A Mark-Release-Recapture Study to Estimate Field Performance of Imported Radio-Sterilized Male Aedes albopictus in Albania.

The pathogen transmitting Aedes albopictus mosquito is spreading rapidly in Europe, putting millions of humans and animals at risk. This species is well-established in Albania since its first detection in 1979. The sterile insect technique (SIT) is increasingly gaining momentum worldwide as a component of area-wide-integrated pest management. However, estimating how the sterile males will perform in the field and the size of target populations is crucial for better decision-making, designing and elaborating appropriate SIT pilot trials, and subsequent large-scale release strategies. A mark-release-recapture (MRR) experiment was carried out in Albania within a highly urbanized area in the city of Tirana. The radio-sterilized adults of Ae. albopictus Albania strain males were transported by plane from Centro Agricoltura Ambiente (CAA) mass-production facility (Bologna, Italy), where they were reared. In Albania, sterile males were sugar-fed, marked with fluorescent powder, and released. The aim of this study was to estimate, under field conditions, their dispersal capacity, probability of daily survival and competitiveness, and the size of the target population. In addition, two adult mosquito collection methods were also evaluated: BG-Sentinel traps baited with BG-Lure and CO2, (BGS) versus human landing catch (HLC). The overall recapture rates did not differ significantly between the two methods (2.36% and 1.57% of the total male released were recaptured respectively by BGS and HLC), suggesting a similar trapping efficiency under these conditions. Sterile males traveled a mean distance of 93.85 ± 42.58 m and dispersed up to 258 m. Moreover, they were observed living in the field up to 15 days after release with an average life expectancy of 4.26 ± 0.80 days. Whether mosquitoes were marked with green, blue, yellow, or pink, released at 3.00 p.m. or 6.00 p.m., there was no significant difference in the recapture, dispersal, and survival rates in the field. The Fried competitiveness index was estimated at 0.28. This mark-release-recapture study provided important data for better decision-making and planning before moving to pilot SIT trials in Albania. Moreover, it also showed that both BG-traps and HLC were successful in monitoring adult mosquitoes and provided similar estimations of the main entomological parameters needed.

The native European Aedes geniculatus mosquito species can transmit chikungunya virus.

Europe is the world's leading tourism destination and is receiving every year travellers from areas with active arbovirus transmission. There is thus a threat of mosquito-borne virus emergence in Europe due to the presence of the invasive mosquito vector Aedes albopictus. Little attention has been paid about the possible role of indigenous mosquito species as vectors of emerging arboviruses. Here, we assessed the vector competence dynamic of Aedes geniculatus, a European anthropophilic mosquito species, for chikungunya virus (CHIKV) in comparison with an European population of Ae. albopictus. We revealed that Ae. geniculatus is highly susceptible to CHIKV infection and could transmit the virus. By specifically exploring the vector competence dynamic in both mosquito species, we revealed that the cumulative distribution of CHIKV incubation period in Ae. geniculatus was delayed by several days as compared to Ae. albopictus. Our results strengthen the importance of considering indigenous species as potential vectors for emerging arboviruses. They also revealed the importance of considering variation in arbovirus dissemination or transmission dynamics in mosquitoes when performing vector competence assays. We will discuss the implications of our results on a CHIKV outbreak dynamic in a theoretical framework.

Knowledge, practice and approaches of health professionals to adverse events following immunization and their reporting in Albania.

In Albania, the reporting of an adverse events following immunization (AEFI) is done not only by immunization providers but also from clinicians providing clinical treatment of AEFI in health posts, health centers and private or public hospitals. The AEFI reporting system in Albania has started in 2001 with the establishment of National Regulatory Authority of Vaccines in the Institute of Public Health. The most important problems of passive surveillance systems include underreporting, deficiency and inaccuracy of information. A structured questionnaire containing 68 questions constructed from immunization experts constituted the study tool. The questionnaire addressed health professionals working at child consultant's facilities and primary health centers in the district of Tirana. There were a total of 102 health professional interviewed. The majority of the respondents working at health centers in the district of Tirana in general, had poor knowledge levels on AEFI surveillance. The lowest score were received in knowledge about the role of different stakeholders involved in AEFI surveillance. The number of years practicing the profession did not influence in the total score of "practice and attitude toward reporting and managing an AEFI". Although the majority of health care professionals have encountered an AEFI during their practice (72/102, 70,5%), only half of them have never reported an AEFI (37/102, 36,2%). Barriers to reporting included lack of interest, unclear definition of AEFI and lack of awareness of what to report. Nevertheless, the main reason for not reporting was because a respondent thought he or she had not observed an AEFI in the last years (44,1%). Majority of the respondents did not have any training about AEFI (68,6%, 70/102). From this study it is concluded that it is necessary to develop training and educational programs in order to increase awareness of all health professionals involved in child health toward reporting of adverse events following immunization. It is necessary to build feedback systems to give information on AEFI. This study shows the influence of knowledge, perceptions and practices of health care workers in the surveillance of adverse events following immunization. Thus, information generated from this study might be valuable for the public health regulators to generate new guidelines about AEFI surveillance and update existing information.

