Publications by authors named "Snezana Medić"

15 Publications

  • Page 1 of 1

Genetic variability of the neuraminidase gene of influenza A(H1N1)pdm09 viruses circulating from the 2012/2013 to 2017/2018 season in Vojvodina Province, Serbia.

Mol Cell Probes 2020 08 5;52:101557. Epub 2020 Mar 5.

Institute of Public Health of Vojvodina, Futoska 121, 21000, Novi Sad, Serbia; University of Novi Sad, Medical Faculty, Hajduk Veljkova 1-3, 21000, Novi Sad, Serbia.

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http://dx.doi.org/10.1016/j.mcp.2020.101557DOI Listing
August 2020

Vaccination Programs for Adults in Europe, 2019.

Vaccines (Basel) 2020 Jan 20;8(1). Epub 2020 Jan 20.

Department for Interventions in Health Care Facilities, National Organization of Public Health, 15123 Athens, Greece.

Background: While all European countries implement vaccination programs for children, there are gaps in terms of vaccination programs for adults.

Methods: We studied the 2019 vaccination policies for adults in 42 European countries.

Results: Vaccination programs for adults were in place in all countries. However, there were considerable differences between countries in terms of number of vaccinations, target populations and frame of implementation (recommended or mandatory vaccinations). In particular the following vaccination policies were in place: influenza (42 countries), tetanus (31), diphtheria (30), pneumococcus (29), hepatitis B (20), pertussis (18), measles (14), human papilloma virus (14), meningococcus tetravalent A,C,W,Y (14), rubella (13), hepatitis A (11), mumps (11), poliomyelitis (10), herpes zoster (9), varicella (8), tick-born encephalitis (8), meningococcus B (6), rabies (6), type b (5), tuberculosis (3), typhoid fever (3), meningococcus C (2), and yellow fever (1). Seventeen countries implement mandatory vaccinations, mainly against diphtheria, tetanus and hepatitis B.

Conclusions: There are significant differences in vaccination programs for adults in Europe. Routine vaccination programs for adults need to be strengthened. A consensus-based vaccination program is needed.
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http://dx.doi.org/10.3390/vaccines8010034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7157239PMC
January 2020

Seroepidemiological study of rubella in Vojvodina, Serbia: 24 years after the introduction of the MMR vaccine in the national immunization programme.

PLoS One 2020 13;15(1):e0227413. Epub 2020 Jan 13.

Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.

Although rubella is usually a mild childhood disease, this infection in early pregnancy poses a serious problem due to its teratogenic effect. The goal of interrupted circulation and elimination of rubella virus was achieved in many countries in the world. The aim of this study was to determine the status of rubella immunity in Vojvodina and evaluate Serbia's progress toward this goal. A total of 3404 residual serum samples from patients of all ages (1 to 84 years) were included in the study. Samples were collected between May 2015 and December 2017 in Vojvodina. Rubella IgG antibodies were determined using an indirect chemiluminescent immunoassay. Percentage of participants seropositive for rubella antibodies was 92.9% in the entire sample. The highest number of seronegatives was in the youngest (1 year) age group (44.7%), followed by the group aged 24-49 (6.4%) and 2-11 years (6.2%). The absence of a higher percentage of children with protective anti-rubella antibodies in the group aged 2-11 can be explained by a lower immunization coverage during certain years. Participants in the group aged 24-49 were born during the pre-vaccination period with lower rubella incidence, leading to the conclusion that not all individuals of that age came into a contact with the virus. Comparing levels of anti-rubella IgG antibodies of seropositive males and females of different ages reveals that the immunity after a contact with the virus and a previously acquired infection is stronger than the immunity after the vaccination. Although the incidence rate of rubella in Vojvodina has been low for the last ten years, there is still a risk of an outbreak due to a decrease in immunization coverage. This study shows that the percentage of susceptible individuals is high, especially considering women aged 24-49, and that additional ("catch-up") immunization is required.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227413PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957133PMC
April 2020

Vaccination of healthcare personnel in Europe: Update to current policies.

