High vaccine confidence and strong approval of the mandatory immunization schedule among Bulgarian general practitioners in 2022.

In a context of recently decreasing childhood immunization coverage and low uptake of COVID-19 vaccines in Bulgaria, this study measures vaccine hesitancy among general practitioners (GPs) in the country, as they are central to forming patients' attitudes. In 2022, a face-to-face survey was conducted through a simple random sample from an exhaustive national database of Bulgarian GPs. This study measured attitudes on vaccine importance, safety, and effectiveness, and attitudes toward the Bulgarian immunization schedule. Information was collected on demographic and GP practice characteristics and possible predictors of vaccine confidence in order to test for associations with attitudes toward immunization. GP attitudes toward vaccines and the immunization schedule in Bulgaria were generally positive. Among 358 respondents, 351 (98%,95%CI96-99%) strongly agreed/agreed that vaccines are important, 352 (98%,95%CI96-99%) that vaccines are effective, and 341 (95%,95%CI93-97%) that vaccines are safe. 347 respondents (97%,95%CI95-98%) affirmed that "it's good that vaccines from the children's immunization schedule are mandatory", and 331 (92%,95%CI89-95%) agreed with the statement "Bulgaria's childhood immunization has my approval". Trust in information from official institutions was among the strongest predictors of vaccine confidence. Respondents' vaccine confidence levels are within the ranges reported by GPs in other European countries and above those reported within the general Bulgarian population. GPs' vaccine confidence is highly associated with trust in official institutions. It is important to maintain trust in official institutions and to support GPs in communicating vaccine knowledge with patients so that vaccine hesitancy in the general population is countered.

Bulgarian General Practitioners' Communication Styles about Child Vaccinations, Mainly Focused on Parental Decision Making in the Context of a Mandatory Immunization Schedule.

The communication practices of general practitioners in relation with vaccines have not been a topic of wide scientific interest. In this article, we outline them in the context of Bulgaria. A representative, cross-sectional, quantitative, face-to-face survey was conducted among 358 Bulgarian general practitioners in 2022 using simple random sampling. We conducted an exploratory factor analysis using questions about the role of the GPs, which measure models of communication. Based on the factor analysis, we distinguished four communication styles. They were called: active communicator, restrictive communicator, informing communicator, and strained communicator. One-way ANOVA and the T-test were carried out to explore the connections between factor scores (communication styles) and other variables. One of the most important results in the study was that the informing physician (emphasizing the choice of the parents) was the most common model in Bulgaria. This is somewhat contradictory, because of the mandatory status of most vaccines. We found connections between the communication styles and other variables-such as the type of settlement, having a hesitant parent in the practice, recommendations of non-mandatory vaccines, and experience with vaccine-preventable diseases. On the basis of the factor analysis and analysis of relationships with other variables, we reached the conclusion that in Bulgaria, hesitant parents are not sufficiently involved in active, effective communication about vaccines by GPs.

Predicting the Potentiometric Sensitivity of Membrane Sensors Based on Modified Diphenylphosphoryl Acetamide Ionophores with QSPR Modeling.

While potentiometric, plasticized membrane sensors are known as convenient, portable and inexpensive analytical instruments, their development is time- and resource-consuming, with a poorly predictable outcome. In this study, we investigated the applicability of the QSPR (quantitative structure-property relationship) method for predicting the potentiometric sensitivity of plasticized polymeric membrane sensors, using the ionophore chemical structure as model input. The QSPR model was based on the literature data on sensitivity, from previously studied, structurally similar ionophores, and it has shown reasonably good metrics in relating ionophore structures to their sensitivities towards Cu2+, Cd2+ and Pb2+. The model predictions for four newly synthesized diphenylphosphoryl acetamide ionophores were compared with real potentiometric experimental data for these ionophores, and satisfactory agreement was observed, implying the validity of the proposed approach.

Q fever in Bulgaria: Laboratory and epidemiological findings on human cases and outbreaks, 2011 to 2017.