Epidemiological, clinical and therapeutic aspects of cerebral malaria imported in Albania.

This is a case-report of two patients with cerebral malaria (CM) imported from West-African countries. Notably, this form of malaria was developed as a second disease episode, while the first episode was experienced in West Africa. These findings suggest that the second episode of malaria was caused by a different strain of Plasmodium falciparum as compared to the first one. They are the first cerebral malaria cases imported in Albania after the eradication and absence of Plasmodium for five decades. Early treatment of cerebral malaria is decisive on the duration of coma and disease's outcome.

A study on the epidemiology and aetiology of acute gastroenteritis in adult patients presenting at the infectious diseases hospital in tirana, Albania.

BACKGROUND: Acute gastroenteritis remains a common cause of hospital emergency room visits in Albania. However, the aetiology of severe gastroenteritis leading to hospitalization in adults frequently remains unclear. AIMS: Our objective was to study the epidemiology and causes of community-acquired, acute gastroenteritis in adult patients presenting to hospital. STUDY DESIGN: Cross sectional study. METHODS: A prospective study was conducted from January 2010 to January 2012, among patients ≥15 years old with community-acquired gastroenteritis presenting to the emergency room of the University Hospital "Mother Theresa" in Tirana, Albania. Stool samples and rectal swabs were collected from the patients for microbiological testing. RESULTS: The median age of the study patients was 33 (15-88) years and 577 (58%) were females. The median age of males was 35 (15-87) years. The vast majority of cases occurred in urban area (849, 85%), p<0.01. Patients were admitted throughout the year with peak admissions for patients infected by bacterial pathogens in summer and those affected by viral pathogens in autumn. A total of 917 (91.7%) patients underwent a laboratory examination. The overall isolation rate was 51%. Bacterial pathogens were found in 29%, viral pathogens in 19% and protozoal pathogens in 2.5% of patients. No aetiological agent or other cause of acute diarrhoea was found in 449 (49%) patients. Twenty-nine (3.2%) patients were hospitalized. CONCLUSION: Despite extensive laboratory investigations, enteropathogens were detected in only 51% of adult patients who presented to the hospital ER with acute gastroenteritis. Viral infections ranked as the second most common cause of gastroenteritis in adults.

Reconstruction of the epidemic history of hepatitis B virus genotype D in Albania.

Despite a recent decrease in the prevalence of HBsAg in the general population, Albania is still highly endemic for HBV infection. Genotype D is the most prevalent HBV strain in the Mediterranean area. We studied the prevalence and distribution of HBV genotypes and subgenotypes in a total of 73 HBsAg-positive patients living in Albania, and reconstructed the epidemiological history of the most prevalent HBV D subgenotype using a "phylodynamic" framework. A time-scaled genealogy of the Albanian patients' and reference P gene sequences with known sampling dates was reconstructed using an MCMC Bayesian approach that allows population growth to be estimated on the basis of coalescent theory. All of the Albanian subjects were infected with the HBV D genotype, and a percentage varying from 44.4% to 100% (depending on the ethnic or risk group) were infected with subgenotype D2, the most prevalent in the study population (72.4%). The other subgenotypes present in a minority of subjects were D1 (13.8%) and D3 (13.8%). The Bayesian skyline plot population dynamics analysis showed that genotype D2 entered the Albanian population in the late 1960s, and that the effective number of infections grew gradually until the second half of the 1980s and more rapidly until the mid-1990s, when it reached a plateau that still persists today. Our data suggest that political and socio-economic factors played an important role in determining the rapid spread of HBV infection in Albania.

Hemorrhagic fever with renal syndrome complicated by orchitis.

