ABSTRACT
INTRODUCTION: The objective was to present the results of surveillance of prion diseases in Slovenia that was established in 1996 and then to assess the interdisciplinary approach according to the algorithm of case management and reporting data to the National Register at the National Institute of Public Health. METHODS: A descriptive study of Creutzfeldt-Jakob disease (CJD) recorded in the period from 1996 to 2017 was carried out. RESULTS: A total of 123 cases of prion disease were notified between 1996 and 2017. Out of these, 68 were recorded and confirmed by autopsy as sporadic CJD with an average incidence rate of 1,5 cases per million population per year. In one case a gene analysis showed mutation E200K in prion protein gene, PRNP. Two cases of the Gerstman-Sträussler Scheinker syndrome and one clinical case of fatal insomnia with new PRNP mutation, N181S, were notified. Diagnostic value of protein 14-3-3 analysis in the liquor reached 82% sensitivity and 71% specificity. 25 cases of notified clinically possible/probable CJD were disproved after autopsy. In eleven notified possible CJD cases the autopsy had not been performed. Variant CJD has not yet been proven in Slovenia. CONCLUSION: Incidence rates were comparable with other European countries. Completeness of reporting and proper management of CJD cases according to the algorithm of reporting, management and case confirmation would need some improvement. A well-functioning surveillance system, including timely notifications, would enable an appropriate epidemiological investigation and an effective response to public health risks, thus the awareness of prion diseases should not decline.
ABSTRACT
BACKGROUND: Lyme borreliosis disease results from infection by members of the Borrelia burgdorferi sensu lato complex. The most common clinical presentation of Lyme borreliosis is erythema migrans (EM). To gain knowledge of the epidemiological parameters and the risk factors of EM in Slovenia, a survey has been carried out in 2010. METHODS: A short anonymous and self-administrated questionnaire was sent to 4917 notified EM patients in 2010, aiming to collect epidemiological data and assess socio-economic determinants in patients with EM. RESULTS: Three thousand and five (61%) patients with EM returned completed questionnaires. One thousand and nine hundred twenty-nine (74%) patients noted the tick where the EM developed. The tick bite was most often located on the legs in adults and in the head/neck area in children. The time that elapsed before the tick has been removed increased significantly with age. The attached tick was most frequently overlooked in preschool children. Nearly 70% of patients believed that they contracted the infection with borrelia near home. Infection away from their permanent residence was more often the case in those with a higher level of education and in 15-49 age groups. Compared to the Slovenian general population over 14 years of age, those with a higher level of education, the unemployed and farmers were overrepresented among the EM patients. CONCLUSIONS: The risk of Lyme borreliosis is widespread in Slovenia, with some areas more affected then others. Determinants of exposure to infected ticks are different, and depend on the socio-economic status and demographic characteristics.
ABSTRACT
There has been a marked increase in the incidence of tick-borne encephalitis (TBE) in the last two decades, with new foci of the disease evolving. TBE is endemic in Slovenia, and the incidence rate is one of the highest in the European Union. A survey of notified TBE cases started in 1999, aiming to collect additional epidemiological data that are not available through the usual notification system. From 1999 to 2009, a short, anonymous, self-administered questionnaire was sent to 2779 notified TBE cases. The response rate was 69.5%. The willingness to respond was higher in those over 60 years of age, but did not differ by gender. In all, 1564 (82.3%) of the responders had a tick bite on one or multiple sites on the body. Age and gender influenced the location of the tick bite: males patients most often had the tick located on the torso, and females had them on the legs. Ticks located on the head and neck were significantly higher in preschool children compared to school children and adults. The estimated duration of tick attachment was less than 6 h in 23.5% of TBE cases. Long attachments (more than 24 h) were reported by only 10% of the patients. The tick bite occurred while the TBE patients were engaged in leisure time activities (sports or camping, 32.8%), mushroom or berry picking (30.2%), or farming (23.3%). Almost two-thirds of TBE patients reported that they had practiced at least one of the recommended preventive measures, most frequently self-inspection, and least often repellent use. The patients were asked to disclose the most probable geographical location of the TBE viral (TBEV) infection. Maps were created on a county level and showed that the risk of TBE is widespread, with few counties unaffected. The counties located in the northern and the central areas had the highest risk of TBEV infection.
