<p><strong>Introduction. </strong>Lyme neuroborreliosis (LNB) can manifest during the early and late stages of Lyme disease (LD). The aim of this study is to determine epidemiology and clinical findings in patients with LNB.&nbsp;<br /><strong>Methods.</strong> The research was conducted in Banja Luka at the University Clinical Center of Republic of Srpska (UCC RS) during a four-year period from 10/2017 to 10/2021. The research included 51 patients admitted to the hospital with some neurological symptoms that could lead to the LNB diagnosis. Patients had lumbar puncture with cytochemical analysis of cerebrospinal fluid (CSF), ELISA anti-Borrelia IgM/IgG in serum and CSF, Immunoblot anti-Borrelia IgM/IgG in serum, and other documentation about epidemiology and clinical findings in LNB. &nbsp;<br /><strong>Results.</strong> A statistically significant (p=0.017) higher proportion of female patients was observed. Most patients were between 50 and 60 years old. Most of them were retirees (31.37%), farmers, medical technicians followed with forestry workers, students etc. Most of examinees did not have information on previous tick bite (64.71%). The largest number (72.55%) did not have data on previous skin changes. The largest number of neurological symptoms at admission related to the feeling of tingling and weakness in the extremities, headache, dizziness and some ophthalmological symptoms. Patients also suffered from consciousness and speech disorder, anxiety, paresis n.VII. The largest number of examinees had some neurological symptoms up to three months prior the admission to the hospital. &nbsp;<br /><strong>Conclusion. </strong>Symptoms of LNB can be quite non-specific or possibly even mimic other neurological diseases. Involvement&nbsp;<br />of peripheral nervous system is dominant in adult patients. It is necessary to work on early diagnosis of LD and it is mandatory to report it to the national epidemiological service.&nbsp;</p>

Introduction. Assessment of the occupational risk of exposure to the new coronavirus of workers engaged in the COVID-19 Departments of the University Clinical Center of Republic of Srpska and the use of personal protective equipment was the aim of this research. Method. In the University Clinical Center of Republic of Srpska (UKC RS), in the COVID-19 Departments, a KAP study (Knowledge Attitudes Practice Study) was conducted among 102 employees of all educational profiles, using the questionnaire of the World Health Organization (WHO), which was adapted for this research. The survey was voluntary and anonymous with the informed approval consent of the respondent. Results. Out of 102 surveyed, 13 of them tested positive for SARSCoV-2. On average, 95.0% of respondents always wear PPE in the COVID-19 Departments of the UKC RS. Putting on/removing PPE and decontamination of contact surfaces have been always carried out by 88.2% of respondents. Out of 64 respondents who used PPE for aerosol generating procedures, 10 of them (15.6%) were positive for SARSCoV-2 and of the other 38 respondents who did not participate in such procedures, three of them (7.9%) were positive for SARS-CoV-2. Statistical data processing was done in the SPSS program package, version 20.0, with a significance level of difference of 5% (p=0.412). Conclusion. There was no significant difference between SARSCoV-2 positive and negative personnel regarding the use and change of PPE, hand hygiene and surface decontamination. The assessment of the occupational risk of exposure to SARS-CoV-2, in addition to the proper use of PPE, takes into account the local epidemiological situation, specific characteristics of the work environment and tasks, the hierarchy of controls and the level of adherence to preventive measures and infection control.

