Clinical repercussions of Glanders (Burkholderia mallei infection) in a Mongolia (A case report) / Монголын Анагаах Ухаан

@#The microbiologist, who aged 44 man has work with glander DNA extraction between January and March at 2022, was developed sumptoms with fever, headache, muscle pain, weakness, cut throat, cough at 4 March, 2022. On March 7, he had tested Covid-19 and the result was negative. He was given 1gr tefazoline by eight-time interval for two days. Despite completing the therapy, episodes of fever and headache increased. A medical evaluation, which included MRI test was no disorder was developed. On March 12, painful with leg and developed muscle pain. He continued to difficulty to walk and cough, fever and weakness. On March 13, he has admitted hospital with diagnoses pneumonia. </br>He had continued sign with pneumonia in both lung, fever, infiltration with right leg, cough, headache, and glandule node in hospital. By PCR test, glander DNA was detected in sputum in National Center for Zoonotic Diseases laboratory. He recovered 20 days in hospital. </br>He has 12 days incubation period and infection route was by worked with glander strain and it was pneumonia form with laboratory-acquired human glanders. </br>Human glander case is rare in Mongolia. Three human glander cases had registered in 1966, 1972, 1977 among prison’s horse herder in Mongolia.

Distribution of tick-borne diseases at Bulgan province, Mongolia / Монголын Анагаах Ухаан

Background@#Tick-borne encephalitis is human viral infection involving the nervous system and transmitted by the bite of infected tick. The TBE Virus is distributed in different geographical areas by three widespread subtypes of the virus: The Far East, Europe, and Siberia. The Far East type has a mortality rate was 30-35%, the European type has a mortality rate of 2.2%, and the Siberian type has a mortality rate of 6-8% (A.G. Pletnev, 1998) [2]. </br>In recent years, human cases of tick-borne infections have been reported in 19 European countries and four Asian countries (Mongolia, China, Japan, and South Korea) [3]. </br>Human cases of tick-borne encephalitis, tick-borne rickettsiosis, and tick-borne borreliosis have been registered in Mongolia since 2005. Deaths have been reported year by year [5]. </br>During 2005 to 2021, tick-borne rickettsiosis (71.6%), tick-borne encephalitis (17.3%) and tick-borne borreliosis (52.9%) were confirmed by epidemiological, clinical and laboratory tests at the NCZD. </br>Tick-borne encephalitis was registered in 63 soums of 15 provinces and 9 districts of the capital city, of which 90% were infected with tick bites in Selenge and Bulgan provinces. The average mortality rate is 4.9% (14), of which 28.6% in Bulgan province and 2.7% in Selenge province. </br>Tick-borne encephalitis is the leading cause of death in Bugat soum of Bulgan province and more infected men about 40 years of age [7]. @*Purpose @#Collect ticks from selected soums of the provinces, identify tick species, species composition, distribution, tick densities, pathogens of tick-borne diseases, conduct population surveys to assess the risk of tick-borne infections, and identify tick-borne infections.@*Material and Method@#Ticks were collected by flag from birch trees in birch forests and meadows with biotope and overgrown berries, determined morphological analyze and molecular biological investigation for detecting tickborne pathogens. </br>Questionnaires were collected from selected soum residents according to a specially designed randomized epidemiological and clinical survey card, collected information and forms were submitted to soum hospitals with a history of tick bites (according to clinical criteria). Serological tests were performed to detect IgG-specific antibodies to the collected serum mites.@*Result and conclusion@#Collected 121 ticks (120 I. persulcatus and 1 D. nuttalli) and not wound egg, larvae, nymphs. By molecular biological investigation detected 3.5% of I.persulcatus from Khutag-Undur soum of Bulgan province, 3.5% of anaplasmosis, and 14.1% of I.persulcatus mites from Bugat soum. 1.5% borreliosis, 3.1% anaplasmosis. </br>Detected DNA of 100% tick-borne rickettsiosis from D.nutalli ticks and determined circulation of infection among tick in Bugat and Khutag-Undur soums of Bulgan province. </br>247 people were surveyed, 56 blood serum from cases. Detected Q fever, erysipelas, and anaplasmosis, tick-borne borreliosis 3 (5.4%), tick-borne rickettsiosis 26 (46.4%), Japanese encephalitis 3 (5.4%), tick-borne encephalitis tick-borne rickettsiosis 6 (13.0%), tick-borne rickettsiosis tick-borne borreliosis 1 (1.8%), tick’s rickettsiosis Japanese encephalitis 1 (1.8%), tick-borne encephalitis tick-borne borreliosis 1 (1.8%). </br>By investigation, vaccination (88%) and wearing long-sleeved shirts and pants (81%) were the most effective ways to prevent tick bites (81%) [15]. According to our research, the percent of population knowledge in Bulgan province was insufficient (40.9%) which there is a lack of information, training and advertisement among the population in the province.

