Studija prevalencije antitela u Vojvodini (Srbija) nakon pandemije gripa A-(H1N1)v 2009. godine

Introduction. The seroprevalence study was performed in Vojvodina during May and June 2010 in order to asses the effects of the 2009 pandemic influenza A(H1N1)v epidemic on herd immunity. It was a part of the Serbian Ministry of Health funded nationwide study. Objective. Prevalence of antibodies against 2009 pandemic influenza A(H1N1)v was determined in a 1% sample of the population monitored for influenza-like illness and acute respiratory infections in Vojvodina through sentinel surveillance system. Methods. The study sample involved a total of 1004 inhabitants of Vojvodina. The control group consisted of randomly selected and age-adjusted 1054 sera collected in the pre-pandemic period. Sera were tested by the reaction of hemagglutination inhibition using influenza A/California/7/2009 (H1N1) antigen in dilution from 1:8 to 1:256. Antibody titers ≥1:32 and ≥1:8 were considered protective and diagnostic, respectively. Results. The differences between control and study sera in all age groups were significant for both diagnostic ≥1/8 and protective titres ≥1/32 of hemagglutination inhibition antibodies (chi square test, p lt 0.001). The highest percentage of seropositive subjects was registered in the age group 15-19 years followed by children aged 5-14 years. Both diagnostic and protective titres were about twice higher in the vaccinated as compared to the non-vaccinated group. There were no statistically significant differences in seroprevalence between seven districts of Vojvodina. Conclusion. The 2009 pandemic influenza A(H1N1)v epidemic significantly influenced the herd immunity in our population regardless of low immunization coverage with highest immunity levels in adolescents aged 15-19 years and with similar herd immunity levels in all the regions in the province six months after the outbreak.Uvod. Studija prevalencije antitela izvedena je u Vojvodini tokom maja i juna 2010. godine, kako bi se procenili efekti epidemije izazvane pandemijskim virusom gripa A­(H1N1)v iz 2009. godine na imunitet stanovništva. Studija je bila sastavni deo nacionalne studije koju je finansiralo Ministarstvo zdravlja Republike Srbije. Cilj rada. Prevalencija antitela protiv pandemijskog virusa gripa A­(H1N1)v je utvrđivana na jednoprocentnom uzorku populacije praćene sentinelnim nadzorom nad oboljenjima sličnim gripu i akutnim respiratornim infekcijama u Vojvodini radi procene imuniteta stanovništva Vojvodine. Metode rada. Ispitivanjem su obuhvaćena 1.004 stanovnika Vojvodine čiji serum je dat na analizu (studijska grupa). Kontrolnu grupu činio je uzorak seruma iz prepandemijskog perioda 1.054 nasumično odabrane osobe sličnog uzrasta. Serološko ispitivanje vršeno je reakcijom inhibicije hemaglutinacije antigenom virusa gripa A/Kalifornija/7/2009 (H1N1). Serumi su testirani u razblaženju od 1:8 do 1:256. Titar antitela u razblaženju većem od 1:32 smatrao se zaštitnim titrom, a u razblaženju većem od 1:8 dijagnostičkim. Rezultati. Utvrđena je visoko statistički značajna razlika (p lt 0,001) u prevalenciji antitela između studijske i kontrolne grupe, kako u dijagnostičkom (≥1:8), tako i u zaštitnom titru (≥1:32) hemaglutinin-inhibirajućih antitela. Najveći procenat seropozitivnih ispitanika otkriven je u dobnoj grupi 15–19 godina, a zatim u grupi 5–14 godina. Prevalencija antitela i u dijagnostičkom i u zaštitnom titru bila je dva puta veća kod vakcinisanih osoba u odnosu na nevakcinisane. Nije utvrđena statistički značajna razlika u seroprevalenciji između pojedinih okruga Vojvodine. Zaključak. Utvrđen je visok kolektivni imunitet, bez teritorijalnih razlika, prema pandemijskom virusu gripa A­(H1N1)v iz 2009. godine uprkos slabom obuhvatu stanovništva imunizacijom. Najveće vrednosti su zabeležene kod adolescenata uzrasta od 15 do 19 godina

