Objectives Viral hepatitis presents a significant public health challenge due to its slow progression leading to severe liver disease and death. The aim of this research is to identify risk behaviors and groups associated with hepatitis C, with the goal of directing prevention measures, increasing mass testing, and potentially facilitating treatment in Bosnia and Herzegovina. Methods A case-control study was conducted from 2017 to 2022, involving 69 anti-HCV-positive and 70 control respondents matched for gender and age. After obtaining of informed consent, respondents completed a questionnaire focusing on sociodemographic status and potential risk factors for HCV-infection. Molecular quantification tests were carried out, and genotyping was performed for respondents positive for HCV RNA. Results In this study, we found statistically significantly that anti-HCV respondents are more frequently male, of younger age, with lower educational levels, unemployed, and often unmarried, predominantly residing in urban areas. Behaviors such as tattooing, piercing, contact with others' blood, drug usage, intimate relationships with hepatitis B or C positive partners and having more than two sexual partners in the last 12 months were statistically significantly more common among anti-HCV-positive individuals compared to the control group. However, binary logistic regression analysis identified drug usage as significant risk factor for HCV-infection. Conclusion Due to the fact that the numbers of drug users are continuously increasing among people of younger age, it is very important to direct prevention measures towards this population.

OBJECTIVES:COVID-19 has had a profound impact on global mortality and morbidity, yet only a fraction of deaths was confirmed and reported. We estimated all-cause excess mortality from 1 January 2020 to 31 December 2022 in the Federation of Bosnia and Herzegovina (FBiH) to assess the true magnitude of the pandemic. METHODS:Data for this analysis was sourced from the FBiH mortality register and supplemented with population statistics and official COVID-19 death counts (i.e., cases where COVID-19 was registered as the cause of death). Using a Poisson model, all-cause excess number of deaths and rates per 100,000 person-years, adjusted for registration delays and stratified by age and gender, were calculated. RESULTS:FBiH experienced three periods of excess all-cause mortality throughout the first 3 years of the pandemic, with a total of 12,000 excess deaths, highest among adults 45-74 years and males. No excess mortality was observed in children <15 years. CONCLUSIONS:The true mortality impact of COVID-19 in FBiH was substantially higher than the reported deaths, including among younger adults. Strengthening civil registration and vital statistics, including establishment of all-cause mortality surveillance, is essential for improved monitoring of future pandemics and other important public health events. A detailed review of the direct and indirect effects of COVID-19 on mortality should be conducted to identify areas that require more resources, improve health provision and inform mitigation efforts in future pandemics to save lives.

We report on an ongoing measles outbreak in the Federation of Bosnia and Herzegovina with 141 cases notified between week 52 2023 and week 6 2024. Among those with known vaccination status, 97% were unvaccinated and the most affected group is children under the age of 5 years (n = 87) who were not vaccinated during the pandemic years. Sixty-eight cases were hospitalised, the most common complications were measles-related pneumonia and diarrhoea. The sequenced measles viruses from four cases belonged to genotype D8.

COVID-19 vaccine uptake in the Federation of Bosnia and Herzegovina (FBiH) accelerated in the second half of 2021, with greater vaccine availability. In this study, we estimated the vaccine effectiveness (VE) of complete primary series BBIBP-CorV vaccine against COVID-19 in patients aged 60 years and older, during the Delta-dominant period, using a test-negative case-control design. Surveillance sites were 11 primary health care centers (PHC) collecting patient data from October 1, 2021, to January 4, 2022, retrospectively according to a common protocol. In total, we included 1711 participants in the analysis: 933 cases and 778 controls. Of the 933 cases, 508 (54.4 %) had mild and 425 (45.6 %) had moderate to severe disease presentation. We observed no effectiveness against mild COVID-19. Overall vaccine effectiveness was 65.0 % (95 %CI: 40.1-79.5) against moderate to severe COVID-19. In time since vaccination analysis, VE was 78.7 % (95 % CI: 54.8-89.9) in patients who received their last dose < 90 days before onset; 66.0 % (95 % CI:- 0.5-88.5) in those 90-119 days before onset; 42.1 % (95 % CI:- 88.6-82.3) in those 120-149 days before onset and 45.0 % (95 % CI:- 94.0-84.4) in those >= 150 days before onset. In our study, two doses of BBIBP-CorV provided considerable protection against moderate to severe COVID-19 in older adults, highest within 3 months after second dose, during the Delta- dominant period. Point estimates declined thereafter, suggesting a need for additional doses.