Geographical Distribution of Tick Borne Encephalitis in Mongolia / Монголын Анагаах Ухаан

Background@#Medical geography deals with the application of major concepts and theories derived from human and physical geography to issues of health and disease. Between1970-1980, Russian scientists were first figured landscape, geographical distribution of TBE in Mongolia. Since human cases of TBD were registered from 2005, around 2000 cases of TBD were registered. From 15% of diseases and 78% of fatal cases were tick-borne encephalitis. Therefore, were tried to create current geographical distribution of TBE in Mongolia and detect risk areas. @*Мaterials and Methods@#287 TBE cases data, information of TBE positive tick and human data were analyzed which registered in NCZD between 2005-2017. Arc GIS 9 were used for create map. Mongolian map was divided by 5 landscape range such as forest-taiga, forest-steppe, steppe, steppe-desert, gobi and high mountain. @*Result@#In forest-taiga range, 57% of TBE cases and incidence was 9.51 per 10000 population. 56.4% of I.persulcatus tick, 1.9% of D.nuttalli tick were found and infection rate of tick was Ixodes persulcatus-6.97%, Dermacentor nuttalli-5.2%. Seroprevalence of TBE was 25±12.1 among population. </br> In forest-steppe range, 40% of TBE cases and incidence was 0.56 per 10000 population. 43.6% of I.persulcatus tick, 44.3% of D.nuttalli, 24.4% of D.silvarum tick tick were found and infection rate of tick was Ixodes persulcatus-3.08%, D.silvarum-1.56% and D.nuttalli-1.56%. Seroprevalence of TBE was 14.5±11 among population.</br> In steppe range, 0.7% of TBE cases and incidence was 0.12 per 10000 population. 62.2% of D.silvarum tick, 23.9% of D.nuttalli tick were found and infection rate of tick was D.nuttalli-2.81% and D.silvarum-1.2%. Seroprevalence of TBE was 16.3±6.5 among population.</br> In other range including steppe-desert, gobi and high mountain, 2.8% of TBE cases and incidence was 0.1-0.27 per 10000 population. 62.2% of D.silvarum tick, 47.6% of D.nuttalli tick were found and infection rate of tick was D.nuttalli-0.84%. Seroprevalence of TBE was 2.5-13.1 among population.@*Conclusion@#Natural foci of tick-borne encephalitis have been registered in all landscape ranges of Mongolia and higher risk area of those ranges were forest-taiga and forest-steppe. Dermacentor silvarum, Dermacentor nuttalli tick becoming dominant vector of TBE in steppe range.

External Quality Assessment Survey for Hematological Laboratories in Mongolia / Эрүүл мэндийн лаборатори

