Sensitivity and specificity of case definition for pertussis

Uprkos rezultatima postignutih imunizacijom, veliki kašalj je i danas vodeći uzrok smrti među zaraznim bolestima protiv kojih se sprovodi imunizacija. Postojanje različitih vrsta nadzora, prisutnih nedostataka laboratorijske dijagnostike oboljenja, slabosti u dostupnim definicijama slučaja velikog kašlja i neprepoznavanje oboljenja, otežavaju realno sagledavanje opterećenja velikim kašljem i poređenje postignutih rezultata u različitim zemljama. Postojeće definicije slučaja velikog kašlja nisu prihvatljive u svim uzrastima. Cilj istraživanja je bio da se na reprezentativnom uzorku Grada Novog Sada utvrdi: stopa incidencije velikog kašlja tokom jedne godine savremenog nadzora; senzitivnost i specifičnost definicija slučaja velikog kašlja, datih od strane Globalne pertusis inicijative za tri uzrasne grupe. U istraživanje je uključeno 213 ispitanika pacijenata iz sentinelnog nadzora nad velikim kašljem Doma zdravlja Novi Sad i 107 ispitanika pacijenata iz hospitalnog nadzora sa iste teritorije koji su ispunjavali predložene definicije slučaja za tri uzrasne grupe (0-3 meseca; 4 meseca-9 godina života; 10 godina i stariji). Podaci za istraživanje dobijeni su popunjavanjem anketnog upitnika. Laboratorijsko testiranje sumnji na veliki kašalj sprovedeno je u Centru za mikrobiologiju Instituta za javno zdravlje Vojvodine. Kod pacijenata sa kašljem u trajanju do 21 dan testiranje je vršeno upotrebom PCR metoda, a kod pacijenata sa kašljem u trajanju više od 21 dan, dokazivanje oboljenja vršeno je upotrebom ELISA IgA i IgG seroloških testova. Potvrđenim slučajem velikog kašlja smatran je pacijent sa ispunjenom definicijom slučaja oboljenja i laboratorijskom potvrdom oboljenja, PCR ili ELISA testom. Procenjena stopa incidencije velikog kašlja u Novom Sadu je 237,7/100.000, a stopa incidencije hospitalizovanih u Novom Sadu je 16,4/100.000. Najviše stope incidencije velikog kašlja u sentinelnom nadzoru registruju se u uzrastu 10-14, a u hospitalnom u uzrastu od 7 do 9 godina. Senzitivnost, specifičnost i stepen verovatnoće pozitivnog rezultata testiranog simptoma/znaka iz predloženih definicija slučaja se razlikuju po uzrastima i po pojedinim simptomima/znacima. Predložene definicije slučaja u uzrastima od 4 meseca do 9 godina i u uzrastu od 10 godina i starijih imaju veću verovatnoću otkrivanja obolelih u hospitalnom u odnosu na sentinelni nadzor za pojedine simptome/znakove. Budući da je tokom istraživanja u sentinelnom nadzoru oboljenje potvrđeno kod svakog petog, a u hospitalnom kod svakog drugog testiranog pacijenta, predložene definicije slučaja se mogu koristiti u nadzoru nad velikim kašljem.Despite all results achieved by immunization, pertussis is still the leading cause of death among vaccine preventable diseases. Different types of surveillance and laboratory confirmation of pertussis, weakness of existing case definitions for pertussis and broad spectrum clinical manifestation of disease, complicate overview of disease and result comparison of surveillance in different countries. The current pertussis case definition is not acceptable for all age groups of patients. The aim of this research was to determine: the pertussis incidence rate in population of Novi Sad during one year of modern surveillance; the sensitivity and specificity of clinical case definition for pertussis, given by the Global Pertussis Initiative for three age groups, with a representative sample of population in the City of Novi Sad. 213 patients from sentinel surveillance of pertussis Novi Sad Health Centre and 107 hospitalized patients from Novi Sad, who fulfilled criteria of case definition proposed for the three age groups (0-3 months, 4 months-9 years; 10 years of age and older), were included in the research. Research data obtained from a questionnaire. Laboratory testing of suspected cases were conducted at the Centre for Microbiology, Institute of Public Health of Vojvodina. For patients with coughing less than 21 days PCR method was used, and for patients with cough lasting more than 21 days, laboratory confirmation of disease was performed using ELISA IgA and IgG serological tests. Confirmed case of pertussis consider to be a patient with symptoms/signs according to proposed case definition and with laboratory confirmation of the pertussis, PCR or ELISA. Estimated incidence rate of pertussis for population in the city of Novi Sad was 237.7/100,000, and the pertussis incidence rate in hospitalized patient in Novi Sad was 16.4/100,000. The highest incidence rate of pertussis in the sentinel surveillance was registered in the age group 10-14 and in the hospital surveillance in the group 7 to 9 years of age. The values of sensitivity, specificity and positive likelihood ratio of symptoms/signs from the proposed case definition were calculated and they different by age and by certain symptoms/signs from proposed case definition. Certain symptoms/signs of the proposed case definition have a higher probability of detection among patients aged 4 months to nine, and at the age of ten year and older, in the hospital versus those in sentinel surveillance for pertussis. During research from the patients who were tested in sentinel surveillance every fifth was laboratory confirmed case and in the hospital surveillance every second patient was confirmed case, so the proposed case definitions can be used in the surveillance of pertussis