Novel H1N1 influenza in neonates: from mild to fatal disease

Analysis of pediatric deaths associated with pandemic A H1N1 influenza shows that fatal outcome is more likely in young children, under the age of 5. Neonates, because of the immaturity of their immune system, could represent a high-risk group for severe disease and fatal outcome. We present a group of five neonates with confirmed novel influenza A H1N1 infection. This report indicates that the full spectrum of influenza A H1N1 infection ranging from mild febrile illness with spontaneous recovery to severe disease with fatal outcome may be expected even in neonates. Journal of Perinatology (2011) 31, 446-448; doi:10.1038/jp.2010.19

Epidemija pandemijskog gripa H1N1 u Vojnoj gimnaziji

Background/Aim. The first cases of the pandemic pH1N1 influenza virus infection was observed in the United States and Mexico in April 2009 and the first laboratory confirmed case in Serbia was registered in June 2009. The aim of this paper was to report on the investigation of the first confirmed outbreak of the 2009 pandemic H1N1 influenza in Serbia and to describe the clinical and epidemiologic findings from this investigation. Methods. Descriptive and analytical epidemiological methods were used. Data were collected from medical records of the Military School students and epidemiological questionnaire. Pandemic H1N1 infection was initially confirmed by the RT-PCR assay in nasopharyngeal and oropharyngeal swabs and subsequently by the complement fixation test in serum samples. Results. The attack rate of acute respiratory illness was 70.8% (204/288). Pandemic H1N1 virus infection was confirmed in 44 of 82 tested cases of acute respiratory illness (53.7%) The most common clinical manifestations of pandemic influenza H1N1 were fever (88.6%), cough (61.4%), malaise (38.6%), runny nose (36.4%), headache (29.6%), sore throat (20.5%) and muscle pain (15.9%). Conclusion. The findings from this investigation suggest that pandemic H1N1 influenza in a high military school was widespread but did not cause severe illness.Uvod/Cilj. Prvi slučajevi pandemijske infekcije virusom influence pH1N1 ustanovljeni su u Americi i Meksiku u aprilu 2009. a u Srbiji prvi laboratorijski potvrđen slučaj registrovan je u junu 2009. godine. Cilj rada bio je da se prikaže istraživanje prve dokazane epidemije pandemijske influence H1N1 u Srbiji i opišu klinički i epidemiološki nalazi iz ovog istraživanja. Metode. Primenjen je deskriptivni i analitički epidemiološki metod. Izvor podataka bila je medicinska dokumentacija učenika Vojne gimnazije i epidemiološki upitnik. Infekcija pandemijskim virusom H1N1 prvo je dokazana pomoću RT-PCR u nazofaringealnim i orofaringealnim brisevima, a zatim i reakcijom vezivanja komlementa u uzorcima seruma. Rezultati. Stopa javljanja akutnog respiratornog oboljenja iznosila je 70.8% (204/288). Infekcija pandemijskim H1N1 virusom potvrđena je kod 44 od 82 testiranih slučajeva akutnog respiratornog oboljenja (53,7%). Najčešće kliničke manifestacije pandemijske influence H1N1 bile su povišena temperatura (88,6%), kašalj (61,4%), malaksalost (38,6%), rinitis (36,4%), glavobolja (29,6%), gušobolja (20,5%) i bol u mišićima (15,9%). Zaključak. Rezultati ovog istraživanja ukazuju da je pandemijska influenca H1N1 bila raširena u Vojnoj gimnaziji, ali da nije izazvala teške forme oboljenja

Overview of the winter wave of 2009 pandemic influenza A(H1N1)v in Vojvodina, Serbia

Aim To analyze the epidemiological data for pandemic influenza A(H1N1)v in the Autonomous Province of Vojvodina, Serbia, during the season of 2009/2010 and to assess whether including severe acute respiratory illness (SARI) hospitalization data to the surveillance system gives a more complete picture of the impact of influenza during the pandemic. Methods From September 2009 to September 2010, the Institute of Public Health of Vojvodina conducted sentinel surveillance of influenza-like illnesses and acute respiratory infections in all hospitalized patients with SARI and virological surveillance of population of Vojvodina according to the European Centers for Disease Control technical document. Results The pandemic influenza outbreak in the province started in October 2009 (week 44) in students who had returned from a school-organized trip to Prague, Bratislava, and Vienna. The highest incidence rate was 1090 per 100 000 inhabitants, found in the week 50. The most affected age group were children 5-14 years old. A total of 1591 patients with severe illness were admitted to regional hospitals, with a case fatality rate of 2%, representing a hospitalization rate of 78.3 per 100 000 inhabitants and a mortality rate of 1.6 per 100 000. Most frequently hospitalized were 15-19 years old patients, male patients, and patients with pneumonia (P < 0.001). The highest case fatality rate was found among patients with acute respiratory distress syndrome (P < 0.001). Nasal/throat swabs were obtained for polymerase chain reaction test from 315 hospitalized patients and 20 non-hospitalized patients, and 145 (46%) and 15 (75%) specimens, respectively, tested positive on A(H1N1)v. Conclusion Sentinel influenza-like illness and SARI surveillance, both followed with virological surveillance, seem to be the optimal method to monitor the full scope of the influenza pandemic (from mild to severe influenza) in Vojvodina

