Abstract
Coronavirus disease 2019 (COVID-19) is currently the biggest public health problem worldwide. Intensive international travel and tourism have greatly contributed to its rapid global spreading. This study is the first comprehensive analysis of the epidemiological characteristics and clinical outcomes of the travel-associated COVID-19 cases in Vojvodina, Serbia, from March 6 to December 31, 2020 and it concerns permanent residents of Serbia. A cross-sectional study was conducted using data from the dedicated surveillance database of the Institute of Public Health of Vojvodina. Overall, 650 travel-associated COVID-19 cases were recorded in Vojvodina during the observed period, mainly imported from Bosnia and Herzegovina, followed by Austria and Germany (N = 195, 30%; N = 79, 12.15% and N = 75, 11.54%, respectively). The majority of cases were in the working-age groups, 18–44 and 45–64 years (56.46% and 34.15%, respectively). Overall, 54 (8.31%) patients developed pneumonia. In comparison to patients without pneumonia, those with pneumonia were older (mean age = 55.39 years vs. 41.34 years, p<0.01) and had a higher percentage of comorbidities (57.41% vs. 16.61%). Men were more likely to develop pneumonia than women (OR = 2.22; 95% CI: 1.14–4.30, p = 0.02), as well as those in retired-age group (OR = 4.11; 95% CI: 2.0–8.46, p<0.01). Obesity (OR = 14.40; 95% CI: 3.8–54.6, p<0.01), diabetes (OR = 9.82; 95% CI: 3.15–30.61, p<0.01) and hypertension (OR = 7.99; 95% CI: 3.98–16.02, p<0.01) were the most prominent main comorbidities as predictors of pneumonia. Our results represent general epidemiological and clinical dynamics of COVID-19 disease in Vojvodina. Also, they provide evidence that the predictors of pneumonia were: increasing age, male sex, having underlying comorbidities, an increasing number of days from the return to laboratory confirmation of COVID-19 (OR = 1.08, 95% CI: 1.03–1.12, p<0.01), as well as an increasing number of days from symptoms onset to diagnosis (OR = 1.14, 95% CI: 1.07–1.21, p<0.01), while anosmia and ageusia were protective factors for developing it (OR = 0.31, 95% CI: 0.12–0.79, p = 0.01).
Highlights
Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently the biggest public health problem around the globe
The study case was a resident of Vojvodina, who was laboratory-confirmed for the presence of the SARS-CoV-2 virus from March 6 until December 31, 2020 and who returned from a trip abroad within 14 days before the onset of symptoms/ signs of COVID-19 or before the date of SARS-CoV-2 laboratory confirmation in case of the asymptomatic patients
The distribution of the COVID-19 travel-associated cases by months of return and by countries of importation is shown in the Fig 1
Summary
Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently the biggest public health problem around the globe. Mild forms of the disease account for the largest proportion of all cases (more than 80%) [1, 2], there is a high percentage of severe (14%) and critical (5%) clinical outcomes of COVID-19 with a high case fatality rate (CFR estimates by country—from less than 0.1% to over 25%) [1, 3]. Travel-associated cases could lead to an increased risk of SARS-CoV-2 transmission during the early phase of the COVID-19 pandemic and in a situation when countries managed to reduce the number of cases to very small. In countries with widespread community transmission of the SARS-CoV-2 virus, travelassociated cases probably have little impact on the dynamics of the outbreak [5]
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