Background: After Action Reviews (AAR) with a One Health perspective were performed in Slovenia, Italy, Serbia and Greece following a severe West Nile virus (WNV) transmission season in 2018. A protocol combining traditional techniques and organizational process analysis was developed and then implemented in each country. Results: In 2018, response to the unusually intense transmission season of WNV in Slovenia, Italy, Serbia and Greece took place through routine response mechanisms. None of the four countries declared a national or subnational emergency. We found a very strong consensus on the strengths identified in responding to this event. All countries indicated the availability of One Health Plans for surveillance and response; very high laboratory diagnostic capacity in the human, veterinary and entomology sectors and strong inter-sectoral collaboration with strong commitment of engaged institutions as critical in the management of the event. Finally, countries implementing One Health surveillance for WNV (in terms of early warning and early activation of prevention measures) consistently reported a positive impact on their activities, in particular when combining mosquito and bird surveillance with surveillance of cases in humans and equids. Recurring priority areas for improvement included: increasing knowledge on vectorcontrol measures, ensuring the sustainability of vector monitoring and surveillance, and improving capacity to manage media pressure. Conclusions: The AARs presented here demonstrate the benefit of cross-sectoral and cross-disciplinary approaches to preparedness for West Nile virus outbreaks in Europe. In the coming years, priorities include fostering and strengthening arrangements that: enable coordinated One Health surveillance and response during WNV transmission seasons; ensure adequate laboratory capacities; strengthen risk communication; and fund longer-term research to address the knowledge gaps identified in this study.

BackgroundIn the Mediterranean and Black Sea Region, arbovirus infections are emerging infectious diseases. Their surveillance can benefit from one health inter‐sectoral collaboration; however, no standardized methodology exists to study One Health surveillance.MethodsWe designed a situation analysis study to document how integration of laboratory/clinical human, animal and entomological surveillance of arboviruses was being implemented in the Region. We applied a framework designed to assess three levels of integration: policy/institutional, data collection/data analysis and dissemination. We tested the use of Business Process Modelling Notation (BPMN) to graphically present evidence of inter‐sectoral integration.ResultsSerbia, Tunisia and Georgia participated in the study. West Nile Virus surveillance was analysed in Serbia and Tunisia, Crimea‐Congo Haemorrhagic Fever surveillance in Georgia. Our framework enabled a standardized analysis of One Health surveillance integration, and BPMN was easily understandable and conducive to detailed discussions among different actors/institutions. In all countries, we observed integration across sectors and levels except in data collection and data analysis. Data collection was interoperable only in Georgia without integrated analysis. In all countries, surveillance was mainly oriented towards outbreak response, triggered by an index human case.DiscussionThe three surveillance systems we observed prove that integrated surveillance can be operationalized with a diverse spectrum of options. However, in all countries, the integrated use of data for early warning and inter‐sectoral priority setting is pioneeristic. We also noted that early warning before human case occurrence is recurrently not operationally prioritized.

The Republic of Serbia applied the booster dose of the following COVID-19 vaccines: BNT162b2 mRNA (Pfizer-BioNTech), Sinopharm BBIBP-CorV (Vero Cell®), Gam-COVID-Vac (Sputnik V) and ChAdOk1 nCoV-19 (AstraZeneca). We aimed to examine the immunogenicity and reactogenicity of the booster dose and identify factors related to immune response and adverse events. Panel study, conducted during August and September 2021, included 300 persons receiving the booster dose at the Institute of Public Health of Serbia. Blood samples were taken on the day of receiving the booster dose, and after 7 and 28 days. When applying homologous regimen, the average increase in anti-spike immunoglobulin G was 8782.2 (after 7 days), 1213.9 after 28 days, while 9179.5 (after 7 days) and 16,728.1 after 28 days of heterologous regimen. Sinopharm BBIBP-CorV (p < 0.001) and Sputnik V (p < 0.001), age 65 and over (p = 0.001) and currently smoking (p < 0.001) were independently associated with lower levels of anti-spike immunoglobulin G. Female sex (OR = 1.77; 95%CI = 1.01–3.12), previous COVID-19 infection (OR = 3.62; 95%CI = 1.13–11.63) and adverse events after the second dose (OR = 2.66; 95%CI = 1.33–5.32) were independently associated with intense systemic adverse events 7 days after. Booster dose significantly increased antibodies titers, especially 28 days after heterologous regimen, without a significant increase in reactogenicity.

Background: Left over medication widely used in hospitals for the treatment of various diseases including malignant illnesses, stand to represent a hazardous form of healthcare waste. According to regulations in the Republic of Serbia dating back to 2009, all healthcare facilities are obligated to separate, label and safely put away said leftover medication, i.e. forward it to authorised operators in order to be securely shipped and properly taken care of abroad. Pharmaceutical waste can lead to dire consequences on a patient's or medical employee's health, as well as cause simultaneous damage to the environment, both work and not. The main aim of this research is the assessment of the state of Serbian hospitals as is, from the perspective of dealing with pharmaceutical waste. Also, the research's objective is to examine the factors that affect the way healthcare waste is handled and the respectful aftermath of their alterations in healthcare institutions. Methods: For the realization of this survey, a special questionnaire was developed, concocted with regard to the margins set out by WHO, in order to promptly assess the management of healthcare waste in hospitals, which had beforehand been pretested. The research was carried out as a cross-sectional study of the representative hospital sample of the secondary and tertiary level of healthcare facilities in the public domain, in November 2014. Results: The questionnaire was completed by 60 hospitals, which typifies a representative number of said facilities in the Republic of Serbia and which covers more than 85% of inpatient capacity within the public sector's network of healthcare hospitals defined by the Bylaw (referred to as the Network of healthcare facilities in Serbia). Conclusion: Tertiary level hospitals, meaning clinical centres, clinicalmedical centres and institutes that offer highly specialized healthcare services and have an admittedly larger number of hospital beds, have a more evolved system of sorting pharmaceutical waste and do away with grander amounts of it on a yearly basis. Establishing a safe and law-abiding management of pharmaceutical waste in hospitals will come to wholly enhance the management of hazardous waste in the healthcare system.

In the first round of the organized colorectal cancer screening in Serbia the participation rate of the targeted population was high and gave encouraging result. It was expected that in the forthcoming rounds even higher coverage of the target population would be accomplished. A positive predictive value of the completed colonoscopies showed that further work on observing the stages of diagnosed adenomas and carcinomas would reach the goals of the expected improvement in early detection of colorectal cancer in Serbia.