Outbreak of West Nile virus infection among humans in Serbia, August to October 2012

We describe the first reported outbreak of West Nile virus (WNV) infection in humans in Serbia in August to October 2012 and examine the association of various variables with encephalitis and fatal outcome. Enzyme-linked immunosorbent assay (ELISA) was used for detection of WNV-specific IgM and IgG antibodies in sera and cerebrospinal fluid. A total of 58 patients (mean age: 61 years; standard deviation: 15) were analysed: 44 were from Belgrade and its suburbs; 52 had neuroinvasive disease, of whom 8 had meningitis, while 44 had encephalitis. Acute flaccid paralysis developed in 13 of the patients with encephalitis. Age over 60 years and immunosuppression (including diabetes) were independently associated with the development of encephalitis in a multivariate analysis: odds ratio (OR): 44.8 (95% confidence interval (CI): 4.93-408.59); p=0.001 (age over 60 years); OR: 10.76 (95% CI: 1.06-109.65); p=0.045 (immunosuppression including diabetes). Respiratory failure requiring mechanical ventilation developed in 13 patients with encephalitis. A total of 35 patients had completely recovered by the time they were discharged; nine patients died. The presence of acute flaccid paralysis, consciousness impairment, respiratory failure and immunosuppression (without diabetes) were found to be associated with death in hospital in a univariate analysis (p lt 0.001, p=0.007, p lt 0.001 and p=0.010, respectively)

Importovanje i širenje pandemijskog virusa influence a(H1N1) u Autonomnoj Pokrajini Vojvodini u predsezonskom periodu

Introduction. Influenza is the most frequently reported communicable disease, having epidemic and pandemic potential. The first influenza pandemic in this century started in Mexico and spread quickly throughout the world. This paper analyses importation of pandemic influenza cases and local transmission among population in the Autonomous Province of Vojvodina. Material and methods. According to the WHO guidelines and national recommendations, the influenza surveillance activities were conducted in Vojvodina in order to detect, isolate and treat affected international travelers and their close contacts. Patients whose pandemic influenza infection was laboratory confirmed were classified as confirmed cases, while those with symptoms who were epidemiologically linked with confirmed cases were classified as probable cases. Results. During the period from the 24th of June to 17th of August 2009, 123 pandemic influenza cases were recorded in Vojvodina. Infection was imported through international travelers and our citizens coming from countries affected by influenza outbreaks. Majority of cases had mild clinical picture. Most frequently reported symptoms were high fever (above 38oC) (85.6%), and cough (61.6%). Difficulty in breathing was recorded in 20 (16.0%) cases, while pneumonia developed in 4 (3.2%) cases but none of the cases required mechanical ventilation. Conclusion. The imported cases of pandemic influenza in the pre-epidemic period led to limited local transmission in general population and caused a small outbreak among visitors of International music festival called EXIT.Influenca je najčešća zarazna bolest sa pandemijskim potencijalom. Prva pandemija influence u ovom veku krenula je iz Meksika i brzo zahvatila čitav svet. Rad analizira importovanje prvih slučajeva i lokalno širenje pandemijske influence među stanovnicima Vojvodine. Nadzorom nad influencom u Pokrajini, u skladu sa smernicama Svetske zdravstvene organizacije i nacionalnim preporukama, obuhvaćeni su putnici u međunarodnom saobraćaju i njihovi kontakti. Bolesnici kod kojih je dokazana infekcija virusom influence A(H1N1) klasifikovani su kao potvrđeni slučajevi, dok su oni sa simptomima influence, epidemiološki povezani sa potvrđenim slučajevima, klasifikovani kao verovatni slučajevi. U periodu od 24. juna do 17. avgusta 2009. godine, na teritoriji Pokrajine su registrovana 123 slučaja pandemijske influence. Infekcija je importovana preko stranih i naših građana koji su dolazili iz zemalja sa lokalnom transmisijom virusa. Importovani slučajevi doveli su u predsezonskom periodu do ograničene lokalne transmisije u opštoj populaciji i epidemijskog širenja među učesnicima Egzita

