Vladimir Petrovic

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.

Artifact reduction in multiscale contrast enhancement for digital radiography

Nonlinear multiscale detail and contrast manipulation of digital radiographic images produces artefacts that reduce the fidelity of the image and have a distracting effect on the observer. These artefacts are most prominent on the borders of highly exposed parts of the image, like the skin line region. In this paper we present a novel method for multiscale image detail, local and global contrast enhancement that adapts to local exposure level and thus reduces the artefacts saliency. Proposed algorithm was incorporated into the digital radiography framework and compared to a reference one without adaptation to intensity. Evaluation on 60 images of different anatomies from different patients showed that the proposed algorithm performs better or equal to the reference one in 93% of the cases without manual adjustment of the parameters.

Immunization Coverage in South Bačka County of Vojvodina, Serbia

Introduction: Immunization coverage is a key measure of immunization system performance. Objective: was to assess immunization coverage by combination series of vaccines 3:3 (3 doses of both DTP/ DTaP and OPV/IPV vaccines) and 4:4:1 (4 doses of both DTP/DTaP and OPV/IPV and one dose of MMR vaccine) in a representative sample of children in South Backa County. Up-to-date (UTD) and age-appropriate criteria of immunization coverage were applied at 6, 12 and 24 months of age. Methods: Modified birth certificates follow-back method was used in order to obtain immunization records of 2058 children and to measure UTD and age-appropriate immunization coverage. Results: UTD coverage with combination series 3:3 was 60.1% and 94.0% at 6 and 12 months of age, respectively. At 24 months of age, 85.8% of children were fully immunized with combination series 4:4:1. Age- appropriate immunization coverage of 94.4% was reached. Conclusion: Effective protection against all targetted diseases has been reached by 12 months of age. High level of age-appropriate immunization coverage shows that the risk of vaccine preventable diseases is small between the 3 rd and 5 th year of life and warrants low risk of vaccine preventable diseases. Though achieved with some delay, high level of age-appropriate immunization coverage warrants low risk of vaccine preventable diseases at preschool age in the studied population. Combination series should be used for measuring immunization coverage because it provides better understanding of the immunization process to all stakeholders.

Epidemiological characteristics of tetanus in Vojvodina

INTRODUCTIONnVojvodina is an endemic area for tetanus.nnnMATERIAL AND METHODSnEpidemiological characteristics of tetanus were analyzed based on registered cases of disease and death in the period 1960-2004, and epidemiological investigation of 50 registered cases during the last 10 years of this period. Epidemiological characteristics were analyzed chronologically, demographically and topographically.nnnRESULTS AND DISCUSSIONnDuring the period of observation, the incidence rate of tetanus declined steadily. Due to immunization and extremely high coverage, tetanus has been practically eliminated in the age group of younger than 29 years. Neonatal tetanus and tetanus in the age group 30-59 years has been reduced to individual cases. Today, tetanus is a problem of the elderly population. Tetanus deaths occur statistically more often among persons older than 66 years. The average case fatality rate during the period of observation was 33.1%. The vaccination history in the majority of investigated cases was unknown (52%) or they have never been vaccinated (28%) because they were mainly elderly people born before introduction of mandatory immunization. Tetanus most often occurs after minor wounds, because of which patients do not seek medical attention. In the majority of cases tetanus occurred after limb injuries.nnnCONCLUSIONnTetanus in Vojvodina is a problem among unimmunized elderly people. It mostly occurs after minor injuries or after contamination of chronic skin lesions. Mandatory vaccination of older age groups should contribute to further reduction in the incidence rate of tetanus.

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.

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.

Factors associated with maintenance of human Q fever in Vojvodina, Serbia

Background/Aim. Q fever occurs worldwide and can be found in humans as well as in domestic mammals. The aim of this study was to describe the epidemiological characteristics of Q fever and evaluate correlation between the Q fever occurrence and weather conditions. Methods. We conducted a descriptive epidemiological study using data of the Institute of Public Health of Vojvodina, Scientific Veterinary Institute, Novi Sad, and the Republic Hydrometeorological Service of Serbia, from 2006 to 2015. Results. Out of 272 human Q fever cases, 114 (41.9%) patients were aged between 20 and 39 years. Between January and May, a total of 193 (71.0%) cases of disease were registered. In the Central Banat and South Banat, a strong positive correlation between an increase in Q fever detection and an increase of average wind speed (ρ= 0.69719 and ρ=0.62303, respectively) was observed, while a strong negative correlation was determined between the average rainfall with the number of Q fever cases in the Central Banat, the South Banat and Srem district (ρ = -0.78033, ρ = -0.70675 and ρ = -0.70431, respectively). During a 10-year period, a strong positive correlation was found between the human Q fever cases compared to the number of cattle and sheep Q cases in the Srem district (r = 0.7989 and r = 0.7966, respectively). Direct contact with domestic animals was the most frequent route of Q fever transmission in Vojvodina. Conclusion. The timely sharing of information between the animal and human health sectors as well as between neighbouring countries is crucial for an appropriate and an early outbreak response, especially during windy and dry months of the year. Additionally, it is essential that people who are exposed to a risk of infection must be permanently educated about reducing the risk of transmission of infection.

Seroprevalence of pertussis in adult population

Online first: December 8, 2017 SUMMARY 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 (Euroimmun®, Lübeck, 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 ± 22.2 IU/mL), and in the participants ≥ 60 years of age (15.0 ± 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.

Low-value Laplacian pyramid coefficient prediction for faster radiography image processing

We propose a method for predicting low-value Laplacian pyramid details that can be used for radiographic image processing time reduction via reorganization of the Laplacian pyramid calculation process. High resolution low-value detail prediction is based on the value of coarser details. Low-value details are then omitted in Laplacian pyramid calculation as well as in the image enhancement process. Proposed algorithm was evaluated on a database consisting of real medical images. Image degradation introduced by the proposed method was measured using structural similarity index (SSIM). It was shown that average processing time reduction of 4.62 % can be achieved without noticeable processed image degradation. The average SSIM obtained on the database was 0.995.