Hemorrhagic fever with renal syndrome (HFRS) is a disease caused by viruses of the family Bunyaviridae, genus Hantavirus. HFRS from Dobrava virus (DOBV) is a seldom reported disease in Albania. Clinically HFRS is manifested as mild, moderate, or severe. Therefore, the number of cases of Hantavirus' infection may be underestimated, and should be included in the differential diagnosis of many acute infections, hematologic diseases, acute abdominal diseases and renal diseases complicated by acute renal failure. We report here an atypical presentation of HFRS from Dobrava virus complicated by orchitis with a positive outcome.

Behavioral risk factors and prevalence of HIV and other STIs among female sex workers in Tirana, Albania.

The paper presents the results of the research and a comparative analysis of findings on key indicators for the study population. The study instrument was a standardized behavior study questionnaire provided in the Family Health International published manual (Family Health International, 2000). The target group was female sex workers working in Tirana. The prevalence of biological infections was low. HIV was detected in one case. Syphilis and Hepatitis B rates resulted to be respectively 6.5% and 7.6%. The median age of the study participants is 28 years. Almost 38% of the participants were illiterate, and more than half belong to the Roma community. Almost 50% of the respondents had received money in exchange of sex for the first time 18 years earlier. Almost 65% of respondents reported two or more different sex partners in the last seven days, while almost 30% referred five or more. Condom use at last sex with a paying client was reported by almost 68%. Consistent condom use with paying clients in the last month was reported by almost 35% of the respondents.

Surveillance of toxoplasmosis in pregnant women in Albania.

This study presents the initial results derived from a collaborative project aimed at the surveillance of the toxoplasma infection in a population of 496 Albanian pregnant women. From October 2004 to March 2005, serum samples were tested to detect IgG, IgM and IgG avidity for toxoplasmosis. Of the 496 pregnant women examined, 241 (48.6% [range 44-53]; IC 95%). resulted positive for IgG, three of whom (1.3%) were also positive for IgM. As the preliminary results of our survey disclose the absence of an efficient pre-gravidic screening and counseling for the prevention of toxoplasmosis in Albania, we propose a health education program for all pregnant women, together with serological testing (screening) for those exposed to predictors of toxoplasmosis infection as an epidemiological support and financially sustainable alternative.

An analysis of respondent driven sampling with Injection Drug Users (IDU) in Albania and the Russian Federation.

Injection drug users in Tirana, Albania and St. Petersburg, Russia were recruited into a study assessing HIV-related behaviors and HIV serostatus using Respondent Driven Sampling (RDS), a peer-driven recruitment sampling strategy that results in a probability sample. (Salganik M, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Sociol Method. 2004;34:193-239). This paper presents a comparison of RDS implementation, findings on network and recruitment characteristics, and lessons learned. Initiated with 13 to 15 seeds, approximately 200 IDUs were recruited within 8 weeks. Information resulting from RDS indicates that social network patterns from the two studies differ greatly. Female IDUs in Tirana had smaller network sizes than male IDUs, unlike in St. Petersburg where female IDUs had larger network sizes than male IDUs. Recruitment patterns in each country also differed by demographic categories. Recruitment analyses indicate that IDUs form socially distinct groups by sex in Tirana, whereas there was a greater degree of gender mixing patterns in St. Petersburg. RDS proved to be an effective means of surveying these hard-to-reach populations.

Cytokine levels in Crimean-Congo hemorrhagic fever.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) virus causes severe disease in humans with a mortality reaching 30%. A CCHF outbreak took place in Albania in 2003. As in other viral hemorrhagic fevers cytokines may be involved and play a role in the pathogenesis and outcome of the disease. OBJECTIVES: To investigate the levels of TNF-alpha, sTNF-R, IL-6 and IL-10 in serum samples obtained from laboratory confirmed CCHF cases and relate them to the severity of the disease. STUDY DESIGN: A study population of 51 was divided into three groups: group A, consisting of PCR-positive cases; group B, consisting of PCR-negative and serology-positive cases; group C, consisting of doubly negative cases. Concentrations of serum TNF-alpha, sTNF-R, IL-6 and IL-10 were measured during the illness. RESULTS: High levels of all cytokines tested were present in one fatal case. Statistically significant differences between the groups were obtained for TNF-alpha and IL-6: TNF-alpha was detected in 3 cases in group A, and in none of the other groups, while IL-6 was elevated in 10/16 patients in group A, 4/9 in group B, and 4/26 in group C. sTNF-R was not significantly different for the three groups. High concentration of IL-10 was detected only in the fatal case. CONCLUSIONS: TNF-alpha and IL-6 are the cytokines most often detected during a CCHF viral infection. TNF-alpha was associated with the severe form of CCHF, while IL-6 was elevated in both severe and mild cases.

