Mirjana Štrbac

Introduction/objectives: The effectiveness of vaccines depends not only on resource availability but also on broad public acceptance and the uptake of widely accessible vaccines. A vaccination campaign is a strategically coordinated initiative designed to enhance vaccine coverage within a specific population. This study evaluated the impact of health promotion strategies (HPS), including social marketing and education, on human papillomavirus (HPV) vaccine uptake among adolescents aged 9–19 years in City of Novi Sad, Serbia (population ~300,000). Since 2020, efforts have transitioned from individual to organized, publicly funded initiatives. Materials and methods: A descriptive epidemiological study was conducted using anonymized data from the electronic immunization registry (2019–2024). Data on HPS implementation were obtained from the Institute of Public Health of Vojvodina. Statistical analyses included Mann–Whitney U test, ANOVA, correlation, and multiple regression with time lag. Results and discussion: From 2019 to 2024, 6,395 adolescents received the HPV vaccine, with sharp increases in 2023–2024. Among the different strategies analyzed, health promotion through educational media content delivered by physicians (TV, radio, social networks) and the implementation of the “Open Door” initiative had the most consistent and positive association with increased vaccination coverage. Vaccination uptake was strongly associated with frequent and accessible promotional activities, especially the “Open Door” initiative (r =.668, p <.01; β =.687, p <.001). Media activities showed moderate effects (r =.270, p <.05). Educational activities show only a weak or non-significant correlation with vaccination rates, except for their modest association with website updates (r =.282, p <.05). Conclusions: Accessible, action-oriented interventions, particularly “Open Door” days, were the most effective strategy for increasing adolescent HPV vaccination. Social marketing combining convenience and multi-channel communication significantly enhanced uptake. These findings support the implementation of targeted, barrier-reducing public health strategies to improve vaccine coverage.

Background: Despite ongoing global elimination efforts, measles remains a persistent public health threat. Methods: This retrospective observational study examines trends in crude measles incidence and vaccination coverage from 1948 to 2024 in the northern region of Serbia—Autonomous Province of Vojvodina (AP Vojvodina)—which accounts for 26.9% of the national population. This study further explores measles vaccination coverage across the province’s seven districts, along with the number of reported measles cases, age distribution, and vaccination status of affected individuals from 2000 to 2024. Data were obtained from official annual immunization records maintained by public health institutions within the framework of Serbia’s national mandatory immunization program. Results: A notable resurgence of measles occurred in Serbia during 2017–2018, following a decline in vaccination coverage. In AP Vojvodina, outbreaks were recorded in 2007, 2014–2015, and 2017–2018, predominantly affecting unvaccinated children and adults aged 20–39 years. Since 2019, the measles incidence has significantly declined. During the 2018 outbreak, the highest incidence was observed among children aged 1–4 years (40.6 per 100,000), followed by infants under 1 year (17.3 per 100,000) and adults aged 20–39 years (12.5 per 100,000). An analysis of the data from 2000 to 2024 revealed substantial age- and dose-related differences in measles incidence, particularly among unvaccinated individuals, those who had received one or two doses of a measles-containing vaccine (MCV), and those with unknown vaccination status. During the 2017–2018 epidemic, unvaccinated children under 1 year and those aged 1–4 years were the most affected. A marked increase in cases among single-dose recipients was noted in 2018, especially in adults aged 20–39 years (9.5%) and those ≥40 years (13.5%). A considerable proportion of measles cases in these age groups had unknown vaccination status: 33.1% among individuals aged 20–39 years and 18.2% among those aged ≥ 40 years. Epidemiological investigation linked the 2007 and 2014–2015 outbreaks in AP Vojvodina to importations from Bosnia and Herzegovina. No specific source was identified for the 2017–2018 outbreak, suggesting possible endemic transmission. Conclusions: These findings underscore the impact of fluctuating vaccination coverage on measles resurgence. Sustaining high two-dose MCV coverage, strengthening routine immunization programs, enhancing surveillance systems, and ensuring timely outbreak preparedness are critical measures for achieving effective measles control.

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.

