Introduction Between 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. Methods For 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. Results On 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. Conclusion Our 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.

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.

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.

Abstract Congenital malformations are defined as structural or functional anomalies that occur in utero or at birth and can be detected at an early age. They are also known as birth defects, disabilities or congenital malformations. Congenital malformations are accompanied by hereditary or developmental disabilities or disease. From the establishment of the registry in early 2019 until the end of 2021, the total number of reported congenital malformations is 449. According to available data from EUROCAT (European network of population-based registries for the epidemiological surveillance of congenital anomalies), the average rate of congenital malformations in the countries of the European Union (EU) is 262/per 10,000 live births, while the registered rate of congenital malformations in the Federation of Bosnia and Herzegovina is 261/per 10,000 live births. In the Federation of Bosnia and Herzegovina, the highest incidence rate was registered in Sarajevo Canton (175 cases with a rate of 416/10,000 live births) and Tuzla Canton (122 cases with a rate of 356/10,000 live births). The most common congenital malformations are heart defects, cleft lip and palate, musculoskeletal deformities and Down syndrome. In the Federation of Bosnia and Herzegovina (FBiH) in 2020, 135 children under the age of 5 died, among which 18 children (13.3%) died from congenital malformations, deformations and chromosomal abnormalities (Q00-Q99). Congenital malformations can lead to chronic diseases and disabilities, death of infants and children up to five years of age. Congenital malformations represent a significant public health problem, given that they lead to disability, incapacity and pressure on the health system, as well as the problem of social integration of patients. Key messages • The registered rate of congenital malformations in the Federation of Bosnia and Herzegovina is 261/per 10,000 live births. • Congenital malformations can lead to chronic diseases and disabilities, death of infants and children up to five years of age.

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.

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 8845 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.

Abstract Background Mortality data are essential for monitoring population health and is one of the most important data for evaluation and comparison of health status at the local, national, and international level. Objective: We analysed all-cause mortality data in the Federation of Bosnia and Herzegovina (FBiH) for the period 2016-2021 and compared it with mortality occurred during the COVID-19 pandemic, in 2020 and 2021. Methods Using data on all-cause deaths for the period 2016-2021, obtained from the Institute for Statistics of the Federation of Bosnia and Herzegovina, we compared annual number of deaths (all-ages) and death rates during the 2020 and 2021 to pre-pandemic years. Results In 2016 the reported number of death was 21,146, in 2017 was 21,942, in 2018 was 21,691, and in 2019 was 22,024, and during the pandemic period in 2020 and 2021, 26,026 and 29,086 deaths were reported respectively. In 2020, 4,115 more deaths has been reported (15,8%), and in 2021 more 6,438 death (22,1%) compared with period 2016-2019. In FBiH in 2021, the death rate per 100,000 inhabitants was 1,341.2 and it is recorded an increase compared to 2020 when it had a value of 1,208.3 while in 2016 the value was 951.7. Conclusions A large proportion of increased mortality during pandemic was probably caused directly by COVID-19. However, the pandemic also resulted in deaths that would otherwise not have occurred (indirect deaths) due lack of access to medical services when hospitals were overwhelmed and changes in health seeking behaviour. An in-depth investigation of the underlying causes of the high excess mortality should be conducted to inform changes in the health care system and efforts to prevent severe COVID-19 through vaccination of vulnerable groups should be a priority. *This abstract is support by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe. Key messages • During the two years of the COVID-19 pandemic, population in FBiH had a significant increase in all-cause mortality. • The direct standardized death rate for all causes and age groups per 100,000 inhabitants in 2020 for FBiH was 818.0 and it is slightly higher compared to the EU average.

Abstract Introduction Road traffic injuries (RTI) are among the ten leading causes of death worldwide, and they are the leading cause of death among young adults aged 15-29 years. In Federation of Bosnia and Herzegovina (FBiH), with population of 2,1 million, around 380 people die every year and additional 11.000 get seriously injured in RTI. Aim The aim of this study was to investigate the incidence and fatality rate of RTI in FBiH in the period of 2006 until the end of 2020. Methods Data source of RTI (ICD-X) incidence and fatality rate was Statistical book for Federation of Bosnia and Herzegovina, which includes all injuries and deaths reported through Ministry of internal affairs. Fatality rate was calculated as number of confirmed deaths in total number of reported RTI. To compare frequencies of reported deaths Chi square test was used. YLD were calculated based on information on injury that was caused in road traffic accidents. Results In the last 15 years, in FBiH, total 39,455 injuries related to road traffic were reported. According to the official data, over the period 2006-2020 the peak of fatality rate (8.52% deaths among all cases with RTI) was in 2016, while it had a statistically significant decline in 2018: 6.51%; 2019: 6.35%; and 2020: 6.32% (x2=7728,584; p < 0,0001). It is estimated that young adults (in the age group 30 to 39 years) injured in the road traffic accidents have 197.01 patient-years of total 881.17 years to live with disabilities just based on serious RTI in 2020. Conclusions RTI pose a significant burden on the health of the population in FBiH. After implementing strict laws in the year 2017, and 2018, a significant decrease of RTI was registered, including the number of deaths due to RTI (fatality rate). This abstract is support and sponsorship by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe. Key messages • RTI are significant burden for health of population in FBH. Strict laws and stronger punishments and fees are decreasing number of RTI. • This abstract is support and sponsorship by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe.

Background Impulsivity, 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. Objective The 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. Methods This 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. Results Patients 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. Conclusions Our 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.