Human papillomavirus (HPV) infection is one of the most common viral infections in sexually active population worldwide, and is the main cause of cervical cancer, which is the fourth most common ...cancer among women. Serbia ranks third in incidence and mortality rate of cervical cancer in Europe. We conducted a cross-sectional study considering parents' motivation for the HPV vaccination of their children. Statistical analysis included descriptive statistics and a logistic regression model. We found that the strongest motive was "Recommendation from paediatrician" (20.2%), followed by the attitude that HPV vaccine protects against cancers in different localization (15.4%), the motive "It is better to vaccinate a child than expose them to potential risk of HPV infection" (13.3%) and "Feeling anxiety due to a possible infection and cancer in the child" (13.1%). For those parents that vaccinated their child for some other strongest motive, reasons like "Vaccine is free of charge", "Recommendation from friends and family" and motive "My child received all obligatory vaccines, so I want to receive this one as well", were significantly more frequently selected. In the group where paediatricians' recommendation was not a motive for accepting the HPV vaccine, the largest percentage of parents (89.6%) selected motive "HPV vaccine protects against cancers in different localization" and the motive "It is better to vaccinate a child than expose them to potential risk of HPV infection" (78.1%). Paediatrician's recommendation is very important for parents' decision to vaccinate, however, other motives also influenced and had significance in making the parents' decision to vaccinate their children against HPV. Encouraging trust in public health authorities in Serbia, highlighting the advantages of the HPV vaccine and further encouraging healthcare workers to give stronger recommendations can increase the HPV vaccine uptake. Finally, we provided the basis to create more targeted messages that will empower parents to vaccinate their children.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Coronavirus disease 2019 (COVID-19) is currently the biggest public health problem worldwide. Intensive international travel and tourism have greatly contributed to its rapid global spreading. This ...study is the first comprehensive analysis of the epidemiological characteristics and clinical outcomes of the travel-associated COVID-19 cases in Vojvodina, Serbia, from March 6 to December 31, 2020 and it concerns permanent residents of Serbia. A cross-sectional study was conducted using data from the dedicated surveillance database of the Institute of Public Health of Vojvodina. Overall, 650 travel-associated COVID-19 cases were recorded in Vojvodina during the observed period, mainly imported from Bosnia and Herzegovina, followed by Austria and Germany (N = 195, 30%; N = 79, 12.15% and N = 75, 11.54%, respectively). The majority of cases were in the working-age groups, 18-44 and 45-64 years (56.46% and 34.15%, respectively). Overall, 54 (8.31%) patients developed pneumonia. In comparison to patients without pneumonia, those with pneumonia were older (mean age = 55.39 years vs. 41.34 years, p<0.01) and had a higher percentage of comorbidities (57.41% vs. 16.61%). Men were more likely to develop pneumonia than women (OR = 2.22; 95% CI: 1.14-4.30, p = 0.02), as well as those in retired-age group (OR = 4.11; 95% CI: 2.0-8.46, p<0.01). Obesity (OR = 14.40; 95% CI: 3.8-54.6, p<0.01), diabetes (OR = 9.82; 95% CI: 3.15-30.61, p<0.01) and hypertension (OR = 7.99; 95% CI: 3.98-16.02, p<0.01) were the most prominent main comorbidities as predictors of pneumonia. Our results represent general epidemiological and clinical dynamics of COVID-19 disease in Vojvodina. Also, they provide evidence that the predictors of pneumonia were: increasing age, male sex, having underlying comorbidities, an increasing number of days from the return to laboratory confirmation of COVID-19 (OR = 1.08, 95% CI: 1.03-1.12, p<0.01), as well as an increasing number of days from symptoms onset to diagnosis (OR = 1.14, 95% CI: 1.07-1.21, p<0.01), while anosmia and ageusia were protective factors for developing it (OR = 0.31, 95% CI: 0.12-0.79, p = 0.01).
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Data on the rate and severity of SARS-CoV-2 reinfections in real-world settings are scarce and the effects of vaccine boosters on reinfection risk are unknown.