Despite the availability of a safe and effective vaccination, uptake of human papillomavirus (HPV) vaccination remains low worldwide. We aimed to analyze the coverage of HPV immunization during the first year of the immunization program and the sociodemographic characteristics across different administrative units in Serbia and Montenegro. Coverage of HPV vaccination in Serbia for females aged 9–14 and 15–19 years was 5.5% and 5.9%, respectively. The coverage rate of immunization against HPV in Montenegro for girls aged 9–14 years was 22.1%. Within Serbia, only one administrative region (Moravica) had HPV immunization coverage in girls 9–19 years old above 10%, 11 districts had coverage from 5 to 10%, while 13 districts had coverage below 5%. As per Montenegro, two administrative units, Cetinje and Berane, reported the highest coverage, with 39% and 36.4% of vaccinated eligible girls, respectively. When we explored the coverage of HPV immunization among girls aged 9–19 years across different regions in Serbia, we observed that the level of coverage did not correlate with the number of pediatricians or with the population density. In Montenegro, we observed a similar situation. On the other hand, we noticed a statistically significant moderate negative correlation (r = −0.446; p = 0.026) between HPV immunization coverage and the percentage of illiterate women in the administrative units. Comparing the coverage between the two countries we found that the higher coverage in Montenegro corresponded with a smaller number of female populations aged 9–14 years, with higher average net monthly income, with smaller population density and smaller number of pediatricians, among divorced persons, and among those without formal education or incompletely primary education. Taking into account the experiences in Montenegro, increasing immunization coverage in Serbia could be achieved through a more vigorous educational campaign targeting schools, the general population, and healthcare workers as well as by additionally incentivizing those engaged in these activities.

Background and Objectives: Human papillomavirus (HPV) infection and its etiological role in the development of cervical cancer are well established. The cervical cancer mortality rate in Serbia is one of the highest among European countries, and this cancer is the second-leading cause of death in Serbian women aged from 15 to 44. Materials and Methods: This retrospective study was conducted at the Institute of Public Health of Vojvodina. A total of 10,062 cervical specimens from Serbian women were collected and HPV tested in ten years. The study patients were divided into five age groups. HPV genotype testing was performed using a commercial kit to detect 14 high-risk (HR) HPV genotypes. Additionally, cervix cytology data have been available for patients tested in 2022 and 2023. Results: An overall positive rate was found in 43.3% of patients (4356/10,062). A single HPV infection (62.1%) was the main infection pattern. The most frequent HR HPV genotypes were HPV 16, 31, 52, 56, 39, and 51, comprising 62.3% of the detected genotypes, including multiple infections. A significant difference was noted in the HPV prevalence across the different age groups, with a bimodal distribution of HPV infection. The highest prevalence was recorded in the age group ≤ 30 and those after 61 years. Women diagnosed with high-grade squamous intraepithelial lesions (HSIL) were significantly older compared to others. HR HPV is the most prevalent in patients with HSIL cytological findings (76.5%). The most common type, according to age-specific distribution and cytological findings, was HR HPV 16. Conclusions: This study provides comprehensive data on HR HPV distribution among Serbian women, which can serve as a basis for subsequent monitoring of genotypic distribution. It is particularly significant considering they are missing in the updated ICO/IARC Report for Serbia, and the cervical cancer mortality rate in Serbia is one of the highest among European countries.

Introduction: Healthcare workers (HCW) can have an important role in educating parents about child road safety, but research on the topic shows that they usually do not have adequate knowledge. Thus, the aim of our study was to analyze their knowledge in the field of child road safety. Methods: The cross-sectional study was conducted among HCW from South Bačka district, Serbia, using a specially created questionnaire for assessing knowledge on road traffic injuries in children. Results: The research involved the participation of 317 healthcare workers (86 physicians and 231 nurses). Healthcare workers from primary healthcare made up almost 70% of all respondents, followed by those from tertiary (21.8%) and secondary (11.3%) level institutions. The average percentage of correct answers on the knowledge test was 74.3% (mean=22.3, SD=4.0). Out of all respondents, HCWs employed in the paediatrics department had a significantly higher percentage of correct answers at 77.7% (mean=23.3, SD=3.4) compared to other health workers at 73% (mean=21.9, SD=4.1) (p=0.002). Association analysis demonstrated that HCW employed at paediatric departments on average scored 1.37 (95% CI: 0.40–2.33, p=0.006) points higher in comparison with other HCW. Conclusion: This research demonstrated an unsatisfactory level of knowledge on child road safety by HCW, and the variability across different question domains, which underlines the need for continuous educations in order to improve their knowledge. Our results may serve in planning additional public health measures and can provide a reference for future studies.

In 2013, a group of European Union (EU) high representatives for traffic safety published a new definition for severe trauma caused by traffic accidents. According to this definition, severe trauma in road traffic accidents are non-fatal injuries with a Maximum Abbreviated Injury Scale (MAIS) of 3 and above. Therefore, since 2014, the EU has recommended using the Abbreviated Injury Scale (AIS) to assess injuries in traffic accidents and MAIS 3+ to assess severe injuries. Previous experiences in countries that record injuries based on the MAIS 3+ classification system have shown the collected data's high validity and reliability, the reduced risk of making arbitrary conclusions and injury severity subjective assessments, and the reduced risk of inadequate reporting. The MAIS 3+ enables better and more complete data collection on traffic accidents at the national and international levels, the international comparability of data, and the creation of adequate preventive strategies. The upcoming goal is for all EU member states to collect data on severe trauma in traffic accidents based on this definition.

