Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2013
Understanding the country-specific epidemiology of disease, which may vary greatly among countrie... more Understanding the country-specific epidemiology of disease, which may vary greatly among countries, is crucial for identifying the most appropriate preventive and control measures. An overview of the local epidemiology of viral hepatitis in Croatia is given in this paper. The overall prevalence of hepatitis B in Croatia is low (less than 2% HBsAg carriers in the general population). Hepatitis B incidence and prevalence began to decline significantly following the introduction of universal hepatitis B vaccination in 1999. Information on HBsAg seroprevalence is derived from routine testing of certain subpopulations (pregnant women, blood donors) and seroprevalence studies mostly targeted at high-risk populations. Universal childhood vaccination against hepatitis B remains the main preventive measure. We recommend testing for immunity one to two months after the third dose of hepatitis B vaccine for health-care workers. The incidence and prevalence of hepatitis C have also been declini...
Tuberculosis (TB) is the second most common contagious disease, caused by Mycobacterium tuberculo... more Tuberculosis (TB) is the second most common contagious disease, caused by Mycobacterium tuberculosis (M. tuberculosis). Besides a rare laryngeal tuberculosis, pulmonary tuberculosis is the only one contagious form of the disease, although it can affect any organ of the human body. TB represents a new challenge to the doctors because it appears with numerous chronic diseases, affects immunocompromised hosts, elderly people and because nonadequate therapy could create drug resistant tuberculosis. Early diagnosis of TB is fundamental for every tuberculosis control program. Before 2001 when QuantiFERON test was approved, tuberculin skin test (TST) was the only diagnostic test for detection of latent M. tuberculosis infection. In contrast of TST, which is in vivo test, the novel whole blood tests in vitro, so-called IGRA tests (QuantiFERON, Elispot.T-SPOT.TB) now exist. This paper presents advantages and disadvantages of both methods. IGRA tests are considered to have higher specifity an...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2004
Drug resistant and multidrug resistant tuberculosis is a consequence of human activity. Resistant... more Drug resistant and multidrug resistant tuberculosis is a consequence of human activity. Resistant strains of M. tuberculosis are mainly prevalent in regions with weak national TB programs or poor socioeconomic environment. Therefore an effective surveillance of the resistance patterns of TB bacilli is an essential tool for the quality of tuberculosis control programs and a demanding task in all countries. Surveillance of tuberculosis in Croatia is based on individual notifications of every newly diagnosed patient by the physicians, followed by laboratory notifications. Data are collected at the Epidemiology Service, National Institute of Public Health Tuberculosis Register (TR). TR is part of the World Health Organization informational system and Surveillance of Tuberculosis in Europe (EuroTB). The results of the ten-year surveillance of the prevalence of drug resistant (5.7%) and multidrug resistant (1.6%) tuberculosis show that Croatia has a favorable situation which should be kep...
The last comprehensive publication on tuberculosis in Croatia and the earliest impact of war, bes... more The last comprehensive publication on tuberculosis in Croatia and the earliest impact of war, besides the yearly routine reports, was done in 1996 in Croatian. We were, therefore, interested to explore incidence trends and to highlight the early post-war tuberculosis epidemiological patterns in the next ten years period (1996-2005). A retrospective analysis of epidemiological data on all registered tuberculosis cases in Croatia searching the databases of 21 Croatian Public Health Institutes and the National Tuberculosis Registry was made. During the study period, the total tuberculosis incidence rates in Croatia dropped from 45 to 25.8/100 000 inhabitants. The average highest age-specific rates were recorded in the age group > or = 65 years being in decrease in all age groups. Paediatric cases (0-14 years) represented 4.5% of all cases. Tuberculosis cases among males were recorded in 64% cases, and 83.6% were indigenous population. Tuberculosis was bacteriologically confirmed in ...
In this paper legal prerequisites for vaccine licensure in Croatia are discussed. The Croatian le... more 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.
