The current problems in the epidemiology and prevention of viral hepatitis B and C in the Russian Federation

The data on the epidemiological situation with hepatitides B and C in the Russian Federation in 1991-1998 are presented. Morbidity rates in hepatitis B, registered during the recent 3 years, were 35.8 (1996), 36.3 (1997) and 35.7 (1998) per 100,000 of the population. Morbidity rates in acute hepatitis C were 3.2 (1996), 9.1 (1997) and 11.6 (1998) per 100,000 of the population. Different regions of the Russian Federation were noted to have pronounced differences in the activity of the epidemic processes of hepatitides B and C.     

An epidemiological analysis of hemorrhagic fever with renal syndrome morbidity in the Republic of Bashkortostan in 1997

The outbreak of hemorrhagic fever with renal syndrome (HFRS) in the Republic of Bashkortostan, resulting in 10,057 registered cases of the disease (287 cases per 100,000 of the population), was analyzed. HFRS cases among the population were registered in 52 out of 54 regions of Bashkortostan. 31% of the total number of patients were the inhabitants of rural regions (170 cases per 100,000) and 69% were urban dwellers (295 cases per 100,000), mainly in Ufa (512 cases per 100,000). HFRS morbidity among males was fourfold higher than among females. In 70% of cases persons aged 20-49 years were affected. 5% of the total number of patients were children aged up to 14 years. In 34 cases (0.4%) the severe clinical course of the disease had a fatal outcome. Cases of HFRS were registered from April 1997 till March 1998 with the highest morbidity rate observed during the period of August-December. In most cases (46.8%) both urban and rural dwellers contacted infection during a short-term stay in the forest. As the result of the serological examination of the patients, all HFRS cases were etiologically attributed to hantavirus, serotype Puumala. The main natural reservoir of this virus and the source of human infection in Bashkortostan were bank voles (Clethrionomys glareolus), the domination species among small mammals in this region.     

The manifestations of an epidemic process of typhoid infection in Moscow

The work deals with the results of typhoid morbidity in Moscow for the period of 1980-1988. The morbidity rate varied from 0.98 to 0.17 cases per 100,000 of population with a tendency towards decrease. In the structure of morbidity local cases accounted for 46.8% and cases of infection contacted outside Moscow accounted for 53.2%. The morbidity level was low throughout the whole territory, only in two districts morbidity rate was significantly higher (P = 95%) than the average morbidity rate in the whole of the city. In the group of local cases morbidity had no pronounced seasonal character, in contrast to cases due to infection contacted outside the city which were mostly registered in summer and autumn. Persons aged 21-30 years were found to be the most affected age group. The general factors, and not the contact route, are supposed to play the main role in the realization of the mechanism of infection transfer. Under modern conditions, some manifestations of the epidemic process of typhoid infection can be detected only at the level of the whole city, or even the whole country.     

Morbidity and mortality in acute viral hepatitides in a hyperendemic region. The role of viral hepatitis E

Official annual statistical data on morbidity in acute viral hepatitides (AVH), including the number of lethal cases, for 1985-1995 were analyzed. Mortality rates per 100,000 of the population at the period of 11 years were calculated for different age groups, sex and the place of residence. 396 and 99 patients were examined for the presence of serological markers of hepatitides A, B and E, respectively, at the periods of epidemic rises in morbidity and satisfactory epidemic situation. In the course of 11 years AVH caused the death of 22,405 persons. In 1985-1987 the average mortality level (ML) reached 12.3-17.8 per 100,000 of the population (with morbidity being 1,200-1,400 and was essentially higher among the rural population in comparison with the urban population. During these years the highest ML, was registered among children aged 0-2 years (190-50 per 100,000) and, among adults, mainly among women aged 20-29 years (21.4-19.6 per 100,000). During the years when the epidemic of AVH was absent, ML among these groups was essentially lower: 40-20 among children aged 0-2 years and 4-5 among women aged 20-29 years. In 1987 in the Fergana Valley hepatitis E was detected in 72.2% of all examined patients, and in the southern areas of the country in 68.7%. A sharp rise on mortality among women of the productive age at the period of the epidemic rise of AVH morbidity in the endemic region indicated that this epidemic was linked with hepatitis E. High ML among young children may be indicative of a highly unfavorable course of hepatitis E in the group of infants, which had never been registered before. This newly established regularity may be used for the retrospective diagnostics of the outbreak of hepatitis E.     

