Factors associated with adverse events following immunization in Albanian children: An analysis of the national database of adverse events after immunization

Background: Adverse events following immunization are a major concern which is influencing vaccination coverage all over the world. It is therefore important to evaluate the reporting of this events and factors associated with their occurrence in order to prevent them. Methods: The national database of adverse events following immunization in Albanian children was de-identified and transferred to the IBM® SPSS version 21. (SPSS Inc, USA). Every medical information was re-entered using the Medical Dictionary for Regulatory Activities (MedDRA) terms. The dose-based reporting rates are calculated always taking in consideration the number of administered vaccines instead of the number of distributed ones, which is an advantage of the Albanian reporting system Results: During a thirteen year period (2003-2015) there have been 307 AEFI cases reported for a total of 7,713,325 doses of vaccines administered. That regarded 106 females and 134 males. Most of the events have been reported during 2004. Most of thecases were non-serious (78,8%). Most of the cases were treated at ambulatory setting (72.55), followed by hospital treatment (24.3%) and no treatment (2.6%). Most of the cases were recorded in infants aged < 4 months. Conclusion: During the 13 year period, there were no severe events. The completeness and accuracy of information in the Albanian vaccine safety surveillance system still need to improve.&nbsp

Syndromic surveillance in early detection of outbreaks of infectious diseases

Aim: Motivated by the threat of infectious diseases and bioterrorism, syndromic surveillance systems are being developed and implemented around the world. The aim of the study was to describe the early warning surveillance system in Albania.Methods: Syndromic surveillance is a primary health care-facility- and emergency room (ER)-based syndromic surveillance system aiming at detecting outbreaks and undertaking public health actions. It is based on weekly notifications of nine syndromes by over 1,600 General Practitioners (GPs) in the 36 districts of Albania. Data is aggregated by district epidemiologists (DE) and centralized by the national Institute of Public Health.Results: A syndrome is “a set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.” In the context of syndromic surveillance, a syndrome is a set of non-specific pre-diagnosis medical and other information that may indicate the release of a bioterrorism agent or natural disease outbreak.Since its inception, syndromic surveillance has mainly focused on early event detection: gathering and analysing data in advance of diagnostic case confirmation to give early warning of a possible outbreak.Conclusion: The system is useful for detecting and responding to natural disease outbreaks such as seasonal and pandemic flu, and thus they have the potential to significantly advance and modernize the practice of public health surveillance

Syndromic surveillance in early detection of outbreaks of infectious diseases

Aim: Motivated by the threat of infectious diseases and bioterrorism, syndromic surveillance systems are being developed and implemented around the world. The aim of the study was to describe the early warning surveillance system in Albania.   Methods: Syndromic surveillance is a primary health care-facility- and emergency room (ER)-based syndromic surveillance system aiming at detecting outbreaks and undertaking public health actions. It is based on weekly notifications of nine syndromes by over 1,600 General Practitioners (GPs) in the 36 districts of Albania. Data is aggregated by district epidemiologists (DE) and centralized by the national Institute of Public Health. Results: A syndrome is “a set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.”  In the context of syndromic surveillance, a syndrome is a set of non-specific pre-diagnosis medical and other information that may indicate the release of a bioterrorism agent or natural disease outbreak. Since its inception, syndromic surveillance has mainly focused on early event detection: gathering and analysing data in advance of diagnostic case confirmation to give early warning of a possible outbreak. Conclusion: The system is useful for detecting and responding to natural disease outbreaks such as seasonal and pandemic flu, and thus they have the potential to significantly advance and modernize the practice of public health surveillance