Sensitivity and specificity of case definition for pertussis

Uprkos rezultatima postignutih imunizacijom, veliki kašalj je i danas vodeći uzrok smrti među zaraznim bolestima protiv kojih se sprovodi imunizacija. Postojanje različitih vrsta nadzora, prisutnih nedostataka laboratorijske dijagnostike oboljenja, slabosti u dostupnim definicijama slučaja velikog kašlja i neprepoznavanje oboljenja, otežavaju realno sagledavanje opterećenja velikim kašljem i poređenje postignutih rezultata u različitim zemljama. Postojeće definicije slučaja velikog kašlja nisu prihvatljive u svim uzrastima. Cilj istraživanja je bio da se na reprezentativnom uzorku Grada Novog Sada utvrdi: stopa incidencije velikog kašlja tokom jedne godine savremenog nadzora; senzitivnost i specifičnost definicija slučaja velikog kašlja, datih od strane Globalne pertusis inicijative za tri uzrasne grupe. U istraživanje je uključeno 213 ispitanika pacijenata iz sentinelnog nadzora nad velikim kašljem Doma zdravlja Novi Sad i 107 ispitanika pacijenata iz hospitalnog nadzora sa iste teritorije koji su ispunjavali predložene definicije slučaja za tri uzrasne grupe (0-3 meseca; 4 meseca-9 godina života; 10 godina i stariji). Podaci za istraživanje dobijeni su popunjavanjem anketnog upitnika. Laboratorijsko testiranje sumnji na veliki kašalj sprovedeno je u Centru za mikrobiologiju Instituta za javno zdravlje Vojvodine. Kod pacijenata sa kašljem u trajanju do 21 dan testiranje je vršeno upotrebom PCR metoda, a kod pacijenata sa kašljem u trajanju više od 21 dan, dokazivanje oboljenja vršeno je upotrebom ELISA IgA i IgG seroloških testova. Potvrđenim slučajem velikog kašlja smatran je pacijent sa ispunjenom definicijom slučaja oboljenja i laboratorijskom potvrdom oboljenja, PCR ili ELISA testom. Procenjena stopa incidencije velikog kašlja u Novom Sadu je 237,7/100.000, a stopa incidencije hospitalizovanih u Novom Sadu je 16,4/100.000. Najviše stope incidencije velikog kašlja u sentinelnom nadzoru registruju se u uzrastu 10-14, a u hospitalnom u uzrastu od 7 do 9 godina. Senzitivnost, specifičnost i stepen verovatnoće pozitivnog rezultata testiranog simptoma/znaka iz predloženih definicija slučaja se razlikuju po uzrastima i po pojedinim simptomima/znacima. Predložene definicije slučaja u uzrastima od 4 meseca do 9 godina i u uzrastu od 10 godina i starijih imaju veću verovatnoću otkrivanja obolelih u hospitalnom u odnosu na sentinelni nadzor za pojedine simptome/znakove. Budući da je tokom istraživanja u sentinelnom nadzoru oboljenje potvrđeno kod svakog petog, a u hospitalnom kod svakog drugog testiranog pacijenta, predložene definicije slučaja se mogu koristiti u nadzoru nad velikim kašljem.Despite all results achieved by immunization, pertussis is still the leading cause of death among vaccine preventable diseases. Different types of surveillance and laboratory confirmation of pertussis, weakness of existing case definitions for pertussis and broad spectrum clinical manifestation of disease, complicate overview of disease and result comparison of surveillance in different countries. The current pertussis case definition is not acceptable for all age groups of patients. The aim of this research was to determine: the pertussis incidence rate in population of Novi Sad during one year of modern surveillance; the sensitivity and specificity of clinical case definition for pertussis, given by the Global Pertussis Initiative for three age groups, with a representative sample of population in the City of Novi Sad. 213 patients from sentinel surveillance of pertussis Novi Sad Health Centre and 107 hospitalized patients from Novi Sad, who fulfilled criteria of case definition proposed for the three age groups (0-3 months, 4 months-9 years; 10 years of age and older), were included in the research. Research data obtained from a questionnaire. Laboratory testing of suspected cases were conducted at the Centre for Microbiology, Institute of Public Health of Vojvodina. For patients with coughing less than 21 days PCR method was used, and for patients with cough lasting more than 21 days, laboratory confirmation of disease was performed using ELISA IgA and IgG serological tests. Confirmed case of pertussis consider to be a patient with symptoms/signs according to proposed case definition and with laboratory confirmation of the pertussis, PCR or ELISA. Estimated incidence rate of pertussis for population in the city of Novi Sad was 237.7/100,000, and the pertussis incidence rate in hospitalized patient in Novi Sad was 16.4/100,000. The highest incidence rate of pertussis in the sentinel surveillance was registered in the age group 10-14 and in the hospital surveillance in the group 7 to 9 years of age. The values of sensitivity, specificity and positive likelihood ratio of symptoms/signs from the proposed case definition were calculated and they different by age and by certain symptoms/signs from proposed case definition. Certain symptoms/signs of the proposed case definition have a higher probability of detection among patients aged 4 months to nine, and at the age of ten year and older, in the hospital versus those in sentinel surveillance for pertussis. During research from the patients who were tested in sentinel surveillance every fifth was laboratory confirmed case and in the hospital surveillance every second patient was confirmed case, so the proposed case definitions can be used in the surveillance of pertussis

