Here we analyzed six years of acute flaccid paralysis (AFP) surveillance, from 2015 to 2020, of 10 countries linked to the WHO Regional Reference Laboratory, at the Istituto Superiore di Sanità, Italy. The analysis also comprises the polio vaccine coverage available (2015–2019) and enterovirus (EV) identification and typing data. Centralized Information System for Infectious Diseases and Laboratory Data Management System databases were used to obtain data on AFP indicators and laboratory performance and countries’ vaccine coverage from 2015 to 2019. EV isolation, identification, and typing were performed by each country according to WHO protocols. Overall, a general AFP underreporting was observed. Non-Polio Enterovirus (NPEV) typing showed a high heterogeneity: over the years, several genotypes of coxsackievirus and echovirus have been identified. The polio vaccine coverage, for the data available, differs among countries. This evaluation allows for the collection, for the first time, of data from the countries of the Balkan area regarding AFP surveillance and polio vaccine coverage. The need, for some countries, to enhance the surveillance systems and to promote the polio vaccine uptake, in order to maintain the polio-free status, is evident.

The WHO Regional Commission for the Certification of Poliomyelitis Eradication has recently indicated Bosnia and Herzegovina (B&H) as a high risk country for transmission, following importation, of wild poliovirus (WPV) or circulating vaccine‐derived poliovirus (cVDPV). We analyzed data on Acute Flaccid Paralysis (AFP) surveillance between 2007 to 2016, and the trend of polio immunization coverage in B&H. The majority of AFP cases was recorded in 2016 suggesting an enhancement of the AFP surveillance activities. However, the decline in the immunization coverage, around 74%, and the isolation of two Sabin‐like poliovirus type 2 strains, one of them close to a VDPV, require a particular attention in the area. Although B&H has successfully maintained its polio‐free status since 2002 several challenges need to be addressed.

Objective – The aim of this study is to summarize the epidemiology of vaccine preventable diseases in the Federation of Bosnia and Herzegovina from 1996 to 2015, and assess the impact of immunization. Methods – The analyses presented in this paper are based on the data collected by the Institute for Public Health of the Federation Bosnia and Herzegovina or by reviews of historical data. Results – Data suggests clear evidence of the reduction of burden of vaccine-preventable diseases after introduction of vaccines in the immunization program. Diphtheria and poliomyelitis have been eliminated, and tetanus and pertussis have been significantly reduced. Since the target of 95% vaccination coverage against measles, mumps and rubella was not achieved and the number of susceptible individuals’ increased, infectious agents still circulates and delayed outbreaks occur. Conclusion – Despite impressive achievements in vaccine-preventable diseases control, continued trust and investments in the immunization program in the Federation of Bosnia and Herzegovina are essential.

Between January 2014 and the beginning of February 2015, the Federal Institute of Public Health in the Federation of Bosnia and Herzegovina has reported 3,804 measles cases. Notable transmission has been observed in three Central Bosnia Canton municipalities: Bugojno, Fojnica and Travnik. Most cases were unvaccinated 2,680 (70%) or of unknown vaccination status 755 (20%). Health authorities have been checking vaccination records and performing necessary prevention measures. The epidemic is still ongoing.

SUMMARY A rubella outbreak involving 1900 cases was recorded in the Federation of Bosnia and Herzegovina between mid-December 2009 and the end of May 2010. Sera from 389 suspected rubella cases were examined for the presence of rubella-specific IgM and IgG antibodies. A total of 32 throat swabs from suspected rubella cases were tested by RT–PCR and were used to attempt virus isolation. Most patients (945/1900, 49·73%) had never received rubella vaccination or had an unknown vaccination status (563/1900, 29·63%). About 45% (178/389) of suspected rubella patients were IgM positive. From 13 of the throat swabs a virus isolate and E1 gene sequences attributed to genotype 2B were obtained. The rubella outbreak was due to failure to vaccinate during the war period (1992–1995) and emphasizes the need for additional vaccination opportunities.

