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Human biomonitoring (HBM) data in Europe are often fragmented and collected in different EU countries and sampling periods. Exposure levels for children and adult women in Europe were evaluated over time. For the period 2000-2010, literature and aggregated data were collected in a harmonized way across studies. Between 2011-2012, biobanked samples from the DEMOCOPHES project were used. For 2014-2021, HBM data were generated within the HBM4EU Aligned Studies. Time patterns on internal exposure were evaluated visually and statistically using the 50th and 90th percentiles (P50/P90) for phthalates/DINCH and organophosphorus flame retardants (OPFRs) in children (5-12 years), and cadmium, bisphenols and polycyclic aromatic hydrocarbons (PAHs) in women (24-52 years). Restricted phthalate metabolites show decreasing patterns for children. Phthalate substitute, DINCH, shows a non-significant increasing pattern. For OPFRs, no trends were statistically significant. For women, BPA shows a clear decreasing pattern, while substitutes BPF and BPS show an increasing pattern coinciding with the BPA restrictions introduced. No clear patterns are observed for PAHs or cadmium. Although the causal relations were not studied as such, exposure levels to chemicals restricted at EU level visually decreased, while the levels for some of their substitutes increased. The results support policy efficacy monitoring and the policy-supportive role played by HBM.

Different vector-borne pathogens are present or have (re-)emerged in Croatia. Flaviviruses tick-borne encephalitis (TBEV), West Nile (WNV), and Usutu (USUV) are widely distributed in continental regions, while Toscana virus (TOSV) and sandfly fever viruses are detected at the Croatian littoral. Recently, sporadic clinical cases of Tahyna orthobunyavirus (TAHV) and Bhanja bandavirus infection and seropositive individuals have been reported in continental Croatia. Acute infections and serologic evidence of WNV, TBEV, USUV, and TAHV were also confirmed in sentinel animals and vectors. Autochthonous dengue was reported in 2010 at the Croatian littoral. Lyme borreliosis is the most widely distributed vector-borne bacterial infection. The incidence is very high in northwestern and eastern regions, which correlates with numerous records of Ixodes ricinus ticks. Acute human Anaplasma phagocytophilum infections are reported sporadically, but there are many records of serologic evidence of anaplasmosis in animals. Mediterranean spotted fever ( Rickettsia conorii ) and murine typhus ( Rickettsia typhi ) are the main rickettsial infections in Croatia. Human leishmaniasis is notified sporadically, while serologic evidence of leishmaniasis was found in 11.4% of the Croatian population. After the official eradication of malaria in 1964, only imported cases were reported in Croatia. Since vector-borne diseases show a growing trend, continuous monitoring of vectors is required to protect the population from these infections.

Viral hepatitis is a significant cause of morbidity and mortality worldwide. In Croatia, hepatitis B virus (HBV) and hepatitis C virus (HCV) are widely distributed, especially in some high-risk groups such as people who inject drugs (PWID), prisoners, and highly promiscuous groups. The seroprevalence of HBV ranges from 7.0% in the general population to 38.8% in PWID, depending on the region. The seroprevalence of HCV is highest among PWID (29-75.5%) as compared to 0.9% in the general population. Analyzing the distribution of HCV genotypes, no substantial changes in the molecular epidemiology of the two most frequent HCV genotypes (1 and 3) in the past 20 years were observed. However, the predominance of subtype 1b compared to subtype 1a as detected in 1996-2005 was not confirmed in 2008-2015. Hepatitis A virus (HAV) incidence was high in the past with a decreasing trend since the 2000s, except for an outbreak in 2017-2018 as part of the large European outbreak, which was mainly among men who have sex with men. Hepatitis E virus (HEV) is an emerging virus detected for the first time in Croatia in 2012. The seroprevalence of HEV is high among hemodialysis patients (27.9%) and liver transplant recipients (19.3-24.4%). In addition, higher seroprevalence rates were observed in animal-related professions (e.g., veterinarians, 15.2%; hunters, 14.9%). All detected HEV strains belonged to genotype 3.

