or Bali because they have to seek a medical facility for wound treatment, tetanus prophylaxis, antimicrobial therapy and rabies postexposure prophylaxis (PEP). In 2014, 706 persons were registered at the Zagreb Antirabies Clinic as having sustained bites by various animals, ten of them reported to have been bitten or injured by monkeys. Nine of them sustained injuries during their travel to India, Thailand, Indonesia and Bali. All injuries occurred when they wanted to pet or tried to feed monkeys, or refused to give them food. Most of the monkeys were macaques, capuchins, or of unknown type. Only one monkey bite recorded in the city of Zagreb occurred in the Zagreb ZOO while a professional animal handler was feeding a capuchin monkey in the cage. He did not receive rabies PEP, but instead, the capuchin monkey was put under veterinary supervision. All other patients started with PEP in the countries where the injuries occurred and continued/completed it at the Zagreb Antirabies Clinic. They received antirabies vaccine only (PVRV, RABIPUR) upon 5-dose regimen (Essen scheme) and 2-1-1 (Zagreb scheme) regimen. None of them contracted rabies. After many years, monkeys were the animal species immediately following dogs and cats in the official report of the Zagreb Antirabies Clinic, which was quite surprising. Usually, monkey bites and injuries do not present a serious problem in daily routine because they occur sporadically.Putovanje diljem svijeta i posjet udaljenim mjestima i zemljama (osobito nacionalnim parkovima, parkovima prirode, prirodnim rezervatima i slično) ponekad može rezultirati ugrizom i ozljedom životinjskih vrsta koje su rijetko izvor humanih slučajeva bjesnoće, kao što su majmuni. U posljednjih 10 do 15 godina ugrizi i ozljede nanesene od majmuna predstavljaju neugodno iskustvo i uzrokuju podosta problema, naročito putnicima koji putuju u Indiju, Tajland, Indoneziju ili Bali, budući da se zbog istih trebaju javiti u medicinsku ustanovu radi obrade rane, antitetanusne profilakse, antibiotske terapije i nerijetko postekspozicijske antirabične profilakse (PEP). U Antirabičnoj ambulanti Referentnog centra za bjesnoću pri Nastavnom zavodu za javno zdravstvo “Dr. Andrija Štampar” u 2014. godini zbog ugriza životinja pregledano je ukupno 706 osoba koje su ugrizle različite vrste životinja, među kojima je bilo registrirano 10 ozljeda zadanih od majmuna. Devetoro osoba zadobilo je ozljede od majmuna prilikom putovanja u Indiju, Tajland, Indoneziju i Bali. Sve ozljede dogodile su se dok su osobe željele gladiti i maziti majmune, pokušale ih hraniti ili im odbile dati hranu. U većini slučajeva radilo se o majmunima vrste makaki, kapucini ili nepoznate vrste majmuna. U jedinom slučaju ozljede od majmuna na području grada Zagreba radilo se o profesionalnom djelatniku Zagrebačkog zoološkog vrta koji je u kavezu hranio majmuna vrste kapucin. On, za razliku od ostalih pacijenata, nije primio postekspozicijsku antirabičnu profilaksu (PEP), nego je majmun stavljen pod veterinarski nadzor. Ostalih devetoro osoba započelo je PEP u zemljama gdje su se dogodile ozljede, a PEP su završile u Antirabičnoj ambulanti grada Zagreba. Pacijenti su primili PEP samo primjenom antirabičnog cjepiva na vero stanicama (PVRV) ili na supstratu pilećih fibroblasta (RABIPUR) prema 5-doznoj shemi (Essenska shema) i 2-1-1 shemi cijepljenja protiv bjesnoće (Zagrebačka shema). Nitko od tretiranih pacijenata nije razvio znakove bjesnoće. Nakon mnogo godina majmuni su životinjska vrsta koja se uz pse i mačke pojavila u službenom izvješću Antirabične ambulante grada Zagreba te zbog toga predstavljaju veliko iznenađenje. Obično ugrizi i ozljede od majmuna ne predstavljaju ozbiljan problem u svakodnevnom radu, jer se javljaju sporadično

Activities of the Reference Centre for Rabies and Antirabies Clinic of Dr. Andrija Štampar Institute of Public Health from 2008 to 2013

Bjesnoća je apsolutno smrtonosna bolest, bez obzira na nekoliko najnovijih slučajeva preživljavanja koja su opisana u literaturi. Zbog visoke smrtnosti od 55 000 slučajeva godišnje, virus bjesnoće nalazi se na osmom mjestu najsmrtonosnijih virusa u svijetu. Zbog te činjenice, bjesnoća je i dalje veliki javnozdravstveni problem pogotovo u slabije razvijenim zemljama Afrike i Azije. Bez dobro organizirane pomoći lokalnih zajednica, financijske potpore državnih ili drugih institucija ili organizacija te suradnje humane i veterinarske medicine, ova velika brojka smrtnih slučajeva, neće se početi smanjivati. Zadnji slučaj humane bjesnoće u Republici Hrvatskoj, dogodio se prije 50 godina, davne 1964. godine. Od tada su zabilježena dva importirana slučaja humane bjesnoće u Republici Hrvatskoj iz Bosne i Hercegovine, prvi 1989., te drugi 1995. godine. Referentni centar za bjesnoću obavlja niz aktivnosti na području humane antirabične zaštite te u tom segmentu surađuje s brojnim veterinarskim