In a population-level observational ...study, registered SARS-CoV-2 laboratory-confirmed Vojvodina residents, between March 6, 2020 and October 31, 2021, were followed for reinfection ≥90 days after primary infection. Data were censored at the end of follow-up (January 31, 2022) or death. The reinfection risk was visualized with Kaplan-Meier plots. To examine the protective effect of vaccination, the subset of individuals with primary infection in 2020 (March 6–December 31) were matched (1:2) with controls without reinfection.
Until January 31, 2022, 13,792 reinfections were recorded among 251,104 COVID-19 primary infections (5.49%). Most reinfections (86.77%, 11,967/13,792) were recorded in January 2022. Reinfections were mostly mild (99.17%, 13,678/13,792). Hospitalizations were uncommon 1.08% (149/13,792) vs. 3.66% (505/13,792) in primary infection and COVID-19 deaths were very rare (20/13,792, case fatality rate 0.15%). The overall incidence rate of reinfections was 5.99 (95% CI 5.89–6.09) per 1000 person-months. The reinfection risk was estimated as 0.76% at six months, 1.36% at nine months, 4.96% at 12 months, 16.68% at 15 months, and 18.86% at 18 months. Unvaccinated (OR=1.23; 95%CI=1.14–1.33), incompletely (OR=1.33; 95%CI=1.08–1.64) or completely vaccinated (OR=1.50; 95%CI=1.37–1.63), were modestly more likely to be reinfected compared with recipients of a third (booster) vaccine dose.
SARS-CoV-2 reinfections were uncommon until the end of 2021 but became common with the advent of Omicron. Very few reinfections were severe. Boosters may modestly reduce reinfection risk.
No specific funding was obtained for this study.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Improvements in socioeconomic and hygienic conditions during the past decades led to declining hepatitis A (HA) seroprevalence in many countries. Aiming at informing HA vaccination policy, we ...assessed current epidemiological trends in Serbia by analyzing surveillance data for 2002-2021.
Data on cases and outbreaks were obtained from the Serbian national surveillance database and descriptively analyzed. HA incidence was calculated in relation to time, patients' residence, and demographics.
Overall, 13,679 HA cases and 419 outbreaks were recorded with the highest incidence in the southeast. Downward HA trends were observed, while infant mortality was halved, and gross domestic product based on purchasing power parity (GDP PP) per capita, tripled. The average incidence dropped from 14.8 (95% CI 14.4-15.2)/100,000) in 2002-2006 to 1 (95% CI 0.9-1.1)/100,000)/100,000 in 2017-2021, while the number of outbreaks decreased (from 174 to 14). Sporadic cases and family clusters living in poor sanitary conditions occurred in recent years. The contact route of transmission was dominant (410/419, 97.9%). The highest average age-specific HA incidence shifted from 5-9 years in 2002-2006 to 10-19 years in 2017-2021.Serbia is transitioning towards very low HA endemicity. Enhanced surveillance and vaccination of high-risk groups are recommended as future public health priorities.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
In the Autonomous Province of Vojvodina, listeriosis has been reported to health authorities since 2005. In this study, we retrospectively analysed the data of listeriosis collected from January 1, ...2005 to December 31, 2020. Descriptive method was applied. Demographic, chronological and topographical distribution of the disease in Autonomous Province of Vojvodina was reviewed. In the study period, a total of 52 cases of listeriosis were registered. The average annual incidence rate of reported cases was 0.16/100,000. The largest annual number of cases (n = 10) was reported in 2020. The highest incidence rate registered in youngest age group < 1 year was (5.4/100,000). Gender distribution of the infected population showed no difference with respect to number of infected males and females. Listeriosis was registered throughout the year, but most frequently in October (21.15%). Topographical distribution revealed that listeriosis was more frequently reported in South Bačka county (2.4/100,000 inhabitants). The overall case fatality rate of reported Listeria monocytogenes infection was 23.08%. The highest case fatality rate was in the age group 19 - 59 years (29.41%), and fatal outcome in males was twofold the fatality rate in females. Our data analysis suggests that our practitioners, gynaecologists, paediatricians, oncologists and other clinicians should take listeriosis into consideration much more often in differential diagnosis in order to improve the diagnosis of the disease and further on epidemiological investigation on source of infection.