Molecular diversity of HIV in Albania.

Little information is available on circulating human immunodeficiency virus (HIV) subtypes and resistance to antiretroviral drugs in Albania. To fill this gap, we studied 72 plasma samples from HIV-infected individuals from throughout the country. Subtype classification and genotypic resistance analysis were performed on the HIV pol gene region. The analysis was successfully performed on 66 (91.6%) plasma samples and showed that 43 (65.2%) strains were non-B subtypes (mostly subtype A, as determined by analysis of pol gene sequences). No major mutations in the protease gene were found, whereas analysis of the reverse transcriptase gene revealed a few major mutations associated with resistance. In conclusion, non-B subtypes are predominant in Albania, and the prevalence of resistance to antiretroviral drugs is still low.

Nucleotide correlation between HAV isolates from human patients and environmental samples.

Hepatitis A disease is endemic in Albania even though records from the Medical Authority show outbreaks involving only limited numbers of people. In the city of Lac, 200 people became ill following an outbreak of hepatitis A started on November 2002. The age distribution of the cases shows a peak in the age group 5-9 (43.5%) followed by the age group 10-14 (28%) and the age group 1-4 (18%). No cases were recorded in the age group 0-1. Drinking water and sewage samples were collected, using electropositive cartridges, during the outbreak. Rotavirus was identified by RT-PCR in two out of five drinking water samples; however, all the samples tested negative for HAV and astrovirus. Rotavirus was also identified in three out of five sewage samples from which four were HAV positive. HAV-RNA was identified in 28 (62.2%) out of 45 IgM anti-HAV positive sera collected during the outbreak. Genotype IA was expressed from all the amplified samples. Sequence analysis of the overlapping VP1-2A region shows 97-99% homology with three Italian strains IT-SCH-00, IT-ZAM-01, and IT-CAP-00 and one Spanish strain (Sa 30/06/95), whereas the phylogenetic tree built from the 168 bp sequence of the VP1-2A shows four clusters, one including 24 out of 28 RT-PCR positive sera. Considering the deduced amino acid sequence, only one substitution was identified and reported previously for genotype IB.

Prevalence of HHV-8 infection in Albanian adults and association with HBV and HCV.

To estimate the prevalence of human herpesvirus type 8 (HHV-8) in Albania and its correlation with HBV and HCV, we tested 196 serum samples collected from apparently healthy adults (i.e., 154 women and 42 men). We found 20% anti-HHV-8 antibodies, about 10% HbsAg-positive, and 67% anti-HBc antibodies; anti-HCV antibody prevalence was 3%. It remains to be determined whether HHV-8 infection and HCV infection have common modes of transmission.

Hepatitis in Albanian children: molecular analysis of hepatitis A virus isolates.

Hepatitis A is a common disease in developing countries and Albania has a high prevalence of this disease associated to young age. In spite of the occurrence of a unique serotype there are different genotypes classified from I to VII. Genotype characterisation of HAV isolates circulating in Albania has been undertaken, as well as the study of the occurrence of antigenic variants in the proteins VP3 and VP1. To evaluate the genetic variability of the Albanian hepatitis A virus (HAV) isolates, samples were collected from 12 different cities, and the VP1/2A junction amplified and sequenced. These sequences were aligned and a phylogenetic analysis performed. Additionally, the amino half sequence of the protein VP3 and the complete sequence of the VP1 was determined. Anti-HAV IgM were present in 66.2% of all the sera. Fifty HAV isolates were amplified and the analysis revealed that all the isolates were sub-genotype IA with only limited mutations. When the deduced amino acid sequences were obtained, the alignment showed only two amino acids substitutions at positions 22 and 34 of the 2A protein. A higher genomic stability of the VP1/2A region, in contrast with what occurs in other parts of the world could be observed, indicating high endemicity of HAV in Albania. In addition, two potential antigenic variants were detected. The first at position 46 of VP3 in seven isolates and the second at position 23 of VP1 in six isolates.