Search

Neuroinvasive flaviviruses such as tick-borne encephalitis virus (TBEV) and West Nile virus (WNV) are widely distributed in continental Croatian regions. We analyzed clinical characteristics, laboratory parameters, and molecular epidemiology of neuroinvasive flavivirus infections in eastern Croatia. A total of 43 patients with confirmed flavivirus infection hospitalized from 2017 to 2023 were included in the study. Reverse-transcription polymerase chain reaction (RT-qPCR) was used to detect flavivirus RNA in clinical samples (cerebrospinal fluid; CSF, urine). ELISA was used for IgM and IgG antibody detection in serum and CSF with confirmation of cross-reactive samples by virus neutralization test. WNV was detected more frequently (74.4%) than TBEV (25.6%). A statistically significant age difference was found between WNV patients (median 65 years) and TBEV patients (median 36 years). Comorbidities were more frequently detected in WNV patients (hypertension 56.3 vs. 18.2%; diabetes 31.3 vs. 0%). Meningitis was the most common clinical presentation in both TBE and WNV neuroinvasive disease (WNND; 63.6 and 59.4%, respectively). In addition, some rare clinical presentations of WNND were also detected (cerebellitis, polyradiculoneuritis). No significant differences in the frequency of clinical symptoms were observed between WNV and TBEV-infected patients (fever 93.7 vs. 100%; malaise 78.1 vs. 100%; headache 75.0 vs. 100%; nausea 50.0 vs. 63.6%; vomiting 34.4 vs. 54.6%). Comparative analysis of total and differential leukocyte blood count showed similar results. However, CSF pleocytosis was higher in TBE patients, with a significant difference in the neutrophil and lymphocyte count (WNND median 48.5% and 51.5%; TBE median 10.0 and 90.0%, respectively). The length of hospital stay was 12 days for WNND and 9 days for TBE. Phylogenetic analysis of detected WNV strains revealed the presence of WNV lineage 2 in eastern Croatia. [ABSTRACT FROM AUTHOR]

Bacillus anthracis is a well-known zoonotic pathogen that can cause disease in both animals and humans. Moreover, it has a high bioterrorism potential as its lethal spores are resistant to inactivation, are easy to produce in large quantities, and are easily spread over large areas. Anthrax cases occur in different parts of the world, including most European countries. Specific areas of Croatia are long known as anthrax districts, but with sporadically reported cases over the years. Here, we present a major outbreak of animal and human anthrax in the region of Lonjsko Polje in Croatia, a region not known to have anthrax cases in the past. The outbreak started in July 2022 and lasted several months, but most human and animal cases were reported in the first month. During the outbreak, there were 17 reported human cases of cutaneous anthrax and 29 laboratory-confirmed animal cases. However, due to issues in reporting in animals and the late finding of the carcasses, which made laboratory diagnostics challenging, the actual number of animal cases was probably significantly higher. [ABSTRACT FROM AUTHOR]

In this article, we report on a rare case of acute respiratory distress syndrome (ARDS) caused by the Puumala orthohantavirus (PUUV), which is typically associated with hemorrhagic fever with renal syndrome (HFRS). This is the first documented case of PUUV-associated ARDS in Southeast Europe. The diagnosis was confirmed by serum RT-PCR and serology and corroborated by phylogenetic analysis and chemokine profiling. The patient was a 23-year-old male from Zagreb, Croatia, who had recently traveled throughout Europe. He presented with fever, headache, abdominal pain, and sudden onset of ARDS. Treatment involved high-flow nasal cannula oxygen therapy and glucocorticoids, which resulted in a full recovery. A systematic literature review identified 10 cases of hantavirus pulmonary syndrome (HPS) caused by PUUV in various European countries and Turkey between 2002 and 2023. The median age of patients was 53 years (range 24–73), and six of the patients were male. Most patients were treated in intensive care units, but none received antiviral therapy targeting PUUV. Eight patients survived hospitalization. The presented case highlights the importance of considering HPS in the differential diagnosis of ARDS, even in areas where HFRS is the dominant form of hantavirus infection. [ABSTRACT FROM AUTHOR]

