Simultaneous chickenpox and measles infection among migrant children who stayed in Italy during the second half of June 2011.

We are reporting on a household outbreak of measles, in which cases of simultaneous measles and chickenpox infection occured in children of a family who resided in Italy during the incubation period (June 2011). In three children, fever and generalized confluent macular rash were the dominant symptoms. Serology testing revealed simultaneous measles and chickenpox infection in four children.

[Prevalence of hepatitis B, hepatitis C and HIV among injecting drug users treated outpatiently and in therapeutic community in Brod-Posavina County, Croatia]. / Usporedba prevalencije biljega hepatitisa B, C i HIV-A medu intravenskim ovisnicima lijecenima ambulantno i u terapijskoj zajednici na podrucju Brodsko-posavske zupanije.

Blood transmitted diseases (hepatitis B, hepatitis C, HIV) are major public health problems. Drug users, especially injecting drug users (IDU), are by nature of their illness, a risk population for these diseases. The aim of the study was to determine the prevalence of blood transmitted diseases among IDU in the Brod-Posavina County due to shared use of needle/syringe in outpatients and those treated in a therapeutic community, and to compare the results obtained. First, we analyzed data separately for hepatitis B and C, and then we selected patients with coinfection. The prevalence of HBsAg positive patients in both groups was significantly lower than the prevalence among drug addicts in Croatia (1.16% and 3.28% vs. 13.2%). Significant correlation was found in outpatients with anti-HBs+anti-HBc antibody (p < 0.05) between those who shared needles/syringes and those who did not. Significant correlation was also found among patients treated at therapeutic community (p < 0.01). Comparing the patients treated as outpatients and in therapeutic community, significant correlation was only found between vaccinated patients. HCV positive outpatients had lower and drug addicts in therapeutic communities significantly higher prevalence as compared with the prevalence of HCV among addicts in Croatia (41.86% and 60.66% vs. 44.6%). A significant correlation between those who shared needles/syringes and those who did not was found in both outpatients and patients treated in therapeutic community (P < 0.01). Comparison of HCV positive patients treated as outpatients and those in therapeutic community also yielded significant correlation (p < 0.05). The prevalence of HBV/HCV coinfection was similar in both groups of patients. Significant correlation (P < 0.05) was only found in the group of patients with anti HBC/anti HCV antibodies. There was no HIV-positive patient in any group. We also found a low prevalence of HBsAg/anti-HCV in both groups of patients (1.16% and 2.46%). Upon establishing a network of centers for the treatment of addicts, constant work on prevention and education, systematic testing and vaccination, and implementation of harm reduction programs, we noticed a trend of reducing the number of people with HBV and HCV in the younger population of addicts.

[Epidemiologic characteristics of endemic nephropathy in Croatia in 2005]. / Epidemioloske osobitosti endemske nefropatije u Hrvatskoj 2005. Godine.

INTRODUCTION: Endemic nephropathy (EN) is chronic renal disease of unknown etiology, characterized with ominous onset and progressive clinical course. It occurs in rural areas in values of tributaries of the river Danube. According to the census from 2001, 10865 farmers live in Croatian endemic focus, i. e. 14 villages in Brod Posavina County. Apart from kidney impairment, high incidence of urothelial cancers is a hallmark of EN. Due to this, most agents that have been investigated were nephrotoxic and carcinogen. PARTICIPANTS AND METHODS: In the last 25 years approximately 70% of 13 Croatian endemic villages' inhabitants were examined following WHO criteria. In spring 2005, 1081 inhabitants of 3 endemic villages (Kaniza, Bebrina, Banovci) and control village of Klakar were examined using the same criteria, and persons were divided as follows: diseased of EN, suspect of having EN, at risk for EN and others. RESULTS: In the group of 1081 persons, we found 25 diseased of EN (12 men and 13 women): Bebrina 11, Banovci 9, Kaniza 5 (chi2 = 8.06; p < 0.05). Prevalence of EN in Kaniza was 0.6%, Bebrina 2.1% and Banovci 2.3%, while prevalence of suspect of EN was 1.7%, 6%, 6%, respectively. One fifth of inhabitants were at risk of having EN. CONCLUSION: This epidemiologic survey that was conducted in spring 2005 found out that prevalence of EN in Croatia is approximately the same as it was in the last decades. Apart from renal impairment, high incidence of urothelial cancers is characteristic of EN in this region. In addition to medical and scientific, we will need social and political help in elucidating the etiology of EN as well as in improving treatment and cure of this poor rural population.

[An epidemic of hemorrhagic fever with renal syndrome at the therapeutic community for treatment of psychoactive drug dependence in Ivanovac]. / Epidemija hemoragijske vrucice s bubreznim sindromom u Zajednici lijecenih ovisnika o psihoaktivnim drogama u Ivanovcu.

GOAL: The outbreak of hemorrhagic fever with renal syndrome (HFRS) at the Ivanovac Drug Therapeutic Community near Nova Gradiska was analyzed. The major epidemiologic, clinical and serologic findings are presented. PATIENTS AND METHODS: During the HFRS outbreak, serum samples were obtained from 31 men from the Community and analyzed by ELISA IgM and IgG tests for Puumala (PUUV) and Dobrava (DOBV) viruses. The main epidemiologic and clinical data were analyzed. RESULTS: At the beginning of March 2002, a-30-year-old male from the Community developed severe clinical picture of HFRS with fulminant systemic hemorrhage, acute renal failure and consecutive death. IgM antibodies to DOBV were detected. HFRS was serologically confirmed in 15 subjects in total. All others were infected with PUUV. During the mild and dry winter, the Community members cut bushes, collected trash, branches and dry leaves near the beech-wood forest border to prepare that part of the field as a garden. They observed a number of rodents, their nests and holes. Most of the patients developed mild to moderate clinical picture with fever, headache, backache, myalgia, abdominal pain, melena, oliguria, polyuria, epistaxis, and conjunctival injection. Hepatitis B (HBV) and/or C (HCV) infection was recorded in 58.1% of Community members. Interestingly, 86.7% of the HFRS patients were HBV and/or HCV positive. CONCLUSIONS: This is the first HFRS outbreak described among drug addicts in Europe, mostly caused by PUUV. Further studies are needed to identify additional risk factors that may contribute to hantavirus infection among drug addicts in HFRS endemic regions in Croatia as well as in Europe.