Background: In aim to promote HPV vaccination among children and youth, the Institute for Public Health of the Federation of BiH in 2023 developed an HPV immunization program, furtherly accepted by the Federal Ministry of Health. In collaboration with WHO and UNFPA country offices, the Institute for Public Health of the Federation of BiH initiated education to emphasize the importance of improving the knowledge and skills for over 280 health professionals in effective communication with parents in the promotion of HPV vaccination. Methods and materials: Paper presents an analysis of results of the pre and post testing of the health professionals directly involved in the HPV vaccination process in the Federation of BiH, regarding their self-confidence in communication with parents about HPV vaccination. For data collection was used the questionnaire as a part of the WHO document "Communicating with caregivers about HPV vaccination: facilitator's guide" published in 2023. The questionnaire was created in Google Forms for health professionals who participated on training. For descriptive and inferential statistics of collected data used IBM SPSS20 package. Results: The data showed an increase in self-confidence of health professionals in communication with parents after completed training. Before training 32.5% of health professionals confirmed self-confidence in talking to parents about HPV vaccination while 68.0% of them after training. Self-confidence about adverse reactions after HPV vaccination is confirmed by 27.4% health professionals before training and by 64.4% of them after training. Conclusions: A systematic approach in improving the communication knowledge and skills of health professionals is significant support for increasement of the coverage and promotion of HPV vaccination.

IntroductionBetween 2021 and 2023, a project was funded in order to explore the mortality burden (YLL–Years of Life Lost, excess mortality) of COVID-19 in Southern and Eastern Europe, and Central Asia.MethodsFor each national or sub-national region, data on COVID-19 deaths and population data were collected for the period March 2020 to December 2021. Unstandardized and age-standardised YLL rates were calculated according to standard burden of disease methodology. In addition, all-cause mortality data for the period 2015–2019 were collected and used as a baseline to estimate excess mortality in each national or sub-national region in the years 2020 and 2021.ResultsOn average, 15–30 years of life were lost per death in the various countries and regions. Generally, YLL rates per 100,000 were higher in countries and regions in Southern and Eastern Europe compared to Central Asia. However, there were differences in how countries and regions defined and counted COVID-19 deaths. In most countries and sub-national regions, YLL rates per 100,000 (both age-standardised and unstandardized) were higher in 2021 compared to 2020, and higher amongst men compared to women. Some countries showed high excess mortality rates, suggesting under-diagnosis or under-reporting of COVID-19 deaths, and/or relatively large numbers of deaths due to indirect effects of the pandemic.ConclusionOur results suggest that the COVID-19 mortality burden was greater in many countries and regions in Southern and Eastern Europe compared to Central Asia. However, heterogeneity in the data (differences in the definitions and counting of COVID-19 deaths) may have influenced our results. Understanding possible reasons for the differences was difficult, as many factors are likely to play a role (e.g., differences in the extent of public health and social measures to control the spread of COVID-19, differences in testing strategies and/or vaccination rates). Future cross-country analyses should try to develop structured approaches in an attempt to understand the relative importance of such factors. Furthermore, in order to improve the robustness and comparability of burden of disease indicators, efforts should be made to harmonise case definitions and reporting for COVID-19 deaths across countries.

