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The molecular diversity of Epstein–Barr virus (EBV) is exceptionally complex and based on the characterization of sequences coding for several viral genes. The aim of this study was to analyze the distribution of EBV types 1 and 2 and to characterize LMP1 variants in a cohort of 73 patients with infectious mononucleosis (IM), as well as to investigate a possible association between viral diversity and relevant clinical parameters. Population-based sequencing of EBNA-2 gene showed the presence of EBV type 1 in all IM patients. Analysis of LMP1 gene found a restricted repertoire of LMP1 variants with the predominance of wild-type B95-8, China1, Mediterranean and North Carolina variants with the presence of more than one LMP1 variant in 16.4% of patients. Co-infections with different LMP1 variants were associated with significantly higher levels of C-reactive protein and lower levels of maximal neutrophil counts and minimal platelet count. The results of this study have shown a narrow repertoire of LMP1 variants and an exclusive presence of EBV type 1 in a cohort of IM from Croatia, suggesting a characteristic local molecular pattern of this virus. The clinical importance of distinct immunobiological features of IM patients with LMP1 variant co-infections needs to be investigated further. [ABSTRACT FROM AUTHOR]

As a leading viral cause of acute gastroenteritis in both humans and pigs, rotavirus A (RVA) poses a potential public health concern. Although zoonotic spillover of porcine RVA strains to humans is sporadic, it has been detected worldwide. The origin of chimeric human-animal strains of RVA is closely linked to the crucial role of mixed genotypes in driving reassortment and homologous recombination, which play a major role in shaping the genetic diversity of RVA. To better understand how genetically intertwined porcine and zoonotic human-derived G4P[6] RVA strains are, the present study employed a spatiotemporal approach to whole-genome characterization of RVA strains collected during three consecutive RVA seasons in Croatia (2018-2021). Notably, sampled children under 2 years of age and weanling piglets with diarrhea were included in the study. In addition to samples tested by real-time RT-PCR, genotyping of VP7 and VP4 gene segments was conducted. The unusual genotype combinations detected in the initial screening, including three human and three porcine G4P[6] strains, were subjected to next-generation sequencing, followed by phylogenetic analysis of all gene segments, and intragenic recombination analysis. Results showed a porcine or porcine-like origin for each of the eleven gene segments in all six RVA strains. The G4P[6] RVA strains detected in children most likely resulted from porcine-to-human interspecies transmission. Furthermore, the genetic diversity of Croatian porcine and porcine-like human G4P[6] strains was propelled by reassortment events between porcine and porcine-like human G4P[6] RVA strains, along with homologous intragenotype and intergenotype recombinations in VP4, NSP1, and NSP3 segments. Described concurrent spatiotemporal approach in investigating autochthonous human and animal RVA strains is essential in drawing relevant conclusions about their phylogeographical relationship. Therefore, continuous surveillance of RVA, following the One Health principles, may provide relevant data for assessing the impact on the protectiveness of currently available vaccines. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess pregnant women's knowledge and attitudes regarding maternal COVID-19 immunization during pregnancy. A cross-sectional study was performed in two teaching hospitals between May and October 2021 in Zagreb, Croatia. During antenatal clinic visit pregnant women were approached and asked to fill out a predesigned questionnaire about their knowledge and attitudes towards COVID-19 vaccination. Collected data was later analyzed. A total of 430 women participated in the study. Only 16% of women expressed their willingness to be vaccinated against COVID-19 if offered, despite that 71% of them believe that COVID-19 might be a serious illness in pregnant women. The most important obstacle in having better acceptance of the vaccines is in the assumption that the vaccines are not safe for pregnant women (73%) or the fetus (75%), or that the vaccines are not effective (41%). The relationship exists between acceptance of vaccination in general and willingness to get other vaccines in pregnancy and readiness to be vaccinated against COVID-19 in pregnancy. Only one out of 55 women who were not adherent to the current vaccination recommendations in Croatia would accept the COVID-19 vaccine during pregnancy if offered. 21 (5%) women stated that vaccination against influenza and pertussis during pregnancy is necessary and 13 (62%) of them would get vaccinated against COVID-19 if offered. This study showed that the crucial reasons for refusing vaccination against COVID-19 among pregnant women in Croatia are the concerns about the vaccines' effectiveness and safety. All healthcare providers should put more effort into education of pregnant women on risks of COVID-19, as well as on the benefits and safety of the vaccines. [ABSTRACT FROM AUTHOR]

