Boban Mugoša

Massive outbreak of viral gastroenteritis associated with consumption of municipal drinking water in a European capital city

On 24 August 2008, an outbreak alert regarding cases of acute gastroenteritis in Podgorica triggered investigations to guide control measures. From 23 August to 7 September, 1699 cases were reported in Podgorica (population 136 000) and we estimated the total size of the outbreak to be 10 000-15 000 corresponding to an attack rate of approximately 10%. We conducted an age- and neighbourhood-matched case-control study, microbiologically analysed faecal and municipal water samples and assessed the water distribution system. All cases (83/83) and 90% (80/90) [corrected] of controls drank unboiled chlorinated municipal water [matched odds ratio (mOR) 11.2, 95% confidence interval (CI), 1.6-infinity]. Consumption of bottled water was inversely associated with illness (mOR 0.3, 95% CI 0.1-0.8). Analyses of faecal samples identified six norovirus genotypes (21/38 samples) and occasionally other viruses. Multiple defects in the water distribution system were noted. These results suggest that the outbreak was caused by faecally contaminated municipal water. It is unusual to have such a large outbreak in a European city especially when the municipal water supply is chlorinated. Therefore, it is important to establish effective multiple-barrier water-treatment systems whenever possible, but even with an established chlorinated supply, sustained vigilance is central to public health.

Improving survey methods in sero-epidemiological studies of injecting drug users: a case example of two cross sectional surveys in Serbia and Montenegro

BackgroundLittle is known about the prevalence of HIV or HCV in injecting drug users (IDUs) in Serbia and Montenegro. We measured prevalence of antibodies to HIV (anti-HIV) and hepatitis C virus (anti-HCV), and risk factors for anti-HCV, in community-recruited IDUs in Belgrade and Podgorica, and determined the performance of a parallel rapid HIV testing algorithm.MethodsRespondent driven sampling and audio-computer assisted survey interviewing (ACASI) methods were employed. Dried blood spots were collected for unlinked anonymous antibody testing. Belgrade IDUs were offered voluntary confidential rapid HIV testing using a parallel testing algorithm, the performance of which was compared with standard laboratory tests. Predictors of anti-HCV positivity and the diagnostic accuracy of the rapid HIV test algorithm were calculated.ResultsOverall population prevalence of anti-HIV and anti-HCV in IDUs were 3% and 63% respectively in Belgrade (n = 433) and 0% and 22% in Podgorica (n = 328). Around a quarter of IDUs in each city had injected with used needles and syringes in the last four weeks. In both cities anti-HCV positivity was associated with increasing number of years injecting (eg Belgrade adjusted odds ratio (AOR) 5.6 (95% CI 3.2–9.7) and Podgorica AOR 2.5 (1.3–5.1) for ≥ 10 years v 0–4 years), daily injecting (Belgrade AOR 1.6 (1.0–2.7), Podgorica AOR 2.1 (1.3–5.1)), and having ever shared used needles/syringes (Belgrade AOR 2.3 (1.0–5.4), Podgorica AOR 1.9 (1.4–2.6)). Half (47%) of Belgrade participants accepted rapid HIV testing, and there was complete concordance between rapid test results and subsequent confirmatory laboratory tests (sensitivity 100% (95%CI 59%–100%), specificity 100% (95%CI 98%–100%)).ConclusionThe combination of community recruitment, ACASI, rapid testing and a linked diagnostic accuracy study provide enhanced methods for conducting blood borne virus sero-prevalence studies in IDUs. The relatively high uptake of rapid testing suggests that introducing this method in community settings could increase the number of people tested in high risk populations. The high prevalence of HCV and relatively high prevalence of injecting risk behaviour indicate that further HIV transmission is likely in IDUs in both cities. Urgent scale up of HIV prevention interventions is needed.

Reconstruction of the evolutionary dynamics of hepatitis C virus subtypes in Montenegro and the Balkan region

More than 20 million hepatitis C virus (HCV) carriers live in the countries of the Eastern Mediterranean. We determined HCV genotype distribution among chronically infected patients in Montenegro and investigated the phylodynamics and phylogeography of the most represented HCV subtypes. The HCV-NS5b sequences of the Montenegrin patients were compared with sequences isolated in different known localities of the Mediterranean area, Europe and Asia. A Bayesian approach was used in order to allow the simultaneous estimate of the evolutionary rate, time-scaled phylogeny, demography and ancestral spatial status. The most frequent HCV subtypes among the Montenegrin patients, were 1b (34.7%) and 3a (24.7%), but there was also a significant prevalence of 1a and 4d (19.5%). Subtype 3a was significantly more frequent among younger patients and intravenous drug users (IDUs), whereas subtype 1b was more frequently associated with iatrogenic exposure and older ages. The spatio-temporal analysis of the epidemic suggested that HCV-1b penetrated Europe at the beginning of the XX century, probably through Greece and Cyprus and in the 1920s reached Montenegro, where there was an exponential increase in the effective number of infections between the 1950s and 1970s. The phylogeographic and phylodynamic analysis of HCV 3a showed that its most probable origin was in the Indian sub-continent (Pakistan in our reconstruction) about 300years ago. The evolutionary dynamics analysis showed that HCV-3a reached Montenegro more recently in the late 1970s and underwent multi-phasic growth still persisting. Our data suggest multiple introduction of HCV subtypes in the area, supported by different causes of dispersion: adverse social conditions and unsafe medical practices for HCV-1b and i.v. drug use for HCV-3a.