Background: Due to rapid spread, the Omicron variant has become the dominant SARS-CoV-2 variant responsible for infections worldwide. We present the first detection of the Omicron variant in Croatia which resulted in rapid cross-border spreading. Methods: Whole-genome sequencing was performed using the Illumina MiniSeq sequencing system. SARS-CoV-2 lineages were identified using the PANGOLIN and GISAID databases. Results: The first case of the Omicron variant (BA.1.17) emerged in Croatia after a workshop held in Zagreb in November 2021. The patient reported a history of previous COVID-19 and received two doses of an mRNA vaccine. Three additional cases were detected among Croatian participants of the workshop. At the beginning of December, SARS-CoV-2 infection was confirmed in one participant from Montenegro and her husband. Phylogenetic analysis showed that the detected Omicron variants were closely related to the first Croatian case, confirming the connection with the workshop outbreak and rapid cross-border spreading. Subsequent analyses of SARS-CoV-2 positive samples in Croatia showed the rapid introduction of the Omicron variant and depletion of the Delta variant resulting in the fifth pandemic wave. Conclusions: Genomic monitoring and early detection of novel SARS-CoV-2 variants are essential to implement timely epidemiological interventions and reduce further transmission in the population. [ABSTRACT FROM AUTHOR]

Copyright of Croatian Journal of Infection / Infektoloski Glasnik is the property of Croatian Society for Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The most important use of serology in the COVID-19 diagnostics is for determination of the extent of disease in the population. However, immunoassays could represent an additional diagnostic method, especially in patients with exposure history and clinical symptoms compatible with COVID-19 who failed to be confirmed by RT-PCR. We analyzed the preliminary results of six serology tests for the diagnosis of SARS-CoV-2. Three point-of-care lateral flow chromatographic immunoassays (POC): ACRO, AMP and ENCODE and three enzyme immunoassays (ELISA): DiaPro, Vircell and Euroimmun were used. A total of 15 serum samples from COVID-19 patients and 15 serum samples from asymptomatic persons were tested. Time of sampling for COVID-19 patients was 4 - 10 days (N=4), 11 - 19 days (N=6) and 20 - 34 days (N=5) after disease onset. Initially reactive results were confirmed using a virus neutralization test (VNT). In COVID-19 patients (N=15), IgM/IgA positive detection rates were 9/60.0% (ACRO), 11/73.3% (AMP, ENCODE, Euroimmun), 12/80.0% (DiaPro) and 13/86.6% (Vircell). Overall IgG detection rates were 10//66.6% (AMP, Euroimmun) and 11/73.3% (other tests). According to the sampling time, positive detection rates were as follows: a) days 4 - 10: 1/25.0% and 2/50.0% (IgM/IgA and IgG); b) days 11-19: 4/66.6%-6/100% (IgM/IgA), 4/66.6% and 5/83.3% (IgG); c) days 20 - 34: 4/80.0% and 5/100% (IgM/IgA), 5/100% (IgG). One asymptomatic participant tested IgM/IgA positive using ACRO, DiaPro and Vircell was confirmed seropositive using a VNT. In a group of asymptomatic persons detected seronegative using a VNT (N=14), IgM/IgA negative detection rates were 12/85.7% (ACRO), 13/92.8% (DiaPro, Vircell) and 14/100% (AMP, ENCODE, Euroimmun). IgG negative detection rates were 13/92.8% (ACRO) and 14/100% (other tests). ELISA tests showed a higher overall IgM/IgA sensitivity compared to POC tests in patients with COVID-19, while the IgG sensitivity was similar in both POC and ELISA. [ABSTRACT FROM AUTHOR]