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Copyright of Croatian Journal of Infection / Infektoloski Glasnik is the property of Croatian Society for Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Influenza vaccination in infants and children with existing health complications is current practice in many countries, but healthy children are also susceptible to influenza, sometimes with complications. The under-recognised burden of disease in young children is greater than in elderly populations and the number of paediatric influenza cases reported does not reflect the actual frequency of influenza. Discussion Vaccination of healthy children is not widespread in Europe despite clear demonstration of the benefits of vaccination in reducing the large health and economic burden of influenza. Universal vaccination of infants and children also provides indirect protection in other high-risk groups in the community. This paper contains the Central European Vaccination Advisory Group (CEVAG) guidance statement on recommendations for the vaccination of infants and children against influenza. The aim of CEVAG is to encourage the efficient and safe use of vaccines to prevent and control infectious diseases. Summary CEVAG recommends the introduction of universal influenza vaccination for all children from the age of 6 months. Special attention is needed for children up to 60 months of age as they are at greatest risk. Individual countries should decide on how best to implement this recommendation based on their circumstances.

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Disease prevention and improving vaccination coverage in Europe are key elements contributing to resilient health systems and ensuring better health outcomes for all. The aim of this study was to describe the immunization funding landscape across all European Union 28 countries (EU28). Data collected in a targeted literature review supported descriptive analysis on the different indicators that were looked at: vaccines included in the EU28 national immunization programs (NIP), national immunization funding, immunization funding per capita (2015–2019) and percentage of health-care budget allocated to immunization. Immunization funding represents a small proportion of total healthcare spend in Europe (median 0.3%). In the context of the current COVID-19 pandemic, demographic changes, and the potential introduction of new vaccines; the need for adequate financing of immunization programs will be important, to establish resilient immunization systems and provide sustainable protection of the population against vaccine-preventable diseases. What is the context? Herpes zoster, or shingles, is a viral disease characterized by a painful, localized skin rash. It affects approximately 32% of US citizens at least once in their lifetime. The risk of contracting shingles increases with age. Most American adults over 50 years have not received the shingles vaccine, and vaccination rates are especially low for African-Americans. What is new? This is the first study to evaluate what drives shingles vaccination decisions among US adults ≥ 50 years of age. We also assessed the differences between African-American and non-African-American adults, and inside the African-American group. In this choice experiment, 1,454 people ≥ 50 years completed a survey of 8 choice questions, as well as questions on their previous experiences with vaccines, socioeconomic, and demographic characteristics. Seven factors were evaluated. We found that American adults preferred to get vaccinated, and the most influential factors were costs and vaccine effectiveness while location of vaccination was the least important. There were differences in preferences between African-American and non-African-American adults, mainly driven by costs and vaccine effectiveness. 3 different groups of African-American adults with systematically different preferences could be identified; two were likely to vaccinate, with one being more cost sensitive at lower price thresholds, and the third was unlikely to vaccinate. What is the impact? Decisions on shingles vaccination appear to be mostly driven by costs, which could be a barrier to those who do not have appropriate insurance, especially among some African-Americans. However, healthcare professionals should continue to educate patients on other vaccine characteristics, as they also influence vaccination decisions. [ABSTRACT FROM AUTHOR]

