Knowledge of Healthcare Workers Regarding Road Traffic Child Safety in South Backa District, Serbia.

Introduction: Healthcare workers (HCW) can have an important role in educating parents about child road safety, but research on the topic shows that they usually do not have adequate knowledge. Thus, the aim of our study was to analyze their knowledge in the field of child road safety. Methods: The cross-sectional study was conducted among HCW from South Backa district, Serbia, using a specially created questionnaire for assessing knowledge on road traffic injuries in children. Results: The research involved the participation of 317 healthcare workers (86 physicians and 231 nurses). Healthcare workers from primary healthcare made up almost 70% of all respondents, followed by those from tertiary (21.8%) and secondary (11.3%) level institutions. The average percentage of correct answers on the knowledge test was 74.3% (mean=22.3, SD=4.0). Out of all respondents, HCWs employed in the paediatrics department had a significantly higher percentage of correct answers at 77.7% (mean=23.3, SD=3.4) compared to other health workers at 73% (mean=21.9, SD=4.1) (p=0.002). Association analysis demonstrated that HCW employed at paediatric departments on average scored 1.37 (95% CI: 0.40-2.33, p=0.006) points higher in comparison with other HCW. Conclusion: This research demonstrated an unsatisfactory level of knowledge on child road safety by HCW, and the variability across different question domains, which underlines the need for continuous educations in order to improve their knowledge. Our results may serve in planning additional public health measures and can provide a reference for future studies.

Epidemiological Characteristics of COVID-19 during Seven Consecutive Epidemiological Waves (2020-2022) in the North Backa District, Serbia.

The COVID-19 pandemic continues to pose a threat to global public health. The purpose of this research was to determine the epidemiological characteristics of COVID-19 in the North Backa district while observing seven pandemic waves. The cross-sectional study was based on data from the COVID-19 surveillance database of the Institute for Public Health of Vojvodina during the period from March 2020 to December 2022. A total of 38,685 primary infections and 4067 reinfections caused by SARS-CoV-2 were notified. Pandemic waves caused by the Delta variant (cumulative incidence rate of 2482.37/100,000) and by the Omicron variant (cumulative incidence rate of 2994.45/100,000) emerged as significant focal points during the surveillance period. Over the course of three consecutive years (2020-2022), women were more affected (50.11%, 54.03%, and 55.68%, respectively). The highest incidence rates in age-specific categories were recorded in 2021 for the age group 40-49 (1345.32 per 10,000 inhabitants), while in 2022, they shifted towards the elderly population. Regarding vaccination status at the time of diagnosis, in 2021, around 15% of patients were vaccinated, while in 2022, the number increased to 37%. The most widely received vaccine was BBIBP-CorV (67.45%), followed by BNT162b2 (19.81%), Gam-COVID-Vac (9.31%), and ChAdOx1 nCoV-19 (3.42%) vaccine. The implementation of stringent public health measures and their mitigation, together with the emergence of new variants, influenced the dynamics of COVID-19 pandemic waves in the North Backa district. Notably, throughout the study period, the working-age population was the most affected, along with females, with a mild clinical presentation dominating. Reinfections were most frequently recorded during the latter pandemic waves. Dealing with this pandemic has provided some valuable lessons for the development of future strategies in the case of a similar public health crisis.

Motives and attitudes of parents toward HPV vaccination: Results from the initial period of HPV vaccine rollout in Serbia.

Human papillomavirus (HPV) infection is one of the most common viral infections in sexually active population worldwide, and is the main cause of cervical cancer, which is the fourth most common cancer among women. Serbia ranks third in incidence and mortality rate of cervical cancer in Europe. We conducted a cross-sectional study considering parents' motivation for the HPV vaccination of their children. Statistical analysis included descriptive statistics and a logistic regression model. We found that the strongest motive was "Recommendation from paediatrician" (20.2%), followed by the attitude that HPV vaccine protects against cancers in different localization (15.4%), the motive "It is better to vaccinate a child than expose them to potential risk of HPV infection" (13.3%) and "Feeling anxiety due to a possible infection and cancer in the child" (13.1%). For those parents that vaccinated their child for some other strongest motive, reasons like "Vaccine is free of charge", "Recommendation from friends and family" and motive "My child received all obligatory vaccines, so I want to receive this one as well", were significantly more frequently selected. In the group where paediatricians' recommendation was not a motive for accepting the HPV vaccine, the largest percentage of parents (89.6%) selected motive "HPV vaccine protects against cancers in different localization" and the motive "It is better to vaccinate a child than expose them to potential risk of HPV infection" (78.1%). Paediatrician's recommendation is very important for parents' decision to vaccinate, however, other motives also influenced and had significance in making the parents' decision to vaccinate their children against HPV. Encouraging trust in public health authorities in Serbia, highlighting the advantages of the HPV vaccine and further encouraging healthcare workers to give stronger recommendations can increase the HPV vaccine uptake. Finally, we provided the basis to create more targeted messages that will empower parents to vaccinate their children.