Assessment of Ecological Risk of Heavy Metal Contamination in Coastal Municipalities of Montenegro

Assessment of heavy metal concentrations in the soil samples of urban parks and playgrounds is very important for the evaluation of potential risks for residents, especially children. Until recently, there has been very little data about urban parks pollution in Montenegro. To evaluate the sources of potential contamination and concentration of heavy metals, soil samples from coastal urban parks and kindergartens of Montenegro were collected. Based on the heavy metal concentrations, multivariate analysis combined with geochemical approaches showed that soil samples in coastal areas of Montenegro had mean Pb and Cd concentrations that were over two times higher than the background values, respectively. Based on principal component analysis (PCA), soil pollution with Pb, Cd, Cu, and Zn is contributed by anthropogenic sources. Results for Cr in the surface soils were primarily derived from natural sources. Calculation of different ecological contamination factors showed that Cd is the primary contribution to ecological risk index (RI) origins from anthropogenic, industry, and urbanization sources. This data provides evidence about soil pollution in coastal municipalities of Montenegro. Special attention should be paid to this problem in order to continue further research and to consider possible ways of remediation of the sites where contamination has been observed.

Hepatitis C Virus Infection and Related Risk Factors among Injection Drug Users in Montenegro

Background: In Southeastern Europe, similar to other postsocialist regions on the continent, injection drug users (IDU) are exposed to a high risk of blood-borne infections. In this paper, we report the prevalence of HIV, hepatitis C (HCV) and hepatitis B (HBV) among IDUs in Montenegro. We also examine the risk factors associated with HCV diagnosis. Methods: In 2008, 322 IDUs in Montenegro participated in a respondent-driven sampling survey. Blood specimens were collected and tested for HIV, HCV and HBV. Behavioral data were collected with self-administered questionnaires. Results: In comparison to 2005, HCV prevalence had increased from an estimated 22 to 53.7%. Only one HIV and no HBV cases were detected. Anti-HCV positivity was associated with the region of origin, income, sharing injection equipment and frequency of injecting drugs. Conclusion: The increasing HCV prevalence among IDUs in Montenegro calls for increased and better designed programs to prevent its further spread and a potential HIV outbreak.

Hepatitis B virus genotype and subgenotype prevalence and distribution in Montenegro

The Mediterranean area and the Balkans in particular show the highest level of genetic heterogeneity of HBV in Europe. Data about the circulation of HBV genotypes in Montenegro are lacking. It was studied the prevalence and distribution of HBV genot/subgenotypes in a total of 150 HBV infected patients living in Montenegro. Phylogenetic analysis of 136 successfully amplified P sequences showed a high degree of genetic heterogeneity of HBV in Montenegro. Subgenotype D2 (36.8%) and D3 (32.3%) were the most prevalent, followed by genotype A (subgenotype A2 in all of the cases‐19.8%). Eight patients were infected with recombinant strains. HBV‐D1 which is the most spread HBV subgenotype in the south‐eastern Mediterranean countries, seems to be relatively rare in Montenegro, suggesting a penetration of HBV more probably from North‐East or West than from Eastern Mediterranean countries. The relatively different prevalence of D3 and A2 among subjects infected through sexual route, seems to confirm the association of these subgenotypes with different route of transmissions (mainly parenteral for D3 and mainly sexual for A2) even in Montenegro. The low prevalence of D2 among children and its absence in perinatal transmission, suggests that this subgenotype circulated prevalently in the past. If this is due to changes in the most prevalent way of transmission and in the recent different contacts of Montenegro with other European countries, it remains to be established by other larger studies. J. Med. Virol. 87:807–813, 2015.

Behavior of Young People Regarding Family Planning.

Conflict of interest: none declared. Family planning is a conscious activity of reproductive age that inclines, not only to regulate the number and timing of birth, but also to have a healthy child and to fulfill all of its role throughout the life cycle. The survey included 1804 students of various generations, which is approximately 9.3% of all students of the University of Montenegro. Instrument of survey was questionnaire with 25 closed type questions. Methods used for statistical data analyses were methods of descriptive statistics and nonparametric methods to analyze significance of differences at the significance p>0.05. The study comprised 53.9% of students aged up to 20 years and 46.1% of students aged from 21 to 26 years. There is statistically significant difference among students regarding sources of knowledge on family planning by age (Chi 2 = 14.54, p<0.05). The students have got information on family planning mostly from parents (46.7%). Out of total number of interviewed students, who stated that abortion is good method of contraception, 12.8% claimed doctors as the source of information, then books, mass media and parents. The most of interviewed students find condom as the best contraceptive method. Students used to get information on family planning mostly often from their parents, and most of them consider that they are well informed. One third of students do not protect themselves from undesired pregnancy, but most of them consider abortion as non adequate method of family planning.