Introduction. The aim of this study was to determine the epidemiological and clinical characteristics of hemorrhagic fever with renal syndrome in Vojvodina from 2008-2015 and to examine the factors associated with acute renal failure and hemorrhagic syndrome. Material and Methods. Data were extracted from medical records spanning 2008 to 2015, including demographic, epidemiological, clinical, and laboratory findings at hospital admission, as well as the course and outcome of treatment. The study investigated the correlation between disease incidence and climate, focusing on acute renal failure, its risk factors, the incidence of hemorrhagic syndrome, and factors influencing hospital stay duration. Results. The highest incidence for hemorrhagic fever with renal syndrome was recorded in 2014, with a rate of 0.5 per 100.000 inhabitants. Acute renal failure was observed in 40% of patients, while mild manifestations of hemorrhagic syndrome were noted in 46.7% of cases. Factors contributing to acute renal failure included lumbar pain (p=0.005), creatinine concentrations (p=0.011), and Simplified Acute Physiology score (p=0.013). The average length of hospitalization was 10 days (range 7-13 days) and was correlated with increased leukocytosis (p=0.028; ?=0.566), higher C-reactive protein values (p=0.014; ?=0.686), lower serum sodium levels (p=0.009; ?=0.772), higher serum creatinine concentrations (p=0.002; ?=0.742), the Sequential Organ Failure Assessment score (p=0.013; ?=0.612) and the Simplified Acute Physiology score (p=0.023; ?=0.582). Conclusion. Climatic factors are associated with the incidence of hemorrhagic fever with renal syndrome. The overall outcome of the disease was favorable.

Background: Cervical cancer is a major global health problem, and one of the most common causes of cancer in women. This descriptive epidemiological study aimed to provide an overview of the cervical cancer incidence and mortality in Vojvodina. Methods: The data from the Serbian Cancer Registry regarding the cervical cancer incidence and mortality for the period 2016?2021 were analyzed. Results: During the observed 6-year period, the average age-standardized incidence rates of cervical cancer in Vojvodina and Serbia were 20.4 and 19.1 per 100,000 women, respectively. The average age-standardized incidence rates by the district of Vojvodina ranged from 16.8 to 30.2/100,000. The average age-standardized cervical cancer mortality rate in Vojvodina and Serbia was 7.0 and 6.6/100,000, respectively. The average mortality rates by the district of Vojvodina ranged between 5.6/100,000 and 9.9/100,000. Conclusion: The cervical cancer incidence and mortality rates in Vojvodina exhibited significant variation across different districts and observed years, with their average values surpassing the national average. To improve the epidemiological situation of cervical cancer in Vojvodina, it is imperative to enhance the implementation of organized screening at the district level, coupled with intensified efforts to promote HPV vaccination throughout Vojvodina. Additionally, more research on screening coverage and vaccination rates and improved reporting cervical cancer cases and deaths are needed.

Human papillomavirus (HPV) infection is one of the most common viral infections in sexually active population worldwide, and is the main cause of cervical cancer, which is the fourth most common cancer among women. Serbia ranks third in incidence and mortality rate of cervical cancer in Europe. We conducted a cross-sectional study considering parents’ motivation for the HPV vaccination of their children. Statistical analysis included descriptive statistics and a logistic regression model. We found that the strongest motive was “Recommendation from paediatrician” (20.2%), followed by the attitude that HPV vaccine protects against cancers in different localization (15.4%), the motive “It is better to vaccinate a child than expose them to potential risk of HPV infection” (13.3%) and “Feeling anxiety due to a possible infection and cancer in the child” (13.1%). For those parents that vaccinated their child for some other strongest motive, reasons like “Vaccine is free of charge”, “Recommendation from friends and family” and motive „My child received all obligatory vaccines, so I want to receive this one as well“, were significantly more frequently selected. In the group where paediatricians’ recommendation was not a motive for accepting the HPV vaccine, the largest percentage of parents (89.6%) selected motive “HPV vaccine protects against cancers in different localization” and the motive “It is better to vaccinate a child than expose them to potential risk of HPV infection” (78.1%). Paediatrician’s recommendation is very important for parents’ decision to vaccinate, however, other motives also influenced and had significance in making the parents’ decision to vaccinate their children against HPV. Encouraging trust in public health authorities in Serbia, highlighting the advantages of the HPV vaccine and further encouraging healthcare workers to give stronger recommendations can increase the HPV vaccine uptake. Finally, we provided the basis to create more targeted messages that will empower parents to vaccinate their children.