BackgroundQ fever is a zoonosis, included in category B of particularly dangerous infectious agents and as such merits careful surveillance and regular updating of the information about its distribution.AimThis observational retrospective study aimed to provide an overview of Q fever incidence in Bulgaria in the period 2011 to 2017.MethodsAggregated surveillance data from Bulgaria's mandatory surveillance system, laboratory data on individual samples received at the National Reference Laboratory Rickettsiae and Cell Cultures and outbreak reports sent by the regional health authorities to the National Centre of Infectious and Parasitic Diseases, were used in this analysis. Cases were described by year, region, age group and most commonly identified risk behaviours.ResultsA total of 139 confirmed cases were reported in the study period (average annual incidence: 0.27 cases/100,000 inhabitants). No seasonality or trend in reported cases was observed. Cases were mostly sporadic, with two small outbreaks in 2017. Identified risk behaviours among cases were occupational exposure and consumption of milk and dairy products, although exposure data were incomplete. The male/female ratio was 1.4. The identification and resolution of the two rural outbreaks in 2017 with a total of 18 cases involved good practices: active case finding and collaboration between public health and veterinary authorities.ConclusionBetween 2011 and 2017, Bulgaria retained low Q fever incidence, mostly sporadic cases and two small outbreaks. Occupational exposure and consumption of milk and dairy products were the most often reported likely exposures among cases. The outbreak investigations demonstrate the application of good control practices.

Meningococcal serogroups and surveillance: a systematic review and survey.

BACKGROUND: Meningococcal disease continues to be a global public health concern due to its epidemic potential, severity, and sequelae. The global epidemiological data on circulating meningococcal serogroups have never been reviewed concurrently with the laboratory capacity for meningococcal surveillance at the national level. We, therefore, aimed to conduct a country-level review of meningococcal surveillance, serogroup distribution, and vaccine use. METHODS: We conducted a systematic literature review across six databases to identify studies (published January 1, 2010 to October 16, 2017) and grey literature reporting meningococcal serogroup data for the years 2010-2016. We performed independent random effects meta-analyses for serogroups A, B, C, W, X, Y, and other. We developed and circulated a questionnaire-based survey to surveillance focal points in countries (N = 95) with known regional bacterial meningitis surveillance programs to assess their surveillance capacity and summarized using descriptive methods. RESULTS: We included 173 studies from 59 countries in the final analysis. The distribution of meningococcal serogroups differed markedly between countries and regions. Meningococcal serogroups C and W accounted for substantial proportions of meningococcal disease in most of Africa and Latin America. Serogroup B was the predominant cause of meningococcal disease in many locations in Europe, the Americas, and the Western Pacific. Serogroup Y also caused many cases of meningococcal disease in these regions, particularly in Nordic countries. Survey responses were received from 51 countries. All countries reported the ability to confirm the pathogen in-country, while approximately 30% either relied on reference laboratories for serogrouping (N = 10) or did not serogroup specimens (N = 5). Approximately half of countries did not utilize active laboratory-based surveillance system (N = 22). Nationwide use of a meningococcal vaccine varied, but most countries (N = 36) utilized a meningococcal vaccine at least for certain high-risk population groups, in private care, or during outbreaks. CONCLUSIONS: Due to the large geographical variations in circulating meningococcal serogroups, each country should continue to be monitored for changes in major disease-causing serogroups in order to inform vaccine and control policies. Similarly, laboratory capacity should be appropriately scaled up to more accurately understand local epidemiology and disease burden, as well as the impact of vaccination programs.

Formation of Ordered Honeycomb-like Structures of Manganese Oxide 2D Nanocrystals with the Birnessite-like Structure and Their Electrocatalytic Properties during Oxygen Evolution Reaction upon Water Splitting in an Alkaline Medium.