Background and Objectives: Burden of cervical cancer in Central and Eastern Europe is higher than in other parts of Europe. We analyzed cervical cancer epidemiology in Serbia and Bosnia and Herzegovina (the Federation of Bosnia and Herzegovina and the Republic of Srpska) from January 2016 to December 2020, exploring the role of available sociodemographic factors and healthcare service parameters on incidence and mortality rates, using an ecological approach based on aggregated data. Materials and Methods: Incidence and mortality rates are standardized using the method of direct standardization with the World-ASR-W. Administrative units are grouped by tertiles of incidence and mortality to explore sociodemographic factors and healthcare parameters across these groups. Results: Average age-standardized incidence rates of cervical cancer per 100,000 females were 19.28 in Serbia, 12.48 in the Federation of Bosnia and Herzegovina, and 22.44 in the Republic of Srpska. Mortality rates per 100,000 females were 6.67, 5.22, and 4.56 in Serbia, the Federation of Bosnia and Herzegovina, and the Republic of Srpska, respectively. Several parameters of sociodemographics and health service usage differed significantly across units grouped by tertiles based on incidence level, i.e., female population ≥ 15 years old (p = 0.028), population density (p = 0.046), percent of gynecologists in the primary healthcare (p = 0.041), number of gynecologists per 10,000 females ≥ 15 years (p = 0.007), and the area-to-gynecologist ratio (p = 0.010). A moderate negative correlation was found between incidence and population density (rho = −0.465, p = 0.017), and a moderate positive correlation between incidence and area-to-gynecologist ratio (rho = 0.534, p = 0.005). Conclusions: Cervical cancer remains a leading cause of cancer among women in developing countries. Implementing tailored activities, such as educational programs, preventive services, and investments in healthcare infrastructure, particularly at the administrative units’ level, can help in reducing health disparities and improving health outcomes.

In response to the significant public health threat caused by coronavirus disease (COVID-19), real-time surveillance, containment, and mitigation measures were implemented in the Federation of Bosnia and Herzegovina (FBiH). Our objective was to describe the surveillance methodology, response measures, and epidemiology of COVID-19 cases in FBiH from March 2020 to March 2022. The surveillance system implemented across FBiH enabled health authorities and the population to monitor the development of the epidemiological situation, the daily number of reported cases, as well as basic epidemiological characteristics and geographic distribution of cases. As of 31 March 2022, 249,495 cases of COVID-19, and a total of 8,845 deaths were recorded in FBiH. Upkeeping of real-time surveillance, maintaining non-pharmaceutical interventions, and speeding up the vaccination roll-out were paramount for controlling COVID-19 in FBiH.

Background Sarajevo Canton in the Federation of Bosnia and Herzegovina has recorded several waves of high SARS-CoV-2 transmission and has struggled to reach adequate vaccination coverage. We describe the evolution of infection- and vaccine-induced SARS-CoV-2 antibody response and persistence. Methods We conducted repeated cross-sectional analyses of blood donors aged 18-65 years in Sarajevo Canton in November-December 2020 and 2021. We analyzed serum samples for anti-nucleocapsid (anti-N) and anti-spike (anti-S) antibodies. To assess immune durability, we conducted longitudinal analyses of seropositive participants at 6 and 12 months. Results 1015 participants were included in Phase 1 (November-December 2020), and 1152 in Phase 2 (November-December 2021). Seroprevalence increased significantly from 19.2% (95% CI: 17.2-21.4%) in Phase 1 to 91.6% (95% CI: 89.8-93.1%) in Phase 2. Anti-S IgG titers were significantly higher among vaccinated (58.5%) than unvaccinated infected participants across vaccine products (p<0.001), though highest among those who received an mRNA vaccine. At 6 months, 78/82 (95.1%) participants maintained anti-spike seropositivity; at 12 months, 58/58 (100.0%) participants were seropositive and 33 (56.9%) had completed the primary vaccine series within 6 months. Among 11 unvaccinated participants who were not reinfected at 12 months, anti-S IgG declined from median 770.1 (IQR 615.0-1321.7) to 290.8 (IQR 175.7-400.3). Anti-N IgG antibodies waned earlier; from 35.4% seropositive at 6 months to 24.1% at 12 months. Conclusions SARS-CoV-2 seroprevalence increased significantly over 12 months from end of 2020 to end of 2021. Although individuals with previous infection may have residual protection, COVID-19 vaccination is vital to strengthening population immunity.

