[Underestimation of varicella incidence--frequency of requests for medical assistance].
BACKGROUND
The Netherlands Institute of Primary Health Care (NIVEL), University of Utrecht, conducted an international scientific project "Health Monitoring in Primary Care Based Sentinel Practice Network" in 10 European countries, based upon regular and continuous observations of one or more diseases. Sentinel practice networks have been established to provide data on incidence and other health indicators of the diseases managed predominantly in primary care. Department of Family Medicine of the "Andrija Stampar" School of Public Health, Zagreb Medical School, participated in the research. Information from primary health care is especially useful for diseases mainly diagnosed and treated in primary health care. For self-limiting diseases, varicella for example, there are no other information sources that would include professional judgement and would be available for estimation of incidence and limits of the disease in the community. Varicella is a notifiable disease in Croatia; however, every infected person does not consult a physician due to a mild or uncomplicated nature of the disease, which may cause underestimation of disease incidence in the community.


OBJECTIVE
Of this research was to establish incidence of varicella as well as incidence of varicella in other family members not seeking help from a physician.


METHODS
Data on patients with varicella were retrospectively collected from medical records (incident cases). A prospective data collection registered every new case of varicella in the families related to the incident case during the period of three weeks before or after the incident case (secondary cases). Data on age, gender, and seeking help from a physician were collected. Another prospective data collection registered cases of varicella in the families with children under 15 years of age and with no information on varicella infection in their medical records. Data on age, gender, and seeking help from a physician were collected.


RESULTS
From January 1 to June 30, 2000, 19 out of 50 contacted family physicians collected data on 182 children (52.7% boys) suffering from varicella. Most of them, 84 (46.1%), were in the age group 4-6 years; 70 (38.5%) were in the age group 7-15 years, and 28 (15.4%) were between 1-3 years of age. Another 103 children were registered in the families in the period from three weeks before to three weeks after the first case: 43 (41.7%) in the age group 4-6 years, 32 (31.1%) in the age group 7-15 years, and 28 (27.2%) between 1-3 years of age. Thirteen families had 2 diseased children during that period. In 31 (30.1%) secondary cases no physician was consulted. In 95 investigated families, there were 139 children under 15 years of age with no registered varicella infection; 69 (49%) of these children had had varicella and 38 (27%) consulted a physician but had not been registered. Most of them, 37 (53.6%), were in the age group 4-6 years; 19 (27.5%) were in the age group 7-15 years, and 13 (18.9%) between 1-3 years of age.


CONCLUSIONS
Results of this study indicate that a family physician should always actively search for secondary cases of varicella in the families with one reported case of the disease, and register them in medical records. Such records would provide better morbidity registration of the population for which a family physician provides care, especially for uncomplicated, self-limiting diseases.
Jurković
Ljiljanka
L
Skola narodnog zdravlja Andrija Stampar, Medicinski fakultet Sveucilista u Zagrebu, Zagreb, Hrvatska.
Katić
Milica
M
Ozvacić
Zlata
Z
Stojanović-Spehar
Stanislava
S
Vinter-Repalust
Nevenka
N
D000293:Adolescent; D002644:Chickenpox / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D017523:Croatia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010821:Physicians, Family / Q000706:statistics & numerical data*