Copyright of Croatian Journal of Infection / Infektoloski Glasnik is the property of Croatian Society for Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Croatian Journal of Infection / Infektoloski Glasnik is the property of Croatian Society for Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Croatian Journal of Infection / Infektoloski Glasnik is the property of Croatian Society for Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The families Paramyxoviridae and Pneumoviridae comprise a broad spectrum of viral pathogens that affect human health. The matrix (M) protein of these viruses has a central role in their life cycle. In line with this, molecular characteristics of the M proteins from variable viruses that circulated in Croatia were investigated. Methods: Sequences of the M proteins of human parainfluenza virus (HPIV) 1–3 within the family Paramyxoviridae, human metapneumovirus (HMPV), and human respiratory syncytial virus from the family Pneumoviridae were obtained and analyzed. Results: M proteins were very diverse among HPIVs, but highly conserved within each virus. More variability was seen in nucleotide sequences of M proteins from the Pneumoviridae family. An insertion of 8 nucleotides in the 3′ untranslated region in 1 HMPV M gene sequence was discovered (HR347-12). As there are no samples with such an insertion in the database, this insertion is of interest and requires further research. Conclusion: While we have confirmed that M proteins were conserved among individual viruses, any changes that are observed should be given attention and further researched. Of special interest is inclusion of HPIV2 M proteins in this analysis, as these proteins have not been studied to the same extent as other paramyxoviruses. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Measles is a very contagious viral disease characterized with appearance of rash, transient immunosuppression and relatively frequent complications related to respiratory tract and central nervous system. Development of an effective vaccine and vaccination has significantly reduced measles incidenceall over the world, with elimination of measles declared in the United States in 2000. In Europe,during last six years the incidence decreased by 90 %, but occasional outbreaks are still detected. In the developing world, measles is still one of the leading causes of death in children, while in the developed countries measles occur in unvaccinated young and middle-aged persons,representing a public health challenge globally. In Croatia, the mandatory vaccination was introduced in 1969. During last 20 years approximately ten cases have been detectedannually,with occasional small outbreaks caused by imported viruses. Large outbreak with a total of 220 reported cases has been recorded in 2014/2015. Detection of clinical cases, epidemiological surveillance and laboratory confirmation of measles including genotyping, are crucial steps in tracing the source of infection and monitoring transmission. Eradication of measles can be achieved only by a consistent vaccination with twodoses schedule regimen. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Seroprevalence data on viral hepatitis in the general population vary widely. The aim of this study was to determine the prevalence of hepatitis A (HAV), hepatitis B (HBV) and hepatitis C (HCV) viruses in the general Croatian adult population undergoing routine check-ups. The seroprevalence of anti-HAV, anti-HBc and anti-HCV was 40.5%, 7.0% and 0.9%, respectively. HBsAg was found in 0.7% and anti-HBs antibodies in 24.4% of participants. Gender was not associated with HAV, HBV or HCV seropositivity. HAV and HBV seropositivity increased progressively with age (HAV from 11.7% to 90.4%, p < 0.001; HBV from 1.7% to 15.8%, p < 0.001 ). Participants from rural areas showed a significantly higher HBV seroprevalence rate than those from urban areas (10.7% vs. 6.1%, p = 0.007). Results of univariate and multiple logistic regression showed that older age was a significant predictor for both HAV and HBV seropositivity while rural place of residence was a significant predictor for HBV seropositivity. [ABSTRACT FROM AUTHOR]

In the period from 6 to 21 September, Croatia reported the first clinical cases of human West Nile virus (WNV) neuroinvasive infection in three counties (Brod-Posavina, Osijek-Baranja and Vukovar-Srijem County). The first case was most probably imported from Serbia where the patient resided during the incubation period, while the others represent autochthonous cases. Five patients presented with meningoencephalitis and two with meningoencephalitis followed by acute flaccid paralysis. In all samples WNV IgG and/or IgM antibodies were detected using enzyme-linked immunosorbent assay (ELISA) and confirmed by plaque-reduction neutralization (PRNT) and micro-neutralization test (MNT). Following the outbreak, a total of 178 serum samples were collected from healthy inhabitants of Osi-jek-Baranja County where the incidence of cases were highest. WNV IgG antibodies were detected by ELISA in 4 (2.2%) participants indicating the increased WNV circulation in this area in comparison with season 2011 resulting in the first reported clinical cases. [ABSTRACT FROM AUTHOR]