Rezultati nadzora nad gripom tokom pandemijske i postpandemijskih sezona u AP Vojvodini, Srbija

Introduction. Although influenza is longest and most studied infectious disease, to date, not much has been achieved in preventing and combating this disease. Many infectious diseases are now eliminated or significantly reduced, but only influenza remained epidemic and pandemic character. Influenza epidemics occur every year. Increase in number of patients occurs in early winter. Pandemics occur over long intervals of time and are caused by new subtypes of the influenza virus. Objective. To analyze the epidemiological characteristics of influenza through surveillance of influenza during 3 seasons of monitoring. Method. Data for the analysis were gathered from epidemiological surveillance of influenza through sentinel surveillance, virological surveillance and control of severe acute respiratory distress syndrome. Sentinel physician network consisted of doctors from the public sector, general practitioners, pediatricians, and specialists of emergency medicine and pulmonologists from intensive care units. Supervisors were experts from the Institute of Public Health of Vojvodina, Novi Sad. Samples from the patients (nasopharyngeal swabs) were tested by PCR in National Reference Laboratories (Institute of Virology, Vaccines and Sera 'Torlak' in Belgrade) and in Institute of Public Health of Vojvodina). Results. During the pandemic season, based on the recorded incidence or intensity of clinical activity, incidence rate of the influenza virus infections was above the intermediate threshold (246.3) for the territory of Vojvodina in the period from 45th to 52nd week of surveillance with the peak incidence at 50th week (1090.3 / 100,000). In the next two seasons of sentinel surveillance intensity of virus activity threshold was above the average over the period of 4 to 10 weeks (season 2010/11) and of 11 to 13 weeks of surveillance (season 2011/12). The largest number of patients was registered in the age group of 5-14 years, and the lowest number of patients was in age group over 65. Summarized results of virological surveillance of influenza show that during the pandemic season the most frequent isolate was the virus influenza A (H1N1). The largest number (24) of confirmed cases was registered in 51st week of surveillance, which coincided with the highest activity of the virus influenza during sentinel surveillance of ILI. Within virological surveillance in the season 2010/11 out of total of 213 tested samples of patient material, infection was confirmed in 112 samples: influenza A (H1N1) was confirmed in 90% (101/112), type B in 6.3% (7/112) and influenza A (H3N2) in 3.6% (4/112) samples. During the last season dominant infection was influenza A (H3N2) with a share of 96.5% (55/57) of all confirmed cases of sentinel and non-sentinel specimens tested. The average age of the 38 patients with fatal outcome during the seasons 2009/10 and 2010/11 was 47.1 (range: 12 to 76 years), and all were confirmed to infection with influenza virus A (H1N1). Obesity had the largest share as a factor of comorbidity, and was registered in 36.8% (14/38) patients with fatal outcome. Conclusion. The influenza virus is constantly present in a population with different intensity from year to year. Disease is the most often registered in the preschool and school children, but fatalities due to influenza are usually registered among the working population.Uvod. Iako je influenca najduže i najviše izučavana zarazna bolest, do danas se nije mnogo postiglo u sprečavanju i suzbijanju ovog oboljenja. Mnoge zarazne bolesti su danas eliminisane ili je njihovo javljanje značajno smanjeno, ali je influenca zadržala epidemijski i pandemijski karakter. Epidemije influence se javljaju svake godine. U zemljama severne hemisfere epidemije imaju sezonski karakter. Porast broja obolelih je superponiran, odnosno poklapa se sa početkom zimskog perioda. Pandemije se javljaju u dužim vremenskim intervalima i uzrokovane su novim podtipovima virusa. Cilj rada. Analizirati epidemiološke karakteristike influence kroz nadzor nad gripom tokom tri sezone praćenja. Metod. Podaci za analizu potiču iz epidemiološkog nadzora nad gripom kroz predostrožni (sentinel) nadzor, virusološki nadzor i nadzor nad teškim akutnim respiratornim distres sindromom. Mrežu sentinel lekara činili su lekari iz državnog sektora, lekari opšte medicine i pedijatri, a u jedinicima intenzivne terapije specijalisti urgentne medicine i pulmolozi. Koordinatori nadzora su bili stručnjaci Instituta za javno zdravlje Vojvodine, Novi Sad. Rezultati. U AP Vojvodini, tokom pandemijske godine nadzora nad gripom, stopa incidencije je iznad srednjeg praga intenziteta u periodu od 45. nedelje tekuće godine do 1. nedelje naredne godine, dok su u postpandemijskom periodu vrednosti stopa incidencije iznad praga srednjeg intenziteta u periodu od 1. do 11. nedelje (sezona 2010/2011), odnosno od 11. do 14. nedelje (sezona 2011/2012) nadzora. Tokom pandemijske i naredne godine u uzorcima bolesničkog materijala (bris grla/nosa) dominira infekcija virusom gripa tip A podtip H1N1, a u sezoni 2011/2012 infekcija virusom gripa tip A podtip H3N2. Tokom pandemijske godine ukupan broj umrlih je 32, a tokom naredne sezone 6, dok u poslednjoj sezoni nadzora nisu registrovani smrtni ishodi od gripa. Najveće procentualno učešće umrlih je u uzrastu od 40 do 59 godina i iznosi 55,3% (21/38). Zaključak. Virus influence je konstantno prisutan u populaciji, s različitim intenzitetom aktivnosti od godine do godine. Oboljenje se najčešće registruje u predškolskom i školskom uzrastu, ali su smrtni ishodi zbog gripa najčešće registrovani među radno aktivnim stanovništvom

