Vesna Milosevic

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.

Testing for viral material in water of public bathing areas of the Danube during summer, Vojvodina, Serbia, 2014.

From August to September 2014 a water quality study was conducted on five popular public Danube beaches in Vojvodina, Serbia. To assess the safety of Danube water for bathing, physical, chemical, bacteriological tests were performed. While many parameters for monitoring the quality of water are regulated by law, there are neither national nor international legislations addressing the presence of viruses in recreational waters. In this study, we performed analyses that surpassed national requirements, and investigated if adenovirus, enterovirus or rotavirus genetic material was present in samples of recreational water collected for quality monitoring. Of 90 water samples obtained during the study, enterovirus material was not found in any sample, but adenovirus and rotavirus genetic materials were respectively detected in 60 and 31 samples. Statistical analyses showed a significant correlation between adenovirus DNA and total coliforms in the water. Even when water samples were adequate for recreational use, adenoviruses were detected in 75% (57/76) of such samples. Our results indicate that implementation of viral indicators in recreational water might be helpful to better assess public health safety. This might be particularly relevant in areas where urban wastewater treatment is insufficient and surface waters affected by wastewater are used for recreation.

Unusual high rate of asymptomatic maternal parvovirus B19 infection associated with severe fetal outcome

Objective. To study the role of asymptomatic maternal parvo B19 infection in severe fetal outcome in Province of Vojvodina. Methods. One hundred seventy-six pregnant women (13–25 weeks of gestation) were divided in two groups – patients with symptoms of imminent spontaneous abortion and poor pregnancy outcome and patients with normal course of pregnancy. Double serum samples were analyzed to quantify IgM and IgG to parvovirus B19. Results. Among pregnant women with symptoms of spontaneous abortion, we found significantly higher percentage of acute parvovirus B19 infection. Conclusions. Asymptomatic parvo B19 infection is associated with poor fetal outcome much more than we presumed previously.

Frequency of twelve carcinogenic human papilloma virus types among women from the South Backa region, Vojvodina, Serbia

BACKGROUND/AIM The aim of this study was to determine the presence and age distribution of different oncogenic human papilloma virus (HPV) types in women in the South Backa region and its relationship to Pap results. MATERIALS AND METHODS In a group of 1087 women with normal and abnormal cytology, the commercial HR HPV Real-TM kit (Sacace Biotechnologies, Italy) was used. RESULTS Overall, 50.5% of the women were HPV positive. The presence of HPV types 18, 31, 51, and 58 was significantly influenced by age, while the presence of HPV types 16 and 45 was significantly influenced by cervical cytology. Results of the LSD test show a wide spectrum of high risk HPV among women with normal cytology and women with a low grade cervical lesion rate (atypical squamous cell of undetermined significance (ASCUS) and low grade squamous intraepithelial lesions (LSIL). The most prevalent HPV types found were 16, 31, 51, 18, and 52. In the HSIL group the most prevalent HPV types were 16 and 45. CONCLUSION The reported results provide new data on the circulation of oncogenic HPV genotypes and frequency of multiple infections among women in Vojvodina and suggest that a prophylactic vaccine against HPV 16 and 18 has the potential to prevent approximately half of the high-grade lesions.

First report of imported case of dengue fever in Republic of Serbia

we would like to follow up on a recent paper Valerio et al. Authors stated in conclusion that the incidence of dengue and chikungunya is steadily increasing in the North Metropolitan area of Barcelona, a region densely colonized by Aedes albopictus, at the entire expense of imported cases (especially visiting friends and relatives travelers) [1]. We report, for the first time, a viraemic dengue primary infection imported from an endemic country (Havana, Cuba) to Republic of Serbia. The patient was admitted to the hospital at early post-febrile period (stage II). Dengue fever was caused by DENV-3 with clinical presentation of febrile illness without progress to more severe and potentially fatal disease involving haemorrhage or shock. The 43 years old male patient with residence in Ka c (Municipality of Novi Sad), Serbia works as a travel guide. The disease started on the same day after return from Havana (2015-09-29), in the evening, by increased temperature, chills and muscle aches. During his last stay in Havana, Cuban health authorities informed him that prior to his stay 2 dengue cases were confirmed from the building he was residing. He was not vaccinated against Yellow fever or Tick-borne encephalitis and his anamnesis did not have previous dengue fever infections. Serological analysis by indirect immunofluorescence test (“Flavivirus profile 2”, Euroimmune, Germany) revealed Dengue 3 virus e specific IgM antibodies. The sample had a borderline result for Dengue 3 IgG antibodies and a negative result for IgM and IgG antibodies against the West Nile virus, Japanese encephalitis virus, and Yellow fever virus. The case was confirmed as Dengue 3 virus infection by real-time RT PCR, using “DENV-1-4-RT-PCR” primers and probe kit, provided by CDC (Atlanta, USA). Presence of IgM with borderline result of IgG antibodies accompanied with RT-PCR positive result demonstrated that this DENV-3 infection was primary.