Purpose: Lyme borreliosis (LB) occurs throughout Europe. No clinical and seroprevalence studies for LB in Kosovo have been publicly available thus far. Therefore, this study aimed to investigate LB from a tick bite perspective in the Pristina region, Kosovo. Methods: This single-center prospective observational study enrolled consecutive adult participants (≥18 years of age) with tick bite (embedded tick in the skin), who were examined at the Clinic of Infectious Diseases, Pristina, between January 2015 and August 2018. At the first visit related to the index tick bite, ticks (the complete ticks or parts of the ticks) were removed from the skin, blood samples were taken for serological tests, and antibiotic treatment was started when deemed necessary. The complete, undamaged ticks removed were proceeded for entomological identification. Participants were followed up at 2 months (serological tests were repeated) and 6 months after the index event for the development of clinical manifestations of LB and/or seroconversion against Borrelia burgdorferi. Results: A total of 380 subjects were included in the study. Most cases were seen in May and June in all study years. All 117 preserved ticks were identified as Ixodes ricinus. Immunoglobulin G seroprevalence among subjects during the first visit in the study was 28/380 (7.4%). Erythema migrans (EM) was clinically diagnosed in 74/380 patients (19.5%, 95% confidence interval 15.6–23.8). Only 15 clinically diagnosed EM (in seronegative patients) were serologically confirmed with seroconversion (2 months later), 3.9% of all subjects included in the study. There were three cases with clinical manifestation between the second and third visit: EM recidivans, multiple erythema, or several nonspecific systemic symptoms. Doxycycline and amoxicillin were mainly used for the treatment of borrelial skin lesions. Conclusion: This assessment can help indicate the need for disease awareness and reinforce the importance of primary prevention measures, early diagnosis, and appropriate treatment. [ABSTRACT FROM AUTHOR]

The article offers information on measles outbreak. Topics discussed include information on European Vaccination Action Plan for 2015-2020, that anticipates the elimination of measles; continuous transmission with occasional measles outbreaks in the European region; and need to remove obstacles to vaccination.

Copyright of Paediatria Croatica is the property of Paediatria Croatica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Vaccination against varicella rapidly reduces disease incidence, resulting in reductions in both individual burden and societal costs. Despite these benefits, there is no standardization of varicella immunization policies in Europe, including countries in Central and Eastern Europe (CEE). Areas covered: This systematic literature review identified publications on the epidemiology of varicella, its associated health and economic burden, and vaccination strategies within the CEE region, defined as Albania, Bosnia-Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, Slovakia, and Slovenia. Twenty-six studies were identified from a search of PubMed, Embase®, and MEDLINE® biomedical literature databases, supplemented by gray literature and country-specific/global websites. Expert commentary: Limited information exists in published studies on the burden of varicella in CEE. The wide variability in incidence rates between countries is likely explained by a lack of consistency in reporting systems. Funded universal varicella vaccination (UVV) in CEE is currently available only in Latvia as a one-dose schedule, but Hungary together with Latvia are introducing a two-dose strategy in 2019. For countries that do not provide UVV, introduction of vaccination is predicted to provide substantial reductions in cases and rates of associated complications, with important economic benefits. [ABSTRACT FROM AUTHOR]

Copyright of Croatian Journal of Infection / Infektoloski Glasnik is the property of Croatian Society for Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Collegium Antropologicum is the property of Croatian Anthropological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Human bocavirus (HBoV) is known to cause lower respiratory tract infections (LRTI) in children and may result in substantial morbidity and mortality. The aim of this study was to determine HBoV prevalence among hospitalized infants and small children with acute LRTI in Zagreb, Croatia, as well as to evaluate HBoV DNA quantity in samples in relation to the patients' age and co-infection with other respiratory viruses. Methods: During winter season 2016/2017, a total of 295 children younger than three years of age who were admitted to hospitals with LRTI were tested for the presence of HBoV, respiratory syncytial virus (RSV), adenovirus (ADV), parainfluenza virus (PIV) types 1 to 3, and human metapneumovirus (HMPV). HBoV was detected with a real-time PCR method, and the other viruses were diagnosed using monoclonal antibodies in direct fluorescence assay. Results: Viral etiology was proven in 225/295 (76.3%) of patients. The most commonly diagnosed virus was RSV (59.3%), followed by HBoV (23.1%), PIVs (4.4%), ADV (3.1%), and HMPV (1.4%). HBoV-infected children were older than RSV-infected children; likewise, detection rates of HBoV infection increased with age, while RSV infection rates decreased with age. In 51% of HBoV-positive samples an additional respiratory virus was also detected. There was no difference in HBoV DNA quantity between samples with single virus detection and those with multiple virus detection (p = 0.056), although samples positive only for HBoV showed higher cycle threshold values. There was no difference in HBoV DNA quantity in samples of different age groups (p > 0.05). Conclusions: Frequent detection of HBoV in small children with LRTI, even in combination with other viruses, highlights its role in the pathogenesis of respiratory disease. [ABSTRACT FROM AUTHOR]