Prevalence of Smoking and Other Smoking-Related Behaviours Among Students Aged 13 to 15 Years in Montenegro: Results from the Global Youth Tobacco Survey of 2008

Prevalence of Smoking and Other Smoking-Related Behaviours Among Students Aged 13 to 15 Years in Montenegro: Results from the Global Youth Tobacco Survey of 2008 The Global Youth Tobacco Survey (GYTS) is an international study that provides data on youth tobacco use for development of tobacco control programs. It is a school-based survey that uses a standardised methodology for sampling, core questionnaire items, training protocol, field procedures, and data management. This article reports the findings from a GYTS conducted in Montenegro in 2008, which included 5723 adolescents. More than 30 % of students aged 13 to 15 tried smoking, 5.1 % smoked cigarettes, and 3.6 % of students used tobacco products other than cigarettes. Four in 10 ever smokers started to smoke before the age of 10. More than half the students reported secondary smoke exposure at home. Almost all (96.5 %) current smokers bought cigarettes in a store. Two in 10 students owned an artifact with a cigarette or tobacco brand logo on it. The GYTS study has shown that there is an urgent need to introduce effective child-oriented smoking prevention programmes in early elementary school classes. These should be accompanied by public awareness campaigns on smoke-free homes. Zastupljenost pušenja i pušačke navike učenika dobi 13 do 15 godina u Crnoj Gori: rezultati globalnog istraživanja o potrošnji duhana kod mladih (GYTS) 2008 Globalno istraživanje o potrošnji duhana kod mladih (GYTS) međunarodna je studija koja pruža podatke o pušačkim navikama mladih i omogućava razvijanje programa čiji je cilj kontrola duhana. U ovom radu dati su rezultati istraživanja GYTS koje je provedeno 2008. godine u Crnoj Gori. Istraživanje GYTS provodi se u školama pri čemu je standardizirana metodologija za formiranje uzorka, upitnik, prikupljanje i obrada podataka. Ukupno su 5723 učenika sudjelovala u istraživanju. Više od 30 % učenika dobi 13 do 15 godina eksperimentiralo je cigaretama. U ovoj populaciji ima 5.1 % stalnih pušača cigareta, dok 3.6 % učenika koristi neke druge duhanske proizvode. Četiri od 10 pušača počela su pušiti prije desete godine života. Više od pola ispitanika odgovorilo je da su izloženi duhanskom dimu u svojoj kući. Gotovo svi pušači (96.5 %) najčešće kupuju cigarete u prodavaonicama. Dva od 10 ispitanika imaju neki predmet s logom proizvođača cigareta. Rezultati istraživanja pokazuju da je potrebno hitno pokrenuti preventivne programe kontrole duhana u nižim razredima osnovne škole. Također, potrebno je osmisliti i implementirati kampanje čiji je cilj podizanje svijesti građana o štetnosti pušenja u zatvorenom prostoru.

Haemorrhagic fever with renal syndrome in Montenegro, 2004-14

From 2004 to 2014, 106 cases of Human haemorrhagic fever with renal syndrome were notified in Montenegro, with a peak in 2014. Most of the cases occurred in summer, in the North-east and Central Montenegro, a hilly/mountainous area, that provides suitable habitats for the main rodent carriers. Cases were mainly males (71) and exposures were often working outdoor or spending time visiting mountains and lakes. Incidence correlated with average annual temperature increase and average annual rainfalls decrease, but not with land cover. Environment and climate effects on HFRS in Montenegro need further investigation to get insight into future trends.

Hepatitis C virus genotype 3A in a population of injecting drug users in Montenegro: Bayesian and evolutionary analysis

Few reports are available on HCV molecular epidemiology among IDUs in Eastern Europe, and none in Montenegro. The aim of this study was to investigate the HCV genotype distribution in Montenegro among IDUs and to perform Bayesian and evolutionary analysis of the most prevalent HCV genotype circulating in this population. Sixty-four HCV-positive IDUs in Montenegro were enrolled between 2013 and 2014, and the NS5B gene was sequenced. The Bayesian analysis showed that the most prevalent subtype was HCV-3a. Phylogenetic data showed that HCV-3a reached Montenegro in the late 1990s, causing an epidemic that exponentially grew between the 1995 and 2005. In the dated tree, four different entries, from 1990 (clade D), 1994 (clade A) to 1999 (clade B) and 2001 (clade C), were identified. In the NS5B protein model, the amino acids variations were located mainly in the palm domain, which contains most of the conserved structural elements of the active site. This study provides an analysis of the virus transmission pathway and the evolution of HCV genotype 3a among IDUs in Montenegro. These data could represent the basis for further strategies aimed to improve disease management and surveillance program development in high-risk populations.