Human Coxiella burnetii infections in regions of Bosnia and Herzegovina, 2002.

Acute infections in humans and animals caused by Coxiella burnetii (C. burnetii) are becoming an important medical problem for Bosnia and Herzegovina (B&H). From a clinical and epidemiological aspect, Q fever represents a complex medical problem, considering that one of the highest incidence rates of Q fever in Europe has been recorded during the last few years in B&H. The first case of this disease in B&H was described in 1950, by Muray et al., and the first epidemic, with 16 infected individuals, was recorded the same year. Confirmed animal infections by C. burnetii in B&H were first reported in 1985 when, of all tested sheep, positive results were found in 12.4%. During 2001, 2.11% of tested sheep and goats were found to have a positive result, which was also confirmed by studies from the following years in particular regions of B&H. These studies suggest that endemic loci of infected animals are established in particular geographic regions in B&H, which is important to emphasize for better understanding of the sources and routes of C. burnetii transmission to the human population. This conclusion is based on the studies from 2000, when 2.17% of positive cattle, 1.85% of positive sheep, and 0.27% of positive goats were registered. During the same period, in B&H, in 6 different regions, 156 individuals with Q fever were registered as were 3 separate epidemics with 115 infected individuals. Official data on the number of detected animal C. burnetii infections during 2002 suggest that 10 positive cattle and 88 positive sheep or goats were registered. During 2003, 24 positive cattle, 29 positive goats, and 167 positive sheep were detected, while in 2004, 71 positive cattle, 4 positive goats, 37 positive sheep, and 72 positive animals from the sheep-goat group were registered. According to official reports from 2001, 19 individuals with Q fever were registered in B&H, while in 2002, the number of infected individuals increased to 250. In five cantons in B&H, 43 infected individuals were registered during 2002, while in Republika Srpska of B&H, 207 infected individuals in the region of Banja Luka were registered. From 1998 to 2003, 373 individuals with Q fever were reported in B&H, whereof 265 individuals (71.04%) were infected during epidemics, and 108 (28.95%) sporadically. Q fever incidence rates in B&H were high during 1998 (5.68%ooo) and very high in 2000, with 115 individuals with an acute clinical form and an incidence rate of 6.95%ooo. The incubation time varied between 9 and 28 days.

HIV/AIDS cases according to the year of diagnosis and selected characteristics of cases registered in the Federation of Bosnia and Herzegovina 1991-2004.

In the period between 1991-2004, in the Federation of Bosnia and Herzegovina there were altogether 59 registered HIV positive persons, out of those 43 were clinically diagnosed with AIDS. Gender-wise, 83% of the infected were male, and 17% female. The age groups with the highest risk of being infected with HIV are 20-24 and 40-44. The most frequent way of infection is heterosexual intercourse (46%), followed by intravenous drug use (31%), whilst 23% of the registered were infected through homosexual intercourse. Out of 43 diagnosed AIDS cases, 42% are heterosexuals, 35% intravenous drug users, whilst 21 % are homosexual or bisexual. Out of the total number of registered HIV/AIDS cases in the Federation of Bosnia and Herzegovina, thirty two died during the mentioned period (54%).

[Epidemiological characteristics of trichinosis in Federation of Bosnia and Herzegovina]. / Epidemioloske karakteristike trihineloze u Federaciji Bosni i Hercegovini.

The territory of Bosnia and Herzegovina, by its geographical setting and climate characteristics has the conditions for breeding and spreading the cause of trichinosis in environment. This, under certain conditions, in the context of different socio-economic, social and zoological-sanitary circumstances, can lead to the periodical epidemic outbreaks of the disease among people on a small or larger scale. Data on registered cases of human trichinosis collected during annual monitoring of trichinosis cases on the territory of Federation of Bosnia and Herzegovina in the past fourteen years, show its continual presence in this area, with a varying rate of morbidity, from 0,1 (2002) to 11,73 (1998) per 100.000 inhabitants. In the mentioned period, during 51 epidemics, 775 cases of trichinosis have been registered altogether, with approximately 10-15 cases per outbreak.

Eradication of typhus exanthematicus in Bosnia and Herzegovina.