Measles situation in Serbia in an era of measles elimination (2007-2009)

Following the introduction of measles immunization in Serbia in 1971, measles outbreaks were recorded every 3 to 5 years until 1997. The outbreak in 1997 with 4000 cases was the last large outbreak in Serbia. In 2007, an outbreak with 191 laboratory confirmed or epidemiologically linked cases was reported in Vojvodina. In 2008 and 2009, only 3 cases were confirmed. From 2007-2009, measles infections were most frequently detected in the Roma population but also in non-immunized or partially immunized persons from the general population

A Mumps Outbreak in Vojvodina, Serbia, in 2012 Underlines the Need for Additional Vaccination Opportunities for Young Adults

In 2012, mumps was introduced from Bosnia and Herzegovina to Vojvodina, causing an outbreak with 335 reported cases. The present manuscript analyses the epidemiological and laboratory characteristics of this outbreak, identifies its main causes and suggests potential future preventive measures. Sera of 133 patients were tested for mumps-specific antibodies by ELISA and 15 nose/throat swabs were investigated for mumps virus RNA by RT-PCR. IgG antibodies were found in 127 patients (95.5%). Mumps infection was laboratory-confirmed in 53 patients, including 44 IgM and 9 PCR positive cases. All other 282 cases were classified as epidemiologically-confirmed. More than half of the patients (n = 181, 54%) were 20-29 years old, followed by the 15-19 age bracket (n = 95, 28.4%). Twice as many males as females were affected (67% versus 33%). Disease complications were reported in 13 cases (3.9%), including 9 patients with orchitis and 4 with pancreatitis. According to medical records or anamnestic data, 190 patients (56.7%) were immunized with two doses and 35 (10.4%) with one dose of mumps-containing vaccine. The Serbian sequences corresponded to a minor genotype G variant detected during the 2011/2012 mumps outbreak in Bosnia and Herzegovina. Vaccine failures, the initial one-dose immunization policy and a vaccine shortage between 1999 and 2002 contributed to the outbreak. Additional vaccination opportunities should be offered to young adults during transition periods in their life trajectories

High genetic diversity of measles virus, World Health Organization European region, 2005-2006

During 2005-2006, nine measles virus (MV) genotypes were identified throughout the World Health Organization European Region. All major epidemics were associated with genotypes D4, D6, and B3. Other genotypes (B2, D5, D8, D9, G2, and H1) were only found in limited numbers of cases after importation from other continents. The genetic diversity of endemic D6 strains was low; genotypes C2 and D7, circulating in Europe until recent years, were no longer identified. The transmission chains of several indigenous MV strains may thus have been interrupted by enhanced vaccination. However, multiple importations from Africa and Asia and virus introduction into highly mobile and unvaccinated communities caused a massive spread of D4 and B3 strains throughout much of the region. Thus, despite the reduction of endemic MV circulation, importation of MV from other continents caused prolonged circulation and large outbreaks after their introduction into unvaccinated and highly mobile communities