Enhancement of Aedes albopictus collections by ovitrap and sticky adult trap

Abstract Background: In the last decades, Aedes albopictus has become an increasing public health threat in tropical as well as in more recently invaded temperate areas due to its capacity to transmit several human arboviruses, among which Dengue, Chikungunya and Zika. Enhancing the efficiency of currently used collection approaches, such as ovitraps and sticky traps, is desirable for optimal monitoring of the species abundance, for assessment of the risk of arbovirus transmission and for the optimisation of control activities. Findings: Two sets of 4 × 4 Latin-square experiments were carried out in Tirana (Albania) to test whether modifications in ovitrap shape and size and in oviposition substrate would increase collections of Ae. albopictus eggs and whether hay-infusion would increase adult catches by sticky trap. Generalized Linear Mixed Models with negative binomial error distribution were carried out to analyse the data. Cylindrical ovitraps lined with germination paper yielded significantly higher egg catches than those exploiting either the (commonly used) wooden paddles or floating polystyrene blocks as oviposition substrates. No difference was observed between cylindrical and conical shaped ovitraps. Ovitraps and sticky traps baited with hay infusion yielded significantly higher egg and adult catches than un-baited ones. A significant relationship between ovitrap and sticky trap catches was observed both in the absence and in the presence of attractants, with ovitrap catches increasing more than sticky trap catches at increasing adult female densities. Conclusions: This study provides grounds for optimisation of ovitraps and sticky traps as monitoring tools for Ae. albopictus by (i) supporting use of germination paper as most appropriate oviposition substrate; (ii) suggesting the possible use of stackable conical ovitraps for large scale monitoring; (iii) confirming the use of hay-infusion to increase egg catches in ovitraps, and showing that hay-infusion also significant increases adult catches by sticky traps

Forecasting the spatial and seasonal dynamic of Aedes albopictus oviposition activity in Albania and Balkan countries

The increasing spread of the Asian tiger mosquito, Aedes albopictus, in Europe and US raises public health concern due to the species competence to transmit several exotic human arboviruses, among which dengue, chikungunya and Zika, and urges the development of suitable modeling approach to forecast the spatial and temporal distribution of the mosquito. Here we developed a dynamical species distribution modeling approach forecasting Ae. albopictus eggs abundance at high spatial (0.01 degree WGS84) and temporal (weekly) resolution over 10 Balkan countries, using temperature times series of Modis data products and altitude as input predictors. The model was satisfactorily calibrated and validated over Albania based observed eggs abundance data weekly monitored during three years. For a given week of the year, eggs abundance was mainly predicted by the number of eggs and the mean temperature recorded in the preceding weeks. That is, results are in agreement with the biological cycle of the mosquito, reflecting the effect temperature on eggs spawning, maturation and hatching. The model, seeded by initial egg values derived from a second model, was then used to forecast the spatial and temporal distribution of eggs abundance over the selected Balkan countries, weekly in 2011, 2012 and 2013. The present study is a baseline to develop an easy-handling forecasting model able to provide information useful for promoting active surveillance and possibly prevention of Ae. albopictus colonization in presently non-infested areas in the Balkans as well as in other temperate regions

Influenza and respiratory syncytial virus in infants study (IRIS) of hospitalized and non-ill infants aged <1 year in four countries: study design and methods

