IntroductionCritical questions remain about COVID-19 vaccine effectiveness (VE) in real-world settings, particularly in middle-income countries. We describe a study protocol to evaluate COVID-19 VE in preventing laboratory-confirmed SARS-CoV-2 infection in health workers (HWs) in Albania, an upper-middle-income country.Methods and analysisIn this 12-month prospective cohort study, we enrolled HWs at three hospitals in Albania. HWs are vaccinated through the routine COVID-19 vaccine campaign. Participants completed a baseline survey about demographics, clinical comorbidities, and infection risk behaviours. Baseline serology samples were also collected and tested against the SARS-CoV-2 spike protein, and respiratory swabs were collected and tested for SARS-CoV-2 by RT-PCR. Participants complete weekly symptom questionnaires and symptomatic participants have a respiratory swab collected, which is tested for SARS-CoV-2. At 3, 6, 9 months and 12 months of the study, serology will be collected and tested for antibodies against the SARS-CoV-2 nucleocapsid protein and spike protein. VE will be estimated using a piecewise proportional hazards model (VE=1−HR).Baseline dataFrom February to May 2021, 1504 HWs were enrolled. The median age was 44 (range: 22–71) and 78% were female. At enrolment, 72% of participants were seropositive for SARS-CoV-2. 56% of participants were vaccinated with one dose, of whom 98% received their first shot within 4 days of enrolment. All HWs received the Pfizer BNT162b2 mRNA COVID-19 vaccine.Ethics and disseminationThe study protocol and procedures were reviewed and approved by the WHO Ethical Review Board, reference number CERC.0097A, and the Albanian Institute of Public Health Ethical Review Board, reference number 156. All participants have provided written informed consent to participate in this study. The primary results of this study will be published in a peer-reviewed journal at the time of completion.Trial registration numberNCT04811391.

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BACKGROUND: Contaminated drinking water causes extensive outbreaks of illness because of the large number of people served by water supply facility. AIM: The present study describes a community epidemic outbreak of infection with multiple pathogens in Kruja city, Albania, in October 2021. METHODS: This descriptive study presents a case of epidemic outbreak caused by the hydric system in the inhabitants of the Kruja city from October 23, 2021 to October 29, 2021. A standard questionnaire was used for interview that addressed clinical symptoms, food consumption, and environmental exposures. Clinical specimens were cultured using standard microbiological methods for bacterial and viral pathogens. During 6 days of epidemy, 690 patients were treated to the emergency room of Kruje hospital. RESULTS: Day 3 presented the highest number of patients 39.1% (270/690) and the last day of epidemy presented the lowest number of patients 1.4% (10/690). Abdominal pain continuing with vomiting was more frequently clinical sign among patients. The most affected age group is 15–44 years old, which is also the most active age group. Salmonella Gr. B and Norovirus G2 were the results taken from the examination of stool samples. Analysis of a water sample resulted in Enterococcus faecalis contamination. CONCLUSION: Problems with drinking water are still present in our country. The latest outbreak shows the special care and importance of safe storage and distribution of drinking water. Investments in water supply as well as rigorous monitoring of drinking water should be an absolute priority of both public health and local government employees.

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