Vaccine 2019 12 14;37(52):7576-7584. Epub 2019 Oct 14.

Director, Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN, United States.

We investigated and compared current national vaccination policies for health-care personnel (HCP) in Europe with results from our previous survey. Data from 36 European countries were collected using the same methodology as in 2011. National policies for HCP immunization were in place in all countries. There were significant differences in terms of number of vaccinations, target HCP and healthcare settings, and implementation regulations (recommended or mandatory vaccinations). Vaccination policies against hepatitis B and seasonal influenza were present in 35 countries each. Policies for vaccination of HCP against measles, mumps, rubella and varicella existed in 28, 24, 25 and 19 countries, respectively; and against tetanus, diphtheria, pertussis and poliomyelitis in 21, 20, 19, and 18 countries, respectively. Recommendations for hepatitis A immunization existed in 17 countries, and against meningococcus B, meningococcus C, meningococcus A, C, W, Y, and tuberculosis in 10, 8, 17, and 7 countries, respectively. Mandatory vaccination policies were found in 13 countries and were a pre-requisite for employment in ten. Comparing the vaccination programs of the 30 European countries that participated in the 2011 survey, we found that more countries had national vaccination policies against measles, mumps, rubella, hepatitis A, diphtheria, tetanus, poliomyelitis, pertussis, meningococcus C and/or meningococcus A, C, W, Y; and more of these implemented mandatory vaccination policies for HCP. In conclusion, European countries now have more comprehensive national vaccination programs for HCP, however there are still gaps. Given the recent large outbreaks of vaccine-preventable diseases in Europe and the occupational risk for HCP, vaccination policies need to be expanded and strengthened in several European countries. Overall, vaccination policies for HCP in Europe should be periodically re-evaluated in order to provide optimal protection against vaccine-preventable diseases and infection control within healthcare facilities for HCP and patients.
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http://dx.doi.org/10.1016/j.vaccine.2019.09.061DOI Listing
December 2019

Epidemiological, clinical and laboratory characteristics of the measles resurgence in the Republic of Serbia in 2014-2015.

PLoS One 2019 17;14(10):e0224009. Epub 2019 Oct 17.

WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg.

The Republic of Serbia is a country with ongoing endemic transmission of measles. The aim of this study is to summarize the main characteristics of the measles resurgence that occurred in Serbia in 2014-2015. The national surveillance data on measles was analysed in relation to the clinical, epidemiological and laboratory data. Between November 2014 and December 2015 a measles resurgence with 420 cases was observed in Serbia. Measles virus was initially introduced by and spread among citizens of Bosnia and Herzegovina with temporary residence in Serbia, before spreading to the resident population. Of the 223 patients with available medical records, 173 (77.6%) were unvaccinated. The overall measles incidence during the outbreak was 5.8/100.000. The highest age-specific incidence rate was recorded in children aged ≤4 years (25.9/100.000), but most cases (67.9%) were ≥20 years old. Hospitalization rate was high (32.9%) and included two cases of encephalitis associated with measles. In total, 42 health-care workers and 22 related cases including hospitalized patients (n = 13) contracted measles. The overall percentage of laboratory confirmed cases was 81.7% (n = 343/420). All measles virus sequences except one (D9) belonged to genotype D8, suggesting interruption of transmission after the previous outbreak in 2010-2011 caused by genotype D4 viruses. The growing number of adult patients as compared to previous epidemics, suggests an urgent need for supplementary immunization activities targeting susceptible health care workers, unvaccinated or incompletely vaccinated adults as well as people without vaccination records. The comprehensive investigation of the 2014/2015 measles resurgence will contribute to decisions about appropriate countermeasures to stop the future measles resurgences in Serbia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224009PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797132PMC
March 2020

Declining seroprevalence of hepatitis A in Vojvodina, Serbia.

PLoS One 2019 4;14(6):e0217176. Epub 2019 Jun 4.

Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, Novi Sad, Serbia.