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim. To assess the seroprevalence of human metapneumovirus (hMPV) in Croatia. Methods. During 2005, a total of 137 serum specimens from Croatian patients aged from 6 days to 51 years, without respiratory symptoms, were collected at the Croatian National Institute of Public Health. The sera were examined using the indirect immunofluorescent assay. Results. The overall hMPV seropositivity rate in the samples tested was 77.4% (106/137). The seropositivity rate increased from 18.7% in children aged between 6 months and 1 year to 100% in people older than 20 years of age. The highest proportion of titers ≥1:512 was found in children aged from 1 to 2 years. Conclusion. Our results suggest that hMPV infection is present in Croatia, with primary infection occurring in early childhood. This is the first study that indicates the circulation of hMPV in Croatia. [ABSTRACT FROM AUTHOR]

During August and September of the year 2012th there were 5 patients with meningoencephalitis treated at Clinic of Infective Diseases, University Hospital Centre Osijek. In all of them West Nile virus was confirmed to be cause, serologically (ELISA IgG and IgM positive). These are the first confirmed cases of West Nile encephalitis in Eastern Slavonia, Croatia (Budimci, Vukovar, Belisće, Kuševac, Petrijevci). Patients ranged in age from 48 to 77 years. One year ago, three of these patients were treated in Neurology; two of them due to the stroke, and third because the vertigo. Patients were admited to the hospital on the 4th to 6th day from the begining of general infectious symptoms, and the first day of neurological symptoms. Two patients had confusion, disorientation and hallucinations, two patients had somnolence and sopor, and two patients had tremor. During first two days of treatment, all patients had raised body temperature in range from 37.2° C to 38.3° C. Cerebrospinal fluid analysis in all patients spoke in favor of serous meningitis. The number of leukocytes (mainly lymphocytes) ranged from 10 to 517 x106/L, there was a moderate protein elevation and marginal lactate elevation. Glucose and chlorides were within normal range. All patients had EEG changes dysrithmic, diffuse or laterally. CT scan of the brain was normal in two patients, two patients had diffuse brain atrophy, and one had chronic vascular lesions. MRI scan of the brain in two patients was normal. Patients were treated with anti-edematous therapy with infusion 10% Mannitol and 10% Dextrose and other symptomatic therapy. Clinical signs improved within 5 days of treatment. Hospitalization lasted 2-3 weeks. All patients were discharged without neurological sequelae. [ABSTRACT FROM AUTHOR]

Introduction: The data on the coronavirus disease (COVID-19) in solid-organ transplant recipients (SOTRs) in Croatia is unknown. The aim of this study was to analyze the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Croatian SOTRs. Materials and methods: From 7 September to 27 November 2020 (beginning of the second COVID-19 pandemic wave), a cross-sectional screening for COVID-19 was performed in the adult outpatient liver (LTRs; N = 280) and kidney transplant recipients (KTRs; N = 232). Serum samples were initially tested for SARS-CoV-2 IgG antibodies using a commercial enzyme-linked immunosorbent assay (ELISA; Vircell Microbiologists, Granada, Spain). All positive samples were confirmed using a virus neutralization test (VNT). Data on risk exposure and COVID-19 related symptoms were collected using a questionnaire. Results: The transplanted cohort's seroprevalence detected by ELISA and VNT was 20.1% and 3.1%, respectively. Neutralizing (NT) antibodies developed in 15.6% of anti-SARS-CoV-2 ELISA IgG positive SOTRs. The difference in seropositivity rates between LTRs and KTRs was not statistically significant (ELISA 21.1% vs. 19.0%, P = 0.554; VNT 3.6% vs. 2.6%, P = 0.082). Overall VNT positivity rates were higher in patients who reported participation in large community events (5.9% vs. 1.0%; P = 0.027) as well as in patients who reported COVID-19 related symptoms in the past six months. In addition, symptomatic VNT positive patients showed significantly higher (P = 0.031) NT antibody titers (median 128, interquartile range (IQR) = 32-128) compared to asymptomatic patients (median 16, IQR = 16-48). Conclusions: This study showed that 15.6% of anti-SARS-CoV-2 ELISA positive Croatian SOTRs developed NT antibodies indicating protective immunity. Further studies are needed to determine the dynamic of NT antibodies and COVID-19 immunity duration in immunocompromised populations such as LTRs and KTRs. [ABSTRACT FROM AUTHOR]