Typhus exanthematicus in Bosnia and Herzegovina held in endemic areas from which especially quickly began spread after 1945. That year, in 1945, one hundred epidemics of typhus fever appeared, with the highest incidence rate in Europe of 215.04 per 1,000. Directions of unique program in the world were to eradicate lice of the body, but also establish monitoring of the recidivism, Brill-Zinsser disease. Since 1971, typhus exanthematicus (classical typhus) hasn't appeared in Bosnia and Herzegovina, so epidemic typhus can considered as an eradicated communicable disease.

Long term protection after hepatitis B vaccination.

A survey of persistence of anti-HBs after hepatitis B vaccination has shown that five years after vaccination on a sample of 152 persons, or 82.53%, stands at >10 IU/I. Long term immunogenicity of vaccinated children remained at 88.89%, health workers 79.41% and drug addicts 64.28%. The results of these studies in Bosnia and Herzegovina show the high level of protection hepatitis B vaccine against HBV infection. Vaccination against viral hepatitis B results in immunologic memory response among the vaccinated, and even after a decrease of anti-HB level following the third vaccine dose inoculation, a booster dose is not needed. Immunity remains steady and a booster dose is not recommended.

Serotesting of human brucellosis on wider area of Bosnia and Herzegovina.

The study involved 286 individuals from different regions of Bosnia and Herzegovina, whose sera were tested in the Laboratory for specific diagnosis of human brucellosis in Microbiology Department of Medical Faculty of University in Sarajevo, during the period from 2000. to 2003. Sera were tested using Brucelloslide Test, qualitative agglutination test Rose Bengal. Using the agglutination test, we serologically confirmed a diagnosis of human brucellosis in 59 (20.62%) seropositive individuals, whereof 38 (64.40%) men and 21 (35.60%) women. Individuals with human brucellosis were the most present in the age group of 31-40 (22.03%) and 41-50 (22.03%). One serologically confirmed death case was registered. The most seropositive individuals were from Zenica-Doboj Canton (32.20%), Sarajevo Canton (28.82%), Herzegovina-Neretva Canton (23.73%), Central Bosnia Canton (13.55%) and Una-Sana Canton (1.70%). During our four-year study, it was serologically confirmed that human brucellosis is present in Bosnia and Herzegovina and, through seropositive testing, we revealed the level of general exposition to Brucella spp. on wider area of Bosnia and Herzegovina.

Vineyard pesticide induced changes in the lungs: experimental studying on rabbits.

Our intention was to analyze changes in the lungs in rabbits induced by the inhalation of the Bordeaux Mixture aerosol and determination of the time necessary for development of changes that cause respiratory failure and eventually precancerous changes. To experimental rabbits aerosol was administred for 4 months. Lungs were examined pathohistologically and histochemically with rubeanic acid for copper detection. After 4 months of everyday inhalation lung tissue showed diffuse inflammation in all experimental animals, but without granulome formation and fibrosis. The bronchial epithelia showed basal hyperplasia and ciliocytophtoria without precancerous atypical squamous metaplasia. The development of centrilobular emphysema was also observed. Numerous macrophages within the lumen of bronchi, in the interstitium as well as those within the lung alveoli, contain granules with a positive reaction on copper. A four-month-period is not enough for inducing interstitial fibrosis or granuloma foration within the lung tissue, what some authors have found in experimental animals during their longer exposure in relation to humans, as well as in vineyard sprayers during their longer exposure at work, where cytologically can be found unusual mataplastic bronchi cells. At least a six-month period of exposure influenced by Bordeaux Mixture is thought to be the minimal period needed for development of changes in the lung tissue which can cause "Respiratory Failure" as well as unplastic expansion.

[Viruses in water]. / Virusi u vodi.

The article elaborates the significance of water, which is necessary for the maintenance of an organism and specifies its daily needs in human beings. Reference data on the early isolations of viruses from sewage water and modern understanding on the occurring virus species are listed. The article considers virus survival in sewage and flowing water and other fresh and marine water systems as well as marine silt or fruit. Finally, we give here an overview of basic features of individual virus kinds that are potential water contaminants.

Higher mortality risk of lungs carcinoma in vineyard sprayers.