To assess the current hepatitis A virus (HAV) endemicity in the Autonomous Province of Vojvodina, Serbia, we examined the seroprevalence and susceptibility profiles of the general population. A serum bank of 3466 residual samples, collected in 2015-16 as per the specifications of the European Sero-Epidemiology Network 2 project (ESEN2), was tested for anti-HAV antibodies with an enzyme immunoassay. Relationships between anti-HAV positivity and demographic features of respondents were examined by univariable and multivariable analyses. Present-day HAV seroprevalence was compared with that obtained in 1978-79. Surveillance data for hepatitis A recorded between 2008 and 2017 were also analyzed. Age was the only demographic variable found to be independently associated with a HAV seropositive status. Seropositivity (17% overall vs. 79% in 1978-79) increased with age to a maximum of 90% in the elderly ≥60 years. Only 5% of subjects <30 years were seropositive, unlike the 44% of seropositives ≥30 years. The estimated age at midpoint of population immunity (AMPI) increased markedly from 14 years in the late 70s to 55 years in 2015-16. Meanwhile, disease incidence decreased noticeably in recent years (from 11 in 2008 to 2 per 100,000 population in 2017). In the ongoing pre-vaccine era, natural infection provides immunity for merely a third (31%) and two thirds (57%) of people in their 40s and 50s, respectively. Hence, the majority of people ≤40 years (94%) and middle-aged adults 40-49 years (69%) are susceptible to HAV. Older susceptible individuals, particularly those ≥50 years (24%), are prone to severe symptoms. Taken together, these changes reflect the epidemiological transition of Vojvodina and Serbia from high to very low HAV endemicity, thereby supporting the current national policy of immunization of only high-risk groups.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217176PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548380PMC
February 2020

Sero-epidemiological study in prediction of the risk groups for measles outbreaks in Vojvodina, Serbia.

PLoS One 2019 9;14(5):e0216219. Epub 2019 May 9.

University of Novi Sad, Faculty of Medicine, Department of Epidemiology, Novi Sad, Serbia.

Background: Age-stratified serologic surveys provide insight into the gaps of measles-specific immunity as well as estimates of the age-specific seroprevalence. The aim of this study was to describe the measles sero-epidemiology in Vojvodina before the occurrence of outbreak in 2017/18 and to discuss preventive measures for potential future epidemics.

Methods: A seroprevalence study was conducted from April 2015 to June 2017 on serum bank of 3199 residual samples. Study was performed prior to the last measles outbreak in Vojvodina that occurred between 12th November 2017 and 30th June 2018. Measles-specific IgG antibodies were determined using an indirect chemiluminescent immunoassay (CLIA).

Results: Median age of enrolled participants was 20 years (IQR 11-37). Overall, 86.9% serum samples were seropositive. The highest proportion of measles seronegativity was observed in children aged 12-23 months of age and in adults aged 20-39 years (56.1% and 18.5%, respectively). Prevalence of measles seronegativity above WHO target levels susceptibility was observed in the following age groups: 2, 7, 13, 15, and among all adults aged between 20 and 49 years. Out of total measles outbreak cases (177), there were 91 (51.4%) participants aged 20-39 years. A significant positive correlation was observed between measles seronegativity and the number of reported measles cases aged ≥ 12 months (r = 0.4675, p = 0.0213).

Conclusions: In order to prevent new outbreaks and achieve the elimination of measles in Vojvodina, the vaccination coverage of both measles-mumps-rubella (MMR1 and MMR2) vaccines needs to be improved and sustained. Educational campaigns for the improvement of acceptance and timely vaccination with vaccine against measles among doctors and the general population are crucial. Our results indicate possible gap in measles protection in adults born during implementation of one dose of measles vaccine and prioritize supplementary immunization activities targeting adults in Vojvodina, Serbia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216219PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508608PMC
January 2020

Epidemiology of human trichinellosis in Vojvodina province, Serbia, from 2005 to 2016.

