Epidemiology and Infectious Diseases. Current Items

Objective. To study the epidemic situation of hepatitis A (HA) in the North-Western Federal District (NWFD) in the first twenty years of the twenty first century and to identify key trends and possible causes. Materials and methods. The authors analyzed the data of state statistical reporting on HA (Form No. 2 “Information on Infectious and Parasitic Diseases”) and the analytical tables designed at the Pasteur Research Institute of Epidemiology and Microbiology and at the Reference Center for Viral Hepatitis Monitoring, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being. A healthy population was examined for anti-HAV IgG to determine the proportion of a latent component. Results. The intensity of the epidemic process of HA decreased substantially in both the NWFD and Russia in the first twenty years of the twenty first century. During the 2020-2021 COVID-19 pandemic, the lowest HA incidence was recorded possibly due to the activity of general preventive and anti-epidemic measures for two infections. The activity of the epidemiological process is estimated much lower than the real one, since the latent component is not taken into account. Viral load was found to play a role in developing severe cases of the disease and cytolytic syndrome. Conclusion. The current epidemic situation in the Russian Federation necessitates a wide routine vaccination of the population against HA as a priority in the set of preventive and anti-epidemic measures.

Objective. To develop a procedure for determining the minimum set of available criteria for ranking the administrative territories in the constituent entities of the Russian Federation according to the degree of risk for complicating the epizootiological and epidemiological situation of anthrax on the basis of multivariate analysis (in case of the constituent entities of the North Caucasian and Southern Federal Districts). Materials and methods. The investigators used information from the Directorates for the Republic of Dagestan, the Stavropol Territory, and the Rostov Region, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being. Assessing the risks for anthrax provided the ranking factors characterizing the epizootiological and epidemiological activity of the actualized settlements permanently unfavorable for anthrax (PUSs) in the administrative territorial units (ATUs) of the constituent entities: amounts (R1 ) and number of years of activity (R 2 ) of PUSs, proportion of active PUSs (R 3 ) and number of years of activity years (R4 ) over the last 10 years, multiplicity of PUS activity (R 5 ), density (R6 ) and specific gravity (R7 ) of PUSs, and epizootic index (R8 ). The investigators explored the following procedures: ∑R 1-8 , ∑R 1-7 , ∑R 1-6 , ∑R 1-5 , ∑R 1-5.7, and ∑R 1-5.8 . Results. Significant differences (p ≤ 0.05) in the division of ATUs in the constituent entities into 4 risk groups were found in most cases of comparison: between ∑R 1-8 and ∑R 1-6 , ∑R 1-5 (the Republic of Dagestan), ∑R 1-6 , ∑R 1-5 , ∑R 1-5.7 , ∑R 1-5.8 (the Stavropol Territory), ∑R 1-7, ∑R 1-6 , ∑R 1-5 (the Rostov Region). At the same time, the ∑R 1-8 procedure more accurately and objectively reflected the situation and risks of anthrax, whereas the exclusion of factors caused a distortion of the results. Conclusion. To rank the constituent entities of the Russian Federation, a ∑R 1-8 -based approach is proposed to make evidence-based planning of preventive measures to improve infection surveillance in the country.

Objective. To assess the intensity of an epidemic process and the risk ofpyoseptic infections (PSIs) in children after different types of open heart surgery for congenital malformations. Subjects and methods. The medical records of 199 patients under the age of 18 who had undergone open heart surgery for congenital heart defects were examined. The typical and prenosological forms of PSI were taken into account in accordance with epidemiological standard case definitions. Results. The incidence rates of typical and prenosological PSIs after open heart surgery in children were 95.5 and 150.8 cases per 1000 operations, respectively. The main clinical forms of postoperative GSI were nosocomial pneumonia, bloodstream infection, surgical site infection, urinary tract infection. The maximum incidence rates of PSI, nosocomial pneumonia in particular, were recorded after open heart surgery with a high risk of death. Conclusion. The higher incidence of PSI, including nosocomial pneumonia, after high-risk surgical interventions is due to longer surgery and accordingly prolonged intensive care unit stay accompanied by mechanical ventilation than during other cardiac surgeries.

