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.

Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran--a prospective multicenter point prevalence study.

OBJECTIVE: We aimed to compare the features of intensive care units (ICUs), their antimicrobial resistance patterns, infection control policies, and distribution of infectious diseases from central Europe to Mid-West Asia. METHODS: A cross-sectional point prevalence study was performed in 88 ICUs from 12 countries. Characteristics of ICUs, patient and antibiotic therapy data were collected with a standard form by infectious diseases specialists. RESULTS: Out of 749, 305 patients at least with one infectious disease were assessed and 254 patients were reported to have coexistent medical problems. When primary infectious diseases diagnoses of the patients were evaluated, 69 had community-acquired, 61 had healthcare-associated, and 176 had hospital-acquired infections. Pneumonia was the most frequent ICU infection seen in half of the patients. Distribution of frequent pathogens was as follows: Enteric Gram-negatives (n = 62, 28.8%), Acinetobacter spp. (n = 47, 21.9%), Pseudomonas aeruginosa (n = 29, 13.5%). Multidrug resistance profiles of the infecting microorganisms seem to have a uniform pattern throughout Southern Europe and Turkey. On the other hand, active and device-associated infection surveillance was performed in Turkey more than Iran and Southeastern Europe (p < 0.05). However, designing antibiotic treatment according to culture results was highest in Southeastern Europe (p < 0.05). The most frequently used antibiotics were carbapenems (n = 92, 30.2%), followed by anti-gram positive agents (vancomycin, teicoplanin, linezolid, daptomycin, and tigecycline; n = 79, 25.9%), beta-lactam/beta lactamase inhibitors (n = 78, 25.6%), and extended-spectrum cephalosporins (n = 73, 23.9%). CONCLUSION: ICU features appears to have similar characteristics from the infectious diseases perspective, although variability seems to exist in this large geographical area.

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 100000 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 100000 inhabitants and a mortality rate of 1.6 per 100000. 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.

[Characteristics of shigellosis outbreaks in the AP of Vojvodina]. / Karakteristike epidemija bacilarne dizenterije u autonomnoj pokrajini vojvodini.

INTRODUCTION: Shigellosis causes around 165 million infections and around 1 million deaths in the world every year. Two thirds of both infections and deaths are among children younger than 10. Shigellosis mainly spreads by direct or indirect contact, but water- and food-borne outbreaks are not rare. MATERIAL AND METHODS: A descriptive epidemiological method was used to analyse characteristics of shigellosis outbreaks in the AP of Vojvodina in the period 1979-2005. RESULTS: During this period 9.083 shigellosis infections were registered, 51,9% of them in 202 shigellosis outbreaks. The leading way of transmission was contact, but water- and food-borne outbreaks were also detected The average number of infections in contact outbreaks of shigellosis was small--6.3 infections. The highest average is in water-borne outbreaks--55.1. Most of the outbreaks were those occuring in families (47.5%) and most of them were registered in august. DISCUSSION: Shigellosis has been mandatory reported in the AP of Vojvodina since 1945 and results of outbreak investigation of this disease were analyzed since 1979. In the first half of this period water was the most common way of agent transmission in shigellosis outbreaks, but in recent 15 years the contact became the leading one. In the last 5 years there was no water-borne shigellosis outbreaks. Almost one third of all outbreaks were imported from Montenegro and Croatia by tourists coming back from those countries. Most of the outbreaks are small outbreaks occuring in families, primarily transmitted by contact. Outbreaks in facilities for care of disabled children and elders are also important. Sh. sonnei and Sh. flexneri are the two serotypes identified, the former in 57.4% and the latter in 40.1% outbreaks. CONCLUSION: Shigellosis is a disease occurring in the AP of Vojvodina primarily in small outbreaks inside families, transmitted by contact, most often in August and more often caused by Sh. sonnei. Health promotion and strict use of general measures of disease control and prevention are important.

[Outbreaks of health-care-associated infections in the province of Vojvodina].

INTRODUCTION: The goal is to investigate epidemiological characteristics of outbreaks of health-care-associated infections in health care institutions such as hospitals, nursing homes and ambulatory care settings. MATERIAL AND METHODS: Relevant data associated with outbreaks in health-care settings in the period from 1980 to 2004 were retrospectively collected from epidemiological annual reports of infectious diseases in Vojvodina. Descriptive statistics were applied to the data. RESULTS: The mean number of outbreaks is 7 per year (ranging from 0 to 13 outbreaks) involving 22 cases per outbreak (ranging from 2 to 74 cases). The most frequently involved settings (51%) were nursing homes and most (31%) of the patients were more than 60 years old. This surveillance documented that wards for children less than 12 months of age were the most frequently (57.5%) associated with nosocomial outbreaks in hospitals. The leading diseases were gastrointestinal tract infections with case fatality rate of 1.8%, that is 10-100 fold higher than rates in general population. The leading transmission route in 70% of outbreaks was contact, demonstrating the association between infections and poor general and hand-hygiene policies. CONCLUSION: The proportion of nosocomial outbreaks in total number of outbreaks is 9%. The most frequent are gastrointestinal outbreaks transmitted in long-term-care facilities by contact route, involving elderly patients. Introducing proper environmental and hand hygiene policies in health-care settings with strict implementation of procedures may significantly decrease the number of nosocomial infections and prevent nosocomial outbreaks.

[Effects of the immunization program in Vojvodina].

INTRODUCTION: With the widespread use of active immunization, significant results have been achieved in the control and prevention of numerous communicable diseases. The Expanded Programme on Immunization of the World Health Organization is intended to strengthen national programs for the reduction in the incidence and mortality rates and global elimination or eradication of communicable diseases. The aim of this paper is to analyze results of the immunization program in Vojvodina. MATERIAL DND METHODS: The results of the immunization program were analyzed on the basis of the incidence rates, since the introduction of the mandatory reporting system, till 2006. The analysis included immunization coverage against diphtheria, tetanus, pertussis, poliomyelitis and measles as well as reported cases of missed opportunities in the period from 1997 to 2006. RESULTS: Poliomyelitis has not been reported in Vojvodina since 1963, diphtheria since 1978 and measles in the period from 2001 to 2006. Sporadic cases of pertussis have been reported in unimmunized children of the youngest age, and tetanus in unimmunized elderly population. Vaccination coverage against poliomyelitis, diphtheria, tetanus and pertussis was above 96%. Vaccination coverage against measles was lower (95% vaccination, 87% revaccination). The highest proportion of missed opportunities was caused by not responding to immunization calls (46.6%). CONCLUSION: These results can be maintained by up-to-date (UTD) immunization and high vaccination coverage without territorial and population differences. Data on the total number of children without up-to-date vaccination cannot be obtained on the basis of administrative coverage follow-up. It is necessary to establish follow-up mechanisms for UTD immunization, which would reveal the number of children at risk from vaccine preventable diseases and characteristics of unimmunized population.