organizacijama, ustanovama i institucijama te koordinira rad županijskih zavoda za javno zdravstvo diljem Republike Hrvatske, a njegovi djelatnici sudjeluju u brojnim stručnim, nastavnim i edukacijskim aktivnostima. U razdoblju od 2008. do 2013. godine, u Republici Hrvatskoj pregledano je zbog sumnje na izloženost bjesnoći 32 697 osoba, od čega je njih 9 368 odnosno 28,6% primilo postekspozicijsku antirabičnu profilaksu (PEP) zbog ugriza, ogrebotine, kontakta sa slinom preko oštećene kože ili sluznica ili kontakta s domaćom ili divljom, bijesnom ili na bjesnoću sumnjivom životinjom ili kontaminiranim materijalom. Od navedenog broja u 8 668 osoba primijenjena je PEP samo s cjepivom protiv bjesnoće, dok je u 700 osoba primijenjena PEP u kombinaciji antirabičnog cjepiva i humanog antirabičnog imunoglobulina. U sklopu Referentnog centra za bjesnoću pri Nastavnom zavodu za javno zdravstvo "Dr. Andrija Štampar" nalazi se antirabična ambulanta, koja osim suradnje s veterinarskim organizacijama, obavlja preglede ugriženih osoba, upisuje ih u registar, izdaje medicinsku dokumentaciju te prema indikaciji obavlja PEP. U razdoblju od 2008. do 2013. godine pregledano je i obra|eno ukupno 3 690 pacijenata (2 094 muških i 1 596 ženskih), od čega je u 961 osoba (555 muških i 406 ženskih) postavljena indikacija za PEP. Ovi podaci odnose se na područje grada Zagreba. Ovdje nisu uključeni pacijenti s područja Zagrebačke županije koji su se od strane županijskih epidemiologa ciljano upućivali u našu ustanovu, radi pregleda te postavljanja indikacije za PEP.Rabies is an absolutely deadly disease, regardless of the few documented cases of survival, lately reported in the literature. Due to its deadly rate of 55 000 estimated deaths annually, rabies virus is eight among the world\u27s most deadly viruses. Having this in mind, rabies is still a major public health problem in less developed countries of Africa and Asia. Without well organised help of local communities, financial support of governmental or other institutions, and cooperation between human and veterinarian medicine, this number will not begin to decrease. The last case of human rabies in the Republic of Croatia was registered 50 years ago, in 1964. Apart from this, there were two imported human rabies cases reported in the Republic of Croatia, both from Bosnia and Herzegovina. The first one in 1989, and the second in 1995. The Reference Centre (RC) for Rabies is performing numerous activities in the area of human rabies protection, and therefore cooperates with many veterinary organisations, facilities and institutions and is supervising the antirabies activities of county public health institutes in the Republic of Croatia. The employees of the RC are included in numerous professional, teaching and educational activities. In the period from 2008 to 2013 in the Republic of Croatia, a total of 32 697 persons were examined after being in contact with various types of animals, of whom 9 368 (28,6%) received postexposure rabies prophylaxis (PEP) after being bitten, scratched, having contact with saliva against broken skin or mucous membranes or having contact with domestic or wild rabid or suspect rabid animal or having contact with contaminated material (such as fox bait with oral rabies vaccine /ORV/). Out of this number, 8 668 persons received PEP with antirabies vaccine only, while 700 persons received PEP with antirabies vaccine and human rabies immune globulin.At the Dr. Andrija Štampar Institute of Public Health, as part of the Reference Centre for Rabies, an Antirabies Clinic has been established. Apart from cooperating with veterinary organisations, the medical team in this ambulance is performing physical examination of bitten patients, collects and records data in the register, keeps and issues patient medical documentation, and performs PEP according to indications. In the period from 2008 to 2013, there were 3 690 examined patients (2 094 male and 1596 female) at Antirabies Clinic, of whom 961 persons (555 male and 406 female) received PEP based on medical indications. These data refer only to the region of the city of Zagreb. Patients who came to the Zagreb Antirabies Clinic from the Zagreb county were not included in this report because they were referred to our Clinic directly by the county epidemiologists

Activities of the Reference Centre for Rabies and Antirabies Clinic of Dr. Andrija Štampar Institute of Public Health from 2008 to 2013