This study investigated mortality rate of lungs carcinoma in professional vineyard sprayers. Clinical investigation was performed in 187 professional vineyard sprayers who had been exposed to the inhalation of the particles of Bordeaux mixture for 24 years on average. Bordeaux Mixture is used for prevention against mildew attacking vineyards. The control group was composed of 187 inhabitants of the same area who did not have any contact with the mentioned substance. A cytological investigation of the sputum specimens obtained from 104 tested inhabitants was performed. The sputum specimens were stained with standard haematoxylin-eosin method and also with special method (rubeanic acid) to prove the incidence of copper granules in macrophages. The findings show a considerable statistical difference in the frequency of occurrence of lungs carcinoma between the group of vineyard sprayers smokers and the control group (X2=4.77,p<0.01). The risk of lungs carcinoma in the vineyard sprayers was three times higher compared to the risk of smokers in the control group, with a statistical probability of 95% in the scope from 1.16

[Epidemiological investigations transmisssion of Q fever among humans in Bosnia and Herzegovina]. / Epidemioloska istrazivanja prenosenja Q groznice kod ljudi u Bosni i Hercegovini.

Appearance of an acute disease by Coxiella burnetii in humans in Bosnia and Herzegovina is very big epidemiological problem because incidence rate is among the highest incidence rates in Europe. Incidence rate of Q fever in Federation Bosnia and Herzegovina was very high during 1998. year 5.68% and the highest in 2000, with 115 diseases with acute clinical form of the disease and incidence rate of 6.95%. The incubation period varied from 9 to 28 days. Real incidence rate because of asymptomatic appearance of the disease is very much higher, at least 40-50 times higher. Chronic infection with Coxiella burnetii has been the most common developed as infectious endocarditis, which is the hardest complication. The researches of mode of transmission Q fever in humans showed that this disease spreads in epidemic and sporadic form in Bosnia and Herzegovina. In the period 1998-2003 year, there were 373 cases of Q fever, among them 265 or 71,05% cases epidemic transmission, and 108 or 28,95% cases sporadic. The research of outbreaks of Q fever showed that appearance of Q fever is statistical significant with risk factors at 266 cases of disease. The mode of transmission in 107 cases was the most probably across inhalation of infected aerosols.

[Coxiella burnetii infections as the public-health problem]. / Coxiella burnetii infekcije kao javnozdravstveni problem.

THE AIM OF WORK: To evaluate the incidence of human Q-fever in individual regions of Bosnia and Herzegovina, to determine the prevalence and areas at risk of Q-fever incidence, to assess Q-fever seroprevalence and to demonstrate seroprevalence ratings in regard to relevant criteria (sex, age, location of residence). METHODS: The research has involved 708 individuals from different cantons, whose sera were tested in Laboratory for Specific Diagnosis of Human Q-fever on the Microbiology Desk of Medical Faculty of University in Sarajevo, during the period from July 2000-December 2003. Sera were tested by Indirect Immunofluorescence Assay (IFA), using commercial test kit, reagents for Q-fever IFA IgM and IFA IgG for in vitro diagnostic use (Focus technologies). THE RESULTS: Specific anti-C. burnetii antibodies were detected in 249 (35.2%) individuals, whereof 75 (30.12%) female individuals, and 174 (69.9%) male individuals. Individuals suffering from Q-fever were mostly included in 31-40 aged group (26.8%). Most seropositive individuals were from Zenica-Doboj Canton (35.4%), then from Herzegovinian-Neretvian Canton (22.9%), from Sarajevo Canton (14.5%), from Una-Sana Canton (11.6%), and from Middle-Bosnian Canton (11.6%). CONCLUSIONS: In our four-year study, it is serologically demonstrated that Q-fever is imminent in Bosnia and Herzegovina and that it is going to be the actual concern of public health. The number and distribution of seropositive individuals suggest that Q-fever is endemic phenomenon in Bosnia and Herzegovina.

[Strategy for administering hepatitis B vaccine to newborns in Bosnia-Herzegovina]. / Strategija uvodenja neonatalne hepatitis B vakcine u Bosni i Hercegovini.

BACKGROUND: Neonatal hepatitis B vaccination is the best effective measure for prevention hepatitis B infection in the countries with intermediate to high levels of HB endemicity. METHODS: Epidemiological methods of research had the aim to follow the incidence rates of viral hepatitis B and HBsAg carriers and to determine influence on the risks of transmission hepatitis B infection in new-borns in Bosnia and Herzegovina. Serologic immunogenic quality of hepatitis B vaccine is researched. RESULTS: Bosnia and Herzegovina has high incidence of hepatitis B virus in the Europe. The incidence of HBsAg carriers is changing with increasing from 2000. to 2003. Data from this surveillance show in Bosnia and Herzegovina that in one notified case of hepatitis B there is 3.59 cases of HBsAg carriers. Hepatitis B vaccine induces anti-HBs antibodies titres > 10 IJ/ml, considered as seroprotective in 99, 10% vaccinated. CONCLUSION: Neonatal hepatitis B vaccination is new vaccine in national immunization program in Bosnia and Herzegovina. Hepatitis B vaccines are safe and effective in inducing neutralizing HBs antibodies play and have important role in protecting new-borns.