BackgroundImpulsivity, affective instability, and neglect of oneself and other people's safety as symptoms of personality dysfunction are associated with risky behaviors regarding the transmission of infectious diseases either sexually or by intravenous drug abuse.ObjectiveThe aim of this study was to analyze the association between hepatitis C virus (HCV) infection and personality dysfunction in opiate addicts on opioid substitution treatment.MethodsThis was a cross-sectional, observational investigation of patients over 18 years of age who were actively participating in opioid substitution treatment at five centers in Bosnia and Herzegovina. The occurrence of HCV infection was the primary study outcome, and personality functioning, the main independent variable, was assessed using the Severity Indices of Personality Problems (SIPP−118) questionnaire. The association between scores of personality functioning domains items and HCV infection status was determined by binary logistic regression analysis.ResultsPatients on opioid substitution therapy with HCV infection more frequently had personality disorders (OR 2.168, 95% CI 1.161–4.05) and were treated longer than patients without HCV infection (OR 1.076, 95% CI 1.015–1.14). HCV infection was associated with lower self-respect (OR 0.946, 95% CI 0.906–0.988), decreased capacity to have enduring relationships with other people (OR 0.878, 95% CI 0.797–0.966), and lower capability to cooperate with others (OR 0.933, 95%CI 0.888–0.98). On the other hand, except for self-respect, other elements of the Identity Integration domain (enjoyment, purposefulness, stable self-image, and self-reflexive functioning), when more functional, increased the risk of HCV infection.ConclusionsOur study demonstrates that opiate addicts on opioid substitution treatment have a higher risk of HCV infection if their personality is dysfunctional, especially in the aspects of self-respect, enduring relationships, and cooperativity. The risk is even higher in addicts who have an established diagnosis of any kind of personality disorder.

Objectives: Brucellosis is a ubiquitous emergent bacterial zoonotic disease causing significant human mor-bidity in Bosnia and Herzegovina. So far, a high rate of resistant Brucella has been found worldwide. This study prospectively analysed the rates of resistance among human Brucella melitensis strains isolated in Bosnia and Herzegovina.Methods: This study included 108 B. melitensis isolates from 209 patients diagnosed at five medical centres in Bosnia and Herzegovina. The resistance profiles of the B. melitensis isolates for the 13 most commonly used antimicrobials were studied in standard Brucella broth (BB) and cation-adjusted Mueller-Hinton broth (CAMHB) supplemented with 4% lysed horse blood or 5% defibrinated sheep blood.Results: Of the 209 patients, B. melitensis blood cultures were positive for 111 (53.1%). Among the 108 isolates investigated, 91 (84.3%) were resistant to trimethoprim-sulfamethoxazole on BB, but not on either CAMHB. Nearly all isolates ( > 90%) were resistant to azithromycin on BB and both CAMHBs.Conclusion: We observed a high rate of B. melitensis resistance to azithromycin. The high rate of re-sistance to trimethoprim-sulfamethoxazole that we observed was related to BB, so an alternative broth should be used, such as the enriched CAMHBs in this study, for evaluating resistance to trimethoprim-sulfamethoxazole. Whole-genome sequencing studies are needed to understand the development of an-timicrobial resistance in B. melitensis strains isolated from humans.(c) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Cistična ehinokokoza (CE), koju uzrokuje E. granulosus, zoonotska je bolest koja se pojavljuje na gotovo svim kontinentima, a endemična je za područje Mediterana. Bolest se najčešće prezentira afekcijom jednog organa i solitarnom cistom, a kod manjeg broja bolesnika radi se o diseminiranoj bolesti koja pogađa višestruke organe. U ovom je radu prezentirana mlada žena s diseminiranom ehinokokozom kod koje su hidatidne ciste verificirane u jetrima, slezeni, plućima, bubrezima i perikardu. Zbog specifičnosti oblika bolesti, dobi bolesnice te zbog čestih relapsa bolesti nakon završetka terapije, liječena je albendazolom kroz duži vremenski period. Želimo prezentirati nešto drugačiji modus liječenja ehinokokokze koji je rezultirao povoljnom regresijom i kontrolom bolesti.