Abstract Background This multi-country prospective study of infants aged <1 year aims to assess the frequency of influenza virus and respiratory syncytial virus (RSV) infections associated with hospitalizations, to describe clinical features and antibody response to infection, and to examine predictors of very severe disease requiring intensive care. Methods/Design We are enrolling a hospital-based cohort and a sample of non-ill infants in four countries (Albania, Jordan, Nicaragua, and the Philippines) using a common protocol. We are currently starting year 2 of a 2- to 3-year study and will enroll approximately 3,000 infants hospitalized for any acute illness (respiratory or non-respiratory) during periods of local influenza and/or RSV circulation. After informed consent and within 24 h of admission, we collect blood and respiratory specimens and conduct an interview to assess socio-demographic characteristics, medical history, and symptoms of acute illness (onset ≤10 days). Vital signs, interventions, and medications are documented daily through medical record abstraction. A follow-up health assessment and collection of convalescent blood occurs 3-5 weeks after enrollment. Influenza and RSV infection is confirmed by singleplex real time reverse transcriptase polymerase chain reaction (rRT-PCR) assays. Serologic conversion will be assessed comparing acute and convalescent sera using hemagglutination inhibition assay for influenza antibodies and enzyme-linked immunosorbent assay (ELISA) for RSV. Concurrent with hospital-based enrollment, respiratory specimens are also being collected (and tested by rRT-PCR) from approximately 1,400 non-ill infants aged <1 year during routine medical or preventive care. Discussion The Influenza and RSV in Infants Study (IRIS) promises to expand our knowledge of the frequency, clinical features, and antibody profiles of serious influenza and RSV disease among infants aged <1 year, quantify the proportion of infections that may be missed by traditional surveillance, and inform decisions about the potential value of existing and new vaccines and other prevention and treatment strategies.https://deepblue.lib.umich.edu/bitstream/2027.42/136185/1/12879_2017_Article_2299.pd

Information horizons in a complex world

The whole in a complex system is the sum of its parts, plus the interactions between the parts. Understanding social, biological, and economic systems therefore often depends on understanding their patterns of interactions---their networks. In this thesis, the approach is to understand complex systems by making simple network models with nodes and links. It is first of all an attempt to investigate how the communication over the network affects the network structure and, vice versa, how the network structure affects the conditions for communication. To explore the local mechanism behind network organization, we used simplified social systems and modeled the response to communication. Low communication levels resulted in random networks, whereas higher communication levels led to structured networks with most nodes having very few links and a few nodes having very many links. We also explored various models where nodes merge into bigger units, to reduce communication costs, and showed that these merging models give rise to the same kind of structured networks. In addition to this modeling of communication networks, we developed new ways to measure and characterize real-world networks. For example, we found that they in general favor communication on short distance, two-three steps away in the network, within what we call the information horizon.Helheten i ett komplext system är mer än summan av dess delar, då den även inbegriper interaktionerna mellan dem. Att studera sociala, biologiska och ekonomiska system blir därför ofta en fråga om att förstå deras interaktionsmönster, d.v.s. deras nätverk av noder och länkar. Med utgångspunkt i enkla nätverksmodeller undersöker avhandlingen i huvudsak hur kommunikation i nätverk påverkar nätverksstrukturen och, vice versa, hur nätverksstrukturen påverkar villkoren för kommunikation. Vi utforskade mekanismerna bakom hur nätverk är organiserade genom att modellera effekten av kommunikation i förenklade sociala system. En låg kommunikationsnivå visade sig ge upphov till kaotiska nätverk där ingen nod i princip hade fler länkar än någon annan. En hög kommunikationsnivå resulterade däremot i strukturerade nätverk, med några få centrala noder med många länkar, medan flertalet noder var perifera med enbart några få länkar. Det visade sig också att alla aktörer i nätverket gynnades av kommunikation, även när den var ojämnt fördelad. Kvaliteten på kommunikationen, d.v.s. informationens giltighet, var också avgörande för vilka positioner som gynnades i ett nätverk, vilket vi visade genom att studera aktörer som spred falsk information. Eftersom effektiv kommunikation är en viktig del i många nätverk betraktar vi utvecklingen av dem som en optimeringsprocess. Varje kommunikationshandling mellan noderna tar tid och genom att slå sig samman till större enheter begränsas dessa kostnader och gör nätverket effektivare. Dessa s.k. sammanslagningsmodeller gav upphov till samma typ av strukturerade nätverk som ovan. Genom att utveckla olika sätt att mäta nätverksstrukturer visade vi bland annat att många verkliga system främjar kommunikation över korta avstånd, två-tre steg bort i nätverket, innanför det vi kallar informationshorisonten. Vi uppskattade också den mängd information som krävs för att orientera sig i städer, och fann att det är lättare att hitta i moderna, planerade städer än i äldre städer som utvecklats under lång tid