To prevent the transmission of social blood-borne infections that can be transmitted during medical care and to identify the factors that create a threat of transmission of pathogens remain an important task for the facilities of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being. Objective. To conduct an epidemiological investigation of cases of suspected infection in children with hepatitis C virus (HCV) during medical care, to study the ways and risk factors for infection in children, to identify the likely source of infection and the site of a chronic lesion with multiple cases of hepatitis C. Materials and methods. The investigation was conducted by the Directorate for the Amur Region, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, with organizational and methodological assistance from the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, in 2018-2019. The investigators carried out a retrospective analysis of more than 8500 units of the 1997 to 2018 medical records, search and examination for HCV/HBVin 2706 out of4899 contact persons, genotyping and phylogenetic analysis of160samples, including those from 99 affected children, and laboratory studies of the objects of the external environment and health care facilities. The reasons for the occurrence of cases of blood-borne infections associated with the provision of medical care were analyzed to implement a set of preventive and anti-epidemic measures. Results. A total of 169 children were identified as suspected to be infected with HCV when receiving medical care in a hospital. To establish the reasons for the formation of a long-term focus of hepatitis C, the investigators eliminated the possibility of perinatally contaminating the children with HCV from mothers or family members through household contact, transmission of this virus during blood component transfusions, as well as its transmission from healthcare staff during professional or household contact. In the department, to where all infected children were admitted, the healthcare staff was retrospectively and promptly established to have violated the vascular catheter care rules and the hygienic handwashing ones during medical procedures, the timing and types of examination of patients for HCV, the disinfection of medical devices and to have made a number of other violations, including failure to provide timely information on new-onset hepatitis C cases in children. There was poor provision of hospital departments with disinfectants, antiseptics, and disposable medical products. The same (leading) HCV genotype 3a was detected in 96.1% of the affected children; HCV genotype 1b was seen in 3 children. Molecular biological studies significantly established an epidemiological relationship among 97.2% of the children infected with HCV genotype 3a. The epidemiological relationship was also confirmed between children with HCV genotype 1b. Conclusion. The artificial mechanism of transmitting the infection has been revealed during invasive medical interventions. The factors of its transmission were medical tools and consumables contaminated with the blood of children with hepatitis C. A child who had 15 admissions to the Department of Hematological Oncology from 1996 to 2013 has been found to be most likely a source of infection for most of the others.

Crimean hemorrhagic fever (CHF) is endemic in the southern regions of the Republic of Kazakhstan. During the COVID-19 pandemic, there are cases of CHF and COVID-19 coinfection, presenting substantial difficulties in both the diagnosis and treatment of these patients. CHF cases and outbreaks are an additional threat during the pandemic due to the severity of the course, the difficulty of differential diagnosis, and the poor prognosis of CHF and COVID-19. The 2020-2021 summer as the most active season for the incidence of CHF in the city of Shymkent and the Turkestan Region coincided with the peaks in the waves of the COVID-19 pandemic, whereas the similarity of the symptoms of the diseases involved difficulties in establishing a diagnosis. The paper describes clinical case of a patient with severe CHF in the presence of clinical signs of coronavirus infection, COVID-19-associated pneumonia, with a favorable outcome, who has been treated in the Shymkent City Infectious Diseases Hospital. Timely diagnosis and etiotropic therapy with ribavirin, replacement treatment with blood drugs and the use of immunized convalescent plasma could achieve a favorable outcome.

The paper reviews the scientific, pedagogical, organizational, and social activities of Lev Vasilievich Gromashevsky, a great Russian and Soviet scientist, epidemiologist, and founding academician of the USSR Academy of Medical Sciences and Hero of Socialist Labor.