Background: Echinococcosis is a parasitic infection caused by larvae of Echinococcus. Cystic echinococcosis is caused by E. granulosus, while the rarer type of the disease, alveolar echinococcosis, is caused by E. multilocularis. The most frequent localization of cysts is the liver, followed by lungs, but the involvement of other organs is also possible. The infection could be asymptomatic for a long time, while symptoms are mainly caused by the mechanical pressure of increasing cyst. Benzimidazole derivatives are still the cornerstone in the treatment of echinococcosis, particularly recommended because of dissemination or localization of the disease. Case Description: A 22-year-old previously healthy female was admitted to hospital with the clinical presentation of intensive, dull abdominal pain. The reasonable suspicion of echinococcosis resulted from a workup performed in the outpatient settings which included detailed radiological evaluation and serological tests. The patient was in a good general condition with unmarked clinical status. Further diagnostic workup was performed – laboratory findings were within normal values with liver transaminase levels within reference ranges, while paired serology related to Echinococcus revealed positive titers at the same level. An additional radiological evaluation confirmed multiple disseminated disease with the involvement of liver, spleen, lungs, kidneys, and heart. The cyclical treatment with oral albendazole 2 × 400 mg was initiated with 28 days treatment period followed by 14 days break between treatment cycles. During the next 2 years of outpatient treatment, the patient received 17 cycles of albendazole therapy. Discussion: The patient did not have any issues related to the anthelmintic therapy and therapy did not result in any complication. Abdominal symptoms regressed while imaging methods confirmed significantly decreased size of all cysts. The patient is still on continuous outpatient monitoring in our clinic. The treatment was interrupted because of pregnancy, that went excellent. Child is healthy and progressing well. The treatment is to continue after the breastfeeding period. Conclusion: Prolonged treatment with albendazole of patients suffered from disseminated echinococcosis leads to beneficial result presented through subjective and objective improvement. We indicate that the possibility of toxic effects of the drug on the liver should not cause greater worrying in cases of prolongated treatment with albendazole.

The novel coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still progressing and has been recorded in more than 210 countries and territories worldwide. In Bosnia and Herzegovina, the first cases of COVID-19 were detected on March 5, 2020 in the entity of the Republic of Srpska and on March 9, 2020 in the entity of the Federation of Bosnia and Herzegovina. By May 16, 2020, more than 2,200 COVID-19 cases had been recorded in both entities, with a mortality rate of 5.8% (131 of 2,231 cases). The aim of this ongoing study is to present the current epidemiological and sociodemographic parameters of 380 COVID-19 patients diagnosed at the University Clinical Hospital Mostar (UCH Mostar) during the first two months of the COVID-19 pandemic. Of those 380 patients, 60 (15.8%) required hospitalization. The mortality rate was 5% (19/380). The highest mortality rate (15.2%, 12/79) was recorded in the patients aged ≥65 years. In addition to this single-center experience of the ongoing COVID-19 pandemic, we discuss the epidemiological measures imposed in Bosnia and Herzegovina, with an emphasis on the restrictive measures. The COVID-19 pandemic is still ongoing in Bosnia and Herzegovina.

Aim of the study was comparing the quality of life of addicts treated in frame of methadone substitution programs and addicts undergoing the rehabilitation on the frame of therapeutic community.We have done a crossover study in the Center for Prevention and Out-patient Treatment in Mostar.We have included 60 subjects in our study.All of them were heroin addicts, referred to the Center for Prevention and Out-patient Treatment in Mostar, who satisfied the DSM-IV criteria for the addiction disease.The subjects have been divided in three groups: 1) group of just-admitted patients (N=20), 2) group of patients who had spent six months in methadone program (N=20) and 3) group of patient who had spent six months in the therapeutic community program (N=20).In this study, we have gathered data for social-demographic variables such as age, education, marital and professional status and variables related to the addiction, such as duration of addiction, manner of drug administration, alcohol use and presence of HCV, HBV or HIV viral infections.For the estimation of quality of life, we have used the "Quality of life index", to measure the perception of the important areas of life, such as health and functioning in the fields of social, economic, psychological and spiritual domains.A majority of subjects from this sample had achieved the secondary school education and were of similar age, unmarried, mostly unemployed and only a smaller number of them were living alone, out of their primary families.The groups tested have not significantly differed considering those living conditions which reflect the quality of life.The results of addiction variables had showed that a majority of subjects administered the drug intravenously, there were no significant differences concerning the