Acta Vet Hung 2019 03;67(1):40-50

3 Institute of Public Health of Vojvodina , Novi Sad , Serbia.

Trichinellosis is one of the most important foodborne diseases in the Eastern European countries. The main objective of this study was to investigate the epidemiological patterns of trichinellosis outbreaks that occurred between 2005 and 2016 in Vojvodina, a northern province of the Republic of Serbia. The average incidence was 3.5 per 100,000 inhabitants. A total of 828 people acquired the infection. The disease occurred in all age groups, slightly more often in males, and quite frequently in a severe form considering the high share of hospitalised patients and the fatal outcome rate (41.6 ± 31.1% and 0.4%, respectively). Trichinella spiralis was confirmed as the causative agent in eight outbreaks. The outbreaks usually occurred among family members due to the consumption of pork or traditional pork products from not tested backyard pigs. Veterinary control measures and the education of consumers and farmers should be implemented to control this zoonotic disease.
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http://dx.doi.org/10.1556/004.2019.005DOI Listing
March 2019

Clinical, epidemiological and epizootic features of a Q fever outbreak in the border region between Serbia and Montenegro.

J Infect Dev Ctries 2018 May 31;12(5):290-296. Epub 2018 May 31.

Veterinary Specialized Institute "Kraljevo", Kraljevo, Serbia.

Introduction: Q fever is a zoonosis which commonly manifests as an acute febrile disease accompanied by pneumonia or hepatitis. The aim of this study was to reveal the reservoirs, sources and routes of infection relevant for the Q fever outbreak that occurred in the border region between Serbia and Montenegro.

Methodology: A prospective study was conducted from 3rd to 23rd March, 2016 in Brodarevo, village near the Serbian-Montenegro border. The EU case definition for Q fever was applied and serological evidence of IgM and/or IgG antibody for phase II antigen Coxiella burnetii used for laboratory confirmation. Animal infection was proven by detection of specific biomarkers for Q fever by ELISA and Real-Time PCR.

Results: In total, ten patients were registered with Q fever, giving an attack rate of 0.5% in the village. A severe form of disease with atypical pneumonia ended up with hospitalization of eight patients. Serological surveillance was conducted in 30 herds of the receptive animals in the outbreak area. Overall the anti-Coxiella antibody seroprevalence was 20.6%. Positive molecular findings (68.4%) accompanied with high seroprevalence (63.2%) were identified in a mini-farm of sheep and cattle in the nearby Orasac, these were considered to be active sources of infection. The most probable route of C. burnetii transmission was the inhalation of contaminated aerosols originating from infected animals.

Conclusion: The main reservoirs for human Q fever at the border region between Serbia and Montenegro are infected cattle and ruminants. Adoption of a comprehensive strategy for disease prevention and control at the intergovernmental level is urgent.
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http://dx.doi.org/10.3855/jidc.9918DOI Listing
May 2018

Varicella zoster virus transmission dynamics in Vojvodina, Serbia.

PLoS One 2018 5;13(3):e0193838. Epub 2018 Mar 5.

Division of Genetics, Cell and Developmental Biology, Department of Biology, University of Patras, Patras, Greece.

This study aimed at establishing baseline key epidemiological parameters for varicella zoster virus (VZV) infection in Vojvodina, Serbia, with the ultimate goal to quantify the VZV transmission potential in the population. Seroprevalence data generated during the first large cross-sectional VZV serosurvey were modelled, using a two-tiered modelling approach to calculate age-specific forces of infection (FOI), the basic reproduction number (R0) and herd immunity threshold (H). Seroprevalence and modelling data were compared with corresponding pre-vaccination epidemiological parameters from 11 countries participating in the European Sero-Epidemiology Network 2 (ESEN2) project. Serbia fits into the general dynamic VZV transmission patterns in Europe in the pre-vaccine era, with estimated R0 = 4.12, (95% CI: 2.69-7.07) and H = 0.76 (95% CI: 0.63-0.86). The highest VZV transmission occurs among preschool children, as evidenced by the estimation of the highest FOI (0.22, 95% CI: 0.11-0.34) in the 0.5-4 age group, with a peak FOI of 0.25 at 2.23 years. Seroprevalence was consistently lower in 5-14 year-olds, resulting in considerable shares of VZV-susceptible adolescents (7.3%), and young adults (6%), resembling the situation in a minority of European countries. The obtained key epidemiological parameters showed most intense VZV transmission in preschool children aged <4 years, justifying the consideration of universal childhood immunization in the future. National immunization strategy should consider programs for VZV serologic screening and immunization of susceptible groups, including adolescents and women of reproductive age. This work is an important milestone towards the evaluation of varicella immunization policy options in Serbia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193838PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837184PMC
June 2018

