Mumps outbreak in the Federation of Bosnia and Herzegovina with large cohorts of susceptibles and genetically diverse strains of genotype G, Bosnia and Herzegovina, December 2010 to September 2012.

A mumps outbreak reported from the Federation of Bosnia and Herzegovina involved 7,895 cases between December 2010 and September 2012. This was the largest outbreak in the country since the introduction of the measles, mumps and rubella vaccine in 1980. The highest disease incidence was found among 15 to 19 year-olds. About 39% (3,050/7,895) of cases reported to be unvaccinated; the vaccination status of 31% (2,426/7,895) was unknown. A seroprevalence study among 150 asymptomatic contacts to mumps cases showed that about one third (45/150) were susceptible to mumps. Among 105 clinically suspected mumps patients hospitalised at the Clinical Centre of the University of Sarajevo, orchitis (60% of all males: 51/85) and meningitis (9%: 9/105) were the most common complications. Among 57 outbreak sequences obtained for the small hydrophobic gene, eight different variants of genotype G viruses were identified. The outbreak affected mainly age groups comprising individuals who were not vaccinated during or after the Bosnian war, as well as cantons with single dose immunisation policies until 2001. In addition to issues related to vaccination of individuals, differential responses to vaccines and vaccine strains, waning of antibodies and potentially also the genetically diverse variants of genotype G may have compounded the size and duration of the outbreak. Our report emphasizes the need for supplementary immunisation programmes in particular for adolescents and young adults.

Epidemic of surgical wound infections in wartime Sarajevo.

BACKGROUND: An epidemic of surgical wound infections observed at the State Hospital of Sarajevo during June-September 1992 is reported. METHODS: A cross-sectional survey of 138 surgical patients with wound infection treated by the Department of Surgery of the State Hospital of Sarajevo was performed in mid-September and again in mid-November 1992. A preliminary evaluation of the bactericidal effectiveness of a new antiseptic preparation called DI-ASEPT also was done. RESULTS: The frequency of wound infections was 24.4% in September and 19.2% in November. Pseudomonas species was the primary etiologic agent in this epidemic. DI-ASEPT was as effective as povidone-iodine in producing wound asepsis. CONCLUSIONS: Because of limited resources, large numbers of casualties, and an extremely adverse environment as a result of war that has affected hygienic conditions at the State Hospital of Sarajevo, a high frequency of contaminated or dirty operations were performed. This was the primary reason for the observed increase in wound infections. After hygienic conditions were restored, the epidemic of wound infections was terminated.

[Vaccination against hepatitis B in the Sarajevo Military Hospital]. / Vakcinacija protiv hepatitisa B u Vojnoj bolnici Sarajevo.

The intermediate prevalence of HBV infection (28.6%) was found in the staff of the Sarajevo Military Hospital without any significant difference related to the profession of the examinees. The vaccination against hepatitis B was accepted by 23 (18.3%) of 126 candidates and it was performed with 3 doses of "ENGERIX-B" vaccine. The protective levels of anti-HBs antibodies (10 IG/1) were found in 21 (91.3%) vaccinated persons a month after the third dose had been given. It was concluded that the vaccination is justified in collectives with the registered intermediate prevalence of HBV infection. In collectives with high prevalence, the vaccination is recommended only for newly employed workers.

[Risk of infection with Borrelia burgdorferi in an area endemic for Lyme disease]. / Rizik od infekcije borelijom burgdorferi u endemskom podrucju lajmske bolesti.

The results of the study of the prevalence of antibodies against Borrelia burgdorferi in three categories of subjects from the endemic region of Lyme disease in the northeast Croatia are reported. The study comprised 265 subjects: 97 living in the rural region, 51 forest rangers working in this region and 117 members of the Yugoslav People's Army who spent a certain period of time in this region. Positive titer of specific antibodies were found in 11.3% of local inhabitants, 25.5% forest rangers and 6% soldiers. Serologic testing was performed by the direct immunofluorescent method with aspiration and the titer in the dilution of 1:80 was considered significant. Some risk factors causing disease as well as the relationship between inapparent and clinically manifested cases of infection are pointed out.

[Hemorrhagic fever with renal syndrome--etiology]. / Hemoragicna groznica sa bubreznim sindromom (HGBS)--etiologija.

HFRS was confirmed serologically in two patients, who were infected in the natural focus near Zupanja. Using the bigger number of virus antigens in indirect immunofluorescent antibody test, afterwards was proved the agent could be classified into the serotype 3 of Hantaviruses, and antigenically is identical with virus NE (strain Hällnäs), respectively Yugoslav isolate "Vranica". Serotype differentiation of the agent in patient who were infected in the area of Igman, near Sarajevo, has not been performed by the same test. There was assumed a possibility for circulation of "new", up to now non-identified, serovariant of Hantaviruses in this natural focus.

Hemorrhagic fever with renal syndrome in Yugoslavia: epidemiologic and epizootiologic features of a nationwide outbreak in 1989.

A nationwide epidemic of hemorrhagic fever with renal syndrome (HFRS) occurred in Yugoslavia in 1989. Sera from 609 hospitalized patients, from all six Republics (Bosnia and Hercegovina, Croatia, Macedonia, Montenegro Serbia, Slovenia) and two Provinces (Kosovo and Vojvodina), who had signs and symptoms suggestive of HFRS, and sera and lung tissues from 544 small mammals belonging to 13 species were studied for evidence of hantavirus infection. Of the 226 patients with serologically confirmed HFRS, 182 resided in Bosnia and Hercegovina or in Serbia. The severity of disease differed from region to region, with an overall fatality of 6.6% (15/226). Patients from southern Yugoslavia tended to have more severe disease and exhibited two types of antibody patterns, while approximately equal numbers of clinically severe and mild cases of HFRS were registered in central Yugoslavia, where four types of antibody patterns were found. Two of these antibody patterns suggested the existence of hantaviruses which are antigenically distinct from those reported to date. Two seasonal peaks of disease, one during the summer and the other in late autumn, were found. Hantaviral antibodies and/or antigens were detected most often in the yellow-necked mouse (Apodemus flavicollis) (88/189), the wood mouse (Apodemus sylvaticus) (28/146), the striped field mouse (Apodemus agrarius) (10/64), the bank vole (Clethrionomys glareolus) (36/63), the house mouse (Mus musculus) (14/29), and the Norway rat (Rattus norvegicus) (14/21). Five other species of rodents and insectivores were infrequently infected.