Spread of salmonellosis in Moscow and the ways of its prophylaxis

The article deals with the results of the epidemiological analysis of the spread of salmonellosis in Moscow. During the last 15 years the proportion of Salmonella enteritidis was about 80% and more. After salmonellosis morbidity decreased to 19.9 per 100,000 of the population (the minimum level) in 1985 its sharp rise was noted. Morbidity rate increased from 31.7 in 1987 to 55.1 per 100,000 in 1988, then to 93.9 per 100,000 of the population in 1989 (the maximum level). In the subsequent years up to 1996 a decrease in morbidity rate was observed, but in 1997-2002 morbidity rate stabilized within 29.8-35.7 per 100,000 of the population without a perceptible tendency towards decrease. The sharp increase of the etiological role of S. enteritidis which led to a wide spread of Salmonella infections was caused by the "chicken-egg" factor of their transmission. High morbidity rate among children and adults, registered all the year round, is the consequence of the constant epidemic activity of this factor.     

Epidemic process of pertussis in Moscow

Materials reflecting the dynamics of pertussis morbidity during the period of 1958 - 2003 under the conditions of prolonged mass immunization of the child population with adsorbed DPT vaccine are presented. The planned vaccination of children led to the decrease of pertussis morbidity during the first 10 years, but groundless abstentions from vaccination during the 1980s - 1990s contributed to a sharp rise in morbidity among children of younger age groups. During the recent four years a rise in pertussis morbidity was registered in 2000 (71.79 per 100,000 of the population), followed by the most significant for the last 20 years drop in morbidity in 2002--down to 9.89. But in 2003 the growth of morbidity was again registered (38.67). Recently periodic rises and drops in morbidity occurred simultaneously with the increased coverage of children of younger age groups with vaccination. In recent years changes in the age structure of patients were observed: the specific proportion of school children increased (in 2003 morbidity rates in children aged 6 - 10 years were 288.6 - 270.7), simultaneously high morbidity among children aged up to one year (274.9) was registered. The specific proportion of pertussis-affected children aged above 7 years reached 65%. From the late 1990s until present in 87.1% of cases strains of serotype 1.0.3 prevailed in the population of B. pertussis strains. But in recent years the circulation of strains 1.2.3, spread in the prevaccination period and having toxicity similar to that of strains of serotype 1.0.3, while exceeding them in virulence, in sufficiently high proportion (7.0% in 2002) was noted. This was indicative of the possibility of the unfavorable development of the epidemic process of pertussis infection.     

Comparative characteristics of the immunologic structure of children's collectives as regards scarlatina in different climatic zones]

An immunological study (in respect to scarlet fever) of children in children's collective bodies was conducted in 1971-1972 simultaneously in two towns-Ashkhabad and Petrozavodsk located in the contrast climatic zones. Results of Dick's test and passive hemagglutination test indicated no significant differences in the level and intensity of antitoxic immunity in children of both cities; only during the autumn period, corresponding to the seasonal increase in the incidence of scarler fever in Ashkabad, the number of immune children in this town proved to be greater than in Petrozavodsk, this being connected with a more active process of "mute" immunization. At the same time differences were revealed in the level and dynamics of antibodies to the leading types of M-antigens of hemolytic streptococci. Consequently, a higher immunological reactivity of the organism in children in Ashkhabad (promoting rapid formation of both the antitoxic and the antimicrobial immunity and limiting of the spread of marked scarlet fever affections) underlied the differences in the level of scarlet fever morbidity in different climatic zones.     