[Adverse events due to the immunization--case report].

Med Pregl 2012 Mar-Apr;65(3-4):168-72

Zavod za javno zdravlje Sremska Mitrovica.

Introduction: An adverse event after immunization is a medical incident following the administration of vaccine, which can be connected with vaccine usage. This event could be a reaction to a vaccine component or lapse in vaccine handling, transport and storage or coincidental event. The assessment of severity of this reaction and the decision about prospective permanent contraindications for futher immunization are to be made by the regional expert team for permanent contraindications. This is regulated by low.

Case Report: A series of adverse events after immunization in three children ofa single family is reported. As regulated by law, all three children were vaccinated with different vaccines, from 2007 to 2010. Although the recorded events were diverse by their nature, way of clinical manifestation and severity they all required hospitalization. In addition to being siblings, the three children had the same atopic diseases in their personal and family anamnesis. All adverse events were explored including allergological/immunological tests. Thanks to the good cooperation of involved general practicioners, pediatricians, members of expert team for permanent contraindications and clinicians, two of three children received the full series of vaccines in optimal time.

Discussion: Decision making about futher immunization of children with adverse event after vaccine administration depends on the nature and severity of developed medical condition, results of medical exploration, existing immunity and personal risk of getting disease and subsequent complications.

Conclusion: Bearing in mind the significance of immunization for personal and collective immunity, good cooperation of all physicians and experts involved in each single case of adverse event is required
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http://dx.doi.org/10.2298/mpns1204168mDOI Listing
August 2012

[Analysis of suspected adverse reactions following immunization against pandemic influenza].

Med Pregl 2011 May-Jun;64(5-6):305-9

Institut za javno zdravlje Vojvodinc, Novi Sad.

Introduction: The surveillance on adverse reaction following immunization was aimed at recording all adverse events possibly related with vaccines. During the implementation of immunization strategy against pandemic influenza A(H1N1) in 2009. the post-marketing comprehensive surveillance was suggested to be conducted due to limited clinical experience in applying this particular vaccine and because of the fact that some vaccines had been licensed only on the basis of the data regarding their quality.

Material And Methods: The passive surveillance on adverse events following immunization was conducted simultaneously with immunization campaign against pandemic influenza in the Autonomous Province of Vojvodina. Reporting of adverse events was conducted by health care service through a specially designed questionnaire.

Results: In the period from December 17th 2009 to February 7th 2010, of the total number of 55720 people who were vaccinated, 50433 received one dose and 5287 received two doses of vaccine. The total number of doses administered was 61007. During the observed period, some adverse reactions were recorded in 37 people, the rate of occurrence of adverse reactions being 6.6 per 10.000 vaccinated. Since the majority of patients had several symptoms and signs, the number of recorded clinical manifestations was much higher (140) than the number of patients with reactions. The dominant symptoms and signs were fever (51.4%), weakness/fatigue (48.6%), headache (40.5%) and myalgia (31.5%). The reactions in the majority of patients were mild and transient. Only two patients sought medical care and one was hospitalised. Since the immunization coverage was very small, it was not possible to record rare adverse events, whose expected incidence is, anyway, very low.