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

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

SARS-COV-2 ANTIGEN SCREENING DURING THE FIRST POST-LOCKDOWN MAJOR MUSIC FESTIVAL IN NOVI SAD, SERBIA, IN JULY 2021

Many countries have resumed mass gathering events like music festivals, despite potential risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmissions. This study aimed to examine the frequency of SARS-CoV-2 infection among visitors to a mass event, the EXIT festival, in relation to the proposed preventive measures. A total of 466 visitors were included in this longitudinal study conducted in Novi Sad, Serbia, during July, 2021. All subjects were tested with RDT-Ag test for the presence of SARS-CoV-2 virus at the beginning of the study and seven days after. Basic socio-demographic and epidemiological data were collected through a questionnaire. The average age of participants was 28.34 ± 8.87 years with the majority of men (53.7%). There were 170 (36.5%) vaccinated participants. A 97.1% in vaccinated and 92.2% in unvaccinated group, reported to regularly wear a protective mask (p=0.029). At the second cross-sectional testing, 354 subjects were tested, of which 150 (42.4%) were vaccinated. There was no statistically significant difference in application of preventive measures during and after the festival, in respect to vaccination status of the participants. Twenty participants (5.6%) reported some of the COVID-19-like symptoms in the first seven days after visiting the festival, but no COVID-19 infection was confirmed at the RDT-Ag testing. Despite the potential effectiveness of applied preventive measures such as RDT-Ag screening, mask-wearing and vaccination, additional caution is needed when holding these events during a period of high SARS-CoV-2 transmission, as well as when the new virus variants emerge in community