Epidemiological Transition and Strategies for the Control of Hepatitis A in Serbia.

BACKGROUND: Improvements in socioeconomic and hygienic conditions during the past decades led to declining hepatitis A (HA) seroprevalence in many countries. Aiming at informing HA vaccination policy, we assessed current epidemiological trends in Serbia by analyzing surveillance data for 2002-2021. METHODS: Data on cases and outbreaks were obtained from the Serbian national surveillance database and descriptively analyzed. HA incidence was calculated in relation to time, patients' residence, and demographics. RESULTS: Overall, 13,679 HA cases and 419 outbreaks were recorded with the highest incidence in the southeast. Downward HA trends were observed, while infant mortality was halved, and gross domestic product based on purchasing power parity (GDP PP) per capita, tripled. The average incidence dropped from 14.8 (95% CI 14.4-15.2)/100,000) in 2002-2006 to 1 (95% CI 0.9-1.1)/100,000)/100,000 in 2017-2021, while the number of outbreaks decreased (from 174 to 14). Sporadic cases and family clusters living in poor sanitary conditions occurred in recent years. The contact route of transmission was dominant (410/419, 97.9%). The highest average age-specific HA incidence shifted from 5-9 years in 2002-2006 to 10-19 years in 2017-2021.Serbia is transitioning towards very low HA endemicity. Enhanced surveillance and vaccination of high-risk groups are recommended as future public health priorities.

Incidence, Risk, and Severity of SARS-CoV-2 Reinfections in Children and Adolescents Between March 2020 and July 2022 in Serbia.

Importance: During the COVID-19 pandemic, children and adolescents were massively infected worldwide. In 2022, reinfections became a main feature of the endemic phase of SARS-CoV-2, so it is important to understand the epidemiology and clinical impact of reinfections. Objective: To assess the incidence, risk, and severity of pediatric SARS-CoV-2 reinfection. Design, Setting, and Participants: This retrospective cohort study used epidemiologic data of documented SARS-CoV-2 infections from the surveillance database of the Institute for Public Health of Vojvodina. A total of 32 524 children and adolescents from Vojvodina, Serbia, with laboratory-confirmed SARS-CoV-2 infection between March 6, 2020, and April 30, 2022, were followed up for reinfection until July 31, 2022. Main Outcomes and Measures: Incidence rates of documented SARS-CoV-2 reinfection per 1000 person-months, estimated risk of documented reinfection 90 days or more after laboratory confirmation of primary infection, reinfection severity, hospitalizations, and deaths. Results: The study cohort included 32 524 children and adolescents with COVID-19 (mean [SD] age, 11.2 [4.9] years; 15 953 [49.1%] male), including 964 children (3.0%) who experienced documented reinfection. The incidence rate of documented reinfections was 3.2 (95% CI, 3.0-3.4) cases per 1000 person-months and was highest in adolescents aged 12 to 17 years (3.4; 95% CI, 3.2-3.7). Most reinfections (905 [93.9%]) were recorded in 2022. The cumulative reinfection risk was 1.3% at 6 months, 1.9% at 9 months, 4.0% at 12 months, 6.7% at 15 months, 7.2% at 18 months, and 7.9% after 21 months. Pediatric COVID-19 cases were generally mild. The proportion of severe clinical forms decreased from 14 (1.4%) in initial episodes to 3 (0.3%) in reinfections. Reinfected children were approximately 5 times less likely to have severe disease during reinfection compared with initial infection (McNemar odds ratio, 0.2; 95% CI, 0.0-0.8). Pediatric reinfections rarely led to hospitalization (0.5% vs 1.3% during primary infections), and none resulted in death. Conclusions and Relevance: This cohort study found that the SARS-CoV-2 reinfection risk remained substantially lower for children and adolescents compared with adults as of July 2022. Pediatric infections were mild, and reinfections were even milder than primary infections.