Conclusion: Surveillance on adverse reaction following immunization represents an important component of immunization program, especially when new vaccines are introduced. Therefore, this form of surveillance in our country needs further improvement in order to provide more complete information on occurrence and characteristics of adverse reactions following immunization.
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http://dx.doi.org/10.2298/mpns1106305pDOI Listing
August 2011

[Immune response to hepatitis B vaccine in elite athletes].

Med Pregl 2008 Jan-Feb;61(1-2):55-9

Sanofi Pasteur, Beograd.

Introduction: Hepatitis B viral infection can create serious health problems, such as acute and chronic hepatitis, cirrhosis of liver and hepatocellular carcinoma. Athletes have bigger risk of hepatitis B infection due to frequent injuries with bleeding, their style of living (promiscuity), close contact with teammates, etc. The aim of this study was to investigate the immune response to hepatitis B vaccine among elite athletes, compared to corresponding control group of male subjects front general non-athlete population, and to test out reaction in relation to age.

Method: There were 21 elite football players and 30 control non-athlete males. After written consent, they all received three doses of hepatitis B vaccine (Euvax B, Sanofi Pasteur) during 6 months. Eight weeks later, their immune response (as anti-HBs antibody titre in serum) was assessed and statistical significance of the findings was tested. The level of immune response was also evaluated in different age clusters within test groups.

Results: None of the footballers was without response to the vaccine. One of the subjects from the control group did not develop it. The group of athletes was with better mean values of antibody titre (1626621 mIU/ml vs. 1568455 mIU/ml), but without statistical significance (t = 0.375: p > 0.05), and with a greater deal of subjects who developed very good immune response (titre over 2000 mIU/ml). Younger football players had better immune reaction than older (age 18-24, 1795560 mIU/ml, vs. age 25-29 years, 1597470 mIU/ml vs. age 30 and more, 1360904 mIU/ml), but without statistical importance (H = 1.593; p > 0.05).

Conclusion: Our study has shown that elite athletes respond very well to hepatitis B vaccination and have good immune response. Vaccination against hepatitis B of elite athletes is very important, because viral infection can seriously affect their health and stop their careers.
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http://dx.doi.org/10.2298/mpns0802055rDOI Listing
October 2008

[The significance of age and sex for the absence of immune response to hepatitis B vaccination].

Srp Arh Celok Lek 2008 Jan-Feb;136(1-2):33-7

Introduction: Seroepidemiological investigations after the administration of hepatitis B vaccine have shown that even 15% of vaccinated healthy persons do not generate immune response to the vaccines currently in use.

Objective: The aim of the research is to test the immunogenicity of hepatitis B vaccine in different age groups on the adult vaccinated population sample in Serbia.

Method: The tested general population sample consisted of 154 adult subjects. Immunization was done using the recombinant fungal vaccine obtained by genetic engineering (Euvax B vaccine, manufacturer LG, distributor Sanofi Pasteur). All tested subjects in the research received 1 ml of hepatitis B vaccine administered intramuscularly into the deltoid muscle by 0, 1, 6 schedule.

Results: In the tested sample, 3.13% of persons aged up to 29 years, 6.25% aged 30-35 year and 19.23% of the tested persons aged 40 years and older had no immune response. The relative risk of"no response"findings was twice higher in the group aged 30-39 as compared to the population aged up to 29 years. The detected risk was six times higher for the population of 40 years and older in comparison to the population aged up to 29 years. Also, the relative risk of"no response" findings for the population of 40 years and older was more than three times higher than for the group aged 30-39. Absent immune response in relation to sex was found to be higher in male subjects.

Conclusion: The rates of"no response"finding was the following: 3.13% in the group aged up to 29 years, 6.25% in the group aged 30-39, as well as in the group aged 40 years and older (19.23%). Immune response in relation to age groups was statistically significantly different (p<0.001), while there was a statistically significant correlation (C=0.473; p<0.001) between the age of the subjects and the immune response. In relation to sex, the "no response"finding was found to be increased in the males, but without any statistically significant difference (p>0.05).
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http://dx.doi.org/10.2298/sarh0802033rDOI Listing
May 2008