P3.052 Frequency of Multiple HPV Genotypes in Women from Vojvodina, Serbia

Background Persistent infection with high-risk (HR) human papillomavirus (HPV) types is necessary for cervical cancer development. The risk is much higher for women infected with multiple genotypes of the human papillomavirus (HPV). The aim of this study was to evaluate the frequency of single and multiple HPV infection in relation to age and results of Pap smear cytology. Methods From January to December 2012, frequency of HR HPV was analysed among 398 women from Vojvodina. In determination of the presence HPV DNA commercial HR HPV Real-TM kit (Sacace Biotechnologies, Italy) were applied. PCR was performed and products were detected using ABI 7500 Real-Time PCR instrument. Results The overall prevalence of HPV infection among studied women was 61.3%. Single HPV genotypes were found in 150 (65.3%) and multiple genotypes in 94 (34.7%) of 244 HPV DNA positive samples. The most frequent genotype was HPV 16, followed by HPV 31, 51.52 and 18. Proportion of multiple HPV infection decreased significantly according to age and severity from 48.9% in women under 30 years of age, 39.7% in women from 30 to 40 years of age, 21.3% in women older than 40. Among all women with normal cytology multiple HPV infections were found in (22.4%), (34.9%) among women with ASCUS cytology, (17.0%) in LSIL cytology and (17.9%) in HSIL cytology. Conclusion In the present study, we observed a very high prevalence of multiple (22.4%) of HPV infection among women with normal cytology and (34.9%) in women with indeterminate Pap test, as ASCUS cytology. Sensitive and specific detection methods, as well as, real-time PCR genotyping HPV are required and helpful for triage of women with ASCUS cytology.

Varicella zoster virus transmission dynamics in Vojvodina, Serbia

This study aimed at establishing baseline key epidemiological parameters for varicella zoster virus (VZV) infection in Vojvodina, Serbia, with the ultimate goal to quantify the VZV transmission potential in the population. Seroprevalence data generated during the first large cross-sectional VZV serosurvey were modelled, using a two-tiered modelling approach to calculate age-specific forces of infection (FOI), the basic reproduction number (R0) and herd immunity threshold (H). Seroprevalence and modelling data were compared with corresponding pre-vaccination epidemiological parameters from 11 countries participating in the European Sero-Epidemiology Network 2 (ESEN2) project. Serbia fits into the general dynamic VZV transmission patterns in Europe in the pre-vaccine era, with estimated R0 = 4.12, (95% CI: 2.69–7.07) and H = 0.76 (95% CI: 0.63–0.86). The highest VZV transmission occurs among preschool children, as evidenced by the estimation of the highest FOI (0.22, 95% CI: 0.11–0.34) in the 0.5–4 age group, with a peak FOI of 0.25 at 2.23 years. Seroprevalence was consistently lower in 5–14 year-olds, resulting in considerable shares of VZV-susceptible adolescents (7.3%), and young adults (6%), resembling the situation in a minority of European countries. The obtained key epidemiological parameters showed most intense VZV transmission in preschool children aged <4 years, justifying the consideration of universal childhood immunization in the future. National immunization strategy should consider programs for VZV serologic screening and immunization of susceptible groups, including adolescents and women of reproductive age. This work is an important milestone towards the evaluation of varicella immunization policy options in Serbia.

A large epidemic of hepatitis B in Serbia: An integrated model for outbreak investigations in healthcare settings

We report a comprehensive approach for outbreak investigations, including cluster analysis (Bernoulli model), an algorithm to build inferential models, and molecular techniques to confirm cases. Our approach may be an interesting tool to best exploit the large amount of unsystematically collected information available during outbreak investigations in healthcare settings.

Significance of screening tests in diagnosis of infectious mononucleosis

The investigation included 91 patients in who an acute or previous EBV infection was established by ELISA test. All patients were also subjected to the Paul-Bunnell-Davidsohn test, while 20 patients were tested by the rapid screening test Clearview IM. The diagnosis of acute infective mononucleosis was in 61 patients (67%) confirmed by the Elisa test, and in 12 patients (19.67%) by the Paul-Bunnell-Davidsohn test, while the rapid screening test Clearview IM demonstrated too low a detection of heterophile antibodies. The rapid screening test was not reliable. In 25% cases, the test was invalid, at early infection stages the rapid test failed to diagnose any case of the EBV virus infection. Paul-Bunell-Davidsohn was often negative, especially with young children. Therefore, priority should be given to virology tests based on the detection of specific antibodies to EBV antigen.