Detection and Molecular Characterization of Rotavirus Infections in Children and Adults with Gastroenteritis from Vojvodina, Serbia.

Rotaviruses (RV) are the leading cause of gastroenteritis in infants, young children, and adults, responsible for serious disease burden. In the period 2012-2018, a cross-sectional study was conducted using stool samples collected from patients with acute gastroenteritis from Vojvodina, Serbia. We described age and gender distribution, as well as seasonal patterns of RV prevalence. Out of 1853 included stool samples, RV was detected in 29%. Hospitalized children between 1-2 years old were especially affected by RV infection (45%). The highest prevalence of infection was observed during the colder, winter/spring months. We compared sequenced representative G and P genotypes circulating in Serbia with vaccine strains and determined their genetic similarity. Genotype combination G2P[4] was the most prevalent (34.6%), followed by G2P[8] (24.1%) and G1P[8] (21.1%). Given that several epitopes were conserved, neutralization motifs among circulating strains can be characterized as sufficiently matching vaccine strains Rotarix™ and RotaTeq™, but existing antigenic disparities should not be overlooked. The present results contribute to a better insight into the prevalence of rotavirus infection in our region and point out the need for epidemiological surveillance of rotaviruses before the introduction of vaccines. These data can help formulate future vaccine strategies in Serbia.

Risk and severity of SARS-CoV-2 reinfections during 2020-2022 in Vojvodina, Serbia: A population-level observational study.

Background: Data on the rate and severity of SARS-CoV-2 reinfections in real-world settings are scarce and the effects of vaccine boosters on reinfection risk are unknown. Methods: In a population-level observational study, registered SARS-CoV-2 laboratory-confirmed Vojvodina residents, between March 6, 2020 and October 31, 2021, were followed for reinfection ≥90 days after primary infection. Data were censored at the end of follow-up (January 31, 2022) or death. The reinfection risk was visualized with Kaplan-Meier plots. To examine the protective effect of vaccination, the subset of individuals with primary infection in 2020 (March 6-December 31) were matched (1:2) with controls without reinfection. Findings: Until January 31, 2022, 13,792 reinfections were recorded among 251,104 COVID-19 primary infections (5.49%). Most reinfections (86.77%, 11,967/13,792) were recorded in January 2022. Reinfections were mostly mild (99.17%, 13,678/13,792). Hospitalizations were uncommon [1.08% (149/13,792) vs. 3.66% (505/13,792) in primary infection] and COVID-19 deaths were very rare (20/13,792, case fatality rate 0.15%). The overall incidence rate of reinfections was 5.99 (95% CI 5.89-6.09) per 1000 person-months. The reinfection risk was estimated as 0.76% at six months, 1.36% at nine months, 4.96% at 12 months, 16.68% at 15 months, and 18.86% at 18 months. Unvaccinated (OR=1.23; 95%CI=1.14-1.33), incompletely (OR=1.33; 95%CI=1.08-1.64) or completely vaccinated (OR=1.50; 95%CI=1.37-1.63), were modestly more likely to be reinfected compared with recipients of a third (booster) vaccine dose. Interpretation: SARS-CoV-2 reinfections were uncommon until the end of 2021 but became common with the advent of Omicron. Very few reinfections were severe. Boosters may modestly reduce reinfection risk. Funding: No specific funding was obtained for this study.

Epidemiological study on the incidence of haemorrhagic fever with renal syndrome in five Western Balkan countries for a 10-year period: 2006-2015.