Background/Aim: The World Health Organization (WHO) declared the spread of a novel disease COVID-19 as a pandemic on 11 March 2020. As of 12 June, there have been more than 7.4 million COVID-19 cases and more than 418,000 COVID-19 deaths globally. This paper represents epidemiological analysis of the first 100 days of COVID-19 epidemic in the Republic of Srpska. Methods: Data of all COVID-19 cases confirmed in the Republic of Srpska between 4 March and 12 June were collected from epidemiological and laboratory testing reports obtained from the Public Health Institute of the Republic of Srpska. This cross-sectional analysis was carried out on a sample of 1,607 laboratory-confirmed COVID-19 cases, which included: summary of patient characteristics, examination of age distributions and sex ratios, calculation of case fatality and mortality rates, incidence rates analysis, epidemiological curve construction and subgroup analysis. Results: Over 100 days after the first case was confirmed, the total number of infected patients in the Republic of Srpska rose to 1,607 (31,471 persons had been tested). As of 12 June, 69.9 % of those cases has recovered. During that period there were 117 confirmed deaths (average age 72 years; 60.7 % males; 86 % older than 60 years; 94 % with at least one comorbidity). The sex ratio among the confirmed cases was 0.95:1 (48.7 % men vs 51.3 % women). Infections were less common in persons below 20 years of age (7.3 % of all confirmed cases) and the majority of the affected persons were in the group 40-69 years of age. As much as 86 % of all death cases occurred in persons older than 60 years (average age 72 years) and 94 % of all death cases had at least one underlying condition (mostly cardiovascular diseases, 79.5 %). Conclusion: Evaluating the clinical data of COVID-19 patients, finding the source of infection and studying the behavior of the disease is crucial for understanding of the pandemic.

Climate change is definitely one of the greatest challenges of human development in the 21st century. Climate change is expected to increase the risk of communicable diseases in Europe. This impact will depend not only on local climatic conditions, but on other factors, such as current infrastructure, public health services, biodiversity specificity, etc. The population in Bosnia and Herzegovina, Croatia and Serbia has been severely affected by the floods caused by cyclone Tamara in 2014. The basic mode of transmission of the disease caused by the West Nile virus is the bite of the infected mosquito. The West Nile virus is not transmitted among humans through contact, nor can it be transmitted from infected birds to humans without mosquito bite. The aim of the study was to analyze and present the trend of this disease in the period 2014-2018 and to show the connection between the spatial occurrence of cases and location of the flooded area in 2014 in the Republic of Srpska. Using the descriptive method, the demographic data of the patients were analysed, the most common clinical form of the disease and the incidence of the disease in the period 2014-2018 was analysed. The cases were mapped and we analysed the connection of the case and location that was flooded. The incidence ranged from 0.79 in 2014 to 0.43 in 2018. Patients were of all age groups and both sexes, most commonly cases from rural areas (78%). The most common clinical form of the disease is shown, which were symptoms of the central nervous system infection. Out of the total number of patients, 94% were from flooded areas. All reported cases have been diagnosed at the Institute of Microbiology at the University Clinical Center of Republika Srpska and were reported as probable cases in accordance with the international case definition of communicable diseases. However, it is crucial to implement internationally endorsed procedures as a clinical alghoritm for the confirmation of the case in accordance with the laboratory criteria for the case definition. The occurrence, frequency and spatial distribution of cases indicates a possible connection with the floods in 2014.

Aim To synthesize evidence about the influence of individual antimicrobial stewardship programs (ASP) related to the prevention of Clostridium difficile (C. difficile) infection on primary and secondary outcomes. Methods Relevant databases such as Medline, PUBMED, COCHRANE library and EBSCO were searched from 1 April to 27 April 2017. Additional studies were reached by the manual search for original articles in relevant journals. We included all randomized controlled, quasi-experimental and observational studies, published in the English language from 2007 onward, that evaluated effectiveness of ASP in preventing and controlling C. difficile associated disease (CDAD) among adult inpatients. Results Implementation of ASP interventions was associated with CDAD incidence reduction in 62.5% studies, but no significant differences were reported for the duration of hospitalization, readmission and mortality rate. Improvements in prescribing patterns (decreased antimicrobial use or increased rational use) and microbial outcomes (decreased rates of selected antimicrobial-resistant bacteria) were reported. Evidence on the effects of ASP is mainly limited to the results of studies low in methodological quality with great heterogeneity of outcomes, interventions, and units in which CDAD incidence data were reported. Conclusion Despite the low strength of evidence of reviewed studies, consistency of findings suggest the positive impact of antimicrobial stewardship programs on the prevention and control of nosocomial CDAD. The significance of this problem imposes randomized control trial use as the best instrument to provide highquality evidence. Further studies need to systematically analyse changes in all antibiotic use and its outcomes.

