Suvremeni pogledi na infekcije hidričnog puta prijenosa

Cilj: Cilj ovog rada je istražiti kretanje akutnih crijevnih infekcija (ACI) s posebnim osvrtom na infekcije nealimentarnog puta prijenosa i rizika njihovog prijenosa obzirom na pripadajući vodoopskrbni objekt u razdoblju 2005.-2014. godine po područjima Splitsko-dalmatinske županije. Materijal i metode: Retrospektivnom studijom uspoređeni su poboli od ACI u primarnoj zdravstvenoj zaštiti temeljem prijavnica zaraznih bolesti i bolnički pobol utvrđen temeljem otpusnica hospitaliziranih bolesnika. Komparativnom epidemiološkom metodom uspoređeni su poboli između ispostava/područja Splitsko-dalmatinske županije i između pripadajućih vodoopskrbnih objekata. Rezultati: Ukupno na svim područjima/ispostavama Splitsko-dalmatinske županije prisutan je trend pada ACI hospitaliziranih bolesnika. Klasične crijevne antroponoze registriraju se samo kod importiranih oblika bolesti. Smrtnost je izuzetno niska-0,20/100.000 (od ukupno devet smrtnih ishoda umrlo je dvoje djece u dobi do četiri godine). Statistički značajno najveće stope pobola su kod stanovnika najmlađe dobi. Između pobola utvrđenih temeljem prijavnica zaraznih bolesti i temeljem bolničkih otpusta nema razlika između ispostava/područja SDŽ niti između područja po pripadajućem vodoopskrbnom objektu. Statistički značajno najmanji pobol ACI nealimentarnog puta prijenosa imaju stanovnici područja vodoopskrbe s vodovoda koji zahvaćaju površinsku vodu rijeke Cetine: Regionalni sustav Makarsko primorje 24,19/100.000 i Regionalni sustav Omiš-Brač-Hvar-Šolta 35,51/100.000. Najveće stope pobola imaju stanovnici s malih vodovoda VS Marina 62,74/100.000 i VS Vrgorac 62,45/100.000. Jedine dvije epidemije ACI s hidričnim putem prijenosa posljednjih deset godina zabilježene su kod stanovnika VS Vrgorac izazvane virusima (Norovirus i Rotavirus). Uzrok epidemijama je tehnički propust u kloriranju vode za ljudsku uporabu zbog nepostojanja automatskog plinskog klorinatora.Veliki vodoopskrbni objekti koji koriste vodu s vodozahvata izvora rijeka bez pročišćavanja voda imaju veće stope hospitalizacija zbog ACI nealimentarnog puta prijenosa pripadajućeg stanovništva od vodovoda s vodozahvata površinskih voda rijeke Cetine. Statistički značajno veću stopu od županijskog prosjeka imaju stanovnici najvećeg RS Split-Solin-Kaštela-Trogir 58,94/100.000, dok kod ostalih povećanje nema statističke značajnosti. Zaključak: U suvremenim uvjetima brze kozmoplitske izmjenjivosti uzročnika ACI zbog sve većih migracija, turističkih putovanja, klimatskih promjena, čistoća voda za ljudsku potrošnju zahtijeva sve veću pozornost. Posebno je potrebno pozornost usmjeriti očuvanju čistoće površinskih voda na krškim hidrogeološkim područjima pročišćavanjem otpadnih i kanalizacijskih voda prije ispusta u recipijente riječnih vodotokova. Sve veća turistička aktivnost na području zagore Splitsko-dalmatinske županije bez pročišćavanja otpadnih i kanalizacijskih voda dodatna je ugroza sigurnosti vodoopskrbe stanovnika čitave Županije. Sadašnje, još uvijek povoljno stanje sigurnosti vodoopskrbe, potrebno je osuvremeniti novim suvremenim pristupom u nadzoru nad ACI, kako laboratorijskim mikrobiološkim praćenjem onečišćenja novim PCR - real time tehnologijama, još prije suvremenom elektronskom promptnom dojavom bolesnika po područjima njihovog stanovanja.Objective: The objective of this thesis is to examine the movement of acute intestinal infections (AII) with special reference to the infections of non-alimentary way of transmission and the risk of their transmission due to the corresponding water supply facility from the year 2005 until 2014 throughout regions of the Split-Dalmatia county. Material and methods: Using a retrospective study the morbidity of acute intestinal infections was compared between primary health care which was determined on the basis of registration of infectious diseases and hospital morbidity which was determined on the basis of discharge papers of hospitalized patients. Comparative epidemiological method was used to compare morbidity of acute intestinal infections between the branches/regions of Split-Dalmatia county and between their respective water supply facilities. Results: In total, in all areas/branches of the Split-Dalmatia county, there is a downward trend of patients hospitalized due to acute intestinal infections. The classic intestinal anthroponoses are registered only as imported forms of the disease. The mortality rate is extremely low 0.20/100,000 (from total of nine deaths two of them were children under the age of four). Statistically, the greatest rates of morbidity are with the inhabitants of the youngest age. Comparing the morbidity established on the basis of registration of infectious diseases and of that based on hospital discharge papers, there is no difference between the branches/regions of the Split-Dalmatia county or between areas with corresponding water supply facilities. Statistically, the lowest morbidity rates of AII with non-alimentary way of transmission are amongst the inhabitants of areas where the water supply facilities use surface water from the Cetina river: the regional system of the Makarska littoral 24.19/100,000 and the regional system of Omiš-Brač-Hvar-Šolta 35,51/100, 000. The highest morbidity rates are amongst the inhabitants of areas with small water supply facilities: VS Marina 62,74/100,000 and VS Vrgorac 62,45/100, 000. The only two epidemic outbreaks of waterborne AII in the last ten years were recorded in inhabitants of VS Vrgorac caused by viruses (Norovirus and Rotavirus). The cause of the epidemic outbreaks was a technical flaw in chlorination of water for human use because of the lack of an automatic gas chlorinator. Large water supply facilities that use water from river sources without water purification have higher rates of hospitalization for AII with non-alimentary way of transmission of the corresponding population than the water supply facilities that use surface water of the Cetina river. Statistically, the residents of the largest RS-Solin-Split-Kaštela-Trogir have a significantly higher rate of hospitalizations-58,94/100,000, than the county average, while in others the increase has no statistical significance. Conclusion: In modern cosmopolitan conditions of rapid AII pathogen interchangeability due to major migrations, tourist travel and climate change, clean water for human consumption requires more attention. In particular, the attention should be directed towards the preservation of purity of the surface waters in the karst hydrogeological regions by purifying waste and sewage waters before their discharge into the receiving waters of river watercourses. Increased tourist activity in dalmatian hinterland of Split-Dalmatia county without proper purification of waste and sewage waters represents additional security threats for the residents of the entire county.The current, still favourable state of security of water supply, needs to be modernized with the new modern approach in the supervision of AII, using methods such as laboratory microbiological pollution monitoring, the new PCR-real time technologies and the modern electronic prompt patient alerts by their areas of residence