BACKGROUND: Large-scale epidemics of haemorrhagic fever with renal syndrome (HFRS) have been reported mostly in Asia and Europe, with around 100,000 people affected each year. In the Southeast Europe, Balkan region, HFRS is endemic disease with approximately 100 cases per year. Our aim was to describe epidemiological characteristics of HFRS in five Western Balkan (WB) countries and to describe correlation between HFRS incidence and major meteorological event that hit the area in May 2014. METHODS: National surveillance data of HFRS from Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia and Serbia obtained from 1 January 2006 to 31 December 2015 were collected and analysed. RESULTS: In a 10-year period, a total of 1,065 HFRS patients were reported in five WB countries. Cumulative incidence rate ranged from 0.05 to 15.80 per 100.000 inhabitants (in North Macedonia and Montenegro respectively). Increasing number of HFRS cases was reported with a peak incidence in three specific years (2008, 2012, and 2014). Average incidence for the entire area was higher in males than females (5.63 and 1.90 per 100.000 inhabitants respectively). Summer was the season with the highest number of cases and an average incidence rate of 1.74/100.000 inhabitants across 10-year period. Haemorrhagic fever with renal syndrome incidence was significantly increased (7.91/100.000 inhabitants) in 2014, when a few months earlier, severe floods affected several WB countries. A strong significant negative correlation (r = -.84, p < .01) between the monthly incidence of HFRS and the number of months after May's floods was demonstrated for the total area of WB. CONCLUSION: Our findings demonstrate that the HFRS incidence had similar distribution (general, age, sex and seasonality) across majority of the included countries. Summer was the season with the highest recorded incidence. Common epidemic years were detected in all observed countries as well as a negative correlation between the monthly incidence of HFRS and the number of months after May's cyclone.

Epidemiological characteristics of COVID-19 travel-associated cases in Vojvodina, Serbia, during 2020.

Coronavirus disease 2019 (COVID-19) is currently the biggest public health problem worldwide. Intensive international travel and tourism have greatly contributed to its rapid global spreading. This study is the first comprehensive analysis of the epidemiological characteristics and clinical outcomes of the travel-associated COVID-19 cases in Vojvodina, Serbia, from March 6 to December 31, 2020 and it concerns permanent residents of Serbia. A cross-sectional study was conducted using data from the dedicated surveillance database of the Institute of Public Health of Vojvodina. Overall, 650 travel-associated COVID-19 cases were recorded in Vojvodina during the observed period, mainly imported from Bosnia and Herzegovina, followed by Austria and Germany (N = 195, 30%; N = 79, 12.15% and N = 75, 11.54%, respectively). The majority of cases were in the working-age groups, 18-44 and 45-64 years (56.46% and 34.15%, respectively). Overall, 54 (8.31%) patients developed pneumonia. In comparison to patients without pneumonia, those with pneumonia were older (mean age = 55.39 years vs. 41.34 years, p<0.01) and had a higher percentage of comorbidities (57.41% vs. 16.61%). Men were more likely to develop pneumonia than women (OR = 2.22; 95% CI: 1.14-4.30, p = 0.02), as well as those in retired-age group (OR = 4.11; 95% CI: 2.0-8.46, p<0.01). Obesity (OR = 14.40; 95% CI: 3.8-54.6, p<0.01), diabetes (OR = 9.82; 95% CI: 3.15-30.61, p<0.01) and hypertension (OR = 7.99; 95% CI: 3.98-16.02, p<0.01) were the most prominent main comorbidities as predictors of pneumonia. Our results represent general epidemiological and clinical dynamics of COVID-19 disease in Vojvodina. Also, they provide evidence that the predictors of pneumonia were: increasing age, male sex, having underlying comorbidities, an increasing number of days from the return to laboratory confirmation of COVID-19 (OR = 1.08, 95% CI: 1.03-1.12, p<0.01), as well as an increasing number of days from symptoms onset to diagnosis (OR = 1.14, 95% CI: 1.07-1.21, p<0.01), while anosmia and ageusia were protective factors for developing it (OR = 0.31, 95% CI: 0.12-0.79, p = 0.01).

Epidemiology of human trichinellosis in Vojvodina province, Serbia, from 2005 to 2016.

Trichinellosis is one of the most important foodborne diseases in the Eastern European countries. The main objective of this study was to investigate the epidemiological patterns of trichinellosis outbreaks that occurred between 2005 and 2016 in Vojvodina, a northern province of the Republic of Serbia. The average incidence was 3.5 per 100,000 inhabitants. A total of 828 people acquired the infection. The disease occurred in all age groups, slightly more often in males, and quite frequently in a severe form considering the high share of hospitalised patients and the fatal outcome rate (41.6 ± 31.1% and 0.4%, respectively). Trichinella spiralis was confirmed as the causative agent in eight outbreaks. The outbreaks usually occurred among family members due to the consumption of pork or traditional pork products from not tested backyard pigs. Veterinary control measures and the education of consumers and farmers should be implemented to control this zoonotic disease.