Epidemiologic situation of brucellosis in the regions of the Republic of Dagestan affected by the flood of 2002

The Republic of Daghestan is at present one of the most unsafe territories in the Russian Federation with respect to brucellosis morbidity among humans. The figures of human morbidity in brucellosis grew from 3.4 per 100,000 of the population in 1999 to 10.5 per 100,000 of the population in 2002, thus exceeding the figures for the whole of Russia 15- to 20-fold. The analysis of human morbidity in the Kizlyar region (where the interregional regrouping of the cattle was made) after the natural calamity, as well a in other regions where live-stock was evacuated, indicated that by the end of 2002 an essential deterioration of the epidemiological situation took place in these regions. In view of grave epizootological situation and the absence of epidemiological safety in brucellosis in the Republic of Daghestan the sanitary, epidemiological and veterinary services should, together with other priority tasks in their work aimed at the liquidation of the emergency situation, pay greater attention to measures for the prevention of the spread of brucellosis.     

Epidemiology of hemorrhagic fever with renal syndrome in the north Volga-Viatka region

The results of the ecological and epidemiological study of hemorrhagic fever with the renal syndrome (HFRS) in the Kirov region for the period of 1987-2000 are presented. HFRS morbidity rate varied from 1.3 to 13.7 per 100,000 population, which corresponded to the figures registered in the Volga Vyatka region. Cases of HRFS were mainly (90%) registered in three southern districts of the region. The moderate degree of correlation between morbidity rate and the number of wild mammals (r = 0.55) was established. Periodic morbidity rise occurred every 3 years. In 1998-2000 the contamination of wild mammals with HFRS virus increased and reached 7.6-9.5%. Infection factors connected with everyday human activities somewhat prevailed, industrial and agricultural types of infection constituting 43.8%. Males aged 20-49 years prevailed among the patients. Morbidity rate among urban dwellers exceeded that among town residents.     

Current rabies epizootiology

Situation in rabies in the Russian Federation (RF) remains to be tense and is characterized by important specific features. Central Russia and the Moscow region have essential differences in the epizootic situation, the epizootological structure of rabies and other indices as compared with the Russian Federation. In the course of the last 25 years the ecological stereotype of rabies has undergone considerable transformations, becoming natural focal infection with the circulation of the infective agent among wild carnivores, which is now particularly obvious in the Moscow region. In 1998 a sharp rise in rabies morbidity occurred in Central Russia: peak values exceeded average annual values 2 times for the RF, 4 times for Central Russia and more than 10 times for the Moscow region. The situation in rabies in the Moscow region permits to use it as a model in the study of today rabies.     

The epidemic process of an acute streptococcal respiratory infection in large organized collectives of children

The study of the specific features of the development of the epidemic process of scarlet fever, tonsillitis, and acute respiratory diseases (ARD) in two large organized groups of children revealed the presence of some differences which depended on the character of prophylactic measures taken in these groups. Thus, in the absence of prophylaxis with bicillin a pronounced increase in the level of carriership, accompanied by an increase in the infective capacity of carriers, was noted. This resulted in a high level and unfavorable dynamics of morbidity in scarlet fever, tonsillitis, and ARD. On the contrary, the use of prophylaxis with bicillin ensured the stability of the level of carriership, while the infective capacity of carriers was not pronounced. At the same time a rise in ARD morbidity was insignificant, and morbidity in scarlet fever and tonsillitis was reduced to nil.     

Hereditary blood factors and infectious diseases in children in the 1st 7 years of life

Infectious morbidity in respect to 23 nosological forms was studied in 958 children with known blood groups and Rh factors during the first 7 years of their life. The absence of statistically significant differences in morbidity rates in children with different age groups was revealed in respect to 16 nosological forms. Significant differences in morbidity rates in children with different blood groups were revealed in respect to parotitis, rubella, scarlet fever, E. coli infections, bronchitis and pneumonia; similar differences linked with Rh factor were observed only in cases of measles, rubella and tonsillitis.     