Bjesnoća je apsolutno smrtonosna bolest, bez obzira na nekoliko najnovijih slučajeva preživljavanja koja su opisana u literaturi. Zbog visoke smrtnosti od 55 000 slučajeva godišnje, virus bjesnoće nalazi se na osmom mjestu najsmrtonosnijih virusa u svijetu. Zbog te činjenice, bjesnoća je i dalje veliki javnozdravstveni problem pogotovo u slabije razvijenim zemljama Afrike i Azije. Bez dobro organizirane pomoći lokalnih zajednica, financijske potpore državnih ili drugih institucija ili organizacija te suradnje humane i veterinarske medicine, ova velika brojka smrtnih slučajeva, neće se početi smanjivati. Zadnji slučaj humane bjesnoće u Republici Hrvatskoj, dogodio se prije 50 godina, davne 1964. godine. Od tada su zabilježena dva importirana slučaja humane bjesnoće u Republici Hrvatskoj iz Bosne i Hercegovine, prvi 1989., te drugi 1995. godine. Referentni centar za bjesnoću obavlja niz aktivnosti na području humane antirabične zaštite te u tom segmentu surađuje s brojnim veterinarskim organizacijama, ustanovama i institucijama te koordinira rad županijskih zavoda za javno zdravstvo diljem Republike Hrvatske, a njegovi djelatnici sudjeluju u brojnim stručnim, nastavnim i edukacijskim aktivnostima. U razdoblju od 2008. do 2013. godine, u Republici Hrvatskoj pregledano je zbog sumnje na izloženost bjesnoći 32 697 osoba, od čega je njih 9 368 odnosno 28,6% primilo postekspozicijsku antirabičnu profilaksu (PEP) zbog ugriza, ogrebotine, kontakta sa slinom preko oštećene kože ili sluznica ili kontakta s domaćom ili divljom, bijesnom ili na bjesnoću sumnjivom životinjom ili kontaminiranim materijalom. Od navedenog broja u 8 668 osoba primijenjena je PEP samo s cjepivom protiv bjesnoće, dok je u 700 osoba primijenjena PEP u kombinaciji antirabičnog cjepiva i humanog antirabičnog imunoglobulina. U sklopu Referentnog centra za bjesnoću pri Nastavnom zavodu za javno zdravstvo "Dr. Andrija Štampar" nalazi se antirabična ambulanta, koja osim suradnje s veterinarskim organizacijama, obavlja preglede ugriženih osoba, upisuje ih u registar, izdaje medicinsku dokumentaciju te prema indikaciji obavlja PEP. U razdoblju od 2008. do 2013. godine pregledano je i obra|eno ukupno 3 690 pacijenata (2 094 muških i 1 596 ženskih), od čega je u 961 osoba (555 muških i 406 ženskih) postavljena indikacija za PEP. Ovi podaci odnose se na područje grada Zagreba. Ovdje nisu uključeni pacijenti s područja Zagrebačke županije koji su se od strane županijskih epidemiologa ciljano upućivali u našu ustanovu, radi pregleda te postavljanja indikacije za PEP.Rabies is an absolutely deadly disease, regardless of the few documented cases of survival, lately reported in the literature. Due to its deadly rate of 55 000 estimated deaths annually, rabies virus is eight among the world\u27s most deadly viruses. Having this in mind, rabies is still a major public health problem in less developed countries of Africa and Asia. Without well organised help of local communities, financial support of governmental or other institutions, and cooperation between human and veterinarian medicine, this number will not begin to decrease. The last case of human rabies in the Republic of Croatia was registered 50 years ago, in 1964. Apart from this, there were two imported human rabies cases reported in the Republic of Croatia, both from Bosnia and Herzegovina. The first one in 1989, and the second in 1995. The Reference Centre (RC) for Rabies is performing numerous activities in the area of human rabies protection, and therefore cooperates with many veterinary organisations, facilities and institutions and is supervising the antirabies activities of county public health institutes in the Republic of Croatia. The employees of the RC are included in numerous professional, teaching and educational activities. In the period from 2008 to 2013 in the Republic of Croatia, a total of 32 697 persons were examined after being in contact with various types of animals, of whom 9 368 (28,6%) received postexposure rabies prophylaxis (PEP) after being bitten, scratched, having contact with saliva against broken skin or mucous membranes or having contact with domestic or wild rabid or suspect rabid animal or having contact with contaminated material (such as fox bait with oral rabies vaccine /ORV/). Out of this number, 8 668 persons received PEP with antirabies vaccine only, while 700 persons received PEP with antirabies vaccine and human rabies immune globulin.At the Dr. Andrija Štampar Institute of Public Health, as part of the Reference Centre for Rabies, an Antirabies Clinic has been established. Apart from cooperating with veterinary organisations, the medical team in this ambulance is performing physical examination of bitten patients, collects and records data in the register, keeps and issues patient medical documentation, and performs PEP according to indications. In the period from 2008 to 2013, there were 3 690 examined patients (2 094 male and 1596 female) at Antirabies Clinic, of whom 961 persons (555 male and 406 female) received PEP based on medical indications. These data refer only to the region of the city of Zagreb. Patients who came to the Zagreb Antirabies Clinic from the Zagreb county were not included in this report because they were referred to our Clinic directly by the county epidemiologists