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Viewing cable 08ZAGREB169, CROATIA'S EFFORTS AT FIGHTING TUBERCULOSIS

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Reference ID Created Released Classification Origin
08ZAGREB169 2008-02-29 08:15 2011-08-25 00:00 UNCLASSIFIED Embassy Zagreb
VZCZCXRO0812
PP RUEHAG RUEHAST RUEHDA RUEHDF RUEHFL RUEHIK RUEHKW RUEHLA RUEHLN
RUEHLZ RUEHPOD RUEHROV RUEHSR RUEHVK RUEHYG
DE RUEHVB #0169 0600815
ZNR UUUUU ZZH
P 290815Z FEB 08
FM AMEMBASSY ZAGREB
TO RUEHC/SECSTATE WASHDC PRIORITY 8635
INFO RUEHZL/EUROPEAN POLITICAL COLLECTIVE PRIORITY
UNCLAS ZAGREB 000169 
 
SIPDIS 
 
SIPDIS 
 
DEPARTMENT FOR EUR/PGI TESSLER AND OES/IHB LAURITZEN 
 
E.O. 12958: N/A 
TAGS: TBIO WHO HR
SUBJECT: CROATIA'S EFFORTS AT FIGHTING TUBERCULOSIS 
 
REF: STATE 6989 
 
1. SUMMARY: This cable responds to reftel. According to 2005 
data, Croatia is a middle incidence country for tuberculosis, 
with about 23 new cases per 100,000 people per year. About 
one to two percent of new cases are multidrug resistant 
(MDR). GoC efforts to implement the Berlin Declaration on 
Tuberculosis have focused on improved application of the 
WHO's Stop TB Strategy.  In 1998, the GoC established a 
national strategy for TB prevention that included expanding 
the use of directly observed treatment, short course (DOTS). 
The Croatian Ministry of Health is now revising the national 
strategy to include other components of the Stop TB Strategy. 
Areas for improvement include outreach and education for 
medical staff and further expansion of DOTS. End Summary. 
 
TB in Croatia: Mid-level Incidence, Low MDR Incidence 
 
2. In regard to tuberculosis, Croatia is a middle incidence 
country, recording 23 new cases per 100,000 people in 2005, 
according to statistics from the Croatian Ministry of Health. 
With the exception of a leveling from 1991 to 1998 due to the 
effects of war, the incidence of TB in Croatia has fallen 
steadily since 1981, when the incidence was 87 cases per 
100,000. According Dr. Valerija Stamenic at the Croatian 
Ministry of Health Office of Technical Medical Affairs and 
Dr. Aleksander Simunovic, TB program manager at the Croatian 
National Institute of Public Health, about one to two percent 
of new cases are multidrug resistant (MDR), such that five to 
ten MDR patients are being treated at any given time. 
Stamenic told us Croatia also has a low incidence of TB-HIV 
interaction, although she did not have exact numbers. 
Patients with MDR TB or TB and HIV are treated in specified 
hospitals in Zagreb. 
 
Berlin Declaration: Focus on Stop TB Strategy 
 
3. GoC efforts to implement the Berlin Declaration on 
Tuberculosis have focused on improved application of the 
WHO's Stop TB Strategy. The Ministry established its current 
national TB prevention strategy in 1998 but expects to 
release a revised strategy in the next few months. Simunovic 
said that while the 1998 strategy included the first 
component of the WHO Stop TB Strategy (pursue expansion and 
enhancement of high-quality DOTS), the new strategy will 
incorporate additional components of the WHO strategy. In 
particular, he noted the new strategy will address the need 
for a public-private mix approach, as private practitioners 
play an increasing role in healthcare in Croatia. In line 
with the WHO strategy, Stamenic said the Ministry's goal is 
to detect 70% of cases and cure 85% of detected cases. 
Simunovic said the follow-up program begun five years ago to 
determine treatment outcomes indicates 75% of patients 
complete treatment, and most of those are cured. He said 
achieving an 85% cure rate will be difficult, as it can be 
hard to convince busy doctors to take the time to ensure 
their patients complete the full treatment. 
 
4. Three years ago, with a grant from the Soros Foundation, 
the Ministry developed a course for general practitioners to 
improve detection and control of TB. The Ministry provided 
the course to practitioners in several high-incidence 
counties but had to stop the program after the first year 
because of a financial gap. Stamenic said, however, that the 
Ministry's budget does include funds for educating 
practitioners and others regarding the new national strategy 
upon its release. 
 
Areas of Need: Education and DOTS Expansion 
 
5. Simunovic identified outreach to general practitioners as 
the key area for additional effort. He said an average 
practitioner sees 50 patients a day, but encounters a TB case 
only once in two years. Given this low frequency of cases, 
practitioners can easily forget to watch for TB and often do 
not recognize it in the first couple months. Simunovic 
believes a relatively small effort at outreach--perhaps 
building from the course developed a few years ago--could 
have a big effect at improving detection. Stamenic agreed 
that education is a key area for further effort, saying 
training of laboratory staff and pulmonologists, as well as 
general practitioners, could be improved. She also identified 
two other areas of need: further expansion of treatment in 
line with DOTS and improved outcome monitoring. 
 
6. For a practitioners perspective, we spoke with Dr. Darko 
Richter from the Srebrnjak Children's Hospital in Zagreb. His 
primary concern is latent TB. Because eradicating latent TB 
is not part of the national strategy, Richter fears it is 
more widespread than Ministry of Health officials realize. 
Bradtke