In this work, a chemical reaction between gaseous ozone and aqueous solution of Mn(CH3COO)2 in drops has been researched. It has been shown that the formation of H x MnO2·nH2O nanocrystals with a morphology of nanosheets and a birnessite-like crystal structure with a thickness of 5-8 nm is observed on the surface of drops. These nanocrystals are oriented spontaneously to the solution-gas interface and constitute peculiar ribbons with a width of 1-2 µm, some of which form ordered honeycomb structures (OHS) with a 5-20 µm cell size. To explain the observed effect, the scheme of chemical reactions that take place at the interface between the surface of a drop and ozone has been modeled, and it can be described using a diffusion pattern model taking into account the action of "force fields" on the surface of a drop, which arise due to its curvature. After the drop is dried, these structures practically retain their morphology and form a fractal structure with a geometric area equal to the area of the drop base on the surface of the substrate. The study of the electrocatalytic properties of these structures revealed that they are active electrocatalysts in the oxygen evolution reaction (OER) during water electrolysis in alkaline medium. The most efficient of the obtained electrocatalysts are characterized by an overpotential value of 284 mV at a current of 10 mA/cm2 and the Tafel coefficient of 37.7 mV/dec and are currently one of the best among pure manganese oxides. Finally, it has also been assumed that this effect is explained by the morphological features of the structures obtained, which contribute to the removal of oxygen bubbles from the electrode surface during electrolysis.

Preliminary findings indicate nosocomial transmission and Roma population as most affected group in ongoing measles B3 genotype outbreak in Bulgaria, March to August 2017.

From March to August 2017, 165 measles cases were reported from three regions in Bulgaria. The age range was 0-55 years and 66% of the cases were under 9 years. The Roma population was disproportionally affected (89% of cases), 41% cases were unvaccinated and in 24 cases there was nosocomial transmission mostly in paediatric departments. A child under 12 months of age died. Control measures have been taken and the investigation is still ongoing.

Migrant's access to immunization in Mediterranean Countries.

Countries bordering the Mediterranean are part of a major migration system. The aim of this study is to assess the main access barriers to immunization of mobile populations in the region and propose an action based framework to decrease health access inequalities. A survey on formal and informal barriers to immunization among mobile communities was conducted among public health officials formally appointed as focal points of the EpiSouth Network by 26 Mediterranean countries. Twenty-two completed the questionnaire. Thirteen countries reported at least one vaccine preventable disease (VPD) outbreak occurring among mobile populations since 2006 even though their legal entitlement to immunization is mostly equivalent to the general population's. Informal barriers, particularly lack of information and lack of trust in authorities, and disaggregation of data collection are the major issues still to be addressed. Mediterranean countries need to fill the gap in immunization coverage among pockets of susceptible individuals in order to prevent VPD outbreaks. Having for the most part ensured free entitlement, introducing more migrant friendly approaches, increasing information availability among mobile communities, building trust in public health services and disaggregating data collection to monitor and evaluate service performance among mobile groups are key aspects to address in the region.

Three cases of paralytic poliomyelitis associated with type 3 vaccine poliovirus strains in Bulgaria.

Oral poliovirus vaccine (OPV) can cause, in extremely rare cases vaccine-associated paralytic poliomyelitis in recipients, or contacts of vaccinees. Three cases of vaccine-associated paralytic poliomyelitis (two contacts and one recipient) occurred in the Bourgas region of Bulgaria in the spring of 2006. The first two cases, notified as acute flaccid paralysis, were 55 days old unvaccinated twin brothers, having been in contact with vaccinees. The third case concerned a 4-month-old infant who had received the first OPV dose 37 days prior to the onset of illness. Complete clinical, epidemiological, virological, serological and molecular investigations of the children with paralysis and their contacts were undertaken. In all the three cases type 3 polioviruses were isolated from fecal samples and characterized as Sabin-like poliovirus strains. Type 3 polioviruses isolated from the twin brothers demonstrated by sequence analysis U-to-C back mutation at nt 472 of the 5' UTR, known to correlate with neurovirulence, and mutation in the VP1 region. Type 3 poliovirus isolated from the third child demonstrated in the 3D sequenced region a recombination with Sabin type 1 poliovirus. In the latter region, three silent mutations and one, resulting in amino acid substitution, were also observed. The clinical, epidemiological and virological data and the neurological sequelae observed 60 days following the onset of paralysis, confirmed the diagnosis of vaccine-associated paralytic poliomyelitis in all the three patients.