The aim of this study was to clarify the clinical role of CD44 expression in ovarian serous cancer, and its relation to clinicopathologic prognostic factors, disease free survival and overall survival (OS). Immunohistochemical staining for CD44 was performed on 81 formalin-fixed, paraffin-embedded tumor sections. CD44 expression was found in 43% of ovarian carcinoma samples. Correlations between categorical variables were studied using the χ2 and the Mann-Whitney U test. For survival analysis, the Kaplan-Meier method, the log-rank test and the Cox proportional hazard regression model were used. We did not find any statistically significant difference in the distribution of respondents according to clinical stage of the disease, tumor grade or the presence of vascular invasion in relation to the expression of CD44. According to the results of uninominal analysis, early International Federation of Gynecology and Obstetrics (FIGO) stage of the disease (P=0.003) was associated with longer disease free survival, while the expression of CD44 (P<0.001), FIGO stage III and IV (P=0.009) and the finding of vascular invasion (P=0.005) was related to a shorter OS. In conclusion, we proved that positive CD44 immunoexpression is a independent prognostic indicator of shorter OS of patients with ovarian serous cancer.

Introduction: Use of intravenous heroin carries a risk of serious medical conditions, including acquiring blood-borne infections. Therefore, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection represent a threat for people who inject drugs (PWID). The objectives of this study were to determine the extent and characteristics of risk factors for acquiring HBV and HCV infection in PWID included in opiate substitution treatment in the southern part of Bosnia and Herzegovina (B&H).Methodology: The study included 120 adult PWID of both sexes who participated in opiate substitution treatment. All participants were interviewed, and their blood samples were tested for the presence of the surface hepatitis B virus antigen (HBsAg) and hepatitis C virus antibodies (anti-HCV). Prevalence data were obtained and compared to the serological status.Results: HBsAg prevalence among PWID was 0.8% (1/120), whereas seroprevalence of anti-HCV was 52.5% (63/120). PWID exposed to risk-behavior factors (such as unsafe sexual activity, serving prison sentence, and tattooing) were more frequently anti-HCV positive. Sharing drug paraphernalia was found to be the most significant risk factor. The highest predictive values for acquiring HCV-infection were attributed to PWID who used heroin for more than three years and who were unmarried.Conclusions: HBsAg prevalence among PWID is rare (0.8%), while HCV-infection (52.5%) presents an important health and social issue among PWID in B&H. Sharing drug paraphernalia and intravenous heroin use longer than three years were the most prominent risk-behavior factors among the patients we investigated.

INTRODUCTION:Influenza A H1N1pdm09 virus infection causes an epidemiologically and clinically severe disease mostly characterized by pneumonia, resulting in a high mortality rate. The purpose of this study was to investigate and compare epidemiological and clinical characteristics of influenza A H1N1pdm09 virus infection in patients hospitalized during the pandemic (2009/10) and post-pandemic seasons (2010/11).METHODOLOGY:The data of patients with laboratory-confirmed influenza A H1N1pdm09 virus infection hospitalized and treated at the University Hospital for Infectious Diseases Dr. Fran Mihaljevic in Zagreb, Croatia in the first two seasons of appearance were analyzed.RESULTS:Compared to the pandemic season, in the post-pandemic season, patients were hospitalized longer, had higher values of inflammatory parameters, and were more often treated with antibiotics. The total number of risk factors in patients did not vary significantly between the two seasons. In the pandemic season, a significantly higher number of obese patients and patients with chronic lung disease was observed, whereas in the post-pandemic season, a statistically significant number of patients presented with symptoms of chronic cardiac and neuromuscular diseases. Primary viral pneumonia was frequently registered in younger adults during the pandemic season, whereas in the post-pandemic season, there were more cases of bacterial pneumonia.CONCLUSIONS:During the pandemic season, the influenza A H1N1pdm09 virus infection caused a severe disease with rare bacterial complications, especially in adult patients. The common characteristics of the influenza A H1N1pdm09 virus were lost in the post-pandemic season, assuming the shape and characteristics of the seasonal influenza A virus.

Two cases of human cutaneous anthrax were reported in September 2014 in south-western Bosnia and Herzegovina. The two men were involved in slaughtering a cow and handled its Bacillus anthracis-infected meat. Anthrax has been sporadically observed in livestock in Bosnia and Herzegovina, but no confirmed human cases had been reported in the country in the last two decades. Clinicians in the country should be aware that anthrax may occur in humans, arising from exposure to infected animals.