In 2012 the active WNV surveillance system in horses was introduced in Croatia. Between June and October 2012, in six Croatian counties, 1804 horse sera were sampled and tested for IgM WNV antibodies as the confirmation of an acute infection. Additional 1472 samples were tested for the presence of IgG WNV antibodies in the seroprevalence study. The study showed the increased seroprevalence of WNV infection in horses and acute infections in horses in three Eastern Croatian counties. In the same transmission season, the first human WNV clinical cases were reported in the counties with a confirmed increase in WNV seroprevalence in horses. Even more, the first detection of horses acutely infected with WNV had been two weeks before the first confirmed human clinical case. The results confirmed the active serosurveillance system in horses as a valuable tool for WNV surveillance in Croatia and as the source of important veterinary medicine and public health data. [ABSTRACT FROM AUTHOR]

West Nile Virus Neuroinvasive Disease (WNV NID) requires prolonged intensive care treatment, resulting in high mortality and early disability. Long-term results are lacking. We have conducted an observational retrospective study with a prospective follow-up of WNV NID patients treated at the Intensive Care Unit (ICU), University Hospital for Infectious Diseases, Zagreb, Croatia, 2013-2018. Short-term outcomes were vital status, length of stay (LOS), modified Rankin Scale (mRS), and disposition at discharge. Long-term outcomes were vital status and mRS at follow-up. Twenty-three patients were identified, 78.3% males, median age 72 (range 33-84) years. Two patients (8.7%) died in the ICU, with no lethal outcomes after ICU discharge. The median ICU LOS was 19 days (range 5-73), and the median hospital LOS was 34 days (range 7-97). At discharge, 15 (65.2%) patients had moderate to severe/mRS 3-5, 6 (26.0%) had slight disability/mRS 2-1, no patients were symptom-free/mRS 0. Ten (47.6%) survivors were discharged to rehabilitation facilities. The median time to follow-up was nine months (range 6-69). At follow-up, seven patients died (30.5%), five (21.7%) had moderate to severe/mRS 3-5, one (4.3%) had slight disability/mRS 2-1, six (26.1%) had no symptoms/mRS 0, and four (17.4%) were lost to follow-up. Briefly, ten (43.5%) survivors improved their functional status, one (4.3%) was unaltered, and one (4.3%) aggravated. In patients with severe WNV NID, intensive treatment in the acute phase followed by inpatient rehabilitation resulted in significant recovery of functional status after several months.

Aim: To assess the humoral immunity to COVID-19 in nursing home residents six months after vaccination., Methods: This seroepidemiological research enrolled 118 residents of one nursing home in Zagreb. All participants received two doses of BioNTech/Pfizer COVID-19 and had no previously detected SARS-CoV-2 infection. The samples were tested for the presence of neutralizing antibodies using a virus neutralization test. A SARS-CoV-2 strain isolated in Vero E6 cells from a Croatian COVID-19 patient was used as a stock virus. Neutralizing antibody titer was defined as the reciprocal of the highest serum dilution that showed at least 50% neutralization. Neutralizing antibody titer ≥8 was considered positive., Results: Sixty-four (54%) participants had a positive neutralizing antibody titer, 27 (23%) had a low positive titer (titer 8), and 27 (23%) had a negative titer. Women had a significantly higher median titer than men (16 [interquartile range, IQR 24] vs 8 [IQR 12], Mann-Whitney U=1033, P=0.003). Age was negatively but not significantly correlated with neutralizing antibody titer (Spearman's rho -0.132, P=0.155)., Conclusion: Almost half of the participants (46%) had a negative or low positive titer six months after having been fully vaccinated. This study suggests that humoral immunity among nursing home residents considerably wanes six months after BioNTech/Pfizer COVID-19 vaccination. Our results could contribute to the discussion about the need for a booster dose.