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

Sensitivity and specificity of case definition for pertussis

Uprkos rezultatima postignutih imunizacijom, veliki kašalj je i danas vodeći uzrok smrti među zaraznim bolestima protiv kojih se sprovodi imunizacija. Postojanje različitih vrsta nadzora, prisutnih nedostataka laboratorijske dijagnostike oboljenja, slabosti u dostupnim definicijama slučaja velikog kašlja i neprepoznavanje oboljenja, otežavaju realno sagledavanje opterećenja velikim kašljem i poređenje postignutih rezultata u različitim zemljama. Postojeće definicije slučaja velikog kašlja nisu prihvatljive u svim uzrastima. Cilj istraživanja je bio da se na reprezentativnom uzorku Grada Novog Sada utvrdi: stopa incidencije velikog kašlja tokom jedne godine savremenog nadzora; senzitivnost i specifičnost definicija slučaja velikog kašlja, datih od strane Globalne pertusis inicijative za tri uzrasne grupe. U istraživanje je uključeno 213 ispitanika pacijenata iz sentinelnog nadzora nad velikim kašljem Doma zdravlja Novi Sad i 107 ispitanika pacijenata iz hospitalnog nadzora sa iste teritorije koji su ispunjavali predložene definicije slučaja za tri uzrasne grupe (0-3 meseca; 4 meseca-9 godina života; 10 godina i stariji). Podaci za istraživanje dobijeni su popunjavanjem anketnog upitnika. Laboratorijsko testiranje sumnji na veliki kašalj sprovedeno je u Centru za mikrobiologiju Instituta za javno zdravlje Vojvodine. Kod pacijenata sa kašljem u trajanju do 21 dan testiranje je vršeno upotrebom PCR metoda, a kod pacijenata sa kašljem u trajanju više od 21 dan, dokazivanje oboljenja vršeno je upotrebom ELISA IgA i IgG seroloških testova. Potvrđenim slučajem velikog kašlja smatran je pacijent sa ispunjenom definicijom slučaja oboljenja i laboratorijskom potvrdom oboljenja, PCR ili ELISA testom. Procenjena stopa incidencije velikog kašlja u Novom Sadu je 237,7/100.000, a stopa incidencije hospitalizovanih u Novom Sadu je 16,4/100.000. Najviše stope incidencije velikog kašlja u sentinelnom nadzoru registruju se u uzrastu 10-14, a u hospitalnom u uzrastu od 7 do 9 godina. Senzitivnost, specifičnost i stepen verovatnoće pozitivnog rezultata testiranog simptoma/znaka iz predloženih definicija slučaja se razlikuju po uzrastima i po pojedinim simptomima/znacima. Predložene definicije slučaja u uzrastima od 4 meseca do 9 godina i u uzrastu od 10 godina i starijih imaju veću verovatnoću otkrivanja obolelih u hospitalnom u odnosu na sentinelni nadzor za pojedine simptome/znakove. Budući da je tokom istraživanja u sentinelnom nadzoru oboljenje potvrđeno kod svakog petog, a u hospitalnom kod svakog drugog testiranog pacijenta, predložene definicije slučaja se mogu koristiti u nadzoru nad velikim kašljem.Despite all results achieved by immunization, pertussis is still the leading cause of death among vaccine preventable diseases. Different types of surveillance and laboratory confirmation of pertussis, weakness of existing case definitions for pertussis and broad spectrum clinical manifestation of disease, complicate overview of disease and result comparison of surveillance in different countries. The current pertussis case definition is not acceptable for all age groups of patients. The aim of this research was to determine: the pertussis incidence rate in population of Novi Sad during one year of modern surveillance; the sensitivity and specificity of clinical case definition for pertussis, given by the Global Pertussis Initiative for three age groups, with a representative sample of population in the City of Novi Sad. 213 patients from sentinel surveillance of pertussis Novi Sad Health Centre and 107 hospitalized patients from Novi Sad, who fulfilled criteria of case definition proposed for the three age groups (0-3 months, 4 months-9 years; 10 years of age and older), were included in the research. Research data obtained from a questionnaire. Laboratory testing of suspected cases were conducted at the Centre for Microbiology, Institute of Public Health of Vojvodina. For patients with coughing less than 21 days PCR method was used, and for patients with cough lasting more than 21 days, laboratory confirmation of disease was performed using ELISA IgA and IgG serological tests. Confirmed case of pertussis consider to be a patient with symptoms/signs according to proposed case definition and with laboratory confirmation of the pertussis, PCR or ELISA. Estimated incidence rate of pertussis for population in the city of Novi Sad was 237.7/100,000, and the pertussis incidence rate in hospitalized patient in Novi Sad was 16.4/100,000. The highest incidence rate of pertussis in the sentinel surveillance was registered in the age group 10-14 and in the hospital surveillance in the group 7 to 9 years of age. The values of sensitivity, specificity and positive likelihood ratio of symptoms/signs from the proposed case definition were calculated and they different by age and by certain symptoms/signs from proposed case definition. Certain symptoms/signs of the proposed case definition have a higher probability of detection among patients aged 4 months to nine, and at the age of ten year and older, in the hospital versus those in sentinel surveillance for pertussis. During research from the patients who were tested in sentinel surveillance every fifth was laboratory confirmed case and in the hospital surveillance every second patient was confirmed case, so the proposed case definitions can be used in the surveillance of pertussis

