Background: Q fever is a zoonosis, included in category B of particularly dangerous infectious agents and as such merits careful surveillance and regular updating of the information about its distribution. Aim: This observational retrospective study aimed to provide an overview of Q fever incidence in Bulgaria in the period 2011 to 2017. Methods: Aggregated surveillance data from Bulgaria’s mandatory surveillance system, laboratory data on individual samples received at the National Reference Laboratory Rickettsiae and Cell Cultures and outbreak reports sent by the regional health authorities to the National Centre of Infectious and Parasitic Diseases, were used in this analysis. Cases were described by year, region, age group and most commonly identified risk behaviours. Results: A total of 139 confirmed cases were reported in the study period (average annual incidence: 0.27 cases/100,000 inhabitants). No seasonality or trend in reported cases was observed. Cases were mostly sporadic, with two small outbreaks in 2017. Identified risk behaviours among cases were occupational exposure and consumption of milk and dairy products, although exposure data were incomplete. The male/female ratio was 1.4. The identification and resolution of the two rural outbreaks in 2017 with a total of 18 cases involved good practices: active case finding and collaboration between public health and veterinary authorities. Conclusion: Between 2011 and 2017, Bulgaria retained low Q fever incidence, mostly sporadic cases and two small outbreaks. Occupational exposure and consumption of milk and dairy products were the most often reported likely exposures among cases. The outbreak investigations demonstrate the application of good control practices.

Background/Objectives: Monkeypox (mpox) is currently the most common orthopoxvirus (OPXV) zoonotic disease, and, since 2022, there has been atypical person-to-person transmission observed in non-endemic countries. The present study aimed to investigate the frequency of monkeypox virus (MPXV) and OPXV DNA detection in recommended and alternative clinical materials taken during the acute and convalescent phases of infection in Bulgarian patients. Methods: The study included laboratory investigation by real time PCR of 181 clinical samples from 42 Bulgarian patients with possible mpox infections. Results: MPXV DNA was detected in 23/181 (12.71%), and OPXV DNA in 20/181 (11.05%) clinical samples. There were six mpox-confirmed patients aged 23 to 44. At the highest frequency, MPXV and OPXV DNA were detected in samples of vesicular contents (6/6) and nasal/oropharyngeal secretions (5/6 and 4/6) during the first three days from the appearance of clinical symptoms. We demonstrated MPXV and OPXV DNA in alternative samples (urine, feces, ejaculate, and saliva), and in follow-up patient samples, taken two weeks after mpox confirmation in the convalescent phase (vesicular contentsand urine). Conclusions: Our findings suggested that MPXV may be detected in a larger set of clinical materials, including alternatives, where the virus can persist for more than two weeks.

Primate erythroparvovirus 1, commonly referred to as Parvovirus B19 (B19V), is a DNA virus that normally results in a mild childhood infection called “erythema infectiosum”. Besides respiratory spread, B19V can also be transmitted through transfusions, which may result in persistent anemia in immunodeficient hosts. Dialysis patients often face acute or chronic anemia after infection with B19V. Here, we describe the laboratory investigation of 21 patients with hematological disorders for B19V infections. B19V DNA was detected in 13 (62%) of them, with specific IgM antibodies in three of the DNA positives. All 13 patients received treatment and were laboratory-monitored over a period of one year. In only two patients (a 14-year-old child with a kidney transplantation and a 39-year-old patient with aplastic anemia), markers of recent B19V infection were still detectable in follow-up samples. For four B19V DNA positive samples, short sequences could be obtained, which clustered with genotype 1a reference strains. Our findings suggest that all cases of hematological disorders should be examined for specific B19V antibodies and DNA for accurate diagnosis and appropriate patient management.

To determine the circulation patterns of measles virus in Bulgaria from 2012 to 2018 after a large measles outbreak in the country (2009-2011).Three types of clinical material were collected: serum samples, urine samples, and nasal swabs. Enzyme-linked ...

Background: Healthcare workers are at greater risk of acquiring measles than the general population. Transmission occurs from infected patients to staff and from infected staff to patients and colleagues. In inpatient and outpatient settings, susceptible patients suffering from other conditions, especially the elderly and severely ill patients in intensive care units are at a high risk of severe disease or death if infected with measles. The most effective preventive measure against measles is vaccination with two doses of a measles-containing vaccine. Aim: To perform a serological assessment of the presence of measles IgG antibodies among healthcare workers. Materials and Methods: The present study involves serological testing performed on samples from persons working in hospitals and Regional Health Inspectorates in the country. Screening started in connection with a reported measles outbreak in Bulgaria in 2019, and continued into early 2020. An indirect ELISA assay for the detection of specific measles IgG antibodies in serum samples was used. Results: The tested 152 healthcare workers were from 5 regions of the country, i.e. Sofia-capital (n=87), Burgas (n=6), Blagoevgrad (n=5), Dobrich (n=8) and Pazardzhik (n=46). Anti-measles IgG antibodies were detected in 85.5% of the participants (130/152). Negative results, indicating a possible lack of protective immunity against measles, were obtained primarily in samples from persons younger than 40 years of age. Conclusion: Screening to identify healthcare workers who lack presumptive evidence of protective immunity against measles should be reinforced, especially among younger healthcare workers, in order to minimize the risk of measles both among healthcare workers and among patients.

Background: Healthcare workers (HCWs) are at increased risk of exposure to many viral infections, including vaccine preventable diseases (VPDs) such as measles, mumps and rubella (MMR) as compared to non-HCWs. Immunity of HCWs against these viruses is mandatory in a healthcare setting due to possible exposure from patients or colleagues. Aim: To provide an assessment of anti-measles, mumps and rubella IgG seropositivity among Bulgarian HCWs employed in hospitals and regional health inspectorates (RHI), as an indicator of protective immunity against MMR in this risk group. Materials and Methods: In the current study, 181 HCWs from Infectious Units in regional hospitals in the country, and HCWs from the RHI, involved in the monitoring and surveillance of MMR cases in Bulgaria were screened. Serum specimens from all participants were tested by a commercial indirect enzyme-linked immunosorbent assay (Anti-Measles, Anti-Mumps, Anti-Rubella IgG EIA-Euroimmun®, Germany) for presence of IgG antibodies against measles, mumps and rubella, as an indicator of protective immunity. Results: The study included 181 HCWs, 25 male and 156 female, aged 22 to 66 years. The average protective seroprevalence for measles, mumps and rubella was 82.9%, 76.2% and 92.3% percent, respectively. The highest share of negative results were obtained for mumps-specific IgG – 23.2% (42/181), followed by measles 16.6% (60/181) and rubella-specific IgG 7.7% (19/181). Regarding the age distribution, the highest number of HCWs non-immune to measles and mumps was found among the 31- 40-year olds, and against mumps – among the 41-50-year-olds. Conclusion: HCWs are at greater risk of contracting infections than the general population because of contact with sick patients or infectious material. Infected healthcare workers can spread nosocomial diseases to vulnerable patients with more severe illness, leading to complications and even death. Therefore, the vaccination status of HCWs must be strictly monitored.