Usutu virus (USUV) belongs to the family Flaviviridae, genus Flavivirus, Japanese encephalitis serocomplex. The virus was discovered in 1959 in South Africa and has emerged since 1996 causing epizootics with high avian mortality in Europe. The importance of USUV in humans is not fully understood. However, several human clinical cases of USUV infection described so far indicate the role of this virus as an antropozoonotic agent. In Croatia, serologic evidence of USUV was first documented in 2011 in two horses from Zagreb and Sisak-Moslavina County. In 2012, USUV neutralizing antibodies were found in one human sample from a resident of a Vukovar-Srijem County. Human clinical cases of USUV infection were detected for the first time during the West Nile virus outbreak from July to September 2013. Three patients with USUV neuroinvasive disease were detected in the City of Zagreb and Zagreb County. Our results indicate USUV circulation in Croatia. Further human cases could be expected in the next transmission seasons.

Tick-borne encephalitis virus (TBEV) is a small, enveloped virus that belongs to the family Flaviviridae, genus Flavivirus, tick-borne encephalitis serocomplex. There are three subtypes of TBEV: European, Far-Eastern and Siberian subtypes, which differ in geographical distribution, tick vector and clinical manifestation of disease in humans. TBEV is endemic in a wide geographic area ranging from Central Europe and the Scandinavian Peninsula to Japan. The virus is maintained in nature in so-called natural foci in cycles involving ticks and wild vertebrate hosts (mainly small rodents). The principal vector for the European subtype is Ixodes (I.) ricinus tick, whereas for Far-Eastern and Siberian subtypes it is I. persulcatus. In the Baltic States and Finland, co-circulation of two or all three subtypes was documented. Several animals, principally small rodents, serve as virus reservoirs. In the tick population, TBEV is transmitted by feeding/co-feed ing on the same host, transovarially (from infected females to their eggs) and trans-stadially (from one development stage to the next). An infected tick remains infected for life. While most TBE infections in humans occur following a tick bite, alimentary routes of TBEV transmission (consumption of unpasteurized milk/milk products from infected livestock) have also been described. All three tick stages can transmit the infection to humans. In the last decade, an increase of TBE incidence has been observed in some endemic areas. This could be due to a number of interacting factors such as changes in the climatic conditions affecting tick habitats, improvements in the quality of epidemiological surveillance systems and diagnostics, in landscape resources and their utilization and more outdoor recreation activity. In addition, the endemic area of TBEV has expanded to higher altitudes (up to 1500 m), apparently influenced by climatic changes. The typical clinical picture of infection with European subtype TBEV is characterized by a biphasic course (50%-77%). The first phase is characterized by nonspecific, flu-like symptoms followed by an asymptomatic interval of about one week. In 20%-30% of persons who develop symptoms, the second phase occurs with symptoms of central nervous system involvement (meningitis, encephalitis, myelitis, radiculitis). The mortality rate for European subtype is 1%-2%. Diagnosis is usually based on detection of specific antibodies (enzyme immunoassay, indirect immunofluorescent assay, plaque reduction neutralization test). From 1993 to 2013, a total of 777 cases of TBE were reported in Croatia. Endemicity is highest in north-western counties (mean incidence 3.61-6.78/100,000 inhabitants). The majority of patients were older than 20 years (88%). Most cases (73%) were reported from May to July.

Poliomyelitis is a very old disease of humans, caused by poliovirus. With appearance of the epidemics in the 20th century, poliomyelitis became a global public health issue. In 1988, the World Health Organization started a campaign for global eradication of poliomyelitis and till now poliomyelitis cases have been reduced by more than 99%. In Croatia, the introduction of vaccination in 1961 resulted in dramatic reduction of paralytic disease. The European region, including Croatia was certified polio free in 2002. However, the final goal of the "polio-free world" has not yet been reached. To reinforce the campaign, the global polio eradication initiative has come up with the Polio Eradication & Endgame Strategic Plan 2013-2018 with detailed program how to resolve the main challenges: (a) continued transmission of wild polioviruses in endemic reservoirs; (b) reinfection of polio-free areas; and (c) outbreaks due to the circulating vaccine-derived polioviruses (cVDPV). Global oral polio vaccine cessation will follow, with the introduction of universal use of inactivated polio vaccine.