Measles cases in Split-Dalmatia County (a Croatian tourist region), in May-July 2019: outbreak report and lessons learnt.

BACKGROUND: Measles elimination was accomplished in Croatia in 2016. Split-Dalmatia County, with population of ca. 425 000 inhabitants, is among the most important Croatian tourist areas with numerous seasonal workers coming during summer months. In both 2018 and 2019, more than 3 million tourists visited this county. In 2000-2018, there were no measles cases in this county, or their number was low (1-3 cases per year). METHODS: After measles was clinically suspected, all contacts were traced and contacted. Detection of specific IgM/IgG antibodies and real-time reverse transcription-polymerase chain reaction detection of viral RNA were used for laboratory confirmation. Sequencing and genotyping were performed for strains' molecular epidemiology analysis. RESULTS: Six epidemiologically unlinked measles virus occurrences happened in Split-Dalmatia County in 15 May-19 July 2019. Causative viral strains belonged to genotypes B3 and D8. Four were single imported cases. Ten patients belonged to two separate clusters within domicile population. Multiple individual and public health measures were implemented. In total, 483 contacts were identified, 64.2% within healthcare system where two persons contracted the disease. CONCLUSIONS: Besides the importance of timely vaccination of children, the lessons learned from this outbreak point to the need of stricter implementation of other aspects of Croatian measles prevention programme, such as checking of vaccination status in early adulthood. Despite the fact that measles elimination within domicile population in this tourist region has been accomplished and maintained for years, continuous public health workers' efforts are still necessary for identification and diminishment of populational pockets of susceptibility.

Vaccine regulations in Croatia.

In this paper legal prerequisites for vaccine licensure in Croatia are discussed. The Croatian legislation concerning vaccine licensing, marketing authorisation and utilization is reviewed. The procedures for including a vaccine into the Mandatory Childhood Vaccination Programme are also discussed with focus on Human papillomavirus (HPV) vaccines. Non-obligatory vaccination recommendations are given when according to professional opinion; vaccination is beneficial for the vaccinee. There is little doubt that HPV vaccines should be recommended for preadolescent girls in Croatia. However, reaching a decision on its possible introduction into the Childhood Vaccination Programme will require careful consideration of the larger picture and a comparison of the cost-effectiveness of a mandatory vaccination against other competing public health priorities.

Health care relief to neighbors: Split University Hospital during the 1991-1995 war in Bosnia and Herzegovina.

AIM: To assess the workload of the Split University Hospital during the war and its role in providing help to the neighboring countries. METHODS: We reviewed all available records of patients admitted to the four (out of 15) departments: General Surgery, Traumatology, Dermatovenerology, and Pulmonology. The files of 37,821 patients (78% of total number) treated during 1990-1995 were analyzed. RESULTS: The workload of the hospital paralleled the political crisis in Bosnia and Herzegovina (BH) -- the number of patients from BH increased more than 10-fold between 1990 and 1993, including during the time of armed conflict between BH Croats and Bosniaks (1993-94). Among them, there were 84% of ethnic Croats and 16% of ethnic Bosniaks. The hospital spent US$6.2 million (18% of total costs) on the treatment of BH citizens. Approximately two thirds of BH citizens (62%) were treated at one of the surgical departments, and approximately one third of Bosniak patients were young males, admitted for treatment of war-related injuries. CONCLUSION: The Split University Hospital took a large burden of managing BH citizens, despite the armed conflict of Bosnian Croats and Bosniaks, indicating the high professionalism of the hospital staff and management. Such attitude can contribute to peace and post-war reconciliation in the region.