A pilot sentinel surveillance system to monitor treatment and treatment outcomes of chronic hepatitis B and C infections in clinical centres in three European countries, 2019.

BackgroundThe World Health Organization European Action Plan 2020 targets for the elimination of viral hepatitis are that > 75% of eligible individuals with chronic hepatitis B (HBV) or hepatitis C (HCV) are treated, of whom > 90% achieve viral suppression.AimTo report the results from a pilot sentinel surveillance to monitor chronic HBV and HCV treatment uptake and outcomes in 2019.MethodsWe undertook retrospective enhanced data collection on patients with a confirmed chronic HBV or HCV infection presenting at one of seven clinics in three countries (Croatia, Romania and Spain) for the first time between 1 January 2019 and 30 June 2019. Clinical records were reviewed from date of first attendance to 31 December 2019 and data on sociodemographics, clinical history, laboratory results, treatment and treatment outcomes were collected. Treatment eligibility, uptake and case outcome were assessed.ResultsOf 229 individuals with chronic HBV infection, treatment status was reported for 203 (89%). Of the 80 individuals reported as eligible for treatment, 51% (41/80) were treated of whom 89% (33/37) had achieved viral suppression. Of 240 individuals with chronic HCV infection, treatment status was reported for 231 (96%). Of 231 eligible individuals, 77% (179/231) were treated, the majority of whom had received direct acting antivirals (99%, 174/176) and had achieved sustained virological response (98%, 165/169).ConclusionTreatment targets for global elimination were missed for HBV but not for HCV. A wider European implementation of sentinel surveillance with a representative sample of sites could help monitor progress towards achieving hepatitis control targets.

Digital technology and HIV, HCV and STI voluntary counselling and testing: good practice example from Croatia.

The aim of this paper is to introduce the digitalization process and its effects on better reach of the target population. Progress in the digitalization and e-health tools worldwide enables new opportunities in prevention, diagnostics and treatment for people living with HIV (PLHIV) and people in the risk of HIV infection, hepatitis C (HCV) and other sexually transmitted infections (STIs), especially in the context of the COVID-19 pandemic. The system already used for voluntary counselling and testing (VCT) at the CheckPoint Centre Zagreb run by the non-governmental organization (NGO) Croatian Association for HIV and Viral Hepatitis (CAHIV) was upgraded and adapted (due to the COVID-19 prevention epidemiological measures) and developed for implementation of the pilot project of feasibility and acceptability of home HIV self-testing (HIVST) among men who have sex with men (MSM) in Zagreb. A special feature of the HIVST mobile application enables an innovative approach in collecting clients' test result feedback. This paper presents the method of use digitalization of the VCT and HIVST activities to support and increase availability of screening testing. Described procedures of new technologies application in VCT services and preliminary results of the HIVST pilot project indicate that technology-delivered interventions can contribute and improve access and utilisation of HIV/STI prevention and care services.

The profile of scabies patients in Zagreb.

BACKGROUND: Scabies is a mandatory notifiable disease according to Croatian law. Due to an increased reports of scabies within a couple of years in Zagreb, we decided to present epidemiological characteristics of patients diagnosed with scabies in Zagreb. SUBJECTS AND METHODS: A retrospective survey was carried out in county Public Health Institute "Dr. Andrija Stampar" in Zagreb and analysis was performed for the period of 2010-2013 upon individual notifications on scabies cases. The patients are presented by sociodemographic data, diagnosis and treatment. RESULTS: In a 4 year period there were 246 scabies cases recorded in Zagreb. Cases have been registered in all quarters of the City. The highest incidence (50/100 000) was recorded in every child age group following by incidence of over 30/100 000 in elderly institutionalized in nursing homes. In almost two thirds of patients management of scabies has not been conducted in accordance to current guidelines. 10% of scabies cases were found in medical health personnel predominantly in those working in nursing homes and psychiatric wards. A small amount of cases 19 (8%) were infected outside Croatia; the majority of these cases 15 (78%) are registered within last two years. CONCLUSION: High percentage of scabies cases registered in nursing homes and psychiatric wards suggests that there is a need of raising awareness on scabies epidemiology and management by public health officers. Due to a higher incidence of scabies in children age, the obligation of medical practitioners is also to emphasize the importance of following treatment guidelines. In order to control scabies cases as well to prevent outbreaks within hospital wards or nursing homes there is an obligation of implementation of strict guidelines regarding treatment of scabies and a public health service referral.

Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis.