Introduction: There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilization principally assessed according to ESAC, ECDC, and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighboring countries. Amoxicillin and the penicillins accounted for 29–40 and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7–11%), cephalosporins, macrolides, and quinolones, as well as low use of third and fourth generation cephalosporins vs. first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilization of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilization of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities.

Introduction: Hospital-acquired infections (HAI) and surgical site infections (SSI) are a global public health problem. The aim of the study was to determine the incidence of SSIs at the Surgical Clinics of the University Clinical Centre Banja Luka and to identify risk factors for the development of SSIs. Methods: In order to determine the frequency of SSIs through the incidence compared to the patients operated at the Surgical Clinics of the University Clinical Centre Banja Luka, we conducted a prospective cohort study which encompassed 11.216 operated patients, in the period from November 11th, 2014 to September 30th, 2015. In order to identify risk factors for the development of SSIs, a nested case-control study of risk factors for SSIs was conducted. The study group consisted of patients who were diagnosed with SSIs in the period of monitoring, while the control group was consisted of patients without SSIs who corresponded with the study group in age and sex. Results: The highest values of incidence of SSIs were observed at the Department of Anesthesia and Intensive Care (2.65%), Department of Orthopaedic Surgery (2.48%) and the Department of Vascular Surgery (2.15%), and the lowest ones at the Department of Urology (0.59%). Among the cases of SSIs, deep infections of the surgical site were the most represented (82.7%). Multivariate logistic regression was used to identify the following independent risk factors: length of pore-operative stay in hospital (p=0.000; OR=1.062; 95% CI=1.037-1.087), reintervention (p=0.000; OR=22.409; 95% CI=6.361-79.071) and cotrticosteroids (p=0.023; OR=4.141; 95%CI=1.221-14.047). Conclusion: The incidence of SSIs at the Surgical Clinics of the University Clinical Centre Banja Luka is at the level of hospitals in developed countries. There are a number of risk factors for SSIs, which may be prevented.