The COVID-19 pandemic continues to pose a threat to global public health. The purpose of this research was to determine the epidemiological characteristics of COVID-19 in the North Bačka district ...while observing seven pandemic waves. The cross-sectional study was based on data from the COVID-19 surveillance database of the Institute for Public Health of Vojvodina during the period from March 2020 to December 2022. A total of 38,685 primary infections and 4067 reinfections caused by SARS-CoV-2 were notified. Pandemic waves caused by the Delta variant (cumulative incidence rate of 2482.37/100,000) and by the Omicron variant (cumulative incidence rate of 2994.45/100,000) emerged as significant focal points during the surveillance period. Over the course of three consecutive years (2020-2022), women were more affected (50.11%, 54.03%, and 55.68%, respectively). The highest incidence rates in age-specific categories were recorded in 2021 for the age group 40-49 (1345.32 per 10,000 inhabitants), while in 2022, they shifted towards the elderly population. Regarding vaccination status at the time of diagnosis, in 2021, around 15% of patients were vaccinated, while in 2022, the number increased to 37%. The most widely received vaccine was BBIBP-CorV (67.45%), followed by BNT162b2 (19.81%), Gam-COVID-Vac (9.31%), and ChAdOx1 nCoV-19 (3.42%) vaccine. The implementation of stringent public health measures and their mitigation, together with the emergence of new variants, influenced the dynamics of COVID-19 pandemic waves in the North Bačka district. Notably, throughout the study period, the working-age population was the most affected, along with females, with a mild clinical presentation dominating. Reinfections were most frequently recorded during the latter pandemic waves. Dealing with this pandemic has provided some valuable lessons for the development of future strategies in the case of a similar public health crisis.
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Healthcare workers (HCW) can have an important role in educating parents about child road safety, but research on the topic shows that they usually do not have adequate knowledge. Thus, the aim of ...our study was to analyze their knowledge in the field of child road safety.
The cross-sectional study was conducted among HCW from South Bačka district, Serbia, using a specially created questionnaire for assessing knowledge on road traffic injuries in children.
The research involved the participation of 317 healthcare workers (86 physicians and 231 nurses). Healthcare workers from primary healthcare made up almost 70% of all respondents, followed by those from tertiary (21.8%) and secondary (11.3%) level institutions. The average percentage of correct answers on the knowledge test was 74.3% (mean=22.3, SD=4.0). Out of all respondents, HCWs employed in the paediatrics department had a significantly higher percentage of correct answers at 77.7% (mean=23.3, SD=3.4) compared to other health workers at 73% (mean=21.9, SD=4.1) (p=0.002). Association analysis demonstrated that HCW employed at paediatric departments on average scored 1.37 (95% CI: 0.40-2.33, p=0.006) points higher in comparison with other HCW.
This research demonstrated an unsatisfactory level of knowledge on child road safety by HCW, and the variability across different question domains, which underlines the need for continuous educations in order to improve their knowledge. Our results may serve in planning additional public health measures and can provide a reference for future studies.
Q fever is a globally widespread zoonosis, which has a large number of animal reservoirs. In humans, Q fever is asymptomatic in 60% of cases but may appear in the form of acute or chronic disease. ...The disease is mostly asymptomatic in animals but may be a cause of abortions or stillbirths. The aim of this study was to present and analyze the epidemiological characteristics of Q fever in Srem district, in the Autonomous Province of Vojvodina, Republic of Serbia. We conducted a descriptive study using data from the registries of infectious diseases of the Institutes of Public Health of Vojvodina and Institute of Public Health Sremska Mitrovica in the period 2011-2020. A total of 76 human cases of Q fever were registered in Srem district over ten-year period. The majority of patients (89.47%; N = 68) were registered in municipalities of Sremska Mitrovica and Šid. One third of patients were hospitalized (32.89%; N = 25). Males were 3.2 times more affected than females (M : F = 3.22 : 1). Working age population (20–59 years) were most affected (82.89%; N = 63) with a significantly higher incidence compared to the age category 0-19 years (p < 0.05). The majority of cases were registered in February (60.53%; N = 46). Probable routes of transmission of Coxiella burnetii were: direct contact with animals and the airborne route of transmission (50.00% vs. 47.37%). The highest seroprevalence of Q fever recorded in goats (55.54%) and sheep (11.88%) in the municipality of Šid, which is connected to outbreak in Kukujevci 2017. The high seroprevalence in goats, recorded in Inđija (22.87%) was not accompanied by Q fever in humans. Q fever still represents a significant problem of both veterinary and human medicine and therefore continuous disease monitoring and more efficient cooperation of the veterinary and human health care sectors is necessary.