Introduction: Advertising and marketing of energy dense nutrient poor foods and drinks or „unhealthy foods“ directed to children presents one of the major barriers for children to eat healthy. It has been proved that aggressive marketing of unhealthy foods has extremely negative effects on children knowledge, attitude and behavior related to consumption of unhealthy foods. Aim: presentation of dietary habit indicators related to consumption of unhealthy foods of school children in Federation of Bosnia and Herzegovina and in Europe as well as existing binding international documents that call for putting marketing of unhealthy foods directed to children under control. Methodology: comparison of indicators of energy dense nutrient poor foods consumption derived from Health Behavior of School Aged Children Survey (HBSC Survey 2002/03) among children 11-13 years in Federation of BiH and in selected European countries and review of political strategic and legal documents that serve as base for development and implementation of measures related to control of marketing of unhealthy foods directed to children. Results: Results related to everyday consumption of sweet drinks (37,3%), sweets (59,6%), crisps (49,8%) and chips (47,5%) of children in FBiH showed that with Israel, Malta and Scotland, FBiH is among countries with highest percentages in Europe, and that grazing phenomena is extremely prominent–59,5% of children is snacking more than three times a day. Significant relation between frequent consumption of unhealthy foods and better socio economic status of family has been found in FBiH and that correlates with results found in developing countries of Europe. Conclusion: Unhealthy dietary habits characterized by high consumption of energy dense nutrient poor foods and drinks have been found in FBiH and this problem is widely present in European Region. As marketing of energy dense nutrient poor foods and drinks to children is first to blame for this problem measures for control of the marketing should become a priority.

Neonatal BCG vaccination reduces the risk of tuberculosis and provides protection higher than 80% against the development of meningeal and miliary tuberculosis in newborns. Tuberculosis meningitis remains a major problem and also an important cause of death in some countries. In countries with high and moderate incidence of tuberculosis, prevention from the most severe complications of tuberculosis can be achieved only with a high coverage of the universal BCG neonatal immunization, being higher than 98% in the cohort of newborns. The decrease in BCG immunization coverage within immunization program during the year 2003 in Bosnia and Herzegovina influenced the increase in tuberculous meningitis. During 2002, when coverage with BCG vaccination in cohort of newborns was 90%, the incidence rate of tuberculous meningitis was 19. 04%oo. With the 68% decrease in BCG immunization coverage in the cohort of newborns in Bosnia and Herzegovina during the year 2003, the incidence of tuberculous meningitis raised to 33 33%oo. It has been proven that the 22% decrease of the neonatal BCG immunization coverage in the cohort of newborns /vaccination program of children/ caused 175 times higher number of the tuberculous meningitis cases. Newborns affected by the tuberculous meningitis were not BCG vaccinated. BCG vaccine provided effective protection against tuberculous meningitis, as well against the death of newborns caused by tuberculosis.

BACKGROUND Neonatal hepatitis B vaccination is the best effective measure for prevention hepatitis B infection in the countries with intermediate to high levels of HB endemicity. METHODS Epidemiological methods of research had the aim to follow the incidence rates of viral hepatitis B and HBsAg carriers and to determine influence on the risks of transmission hepatitis B infection in new-borns in Bosnia and Herzegovina. Serologic immunogenic quality of hepatitis B vaccine is researched. RESULTS Bosnia and Herzegovina has high incidence of hepatitis B virus in the Europe. The incidence of HBsAg carriers is changing with increasing from 2000. to 2003. Data from this surveillance show in Bosnia and Herzegovina that in one notified case of hepatitis B there is 3.59 cases of HBsAg carriers. Hepatitis B vaccine induces anti-HBs antibodies titres > 10 IJ/ml, considered as seroprotective in 99, 10% vaccinated. CONCLUSION Neonatal hepatitis B vaccination is new vaccine in national immunization program in Bosnia and Herzegovina. Hepatitis B vaccines are safe and effective in inducing neutralizing HBs antibodies play and have important role in protecting new-borns.

Incidence rate of the harder adverse immunization reactions in the Program of the vaccination children in Federation Bosnia and Herzegovina is similar in the terms of kind and frequency as in the countries with high quality programme of the vaccination. In the period from 2002-2003 year cases of the adverse reactions were not registered, as vaccinal form of polyomyelitis, toxic syndrome or sudden acute deaths. The adverse events following immunization were classified in relation to 100,000 applicated vaccines, the incidence rate of supurative lymphadenitis at BCG vaccination reported are 32@100000, anaphylaxia at MMR vaccination 0.8@100000, DTP vaccination encephalopathy 1@100000 and at TT vaccination anaphylaxia 2@100000 administered vaccines.