Background: Hepatitis E virus (HEV) is an emerging virus of global health concern. The seroprevalence rates differ greatly according to geographic region and population group., Aim: To analyze the seroprevalence of HEV in exposed (animal-related professions) and nonexposed populations, as well as solid organ and hematopoietic stem cell transplant patients., Methods: Forestry workers ( n = 93), hunters ( n = 74), and veterinarians ( n = 151) represented the exposed population. The general population ( n = 126) and pregnant women ( n = 118) constituted the control group. Transplant patients included liver transplant recipients (LTRs) ( n = 83), kidney transplant recipients (KTRs) ( n = 43), and hematopoietic stem cell transplant recipients (HSCRs) ( n = 39). HEV immunoglobulin G antibodies were detected using the enzyme-linked immunosorbent assay and confirmed by the immunoblot test., Results: The HEV seroprevalence significantly differed between groups: Veterinarians 15.2%, hunters 14.9%, forestry workers 6.5%, general population 7.1%, and pregnant women 1.7%. In transplant patients, the seropositivity was highest in LTRs (19.3%), while in KTRs and HSCRs, the seroprevalence was similar to the general population (6.9% and 5.1%, respectively). A significant increase in seropositivity with age was observed from 2.9% in individuals less than 30 years to 23.5% in those older than 60 years. Sociodemographic characteristics (sex, educational level, area of residence, and number of household members), eating habits (game meat, offal, and pork products consumption), and environmental and housing conditions (drinking water supply, type of water drainage/sewer, waste disposal, domestic animals) were not associated with HEV seropositivity. However, individuals who reported a pet ownership were more often seropositive compared to those who did not have pet animals (12.5% vs 7.0%)., Conclusion: The results of this study showed that individuals in professional contact with animals and LTRs are at higher risk for HEV infection. In addition, age is a significant risk factor for HEV seropositivity., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

During the four pandemic waves, a total of 560,504 cases and 10,178 deaths due to COVID-19 were reported in Croatia. The Alpha variant, dominant from March 2021 (>50% of positive samples), was rapidly replaced by Delta variants (>90%) by August 2021. Several seroprevalence studies were conducted in different populations (general population, children/adolescents, professional athletes, healthcare workers, veterinarians) and in immunocompromised patients (hemodialysis patients, liver/kidney transplant recipients). After the first pandemic wave, seroprevalence rates of neutralizing (NT) antibodies were reported to be 0.2-5.5%. Significantly higher seropositivity was detected during/after the second wave, 2.6-18.7%. Two studies conducted in pet animals (February-June 2020/July-December 2020) reported SARS-CoV-2 NT antibodies in 0.76% of cats and 0.31-14.69% of dogs, respectively. SARS-CoV-2 NT antibodies were not detected in wildlife. Environmental samples taken in the households of COVID-19 patients showed high-touch personal objects as most frequently contaminated (17.3%), followed by surfaces in patients' rooms (14.6%), kitchens (13.3%) and bathrooms (8.3%). SARS-CoV-2 RNA was also detected in 96.8% affluent water samples, while all effluent water samples tested negative. Detection of SARS-CoV-2 in humans, animals and the environment suggests that the 'One Health' approach is critical to controlling COVID-19 and future pandemics.

Several arboviruses have emerged in Croatia in recent years. Tick-borne encephalitis is endemic in continental counties; however, new natural micro-foci have been detected. Two autochthonous dengue cases were reported in 2010. West Nile virus emerged in 2012, followed by emergence of Usutu virus in 2013. Although high seroprevalence rates of Toscana virus have been detected among residents of Croatian littoral, the virus remains neglected, with only a few clinical cases of neuroinvasive infections reported. Lymphocytic choriomeningitis virus is a neglected neuroinvasive rodent-borne virus. So far, there are no reports on human clinical cases; however, the seroprevalence studies indicate the virus presence in the Croatian mainland. Puumala and Dobrava hantaviruses are widely distributing rodent-borne viruses with sporadic and epidemic occurrence. Hepatitis E virus is an emerging food-borne virus in Croatia. After the emergence in 2012, cases were regularly recorded. Seropositivity varies greatly by region and population group. Rotaviruses represent a significant healthcare burden since rotavirus vaccination is not included in the Croatian national immunization program. Additionally, rotaviruses are widely distributed in the Croatian ecosystem. A novel coronavirus, SARS-CoV-2, emerged in February 2020 and spread rapidly throughout the country. This review focuses on emerging and neglected viruses of zoonotic importance detected in Croatia.

Floods can pose a number of safety and health hazards for flood-affected populations and rescuers and bring risk of injuries, infections, and diseases due to exposure to pathogenic microorganisms and different biological and chemical contaminants. The risk factors and possible health consequences for the rescuers involved in evacuation and rescuing operations during the May 2014 flood crisis in Croatia are shown, as well as measures for the prevention of injuries and illnesses. In cases of extreme floods, divers play a particularly important role in rescuing and first-response activities. Rescuing in contaminated floodwaters means that the used equipment such as diving suits should be disinfected afterwards. The need for securing the implementation of minimal health and safety measures for involved rescuers is paramount. Data regarding injuries and disease occurrences among rescuers are relatively scarce, indicating the need for medical surveillance systems that would monitor and record all injuries and disease occurrences among rescuers in order to ensure sound epidemiological data. The harmful effects of flooding can be reduced by legislation, improvement of flood forecasting, establishing early warning systems, and appropriate planning and education.