Total immunization of children against influenza decreases morbidity in a number of diseases among elderly persons during influenza epidemic

Immunization of children aged 3-6 years in kindergartens and school children aged 7-17 years against influenza with inactivated influenza vaccine was carried out in two districts of the Moscow region. The comparison of morbidity in influenza-like diseases among the immunized children with that among nonimmunized children in control districts revealed that the effectiveness of immunization was 60.9% in kindergartens and 68.8% in schools. The analysis of morbidity in a number of diseases among 158,451 elderly persons not immunized against influenza demonstrated that, in comparison with the control districts, in those districts where mass immunization of children was carried out morbidity in influenza-like diseases among elderly persons was 3.4 times lower and, out of other 10 diseases under study, morbidity in 8 diseases was 1.5-2.6 times lower. As indicated by the data obtained in this study, total anti-influenza immunization of children in organized groups not only essentially decreased influenza morbidity among children, but also greatly decreased morbidity in influenza and a number of diseases, appearing as complications of influenza infection, among nonimmunized elderly persons during influenza epidemic.     

Use of tomicid in prophylaxis of respiratory streptococcal infection in the organized groups of children of pre-school age

The results of the approbation of the use of Tomicid for the prophylaxis of scarlet fever and other manifestations of streptococcal infection in an organized group of children of pre-school age are presented. The pronounced prophylactic effect of Tomicid, manifested by a reliable decrease of group A streptococcal carrier state, as well as in a decrease in morbidity in respiratory streptococcal infection among children in the test group in comparison with those in the control one. The simplicity of the use of the preparation (as throat gargle for 5 days) makes it possible to regard this preparation as a promising remedy for the urgent prophylaxis of scarlet fever.     

Evidence for an environmental effect in the aetiology of insulin dependent diabetes in a transmigratory population.

OBJECTIVE--To examine whether children of families moving from an area of low incidence of childhood diabetes to one which is higher show a corresponding rise in disease incidence. DESIGN--Disease incidence study over 12 years. SETTING--Bradford District Metropolitan Council area. SUBJECTS--All subjects aged 0-16 years resident within the study area. MAIN OUTCOME MEASURES--The incidences of childhood diabetes in Asian and non-Asian families. RESULTS--The incidence of diabetes in Asian children increased from 3.1/100,000 per year in 1978-81 to 11.7/100,000 per year in 1988-90 (chi 2 for trend = 4.95, df = 1, p = 0.026) whereas that for other children remained constant at 10.5/100,000 per year. Over the entire study period rates were lower in Asian females (4.9/100,000 per year) than in Asian males (8.8/100,000 per year) whereas the reverse was true for other children (males 9.2/100,000 per year; females 12.0/100,000 per year) (test for common odds ratio: chi 2 = 3.81, df = 1, p = 0.052). CONCLUSIONS--Offspring of this transmigratory population had a rising incidence of childhood diabetes which was approaching that of the indigenous population. The data provide strong evidence for an environmental effect in the aetiology of insulin dependent diabetes.     

The epidemiology of epidemic parotitis in the USSR.

Morbidity from epidemic parotitis in the USSR in the period from 1958 to 1972 ranged within the limits of 266.6 and 521.7 cases per 100 000 inhabitants. A 3--4 years cyclic recurrence of rises and falls in morbidity was observed. The bulk of cases of disease occur in the winter-spring period. In towns, parotitis is registered 3 times more frequently, in the mean, than in rural districts. More than 95% of patients in the USSR consisted of children under 15, while in Moscow, children aged 3--5 years were the most affected group. In Moscow in the period from February 1, 1972 to January 31, 1973, the morbidity in men was 493.2 per 100 000 and in women 339.5 per 100 000 (ratio 1:1.45).     

