Tuberculosis and associated risk factors among children and adolescent population in Serbia: 12 year's retrospective study.

INTRODUCTION: Recognition and epidemiological control of childhood and adolescent tuberculosis (TB) is essential to achieve effective control of TB in general as it presents high risk for transmission in the community. The aim of the study is to provide a descriptive and analytic overview of the trends in childhood and adolescent TB notifications and treatment outcomes and to identify factors associated with treatment success in a twelve-year period in Serbia. METHODOLOGY: We performed a retrospective trend analysis and analysis of treatment outcomes of 596 child and adolescent TB cases notified in Serbia in the period 2005-2016 from all health facilities, as well as logistic regression analysis to identify predictors of treatment success. RESULTS: Factors independently associated with treatment success were: new TB (OR=2.60; 95% CI: 1.45-3.74), male sex (OR=2.55; 95% CI: 2.09-3.00), pulmonary TB (OR=3.34; 95% CI: 2.34-4.34), comorbidities (OR=2.58; 95% CI: 2.24-2.91), age below 5 years (OR=0.37; 95% CI: 0.32-0.43), and social vulnerability (OR=0.40; 95% CI: 0.34-0.46). CONCLUSIONS: In order to improve TB treatment outcomes among children and adolescent population in Serbia, it is important to focus on female, age group 5-18, EPTB, retreatment cases and socially vulnerable groups.

Tuberculosis outbreak among high school students in Novi Pazar, Serbia 2016: a retrospective-cohort study.

INTRODUCTION: Between February and November 2016, 17 tuberculosis (TB) cases were identified among high school students in Novi Pazar, Serbia. The objectives of our study were to describe the outbreak, to identify potential risk factors and to evaluate the applied control measures. METHODOLOGY: The outbreak was described by time, person and place. A retrospective cohort study was conducted. Attack rates, unadjusted relative risks (RR) and 95% confidence intervals (CI) were calculated. Multiple log-binomial regression analysis was performed to calculate adjusted RR. RESULTS: Sixteen of the total 17 cases occurred among grade 3 students, AR 5.5%. Previous TB family history, (RR = 5.29; 95% CI = 1.63-17.12), spending time with a known TB case at school (RR = 5.38; 95% CI = 1.48-19.55) and exposure to secondhand smoke (RR = 3.37; 95% CI = 1.11-10.29) were all significantly and independently associated with the occurrence of TB. CONCLUSIONS: Delayed diagnosis and reporting resulted in delayed initiation of the contact investigation and non-identification of latent TB cases probably favored the occurrence of this outbreak in a low incidence country. Public health authorities should consider revising the existing guidelines, promoting inter-sectorial collaboration and increasing awareness of public health professionals.

[Adverse events following BCG vaccination]. / Nezeljene pojave nakon BCG imunizacije.

Bacillus Calmette-Guérin (BCG) is one of the safest vaccines applied worldwide today. Risk of occurrence of adverse effects upon BCG immunization varies with age of children being vaccinated, whereas local reactivity differs among vaccines due to applied strain as well as the number of viable bacilli and type of vaccine. In 1984, Lotte and co-workers analyzed and classified complications associated with BCG vaccination in detail. This classification is based on clinical, bacteriological, histological and biological information. Category 1 involves extensive local lesions and regional suppuration, BCG-related lymphadenitis, which is usually but not always bacteriologically and/or hitologically confirmed. Categories 2 and 3 comprise more serious complications. Non-fatal cases (localized or multiple changes) are included in category 2, while fatal cases (generalized lesions usually associated with immunodeficiency) are in category 3. Category 4 includes complications which occur upon BCG administration, but not definitely confirmed either bacteriologically or histologically. Keloid formation belongs to this category. Bacillus Calmette-Guerin lymphadenitis is the most common complication of BCG vaccination. There are two forms of BCG adenitis in natural course of lymphadenitis. Simple or non-suppurative lymphadenitis, which usually resolves spontaneously within a few weeks, and suppurative lymphadenitis characterized by fluctuation development with edema and erythema above glands. More serious adverse effects rarely occur at 1-3/1 mil of administered doses. In our country, not all adverse effects related to BCG vaccination have been established However, each complication should be reported, because its monitoring enables quality control both of the vaccine and techniques of its application.