Background: Epidemiological data are crucial to monitoring progress towards the 2030 Hepatitis C Virus (HCV) elimination targets. Our aim was to estimate the prevalence of chronic HCV infection (cHCV) in the European Union (EU)/European Economic Area (EEA) countries in 2019. Methods: Multi-parameter evidence synthesis (MPES) was used to produce national estimates of cHCV defined as: π = πrecρrec + πexρex + πnonρnon; πrec, πex, and πnon represent cHCV prevalence among recent people who inject drugs (PWID), ex-PWID, and non-PWID, respectively, while ρrec, ρex, and ρnon represent the proportions of these groups in the population. Information sources included the European Centre for Disease Prevention and Control (ECDC) national operational contact points (NCPs) and prevalence database, the European Monitoring Centre for Drugs and Drug Addiction databases, and the published literature. Findings: The cHCV prevalence in 29 of 30 EU/EEA countries in 2019 was 0.50% [95% Credible Interval (CrI): 0.46%, 0.55%]. The highest cHCV prevalence was observed in the eastern EU/EEA (0.88%; 95% CrI: 0.81%, 0.94%). At least 35.76% (95% CrI: 33.07%, 38.60%) of the overall cHCV prevalence in EU/EEA countries was associated with injecting drugs. Interpretation: Using MPES and collaborating with ECDC NCPs, we estimated the prevalence of cHCV in the EU/EEA to be low. Some areas experience higher cHCV prevalence while a third of prevalent cHCV infections was attributed to PWID. Further efforts are needed to scale up prevention measures and the diagnosis and treatment of infected individuals, especially in the east of the EU/EEA and among PWID. Funding: ECDC.

Self-reported HPV vaccination status and HPV vaccine hesitancy in a nationally representative sample of emerging adults in Croatia.

Introduction: The aim of this study was to determine self-reported human papillomavirus (HPV) vaccination status among emerging adults in Croatia, intention to get the HPV vaccine among unvaccinated individuals and correlates of HPV vaccine hesitancy. Methods: Data were collected via a cross-sectional survey based on a probabilistic national sample. The sample included 1,197 individuals aged 18-25 years (50.6% were women) who were recruited from November 2021 to February 2022 as part of the commercial online panel. Analyses included 981 participants who correctly answered two "attention trap" questions using descriptive statistics and multivariate analyses. The data were post-hoc weighted for gender and age and adjusted for clustering effect. To adjust standard errors for the sampling design, multivariate analyses were carried out using the complex samples module in the IBM SPSS 27 statistical software package. Results: Overall, 18.3% of participants (25.0% of women and 11.7% of men) reported that they were HPV vaccinated, while 21.9% did not know their HPV vaccination status. Of those vaccinated, 65.6% were women. The odds of being HPV-vaccinated were significantly higher among female participants. Among the unvaccinated, 35.4% expressed a willingness to get the vaccine. The odds of vaccination hesitancy were significantly lower among women, participants who reported a higher perceived risk of STIs, those who recognized that HPV could result in cervical cancer, and significantly higher among those who were more religious. Conclusion: Our findings suggest a need to increase HPV vaccination uptake in Croatia through raising awareness about HPV vaccine effectiveness and also through the implementation of strategies to make vaccination more available.

Knowledge about and prevalence of Chlamydia trachomatis in a population-based sample of emerging Croatian adults.

To determine the prevalence of genital Chlamydia trachomatis (chlamydia) infection, knowledge about chlamydia and experience of previous testing for chlamydia, we carried out a national probability-based survey in emerging adults aged 18-25 years in Croatia in 2021-2022. Participants (n = 1197), members of a national online panel, completed a web-based questionnaire that collected information on socio-demographics, sexual behaviours and knowledge about sexually transmitted infections (STIs). Urine specimens from a sample of sexually experienced participants were self-collected and tested for chlamydia using Cobas 4800 CT/NG test. To achieve broad representativeness of the emerging adult population in the country, we applied post-hoc weighting for gender and age. Multivariable ordinary least squares linear regression was used to determine correlates of knowledge about chlamydia infection and binomial logistic regression to assess correlates of the willingness to test for chlamydia. Among 448 participants who sent in their urine specimens chlamydia prevalence was 2.5% (95% CI 1.2-5.1) in women and 1.0% (0.3-3.2%) in men. A total of 8.0% of women and 4.7% men reported testing for chlamydia prior to the survey. About a quarter of the sample was characterized by not answering correctly any of the six questions related to knowledge about chlamydia, while only 9.6% had five or six correct answers. In the multivariable analysis, significantly higher odds of willingness to test for chlamydia were found in females compared to males (OR = 1.34, p = 0.024), those with better knowledge about the infection (OR = 1.11, p = 0.005), and those with lower religiosity (OR = 0.91, p = 0.017). In conclusion, prevalence of chlamydia in emerging adults in Croatia is considerable. Efforts to control this infection should focus on primary prevention and targeted testing combined with effective case management strategies.

Tick-borne encephalitis outbreak following raw goat milk consumption in a new micro-location, Croatia, June 2019.