A trial of using immunoglobulins of known specificity for preventing hepatitis A in regions with high epidemic activity

The economic effectiveness of immunoglobulin prophylaxis (IGP), carried out among children aged 1-3 at the beginning of a seasonal rise in hepatitis A (HA) morbidity with high coefficients of protection (80-85%), was directly related to the activity of the epidemic process. Preparations with sufficiently high content of antibodies to HA virus sharply decreased the manifestation of this infection. The detection rate of the manifest forms of the infection among children covered by prophylactic measures in the foci of HA was considerably lower than among children who had not received the preparation. IGP exerted no essential influence on the dynamics of the formation of population immunity. A high share of children aged 3-4 years, seropositive to HA virus (up to 90%), validates the inadvisability of carrying out IGP in older groups of children.     

The incidence and seasonal variations of acute primary angle-closure glaucoma

The incidence and seasonal variations of acute primary angle-closure glaucoma (APACG) was studied. It was based on a retrospective chart review of 121 hospital patients in Split, Croatia for the fifteen-year period from 1985 through 1999. The average incidence was 4.1 cases per 100,000 per year in the total population and 7.1 per 100,000 in those aged 30 years and older. APACG affects women almost twice more often than men. The incidence rate increased with age. No seasonal variations in the occurrence of APACG and no correlation with the mean duration of light exposure per season were found.     

Hospital admissions for skin and soft tissue infections in a population with endemic scabies: A prospective study in Fiji, 2018–2019

Scabies is an important predisposing factor for impetigo but its role in more serious skin and soft tissue infections (SSTIs) is not well understood. Information is limited on incidence of SSTIs in the presence of endemic scabies. We conducted a prospective study of hospital admissions for SSTIs in the Northern Division of Fiji (population: 131,914). Prospective surveillance for admissions with impetigo, abscess, cellulitis, wound infection, pyomyositis, necrotizing fasciitis, infected scabies, and crusted scabies was conducted at the Division’s referral hospital between 2018 to 2019. Information was collected on demographic characteristics, clinical features, microbiology, treatment and outcomes. Over the study period, 788 SSTI admissions were recorded corresponding to a population incidence 647 per 100,000 person-years (95%CI 571–660). Incidence was highest at the extremes of age with peak incidence in children aged <5 years (908 per 100,000) and those aged ≥65 years (1127 per 100,000). Incidence was 1.7 times higher among the Indigenous Fijian population (753 per 100,000) compared to other ethnicities (442 per 100,000). Overall case fatality rate was 3.3%, and 10.8% for those aged ≥65 years. Scabies was diagnosed concurrently in 7.6% of all patients and in 24.6% of admitted children <5 years. There is a very high burden of hospital admissions for SSTIs in Fiji compared to high-income settings especially among the youngest, oldest and indigenous population which is concordant with scabies and impetigo distribution in this population. Our findings highlight the need for strategies to reduce the burden of SSTIs in Fiji and similar settings.     

The spread of rotavirus gastroenteritis in the Republic of Tajikistan

The article deals with the results of the investigation which has demonstrated the spread of rotavirus infection on the territory of the Republic of Tajikistan. This infection has gained an important place in the regional pathology and requires increased epidemiological surveillance on its spread. As established in the course of this investigation, in patients with the clinical manifestations of pronounced gastroenteritis rotavirus plays the role of the etiological agent in 25.8% of cases in children aged up to 14 years and in 11.0% of cases in adults. Synchronism in the seasonal dynamics of morbidity in acute enteric infections of unclear etiology and rotavirus gastroenteritis among children aged 0-2 years, annually reaching morbidity peak in October, has been revealed. Rotavirus gastroenteritis requires close attention as regards its prophylaxis as one of the main nosological forms of acute enteric infections in the Republic.