This paper describes an action framework for countries with low tuberculosis (TB) incidence (<... more This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to t...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2013
Understanding the country-specific epidemiology of disease, which may vary greatly among countrie... more Understanding the country-specific epidemiology of disease, which may vary greatly among countries, is crucial for identifying the most appropriate preventive and control measures. An overview of the local epidemiology of viral hepatitis in Croatia is given in this paper. The overall prevalence of hepatitis B in Croatia is low (less than 2% HBsAg carriers in the general population). Hepatitis B incidence and prevalence began to decline significantly following the introduction of universal hepatitis B vaccination in 1999. Information on HBsAg seroprevalence is derived from routine testing of certain subpopulations (pregnant women, blood donors) and seroprevalence studies mostly targeted at high-risk populations. Universal childhood vaccination against hepatitis B remains the main preventive measure. We recommend testing for immunity one to two months after the third dose of hepatitis B vaccine for health-care workers. The incidence and prevalence of hepatitis C have also been declini...
Tuberculosis (TB) is the second most common contagious disease, caused by Mycobacterium tuberculo... more Tuberculosis (TB) is the second most common contagious disease, caused by Mycobacterium tuberculosis (M. tuberculosis). Besides a rare laryngeal tuberculosis, pulmonary tuberculosis is the only one contagious form of the disease, although it can affect any organ of the human body. TB represents a new challenge to the doctors because it appears with numerous chronic diseases, affects immunocompromised hosts, elderly people and because nonadequate therapy could create drug resistant tuberculosis. Early diagnosis of TB is fundamental for every tuberculosis control program. Before 2001 when QuantiFERON test was approved, tuberculin skin test (TST) was the only diagnostic test for detection of latent M. tuberculosis infection. In contrast of TST, which is in vivo test, the novel whole blood tests in vitro, so-called IGRA tests (QuantiFERON, Elispot.T-SPOT.TB) now exist. This paper presents advantages and disadvantages of both methods. IGRA tests are considered to have higher specifity an...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2004
Drug resistant and multidrug resistant tuberculosis is a consequence of human activity. Resistant... more Drug resistant and multidrug resistant tuberculosis is a consequence of human activity. Resistant strains of M. tuberculosis are mainly prevalent in regions with weak national TB programs or poor socioeconomic environment. Therefore an effective surveillance of the resistance patterns of TB bacilli is an essential tool for the quality of tuberculosis control programs and a demanding task in all countries. Surveillance of tuberculosis in Croatia is based on individual notifications of every newly diagnosed patient by the physicians, followed by laboratory notifications. Data are collected at the Epidemiology Service, National Institute of Public Health Tuberculosis Register (TR). TR is part of the World Health Organization informational system and Surveillance of Tuberculosis in Europe (EuroTB). The results of the ten-year surveillance of the prevalence of drug resistant (5.7%) and multidrug resistant (1.6%) tuberculosis show that Croatia has a favorable situation which should be kep...
The last comprehensive publication on tuberculosis in Croatia and the earliest impact of war, bes... more The last comprehensive publication on tuberculosis in Croatia and the earliest impact of war, besides the yearly routine reports, was done in 1996 in Croatian. We were, therefore, interested to explore incidence trends and to highlight the early post-war tuberculosis epidemiological patterns in the next ten years period (1996-2005). A retrospective analysis of epidemiological data on all registered tuberculosis cases in Croatia searching the databases of 21 Croatian Public Health Institutes and the National Tuberculosis Registry was made. During the study period, the total tuberculosis incidence rates in Croatia dropped from 45 to 25.8/100 000 inhabitants. The average highest age-specific rates were recorded in the age group > or = 65 years being in decrease in all age groups. Paediatric cases (0-14 years) represented 4.5% of all cases. Tuberculosis cases among males were recorded in 64% cases, and 83.6% were indigenous population. Tuberculosis was bacteriologically confirmed in ...
In this paper legal prerequisites for vaccine licensure in Croatia are discussed. The Croatian le... more 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.
This paper describes an action framework for countries with low tuberculosis (TB) incidence (<... more This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to t...
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Papers by Aleksandar Simunović