engleski

Hemorrhagic fever with renal syndrome in Croatia - what are the news and what have we learned?

Since year 1952 when the first patient with hemorrhagic fewer with renal syndrome (HFRS) was diagnosed, the disease has been regularly reported in Croatia. Until 1995 it has appeared sporadically, and only two smaller epidemics (Plitvice Lakes in 1967, and Kobilić, near Airport Zagreb in 1989) were recorded. In 1995 occurred the first large epidemic of HFRS with 125 patients at several localities (Mala Kapela and Dinara mountains, west Slavonia). Finally, the largest epidemic of HFRS ever recorded in Croatia, with more than 4000 patients, occurred in the year 2002. The epidemic started in early spring, lasted thorough spring and summer and ended in November. During the 50-year experience in HFRS surveillance, we have learned a lot about causative types of hantaviruses, epidemiological and ecological data, and clinical presentations. The largest epidemic confirmed our previous assumption that Croatian territory as a whole, except its narrow coastline area and islands, is a natural focus of HFRS. Two different types of hantaviruses (Puumala, Dobrava) were found, both of them being polyhostal. We made and evaluated Croatian scale for assessing the disease severity. The patients are divided into groups: mild, moderate, severe, and very severe. Statistical analysis showed that a significant number of patients (p<0.01) with Puumala infection have moderate (p<0.001), and severe or very severe (p<0.01) disease. Conventional chest radiography revealed abnormal findings (interstitial infiltrate, pleural effusion, atelectasis) in nearly 30% patients. Efforts should be made to conduct a comprehensive ecological and epidemiological studies on hantaviruses and their biologic characteristics in these areas.

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