Whooping cough (pertussis) is endemic and epidemic disease caused by bacterium Bordetella pertussis (Bp) representing a remarkable cause of morbidity and mortality among young children. Although active immunization significantly decreased the incidence of pertussis, the disease still remains a relevant public health burden worldwide, and it presents as an atypical mild disease in adults and severe disease in infants. World Health Organization (WHO) estimates about 16 million cases of pertussis with 195.000 deaths worldwide in 2008, 95% of which occurred in countries with high vaccination coverage. Challenged with new epidemiological trend, great efforts were invested to introduce new vaccine strategies. The purpose of this paper is to describe modern epidemiological trends in pertussis, and to compare new vaccine strategies.1 [ABSTRACT FROM AUTHOR]

Rotavirus is a major cause of acute gastroenteritis in children less than 5 years of age worldwide, with millions of cases every year, high mortality in low income countries and high costs of health care. Rotaviruses are characterized by great diversity of genotypes whose distribution changes depending on the season and geographic area. Infection caused by one genotype protects against severe forms of infection with other genotypes. This principle represents the basis of rotavirus vaccine development. The most effective mode of protection against rotavirus infection is vaccination. There are currently two vaccines recommended by World Health Organization: monovalent vaccine, which contains attenuated human G1P[8] strain, and pentavalent human-bovine reassortant vaccine (G1-G4 and P[8]). Numerous studies have shown high efficacy of both vaccines in prevention of severe rotavirus gastroenteritis. Therefore many countries have introduced the vaccine into their national immunization program. In Croatia, rotavirus vaccines are provided only for children at increased risk. The data on rotavirus epidemiology, including geographic, seasonal and age distribution of genotypes, are necessary before vaccine implementation in the national immunization program. Recently conducted national study will show this important information. [ABSTRACT FROM AUTHOR]

Measles has rebounded in the European Region. The disease affected 21.315 people and caused 35 deaths in 2017. Countries with most measles cases have experienced a range of challenges in recent years, such as declines in overall routine immunization coverage, consistently low coverage among some marginalized groups, interruptions in vaccine supply or underperforming disease surveillance systems. Actions to stop the current outbreaks and prevent new ones are taking place on various fronts. They include raising public awareness, immunizing health-care professionals and other adults at particular risk, addressing challenges in access, and identifying non-immune groups of patients. The importance of continuous routine immunization of children must not be underestimated. Possibility of transmission to unimmunized contacts highlights the importance of high vaccination coverage to prevent reoccurrence of endemic disease. [ABSTRACT FROM AUTHOR]

Copyright of Paediatria Croatica, Supplement is the property of Paediatria Croatica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Paediatria Croatica, Supplement is the property of Paediatria Croatica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Croatian Journal of Infection / Infektoloski Glasnik is the property of Croatian Society for Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Changes in antimicrobial flora that have occurred in the last two decades, which are mainly caused by direct human action through excessive use of antibiotics, both in the hospital, and in the outpatient environment, actualized the necessity of finding alternative therapeutic solutions. Slow and/or unsuccessful development of new antimicrobial drugs has resulted in a re-introduction into clinical use of some old antibiotics like colistin and fosfomycin, to which, given the long period of non-use or limited use in human medicine, resistance has not developed. Colistin, a polymyxin antibiotic that was developed during fifties, the use of which is due to the risk of undesired side effects abandoned in 70's. After a decade of non-implementation, has become interesting option for clinicians, given the increasing incidence of infections caused by multiply resistant gram negative bacteria. Current recommendations for colistin dosing are mainly based on previous clinical experience, taking into account overestimated risk of nephrotoxicity and lack of modern pharmacokinetic study, resulted in inadequate dosage of the drug, which often resulted in clinical failure. Fosfomycin in therapeutically relevant concentrations shows bactericidal activity against a broad spectrum of gram-positive and gram-negative bacteria including methicillin-resistant isolates of Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE), penicillin - resistant pneumococci, vancomycin resistant enterococci (VRE), gram negative bacteria that produce beta-lactamases (eng. extended spectrum beta-lactamases, ESBL) and most strains of Pseudomonas aeruginosa. Even in areas where fosfomycin is often prescribed / used, the emergence of bacterial resistance to the antibiotic for now is rare. [ABSTRACT FROM AUTHOR]