Despite the availability of a safe and effective vaccination, uptake of human papillomavirus (HPV) vaccination remains low worldwide. We aimed to analyze the coverage of HPV immunization during the ...first year of the immunization program and the sociodemographic characteristics across different administrative units in Serbia and Montenegro. Coverage of HPV vaccination in Serbia for females aged 9–14 and 15–19 years was 5.5% and 5.9%, respectively. The coverage rate of immunization against HPV in Montenegro for girls aged 9–14 years was 22.1%. Within Serbia, only one administrative region (Moravica) had HPV immunization coverage in girls 9–19 years old above 10%, 11 districts had coverage from 5 to 10%, while 13 districts had coverage below 5%. As per Montenegro, two administrative units, Cetinje and Berane, reported the highest coverage, with 39% and 36.4% of vaccinated eligible girls, respectively. When we explored the coverage of HPV immunization among girls aged 9–19 years across different regions in Serbia, we observed that the level of coverage did not correlate with the number of pediatricians or with the population density. In Montenegro, we observed a similar situation. On the other hand, we noticed a statistically significant moderate negative correlation (r = −0.446; p = 0.026) between HPV immunization coverage and the percentage of illiterate women in the administrative units. Comparing the coverage between the two countries we found that the higher coverage in Montenegro corresponded with a smaller number of female populations aged 9–14 years, with higher average net monthly income, with smaller population density and smaller number of pediatricians, among divorced persons, and among those without formal education or incompletely primary education. Taking into account the experiences in Montenegro, increasing immunization coverage in Serbia could be achieved through a more vigorous educational campaign targeting schools, the general population, and healthcare workers as well as by additionally incentivizing those engaged in these activities.
This study attempts to summarize epidemiological characteristics of human leptospirosis and to determine the seroprevalence of this disease among domestic animals in the Autonomous Province ...of Vojvodina, for the period 2009-2018. Chronological, demographic and topographic characteristics of human cases were analyzed. Pearson's correlation was used to explore correlations between different meteorological factors and trends in time-series of human cases. Overall 87 human cases of leptospirosis and five subsequent deaths (CFR: 5.75%) were recorded in the ten-year period. The average annual incidence rate was 0.45/100,000 (range: 0.16-1.50/100,000). The disease was more prevalent in males (M/F=16.40:1), with the majority of cases reported in August (N=23; 26.44%), September (N=20; 23.00%) and October (N=15; 17,24%). A statistically significant weak positive correlation was observed between the mean monthly air temperature and the number of human cases of leptospirosis of the same month (r=0.30, p<0.01) and a statistically significant weak positive correlation was found between the number of human cases and the sum of precipitation in the previous month (r=0.27, p<0.01). The average annual seroprevalence among domestic animals in total was 1.13% (range: 0.23% -3.65%). Seropositivity of tested samples of cats, dogs, cattle, donkeys, horses, sheep, pigs and goats was 25%, 9.50%, 8.55%, 6.25%, 1.59%, 0.25%, 0.18%, 0.00, respectively. Human and animal leptospirosis continuously occurs in Vojvodina, which implies the need for continuous and quality monitoring of the epidemiological and epizootiological situation of this disease. Further, more comprehensive parallel studies in humans and animals are needed, as well as additional studies of living conditions of animals on farms with leptospirosis and the studies that will determine the strength of association between climatic/ environmental factors and leptospirosis in Vojvodina.
Key words: Human leptospirosis, animal leptospirosis, zoonosis, epidemiology, seroprevalence, one health.
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