Seroprevalence of pertussis in adult population

Introduction/Objective. Seroepidemiological studies are crucial for better understanding of pertussis epidemiology. The aim of this study was to assess the seroprevalence of anti-Bordetella pertussis toxin antibodies (anti-PT IgG) in the adult population of Novi Sad, and to evaluate the differences by age and sex. Methods. A cross-sectional study was conducted in 468 healthy adults aged ≥ 20 years stratified into seven age groups. The youngest of our participants received the last dose of the vaccine at least 18 years ago. Positive results of anti-PT IgG concentrations were considered a consequence of natural pertussis infection or reinfection. A commercial ELISA kit (EuroimmunR, Lubeck, Germany), with anti-PT IgG with four calibrators (5 IU/mL, 25 IU/mL, 100 IU/mL, and 200 IU/mL) was used. Results. Most of the subjects (53.8%) had anti-PT IgG of > 5 to < 62.5 IU/mL. The proportion of participants with high concentrations (62.5 to < 125 IU/mL) was statistically significantly higher in females than in males (5.4% vs. 0.4%, p = 0.002). The highest values of anti-PT IgG were detected among subjects in the age group of 20–24 years (17.5 Ѓ} 22.2 IU/mL), and in the participants ≥ 60 years of age (15.0 Ѓ} 29.4 IU/ mL). The percentage of anti-PT IgG concentration of ≥ 62.5 IU/mL was the highest among subjects aged ≥ 60 years (6.6%) and among those aged 20–24 years (5%). Conclusions. The limited duration of vaccine-induced immunity with subsequent infection or reinfection enables the circulation of pertussis in the adult population of Novi Sad that serves as the reservoir of infection for transmission to vulnerable persons

Early Effectiveness of Four SARS-CoV-2 Vaccines in Preventing COVID-19 among Adults Aged ≥60 Years in Vojvodina, Serbia

Real-world evidence of the vaccine effectiveness (VE) of different COVID-19 vaccines is needed in order to better shape vaccine recommendations and policies and increase vaccine acceptance, especially among vulnerable populations such as the elderly. We analyzed the early effectiveness of four COVID-19 vaccines, namely BNT162b2, BBIBP-CorV, Gam-COVID-Vac and ChAdOx1 nCoV-19 in population aged ≥60 years for symptomatic, mild and severe COVID-19, in the period January–April 2021 in Vojvodina, a northern province of Serbia. Incidence rates of SARS-CoV-2 infection were calculated using data from the provincial COVID-19 surveillance registry, and vaccination coverage data were obtained from the nationwide registry of administered COVID-19 vaccines. During the observation period, 134,535 subjects aged ≥60 years were fully vaccinated, of whom 87.7% received BBIBP-CorV, 7.1% BNT162b2 and 5.2% Gam-COVID-Vac vaccines. The estimated VE in fully vaccinated persons was 86.9% (95% CI, 86–87.7) for BBIBP-CorV, 95% (95% CI, 92.4–96.7) for Gam-COVID-Vac and 99% (95% CI, 97.8–99.5) for BNT162b2, while VE after the first dose of ChAdOx1 nCoV-19 was 88.6% (95% CI, 80.5–93.4). Estimates were similar when stratifying the analyses to severe and mild SARS-CoV-2 infections. Our analysis provides evidence of high early effectiveness of BNT162b2, BBIBP-CorV, Gam-COVID-Vac and ChAdOx1 nCoV-19 in elderly people in preventing symptomatic, severe and mild COVID-19 disease, particularly after being fully vaccinated