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.

Key Factors Determining Indoor Air PM10 Concentrations in Naturally Ventilated Primary Schools in Belgrade, Serbia.

INTRODUCTION: Indoor air quality (IAQ) is rated as a serious public health issue. Knowing children are accounted as more vulnerable to environmental health hazards, data are needed on air quality in schools. METHODS: A project was conducted from 2007 until 2009 (SEARCH, School Environment and Respiratory Health of Children), aiming to verify links between IAQ and children's respiratory health. Study was conducted in ten primary schools on 735 children, in 44 classrooms. Children were randomly selected. Research tools and indicators used for children's exposure to school environment were indoor and outdoor pollutants, two standardized questionnaires for school and classroom characteristics. In both classroom air and ambient air in front of them we measured, during a 5-day exposure period for continuous 24h measuring: carbon monoxide, carbon dioxide, indoor air temperature, relative humidity, and PM10 during classes. RESULTS: PM10 concentrations were significantly most frequent in an interval of ≥80.1µg/m3, that is, in the interval above 50µg/m3. Mean PM10 value was 82.24±42.43 µg/m3, ranging from 32.00µg/m3 to of 197.00µg/m3. CONCLUSION: The increase of outdoor PM10 concentration significantly affects the increase of indoor PM10. A statistically significant difference exists for average IAQ PM10 concentrations vs. indicators of indoor thermal comfort zone (p<0.0001); they are lower in the classrooms with indicators within the comfort zone. Moreover, dominant factors for the increase of PM10 are: high occupancy rate in the classroom (<2m2 of space per child), high relative humidity (>75%), and indoor temperature beyond 23°C, as well as bad ventilation habits (keeping windows shut most of the time).

Seroprevalence of Borrelia burgdorferi in occupationally exposed persons in the Belgrade area, Serbia.

Lyme disease (LD) is a natural focal zoonotic disease caused by Borrelia burgdorferi, which is mainly transmitted through infected Ixodes ricinus tick bites. The presence and abundance of ticks in various habitats, the infectivity rate, as well as prolonged human exposure to ticks are factors that may affect the infection risk as well as the incidence of LD. In recent years, 20% to 25% of ticks infected with different borrelial species, as well as about 5,300 citizens with LD, have been registered in the Belgrade area. Many of the patients reported tick bites in city's grassy areas. The aim of this study was to assess the seroprevalence of B. burgdorferi in high-risk groups (forestry workers and soldiers) in the Belgrade area, and to compare the results with healthy blood donors. A two-step algorithm consisting of ELISA and Western blot tests was used in the study. Immunoreactivity profiles were also compared between the groups. The results obtained showed the seroprevalence to be 11.76% in the group of forestry workers, 17.14% in the group of soldiers infected by tick bites and 8.57% in the population of healthy blood donors. The highest IgM reactivity was detected against the OspC protein, while IgG antibodies showed high reactivity against VlsE, p19, p41, OspC, OspA and p17. Further investigations in this field are necessary in humans and animals in order to improve protective and preventive measures against LD.

Seroprevalence of Borrelia burgdorferi in occupationally exposed persons in the Belgrade area, Serbia

Lyme disease (LD) is a natural focal zoonotic disease caused by Borrelia burgdorferi, which is mainly transmitted through infected Ixodes ricinus tick bites. The presence and abundance of ticks in various habitats, the infectivity rate, as well as prolonged human exposure to ticks are factors that may affect the infection risk as well as the incidence of LD. In recent years, 20% to 25% of ticks infected with different borrelial species, as well as about 5,300 citizens with LD, have been registered in the Belgrade area. Many of the patients reported tick bites in city’s grassy areas. The aim of this study was to assess the seroprevalence of B. burgdorferi in high-risk groups (forestry workers and soldiers) in the Belgrade area, and to compare the results with healthy blood donors. A two-step algorithm consisting of ELISA and Western blot tests was used in the study. Immunoreactivity profiles were also compared between the groups. The results obtained showed the seroprevalence to be 11.76% in the group of forestry workers, 17.14% in the group of soldiers infected by tick bites and 8.57% in the population of healthy blood donors. The highest IgM reactivity was detected against the OspC protein, while IgG antibodies showed high reactivity against VlsE, p19, p41, OspC, OspA and p17. Further investigations in this field are necessary in humans and animals in order to improve protective and preventive measures against LD.

Performance indicators collected from primary health centres included in organised cervical cancer screening programme in the Republic of Serbia.

PURPOSE: To present the performance indicators for monitoring the cervical cancer screening process conducted in primary health centres (PHCs) and to identify any shortcomings in the implementation of the Organized Cervical Cancer Screening Programme (OCCSP). METHODS: This study included 16 PHCs participating in the OCCSP in the Republic of Serbia. The data were analysed from the moment the methodology in the PHCs has been accurately and consistently applied in accordance with the European guidelines (earliest from 20th December 2012 until 30th November 2014). We constructed "the standardised" model (adjusted on the number of working months). Performance indicators analysed in this study were: coverage by invitation, coverage by examination, and compliance with invitation. RESULTS: According to "the standardised" model, coverage by invitation was 61.9%, coverage by examination was 35.5% and compliance to invitation was 57.3%. CONCLUSION: Social mobilization, education, effective promotion strategies and training about cervical cancer screening program-especially in women of target population-as well as better coordination and planning of capacity-building, and staff resources in PHCs, are needed in the future in order to obtain higher values for our performance indicators. Screening registration will provide additional information about demographic characteristics of the tested women.