In June 2019, the Croatian Institute of Public Health was informed of a cluster of patients with laboratory confirmed tick-borne encephalitis (TBE) from the Gorski Kotar region. Five of the six patients with TBE reported consuming raw (unpasteurized) goat milk in the two week period before symptom onset, and one reported a recent tick bite. To assess risk factors for infection, we selected six control individuals from among healthy family and community members, and conducted a case-control analysis. None of the cases or controls were vaccinated against TBE. Individuals with TBE (cases) had 25 (95 % CI 0.8-1410.2, p = 0.021) times higher odds of raw goat milk consumption compared to healthy controls. Milk samples from 12 goats from the implicated farm were tested for the TBE virus (TBEV) using RT-PCR. TBEV RNA was not detected in the milk, but serological testing of goats and other farm animals yielded evidence of exposure to the virus: Six goats from the flock had TBEV neutralizing antibodies. Our findings suggest that the vehicle for the outbreak was raw goat milk from a single farm. Following public health advice to cease consumption of raw dairy products, no further cases have been reported.

Seroprevalence and Risk Factors for HIV, Hepatitis B, and Syphilis in Populations with High-risk Behaviors in Croatia.

HIV and sexually-transmitted diseases (STDs) represent a significant public health problem worldwide. We analyzed the seroprevalence and risk factors for HIV, hepatitis B and syphilis in populations with high-risk behaviors in Croatia. During a three-year period, a total of 443 men who have sex with men (MSM) / bisexual persons, sex workers (SW) / clients of SW, persons with multiple sexual partners, and persons with a history of STD were tested for the presence of HIV, hepatitis B virus (HBV), and Treponema pallidum (syphilis) antibodies within the framework of second generation HIV surveillance. Participants were recruited from 11 Croatian counties, the vast majority among clients of voluntary counselling and testing centers. The overall prevalence of HIV, HBsAg, anti-HBc, and syphilis was 1.4%, 2.6%, 12.1%, and 3.4%, respectively. HBV and syphilis seroprevalence differed significantly between, genders with higher prevalence among men (anti-HBc 13.8% vs. 5.7%, P=0.043; syphilis 4.4% vs. 0%; P=0.049), as well as between age groups, with a steady increase according to age. Participants with a history of STD were more often seropositive than participants who did not report STD (HBsAg 8.2% vs. 1.0%, P=0.002; anti-HBc 32.4% vs. 6.4%, P<0.001; syphilis 12.0% vs. 1.7%, P<0.001). Syphilis seroprevalence was higher in homo / bisexual persons (12.2%) compared with heterosexual persons (1.2%, P<0.001). Logistic regression showed that history of STD was a significant risk factor for hepatitis B (HBsAg AOR=6.229, 95% CI=1.491-26.022; anti-HBc AOR=5.872, 95% CI=2.899-11.896) and syphilis seropositivity (AOR=5.572, 95% CI=1.751-17.726), while homo / bisexual behavior was associated with syphilis seropositivity (AOR=12.820, 95% CI=3.688-44.557). Our results highlight the importance of continuing STDs screening and prevention in at-risk populations.

An overview of mosquitoes and emerging arboviral infections in the Zagreb area, Croatia.

Mosquito control in the Zagreb area has been conducted for many years, whereas the fauna has only been investigated in the last 20 years. So far 30 mosquito species have been detected in the city area. Culex pipiens form molestus is the dominant mosquito species in indoor breeding sites. In forested areas and areas exposed to flooding, the active period is early spring and the dominant species are Ochlerotatus sticticus, Ochlerotatus cantans, Ochlerotatus geniculatus and Aedes vexans. The eudominant mosquito species found in the artificial breeding sites are Culex pipiens and the Asian tiger mosquito, Aedes albopictus. Invasive Ae. albopictus, present in the Zagreb area since 2004, has expanded to a larger area of the city during the last three years. The recent emergence of the human West Nile virus and Usutu virus neuroinvasive disease in Zagreb and its surroundings highlighted the role of mosquitoes as vectors of emerging arboviruses. The paper focuses on mosquito species and arboviral infections detected in humans and animals in the Zagreb area, Croatia.

Repeat HIV testing at voluntary testing and counseling centers in Croatia: successful HIV prevention or failure to modify risk behaviors?

HIV testing plays a critical role in preventing the spread of the virus and identifying infected individuals in need of care. Voluntary counseling and testing centers (VCTs) not only conduct testing but they also provide counseling. Since a proportion of people who test negative for HIV on their previous visit will return for retesting, the frequency of retesting and the characteristics of those who retest may provide insights into the efficacy of testing and counseling strategies. In this cross-sectional, retrospective study of 1,482 VCT clients in Croatia in 2010, 44.3% had been tested for HIV before. The rate of repeat HIV testing is lower in Croatia than in other countries. Men who have sex with men (MSM) clients, those with three or more sexual partners in the last 12 months, consistent condom users with steady partners, and intravenous drug users were more likely to be repeat testers. This finding suggests that clients presenting for repeat HIV testing are those who self-identify as being at a higher risk of infection. Our data showed that testing positive for HIV was not associated with repeat testing. However, the effects of repeat testing on HIV epidemiology needs to be explored.