[Determination of the potential number of users of family medicine services--importance of user registration]. / Procjena broja potencijalnih korisnika usluga porodicne medicine--vaznost registracije korisnika.

The family medicine as the determination of the reformators and the strategies of the action in BiH is given in the form of the legal solution in the organization of the primary healhtcare action in BiH given in the form of the legal solution in the organization of the primary healthcare protection (the law about the healthcare protection--official newspaper F/BiH No 29/97). The fact is given the alternative solution--the team of the family medicine or the team of the medicine. Besides this there exist also some essential questions about the registration of the patients for the family medicine teams make complex the forming of the next of the family medicine. Besides that there are also some essential questional about the registration of the patients for family medicine teams--whethers that they registrar all the citizens or only the insureds to which is insured the healthcare protection though the medicine--werther are being registered all the citizens, whom belong the active ensured whom is ensured the healthcare protection through the institutions for the work medicine, the students and sportsmen who also have their institution etc. The further problem, when is in questions the patients registration of the patients, is the nonexistence of the reliable statistical data about the number, sexual inhabitants, as is known all the estimates are being done on the basis of the estimation of the federal institution for statistics. Therefore the registration of the family and the individuals for the family medicine teams will be rather painstaking.

[Oxidative disinfectants--a new strategy in the prevention of viral hepatitis in hemodialysis centers] ]. / Oksidativni dezinficijensi--nova strategija u prevenciji virusnih hepatitisa u centrima za hemodijalizu.

The dialysis setting as a height risk environment for transmission to both patients and health care personnel of blood-born infections, such as hepatitis B virus and hepatitis C virus We report the results of questionnaries of the frequency of occupational exposure in dialysis units. Among 120 health care workers of dialysis units had 25.02% percutaneous injure or mucous. Introducing of oxidative new virucid dezinficients prevent high risks of spreading of viral hepatitis in dialysis units.

[Occupational exposure and prevention of viral hepatitis B in health care personnel in the Canton of Sarajevo]. / Profesionalna izlozenost i prevencija virusnoga hepatitisa B kod zdravstvenih radnika Kantona Sarajevo.

Health workers are exposed to the accidental injuries with blood, so that increasing of HBsAg among inhabitants in Bosnia and Herzegovina and professional risk for VHB is increased in this risk group. Among 6.712 health workers in Canton Sarajevo, it's expected that 1.217 health workers will be exposed to the professional accidental injury with the blood, but it's expected annually 44 professionally infected health workers with HBV. With introduction of vaccine against HBV it would come to very important decreasing of the diseases among health workers (p < 0.001), but the risk for the disease HBV would decrease 45 times.

[Prevention strategy of viral hepatitis B and C]. / Strategija prevencije virusnih hepatitisa B i C.

Infections by Hepatitis B and Hepatitis C viruses, as well as infections caused by microorganisms transmitted through blood, blood products or in any other way, are now reality for all medical workers. This danger is stilll becoming increased for those medial workers who are more exposed in their everyday work to contaminated human blood or other biological materials. Therefore, the health institutions must introduce prevention measures against possible infection, but also the protection procedures to be applied immediately before and after incidental exposition to infectious material. They are especially essential at the occasion of incidental injuries of the persons by medical instruments which had been in the contact with blood. That is why it is obligatory for the employees of the health care institutions to be vaccinated against possible infection by Hepatitis B.

Protective effect of neonatal BCG vaccines against tuberculous meningitis.

