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Eva Grilc

Epidemiološko Spremljanje Črevesnih Nalezljivih Bolezni v Sloveniji Od Leta 1999 Do Leta 2009

Uvod: Epidemiološko spremljanje črevesnih nalezljivih bolezni (ČNB) v Sloveniji temelji na zakonsko obvezni prijavi ČNB, ki jo določata Zakon o nalezljivih boleznih (Ur. l. RS, št. 33/2006, prečiščeno besedilo) in Pravilnik o prijavi nalezljivih bolezni in posebnih ukrepih za njihovo preprečevanje in obvladovanje (Ur. l. RS, št. 16/99).

Metode: Na osnovi prijavljenih primerov smo ocenili epidemiološko situacijo glede ČNB v Sloveniji od leta 1999 do leta 2009.

Rezultati: V Sloveniji smo v letih 1999-2009 zaznali porast incidence vseh ČNB, vključno bakterijske, virusne in neznane etiologije. Incidenca vseh ČNB v letu 2009 je v primerjavi z incidenco leta1999 kljub zmanjšanju incidence bakterijskih ČNB narasla za 61 %. Povečale so se incidence virusnih enteritisov: incidenca rotavirusnih enteritisov za 80 %, incidenca norovirusnih enteritisov za 360 %. V nasprotju z virusnimi enteritisi se je incidenca bakterijskih gastroenterokolitisov (GEK) zmanjšala. Najbolj se je zmanjšala incidenca salmonelnih GEK, za 71 %, E.coli za 53 % in kampilobaktrskih za 32 %. Povprečna incidenca vseh ČNB v letih 1999-2009 je znašala 536/100.000 prebivalcev.

Zaključki: Prijave ČNB zajemajo približno četrtino vseh prijav nalezljivih bolezni in ostajajo pomemben javnozdravstveni problem pri nas.

Open access

Eva Grilc and Maja Sočan

Abstract

Background: The assessment of the incidence of acute gastrintestinal infections (AGI) derived from the notifications underestimates the real burden of AGI. The symptoms of AGI are usually not severe enough for consultation with a physician. The more exact data on the burden of AGI are gained through cross sectional population-based studies. To estimate the burden of AGI in Slovenia, a period prevalence study was conducted.

Methods: A simple random sample consisting of 5000 Slovenian inhabitants was chosen to whom a questionnaire was sent in July 2011. The participants were asked if they experienced AGI in June 2011 according to a symptombased case definition. The participants were asked to fill in the questionnaire on a paper or via a web page created for study purposes.

Results: Out of 5000 participants, 1500 filled out the questionnaire, giving a response rate of 33%. The number of women responding out-numbered men - there were 58% female and 42% male responders. 66 (4.4%) of the responders claimed to have had AGI in June 2011. The incidence rate of acute AGI was therefore 4400 per 100,000 inhabitants. Comparatively, the incidence rate of notified cases in the same month was 78.9 per 100,000 inhabitants. The difference between the incidence of AGI, based on notified cases and incidence, calculated in the first Slovenian cross sectional study, showed that one out of 56 cases of AGI in the community has been notified.

Conclusion: the incidence of AGI among the Slovenian population, based on data from our cross sectional study, is as expected higher than the incidence calculated from notification data from the same period.

Open access

Veronika Učakar, Eva Grilc and Irena Jeraj

An investigation of a waterborne outbreak caused by microbiological contamination of the drinking water supply system

Background: An outbreak of acute gastroenteritis occurred in March and April 2010 in the town of Mengeš where drinking tap water was contaminated, affecting an area with 3000 residents. The aim was to assess the extent of the outbreak, identify the etiological agents and test the hypothesis that drinking unboiled water from the distribution system was the vehicle for the outbreak, and if necessary to initiate appropriate control measures.

Methods: A retrospective cohort study including 160 randomly selected households (20% of the affected residents) was conducted. A case was a resident of Mengeš developing either diarrhoea, vomiting or abdominal pain.

Results: The overall attack rate was 31.3%. The epidemic curve showed a clear peak in the number of cases suggesting a common point source exposure. Residents who consumed unboiled tap water were 4.8 times (95% CI 0.7-32.7) more likely to become ill than the non-exposed. Drinking unboiled water, brushing teeth and eating raw fruit and vegetables washed with unboiled tap water was associated with gastroenteritis (RR 3.1 (CI 95% 1.5-6.5), 3.1 (CI 95% 1.2-8.1) and 2.3 (CI 95% 1.2-4.3)). There was a dose-response relationship between the volume of unboiled tap water drunk and the attack rate among the residents. Norovirus and Rotavirus were detected in the water samples, as well as in stool samples from the cases.

Conclusion: The results suggest that the vehicle of transmission was contaminated drinking water. Residents of affected area were advised to temporarily boil tap water. Because of continuous problems with water from the distribution system, building a new one from other water sources was considered.

Open access

Eva Grilc, Ivanka Gale, Aleš Veršič, Tina Žagar and Maja Sočan

Abstract

Introduction. Even brief episodes of fecal contamination of drinking water can lead directly to illness in the consumers. In water-borne outbreaks, the connection between poor microbial water quality and disease can be quickly identified. The impact of non-compliant drinking water samples due to E. coli taken for regular monitoring on the incidence of notified acute gastrointestinal infections has not yet been studied.

Methods. The objective of this study was to analyse the geographical distribution of notified acute gastrointestinal infections (AGI) in Slovenia in 2010, with hotspot identification. The second aim of the study was to correlate the fecal contamination of water supply system on the settlement level with the distribution of notified AGI cases. Spatial analysis using geo-information technology and other methods were used.

Results. Hot spots with the highest proportion of notified AGI cases were mainly identified in areas with small supply zones. The risk for getting AGI was drinking water contaminated with E. coli from supply zones with 50-1000 users: RR was 1.25 and significantly greater than one (p-value less than 0.001).

Conclusion. This study showed the correlation between the frequency of notified AGI cases and noncompliant results in drinking water monitoring.