Introduction. Antimicrobial resistance is a very serious public health threat worldwide. The main cause of antimicrobial resistance is irrational use of antimicrobial drugs. The goal of the article is to analyze data on outpatient antibiotic consumption in the Republic of Srpska during the period from 2009 to 2014, to present outpatient consumption of the fi rst six antibiotics (the fi fth level of the ATC classifi cation), and, fi nally, to compare the antibiotic use in Republic of Srpska in relation to the antibiotic use in European Union countries. Materials and Methods. Collection and analysis of data on drug consumption is done using ATC/DDD methodology, established by the WHO. Data are taken from the report on drug consumption and distribution in the Republic of Srpska during the period from 2009 to 2014, which are based on submitted data from pharmacies registered in the Republic of Srpska. Results. Results on outpatient antibiotic consumption in the Republic of Srpska, during the period from 2009 to 2014, indicate a total decrease by 3.41 DDDs/1000 inhabitants/day, with the exception of 2010 and 2013, when the antibiotic consumption was increased. In 2014, total outpatient antibiotic consumption in the Republic of Srpska was 31.2% lower than the average consumption in the European Union. During the period from 2010 to 2014, the European Union had a signifi cant increase in antibiotic consumption, while antibiotic consumption in the Republic of Srpska had a tendency of falling. Conclusion. Presented results show a quantitative analysis of antibiotic consumption and provide insight into the outpatient use of antibiotics in the Republic of Srpska, and can be used for further pharmacoepidemiological analysis of antibiotic consumption, which would give a better insight into the therapeutic practice, with the aim of improving the rational pharmacotherapy in the Republic of Srpska. Keywords: antibiotics, outpatient consumption, DDD/1000 inhabitants/day (Scr Med 2016:47:47-52) + , . / 0 1 / 2 3 4 3 5 6 7 8 7 1 7 6 1 9 1 / : 1 0 2 ; < = . : / 3 1 > > ? @ A 4 1 : B 9 C D E F G H I 8 C 7 G H J K L 0 0 A 5 L 0 / @ M = N O P I I 1 B I Q P < . 3 4 0 > 4 0 @ 48 Scripta Medica Vol. 47 • No 1 • April 2016. • www.scriptamedica.com Introduction R S T U V W X Y Z T [ \ Y ] ^ _ ` V a V Y ` V X W V W Y _ T Y ] ` S T b [ T ^ ` T W ` U V W X Y Z c T [ V T W V _ ` S T S V W ` Y [ \ Y ] d S ^ [ e ^ X Y ` S T [ ^ d \ f g _ ] ^ X ` h ` S ^ _ i W ` Y ` S ^ ` U V W X Y Z T [ \ h ` S T T T X ` V Z T X Y _ ` [ Y j Y ] V _ ] T X ` V Y k W U V W T ^ W T W h l S V X S l ^ W ` S T j T ^ U V _ b X ^ k W T Y ] e Y [ a V U V ` \ ^ _ U e Y [ ` ^ j V ` \ V _ S k e ^ _ S V W ` Y [ \ h l ^ W T _ ^ a j T U f m Y l T Z T [ h ` S T U V W X Y Z T [ \ Y ] ^ _ ` V a V Y ` V X W l ^ W Z T [ \ W Y Y _ ] Y j j Y l T U a \ ` S T Y X X k [ [ T _ X T Y ] [ T W V W ` ^ _ X T Y ] W Y e T a ^ X ` T [ V ^ W ` [ ^ V _ W f n _ ] Y [ ` k _ ^ ` T j \ h U k T ` Y ` S T b T _ T ` V X e k ` ^ ` V Y _ W Y ] a ^ X ` T [ V ^ ^ _ U [ T W V W ` ^ _ ` b T _ T W ` [ ^ _ W ] T [ W h ` S T T e T [ b T _ X T ^ _ U W d [ T ^ U Y ] ^ _ ` V a V Y ` V X [ T W V W ` ^ _ X T V W [ V W V _ b T Z T _ ` Y U ^ \ f o p q r _ ` V e V X [ Y a V ^ j [ T W V W ` c ^ _ X T ` Y U ^ \ V W ^ Z T [ \ W T [ V Y k W b j Y a ^ j d k a j V X S T ^ j ` S ` S [ T ^ ` ` Y T T X ` V Z T ` [ T ^ ` e T _ ` Y ] V _ ] T X ` V Y k W U V W T ^ W T W h ^ W l T j j ^ W X Y _ U k X ` V _ b _ k e T [ Y k W Y ] ^ e Y U T [ _ e T U V X ^ j d [ Y X T U k [ T W h ^ _ U V ` [ T s k V [ T W ^ e k j ` V c U V W X V d j V _ ^ [ \ ^ X ` V Y _ V _ Y [ U T [ ` Y W k d d [ T W W Y X X k [ [ T _ X T ^ _ U W d [ T ^ U l Y [ j U l V U T f t r X X Y [ U V _ b ` Y U ^ ` ^ ] [ Y e u v v w h V ` V W T W ` V e ^ ` T U ` S ^ ` ^ a Y k ` u x v v v d T Y c d j T U V T T ^ X S \ T ^ [ V _ ` S T y n ^ W ^ [ T W k j ` Y ] V _ ] T X ` V Y _ W X ^ k W T U a \ [ T W V W ` ^ _ ` a ^ X ` T [ V ^ W ` [ ^ V _ W h l S V X S j T ^ U W ` Y ` S T U V [ T X ` ^ _ U V _ U V [ T X ` X Y W ` W Y ] ^ a Y k ` z f x e V j j V Y _ ^ _ _ k ^ j j \ h V _ X j k U V _ b ` S T X Y W ` Y ] U T X [ T ^ W T U d [ Y U k X ` V Z V ` \ ^ _ U V _ X [ T ^ W T U S T ^ j ` S X ^ [ T X Y W ` W f q { | R S T e ^ V _ X ^ k W T Y ] T e T [ b T _ X T ^ _ U W d [ T ^ U Y ] ^ _ ` V a V Y ` V X [ T W V W ` ^ _ X T V W V [ [ ^ ` V Y _ ^ j ^ _ ` V a V Y ` V X k W T f g ] l T ` ^ i T V _ ` Y X Y _ c W V U T [ ^ ` V Y _ ` S ^ ` Z T [ \ ] T l _ T l ^ _ ` V a V Y ` V X W ^ [ T U T Z T j Y d T U a \ d S ^ [ e ^ X T k ` V X ^ j V _ U k W ` [ \ ` Y U ^ \ h ^ _ U T Z T _ l S T _ l T S ^ Z T ^ _ T l ^ _ ` V a V Y ` V X h a ^ X ` T [ V ^ T Z T _ ` k ^ j j \ S ^ Z T ` S T X ^ d ^ a V j V ` \ ` Y U T Z T j Y d [ T W V W ` ^ _ X T h ` S T [ T ] Y [ T h l T X ^ _ X Y _ X j k U T ` S ^ ` ` S T W V ` k ^ ` V Y _ l T ^ [ T ] ^ X V _ b l V ` S V W Z T [ \ W T [ V Y k W h ^ _ U V ` l V j j a T T Z T _ e Y [ T W T [ V Y k W V ] l T U Y _ Y ` [ ^ ` V Y _ ^ j j \ k W T T } V W ` V _ b ^ _ ` V a V Y ` V X W V _ ` S T ] k ` k [ T f ~ g ` V W T W ` V e ^ ` T U ` S ^ ` a \ u v x v h k _ c j T W W l T S ^ Z T T T X ` V Z T ^ _ ` V a V Y ` V X W h ` S T l Y [ j U d Y d k j ^ ` V Y _ l V j j a T [ T U k X T U a \ z z ` Y    e V j j V Y _ d T Y d j T f € {  r X X Y [ U V _ b ` Y ` S T ‚ Y [ j U m T ^ j ` S ƒ [ b ^ _ V „ ^ ` V Y _ h [ ^ ` V Y _ ^ j k W T Y ] U [ k b W e T ^ _ W ` S ^ ` … d ^ ` V T _ ` W [ T X T V Z T e T U V X ^ ` V Y _ W ^ d d [ Y c d [ V ^ ` T ` Y ` S T V [ X j V _ V X ^ j _ T T U W h V _ U Y W T W ` S ^ ` e T T ` ` S T V [ Y l _ V _ U V Z V U k ^ j [ T s k V [ T e T _ ` W h ] Y [ ^ _ ^ U T s k ^ ` T d T [ V Y U Y ] ` V e T h ^ _ U ^ ` ` S T j Y l T W ` X Y W ` ` Y ` S T e ^ _ U ` S T V [ X Y e e k _ V ` \ † ‡ ‚ m ƒ h z w ˆ x ‰ f Š Objectives: z f R Y ^ _ ^ j \ „ T ` S T U ^ ` ^ Y _ Y k ` d ^ ` V T _ ` X Y _ W k e d ` V Y _ Y ] ^ _ ` V V _ ] T X ` V Z T W ] Y [ W \ W ` T e V X k W T ‡ ‹ b [ Y k d ‰ ^ _ U ^ _ ` V a V c Y ` V X W ‡ ‹ v z b [ Y k d ‰ V _ ` S T Œ T d k a j V X Y ]  [ d W i ^ U k [ V _ b ` S T d T [ V Y U ] [ Y e u v v w ` Y u v z  Ž u f R Y W S Y l Y k ` d ^ ` V T _ ` X Y _ W k e d ` V Y _ Y ] ` S T  [ W ` W V } ^ _ ` V c a V Y ` V X W ^ ` ` S T  ] ` S r R  j T Z T j ‡ g ‘ ‘ ‰ d T [ \ T ^ [ Ž ’ f R Y X Y e d ^ [ T Y k ` d ^ ` V T _ ` ^ _ ` V a V Y ` V X X Y _ W k e d ` V Y _ V _ ` S T Œ T d k a j V X Y ]  [ d W i ^ V _ [ T j ^ ` V Y _ ` Y X Y _ W k e d ` V Y _ V _ ` S T y k [ Y d T ^ _ n _ V Y _ f Materials and Methods  Y j j T X ` V Y _ ^ _ U ^ _ ^ j \ W V W Y ] U ^ ` ^ Y _ U [ k b X Y _ W k e d ` V Y _ V W U Y _ T k W V _ b r R  “ ” ” ” e T ` S Y U Y j Y b \ T W ` ^ a j V W S T U a \ ` S T ‚ m ƒ  Y j j ^ a Y [ ^ ` V _ b  T _ ` [ T ] Y [ ” [ k b  ` ^ ` V W ` V X • T ` S Y U Y j c Y b \ V _ ƒ W j Y f R S T ‚ m ƒ b k V U T j V _ T W ^ [ T k W T U ` Y V e d j T e T _ ` ` S T r R  U [ k b X j ^ W W V  X ^ ` V Y _ ‡ r _ ^ ` Y e V X ^ j R S T [ ^ d T k ` V X  S T e V X ^ j  j ^ W W V  X ^ ` V Y _ ‰ ^ _ U ” ” ” W ‡ ” T  _ T U ” ^ V j \ ” Y W c T W ‰ h ^ _ U ` Y e Y _ V ` Y [ ` S T ^ _ _ k ^ j U [ k b X Y _ W k e d ` V Y _ f w h z v • Y _ V ` Y [ V _ b Y ] ^ _ _ k ^ j X Y _ W k e d ` V Y _ V _ ` S T Œ T d k a j V X Y ]  [ d W i ^ V W [ T b k j ^ ` T U a \ _ ^ ` V Y _ ^ j j T b V W j ^ ` V Y _ f o o p o q r R  “ ” ” ” W \ W ` T e V _ X j k U T W ` S T r _ ^ ` Y e V X ^ j R S T [ ^ d T k ` V X  S T e V X ^ j ‡ r R  ‰  j ^ W W V  X ^ ` V Y _ Y ] U [ k b W ^ _ U U T  _ T U U ^ V j \ U Y W T W ‡ ” ” ” W ‰ ^ W ` S T k _ V ` ] Y [ e Y _ V ` Y [ V _ b ` S T k W T Y ] e T U V c X V _ T W V _ ^ b V Z T _ d Y d k j ^ ` V Y _ Y [ S T ^ j ` S V _ W ` V ` k ` V Y _ f r R  V _ X j k U T W X j ^ W W V  X ^ ` V Y _ Y ] ^ X ` V Z T W k a W ` ^ _ X T W V _ U V T [ c T _ ` b [ Y k d W h U T d T _ U V _ b Y _ ` S T Y [ b ^ _ W Y [ W \ W ` T e W Y ] Y [ c b ^ _ W ` Y l S V X S ` S T \ ^ [ T T T X ` V Z T Y _ h ^ _ U ^ X X Y [ U V _ b ` Y ` S T V [ ` S T [ ^ d T k ` V X ^ j h d S ^ [ e ^ X Y j Y b V X ^ j ^ _ U X S T e V X ^ j d [ Y d T [ ` V T W f ” ” ” V W U T  _ T U ^ W ^ W ` ^ ` V W ` V X ^ j k _ V ` Y ] ^ b [ T T U ^ _ U U T ` T [ c e V _ T U ^ e Y k _ ` Y ] ` S T U [ k b ` S ^ ` V W e Y W ` X Y e e Y _ j \ k W T U ] Y [ ` S T e Y W ` X Y e e Y _ V _ U V X ^ ` V Y _ ] Y [ e T ^ W k [ V _ b T } d Y W k [ T Y ] b V Z T _ d Y d k j ^ ` V Y _ ` Y X T [ ` ^ V _ U [ k b W Y [ b [ Y k d W Y ] U [ k b W f ” ” ” V W e Y W ` j \ T } d [ T W W T U ^ W l T V b S ` k _ V ` W ‡ b h e b h b ‰ h ^ _ U V ] ` S V W V W _ Y ` d Y W W V a j T U k T ` Y Z ^ [ V Y k W [ T ^ W Y _ W ‡ ] Y [ T } ^ e c d j T h ` S T X Y e a V _ T U d [ T d ^ [ ^ ` V Y _ W h Z ^ [ V ^ a j \ U Y W ^ b T h T ` X f ‰ h ` S T k _ V ` U Y W T ‡ n ” ‰ Y ] ^ b V Z T _ d S ^ [ e ^ X T k ` V X ^ j U Y W ^ b T k _ V ` ‡ ` ^ a j T ` h X ^ d W k j T h ^ e d Y k j T ‰ V W k W T U f ” ” ” e T ` S Y U Y j Y b \ V W V _ U T d T _ U T _ ` Y ] d [ V X T ^ _ U _ k e a T [ Y ] V _ S ^ a V ` ^ _ ` W h W Y V ` V W W k V ` ^ a j T ] Y [ U T W X [ V a V _ b ^ _ U X Y e d ^ [ V _ b U [ k b k W T Y Z T [ ` V e T h X Y e d ^ [ V W Y _ Y ] d [ T W X [ V a V _ b a T ` l T T _ U V T [ T _ ` b T Y c b [ ^ d S V X ^ j ^ [ T ^ W ^ _ U U V T [ T _ ` S T ^ j ` S ] ^ X V j V ` V T W f R S T [ T ] Y [ T h ` S V W e T ` S Y U V W W k V ` ^ a j T ] Y [ e Y _ V ` Y [ V _ b d S ^ [ e ^ X Y ` S T [ ^ d \ ^ _ U [ ^ ` V Y _ ^ j V „ ^ ` V Y _ Y ] ` S T [ ^ d \ f ” [ k b X Y _ W k e d ` V Y _ V W T } d [ T W W T U ^ W ` S T _ k e a T [ Y ] ” ” ” W d T [ z v v v V _ S ^ a V ` ^ _ ` W d [ T W X [ V a T U ] Y [ Y _ T U ^ \ ‡ ” ” ” W “ z v v v V _ S ^ a V ` ^ _ ` W “ U ^ \ ‰ h ^ _ U V _ S Y W d V ` ^ j W T ` ` V _ b W ^ W ` S T _ k e a T [ Y ] U T  _ T U U ^ V j \ U Y W T W d T [ z v v d ^ ` V T _ ` c U ^ \ W ‡ ” ” ” W “ z v v d ^ ` V T _ ` c U ^ \ W ‰ f – Results R S T ^ _ ^ j \ W V W Y _ U [ k b X Y _ W k e d ` V Y _ V W a ^ W T U Y _ U ^ ` ^ W k a c e V ` ` T U ] [ Y e w ’ f — ˜ Y ] d S ^ [ e ^ X V T W [ T b V W ` T [ T U V _ ` S T Œ T c d k a j V X Y ]  [ d W

APSTRAKT Vaccines have made a major contribution to global public health, including the eradication of one deadly disease, small pox, and the near eradication of another, poliomyelitis. In the future, vaccination will be expected to eliminate the remaining childhood infectious diseases. Development of new, safe and effective adjuvants is also an important part of vaccine research. The new technologies minimize the risks associated with the new generation of vaccines. Research is also taking place into ways of making vaccines more thermostable, reducing the need for a cold chain for their storage and delivery. There are already needleand pain-free vaccines that can be given as a nasal spray or taken orally, but researchers are coming close to releasing a new form of vaccine delivery called vaccine patches. Vaccines can be used as a prevention of the development of a cancer or control of a cancer, but also to help to control chronic non-infectious diseases in adults. A large number of very important vaccines such as vaccines against human papilloma virus, enterovirus 71, malaria, herpes zoster, meningococcal type B, as well as the first nasal vaccine and the first quadrivalent influenza vaccine etc. have been approved since 2000, and a great number of vaccines are currently under investigation.