Neonatal BCG vaccination reduces the risk of tuberculosis and provides protection higher than 80% against the development of meningeal and miliary tuberculosis in newborns. Tuberculosis meningitis remains a major problem and also an important cause of death in some countries. In countries with high and moderate incidence of tuberculosis, prevention from the most severe complications of tuberculosis can be achieved only with a high coverage of the universal BCG neonatal immunization, being higher than 98% in the cohort of newborns. The decrease in BCG immunization coverage within immunization program during the year 2003 in Bosnia and Herzegovina influenced the increase in tuberculous meningitis. During 2002, when coverage with BCG vaccination in cohort of newborns was 90%, the incidence rate of tuberculous meningitis was 19. 04%oo. With the 68% decrease in BCG immunization coverage in the cohort of newborns in Bosnia and Herzegovina during the year 2003, the incidence of tuberculous meningitis raised to 33 33%oo. It has been proven that the 22% decrease of the neonatal BCG immunization coverage in the cohort of newborns /vaccination program of children/ caused 175 times higher number of the tuberculous meningitis cases. Newborns affected by the tuberculous meningitis were not BCG vaccinated. BCG vaccine provided effective protection against tuberculous meningitis, as well against the death of newborns caused by tuberculosis.

Q-fever serologic diagnostics with inhabitants of Canton of Sarajevo 2001 year.

Q-fever is widely spread antropoozosis caused by Coxiellae burnetti, an intracellular compulsory microbe parasite. Two characteristics of Coxiellae burnetti are of crucial importance for appearance of Q-fever, especially in the circumstances when the cause of infection remains unclear. The first one is a high resistance of Coxiellae burnetti to environment changes and the second one is a small size of the infectious dose. The clinical manifestations of Q-fever can vary, so the making of diagnosis is still based on serology, with Phase I and Phase II antibodies and the difference between the acute and the chronic form of the disease. Serologic diagnostics presents the method of choice with Q-fever (IFT) in serums of patients with clinical suspicion to Coxiellae burnetti infection. We have tested the serums of patients from Canton of Sarajevo which were coming to our laboratory from January 2001-December 2001. Out of 58 processed serums the specific IgM antibodies were found in 10 serums and specific IgG antibodies in 27 serums.

[Expected incidence of post-vaccination complications in vaccination programs]. / Ocekivana incidencija postvakcinalnih komplikacija u programima vakcinacije.

Incidence rate of the harder adverse immunization reactions in the Program of the vaccination children in Federation Bosnia and Herzegovina is similar in the terms of kind and frequency as in the countries with high quality programme of the vaccination. In the period from 2002-2003 year cases of the adverse reactions were not registered, as vaccinal form of polyomyelitis, toxic syndrome or sudden acute deaths. The adverse events following immunization were classified in relation to 100,000 applicated vaccines, the incidence rate of supurative lymphadenitis at BCG vaccination reported are 32@100000, anaphylaxia at MMR vaccination 0.8@100000, DTP vaccination encephalopathy 1@100000 and at TT vaccination anaphylaxia 2@100000 administered vaccines.

Q-fever, human and animal morbidity in some regions of Bosnia and Herzegovina, in 2000.

Q-Fever is a worldwide zoonosis caused by Coxiella burnetti. C. burnetti is an obligate intracellular parasite. It lives in phagolysosome of the host cell. By its infection of the sensitive persons develops the acute noncharacteristic disease, which passes noncharacteristically, with the appearance of higher temperature, headache, fever, weakness of the organism or by the appearance of symptoms of the undifferentiated infection of the upper parties of the respiratory system. In the course of the infection is being developed the intersticial pneumonia, what is the reason of the infected hospitalization. Most often get sick the sheep, cows and goats, what showed also on our examined sample. In most animals the symptoms of this bacterial infection are not present, pass unobviously, and get turned out during their gravidity. The most important carriers of the causes of this disease on the domestic or wild animals are artropodes, in which within the kind is possible also the transvatial and transstadial transfer. The wild animals transfer the disease at the domestic ones, and people most often are infected by contact with these animals, their consuming of meat or milk or by contact with their secretions. Though, the most important way of getting infected of people is aerosol contaminated by the carrier as these bacteria for a long get kept in the contaminated dust, wool, animal skin, fur, straw and the excretions of the infected animals. In the illusorilly healthy and pregnant animals the bacteria are to be found in the fertile water, chorions, and placenta, that is C. burnetti becomes the cause of the premature birth or abortion in these animals. In this way comes to the bacterial contamination of the environment of the animal itself. The diagnosis of Q.-Fever is complement fixation test, indirect immunofluorescence assay (IFT) and enzyme immunoassay (EIA).