Injuries and diseases can significantly affect the creativity and artistic performance. The link between working conditions and artistic performance had been recognised as early as the medieval age. Physically demanding performance arts such as dance can sometimes result in injuries, illnesses, inability to perform, and even end artist's career. Dancers are exposed to specific risks and in need of specific medical care. Many dancers often stretch their physical capabilities and endurance and neglect their physical limitations. Their health problems include a number of work-related illnesses that range from stress and stage fright to metabolic and nutritional disorders. They also include musculoskeletal injuries due to overload training that are often the beginning of chronic health problems.

In 2009, we conducted a survey to assess the use of mercury-based thermometers and sphygmomanometers and their disposal in Croatian healthcare facilities. The questionnaire addressing the use of mercury-based medical devices, waste management, preferences between mercury-based and electronic devices, and the knowledge on mercury toxicity was filled by ward nurses affiliated with 40 (71.4 %) out of 56 contacted healthcare facilities. Only one of these facilities had given up the use of mercury-containing medical devices at the time. As many as 84.6 % of the nurses believed that broken devices did not increase the risk of mercury exposure, even though 90 % claimed they were aware of mercury toxicity. In fact, 69.4 % of the nurses preferred mercury-containing devices on account of their precision and reliability and because they received little training in the use of electronic devices.Breaking of thermometers and sphygmomanometers is common in healthcare facilities. The number of broken thermometers and sphygmomanometers was estimated to 278 and five per month, respectively. Only 18 (46.2 %) of the surveyed healthcare facilities claimed to have had a proper disposal procedure for mercury from broken devices. Nurses, who most often handle these devices and collect mercury spills, are primarily exposed to mercury vapours via inhalation. Croatia has adopted the EU Directive 76/769/EEC intended to reduce mercury exposure in the living and working environment. Our survey suggests that all healthcare professionals need training in proper management of broken mercury-based medical devices, nurses in particular. To reduce the risk of exposure, all Croatian healthcare facilities should implement guidelines for staff protection and programmes to gradually replace mercury-based with electronic devices.

Medical waste management in Croatia is regulated by three fundamental legal acts: Waste Act, Ordinance on Waste Types and Directive on Manipulation of Waste Generated in Health Care. The implementation of these acts and waste management in general are also supported by Transport of Hazardous Materials Act and Toxic Substances Act. Modern trends in waste management promote an integral approach also called "waste chain". This integral approach to medical waste management is based on hierarchical structuring of waste management structure from the point at which the waste is produced to its final disposal. Priority is always given to reducing the amount and the harmfulness of waste by replacing harmful materials with those that are not, but where this is not possible, waste management includes reduction by sorting and separating, pretreatment on site, safe transportation, final treatment and sanitary disposal. Methods of choice for the final treatment should be the least harmful for human health and environment. Integral medical waste management could greatly reduce quantities of medical waste and consequently financial strains. Even though Croatian regulations define and cover all steps in the waste management chain their implementation is one of the country's greatest issues. Improper practice is seen from waste production in healthcare institutions to the final disposal, and includes handling, sorting, use of containers, or treatment in incinerators. Information on quantities, type and flow of medical waste are inadequate, just as sanitary control. In addition, Croatia lacks locations for sanitary landfills. Croatia has signed international conventions on the supervision and control of transfrontier waste shipments. Within the CARDS project, Croatia has started to harmonise its laws with acquis communitaire related to waste management. Although waste management is one of the priorities defined within the National Environment Action Plan, Croatia still has not made a strategy for waste management.

The amount of waste produced is connected with the degree of a country's economic development; more developed countries produce more waste. This paper reviews the quantities, manipulation and treatment methods of medical waste in Croatia, as well as hazardous potentials of medical waste for human health. Medical waste must be collected and sorted in containers suitable for its characteristics, amount, means of transportation and treatment method in order to prevent contact with environment and to protect people who are working with waste. Hazardous medical waste in Croatia is largely produced by hospitals. Even though only one hospital has a licence to incinerate infectious medical waste, many other hospitals incinerate their hazardous waste in inappropriate facilities. Healthcare institutions also store great amounts of old medical waste, mostly pharmaceutical, anti-infectious, and cytostatic drugs and chemical waste. Data on waste treatment effects on human health are scarce, while environmental problems are covered better. Croatian medical waste legislation is not being implemented. It is very important to establish a medical waste management system that would implement the existing legislation in all waste management cycles from waste production to treatment and final disposal.