HEPATITIS A OUTBREAK IN NIS CITY

UNCLAS BELGRADE 001559 SIPDIS SIPDIS E.O. 12958: N/A TAGS: ECON CASC SOCI SR SUBJECT: HEPATITIS A OUTBREAK IN NIS CITY SUMMARY -------------- ¶1. Over 550 cases of Hepatitis A have been reported in and around Nis, Serbia's third largest city, this year. As the number of cases has grown, local press reports have focused on the continued spread of the outbreak. Males between the ages 20-50 make up the majority of those infected. The government believes unsanitary restaurants and other public establishments are the culprits, and not contaminated water and sewage systems. Although the government does not know how widespread the outbreak is, it argues that the situation has been exaggerated and maintains there is no need for concern. END SUMMARY. HEPATITIS A HITS THE PAPERS -------------- ¶2. Local press is reporting on the outbreak of Hepatitis A in Nis as the number of cases continues to grow. From January 1, 2007 to November 16, 2007, at least 550 cases have been reported in Nis. Hepatitis A is a contagious viral liver infection. It usually spreads from person to person by hand-to-mouth contact with stool from an infected person. Fatalities are rare and there is no long-lasting liver damage. Symptoms appear three to four weeks after exposure and last two to three weeks. This is a vaccine preventable disease, but once a person is symptomatic, there is no curative treatment. Infection, however, produces lifelong immunity. HOW BAD IS THE SITUATION? -------------- ¶3. On November 13 the Embassy spoke to Danijela Simic, an epidemiologist at the government's Institute of Public Health. According to Simic, the disease comes in cycles, every 7 to 10 years and it was expected to come this year. However, Nis has not had an outbreak in over 12 years. Danijel Dasic, USAID Program Management Assistant in Nis, said the situation is under control and that the number of those infected is minor considering Nis has roughly 251,000 inhabitants. It is difficult to estimate the number of infcted since the incubation period is about one month. Last year the total number of infected in Serbia was 1,100, this year the Ministry of Health expects 1,500. So far adult males account for the majority cases, with only a few children infected. Misa Spasic, an epidemiologist at the Institute of Public Health in Nis, explained to the Embassy that the disease is concentrated in and around Nis because people in the region are not accustomed to thoroughly washing their hands after using the restroom. THE GOVERNMENT'S RESPONSE -------------- ¶4. The government is downplaying the situation. Simic stressed that there is no need for panic and that the situation has been exaggerated in the media. The government has consistently reported fewer cases than the media and other organizations. Based on a government epidemiological investigation, it ruled out contaminated water and sewage lines as the source of the breakout. Simic also said the Hepatitis A vaccination is not necessary, as good hygienic practices are sufficient. According to Dasic, the Nis city government's Crisis Committee is taking some steps to contain the outbreak, including inspecting fast-food stands and closing those stands that do not meet health standards. ALERTING PRIVATE AMERICAN CITIZENS -------------- ¶5. The Consular Information Sheet for Serbia already refers American citizen travelers to the CDC and WHO websites for health information related to Serbia. The CDC website currently recommends the Hepatitis A vaccine for travelers to Serbia as the country is classified as an area of intermediate risk for Hepatitis A. There are currently no travel advisories on the CDC website related to the current Hepatitis outbreak. COMMENT -------------- ¶6. The government does not seem to know the magnitude of the Hepatitis A outbreak or how much it might grow. The absence of a local campaign to contain the disease is evidence the government does not regard the outbreak as a significant health threat. Overall, the outbreak should not have a considerable, nor a long-term effect, as Hepatitis A is usually not fatal. Yet, the lack of proactive measures and inability to track the disease also demonstrate the government's serious shortage of human capacity in the health sector. Now reeling from the publication of the Mental Disabilities Rights International report on Serbia's treatment of its handicapped population, Serbia needs to take a hard look at the government's management of the health sector, as well as the underlying legislation regulating health issues. END COMMENT. MUNTER