Backround@#Hematology departments of health laboratories, over capital city and 21 provinces both of governmental and private sectors in this country, have to take responsibilities for providing hematology analysis. A wide range of technology and methods have been implemented among these laboratories. Harmonization of the hematology investigations of different laboratories with standard service all over the country is the major goal to reach. We organized the MEQAS (Mongolian External Quality Assessment Scheme) since 2008 on basis the Cooperation agreement between Ministry of Health and Sysmex Corporation in the establishment of Hematology external quality control and reference laboratory system in Mongolia. This is the report of our 8-year experience of MEQAS as the national project, covering increasing numbers of laboratory members. In 2008-2017 years we set up total 18 MEQAS in Mongolia. @*Materials and Methods@#</br> <i>Survey Materials</i> </br> In each survey, the following three different of survey materials were used; </br> Sample A : Hematology Control Material 1* </br> Sample B : Hematology Control Material 2* </br> Sample C : Fresh Whole Blood Sample** </br> *Hematology Control Material provided by Sysmex Corporation </br> **Under cooperation of National Center for Transfusiology, a fresh whole blood sample was drawn from a healthy donor and prepared on the same day of sample delivery, according to the procedures reported by Kondo H et. all. </br><i>Standard Analyzers</i></br> 3 units of fully-automated standard analyzers (KX-21, pocH-100i, XS-1000i), installed at the Shastin Central Hospital, were used to assign the target values for the survey materials. These standard analyzers have been calibrated with SCS-1000® before the survey, and monitored with hematology controls, e-CHECK(XS) ® and EIGHTCHECK-3WP® on daily basis. </br> <i>Instructions & Sample Distribution</i> </br>On every survey, the workshop was held to give guidance and distribute the survey samples to each participant. </br><i>Categorization of Peer Group</i></br> Participating data were divided into two peer groups, based on methodology; Group 1: laboratories used automated hematology analyzer (in further Auto’s), Group 2: manually examined group. Each laboratory was given ID number and was asked to analyze these samples 3 times and report the all data and average for CBC 8 parameters. </br><i>Statistical Evaluation Method</i></br> For individual reports, the results for each participant were evaluated and expressed according to peer group mean and standard deviation index (SDI), Precision index (PI), Absolute evaluation, Scoring system and Target-value evaluation methods (A B C D evaluation).@*Results@#</br>The Auto’s inter-lab CV% of WBC for fresh whole blood showed decrease from 6.1 to 4.2 comparing with17^th and 18th MEQAS.</br> The Auto’s Inter-lab CV% of RBC for fresh whole blood showed decrease from 3.7 to 3.4 comparing with 17^th and 18^th MEQAS.</br> The Auto’s inter-lab CV% of HGB for fresh whole blood were very stable (2.9%, 3.0%), respectively from 17^th to 18^th MEQAS.</br> The Auto’s inter-lab CV% HCT for the fresh whole blood showed go down from 5.5% to 4.8% comparing with 17^th and 18^th MEQAS. </br>The Auto’s inter-lab CV% PLT for fresh blood showed go down from 10.2% to 8.2% comparing with 17^th and 18^th MEQAS. </br> The Auto’s inter-lab CV% of CBC parameter for fresh blood and control Material (Sample A) showed go down from 1^st to 18^th MEQAS.</br> The Auto’s inter-lab CV% of WBC, RBC, HGB, PLT for Control Material (Sample A) were big difference comparing with Japan’s CV%.@*Conclusion@#</br>1. The Auto’s inter-lab CV% of WBC, RBC and PLT for fresh whole blood has been decrease respectively 4.2%, 3.4%, 8.2% in the 18^th MEQAS and there was difference in the CV% between manufacturers.</br> 2. The Auto’s inter-lab CV% of WBC, RBC, HGB, PLT for Control Material (Sample A) showed go down from 1^st to 18^th MEQAS but were big difference comparing with Japan’s CV%. @*Acknowledgements@#We would like to express our appreciation to the Sysmex Corporation (Japan) for providing financial supports investigate this study.

Data analyze of suspicious rodents for zoonotic diseases in Mongolia / Монголын Анагаах Ухаан

BackgroundThere are 137 soums of 17 provinces have plague foci in Mongolia. The 51.7% of them is case, 23.4%- low, 9.5% - high, 0.7% - hyper active. Main host of plague foci is marmot in Mongolia. According last20 year’s surveillance study, about 75.5% of Y.pestis was isolated from marmot, marmot carcassesand their flea. Human plague cases has been caused illegal hunting marmot in Mongolia. Even legaldocument which prohibited marmot hunting was appeared since 2005, people has been hunting marmotfor selling marmot meat, skin and other products. It is depends economy crises and other public issues inMongolia. Also influenced increase risk of human plague and being reverse result in plague preventionactivities.Materials and MethodsStudy was used data of rodent for zoonotic diseases suspicious which tested plague in National centerfor zoonotic disease (NCZD) in 2005-2015 and 13 local center for zoonotic diseases in 1988-2015. Datawas kept in NCZD and National archival authority. For mapping we used Arc View 3.2.ResultsTotally 397 event information of suspicious rodents and other animals was received in NCZD from 8 districtsof Ulaanbaatar city in 2002-2015. Most of information was received from Songinokhairkhan-64.2%district and smallest number was from Nalaikh district-0.3%. 92.2% of them were marmot, 0.1% of themwere marmot raw products for treatment purpose. Totally 1285 animal samples were tested by plaguedisease and the result was negative. Five hundred thirty tree marmots were carried to Ulaanbaatar from10 provinces. In that time plague foci were active and Y.pestis was isolated in provinces which marmotwas carried to Ulaanbaatar.In 1988-2015, totally 257 marmots and animals of 515 event information was received in15 provinces.Including 13.2% of them were birds, 84% of them marmot, 1.6% of them were livestock, 1.2% of themother animals. About 216 marmots were tested by plague. 51.2% of them were detected positive results.We develop conclusion based laboratory investigation result even it need high cost to take earlyprevention and response measures.Conclusion1. It is high risk to spread plague by carrying suspicious animal in urban area. Therefore, it is importantto take early response measures even it high cost. In further, increase cost and support rapid test ofhigh technology.2. To organize rational advertisement and increase knowledge of population about not doing illegalhunting, not selling marmot raw products in urban area, not using marmot raw products for treatmentuse and avoid contact with marmot carcasses.3. It is important to cooperate joint response measures with policeman, inspection agency andveterinary and human health sectors in Mongolia.

Research on natural foci and population based monitoring of tick borne encephalitis in mongolia / Монголын Анагаах Ухаан

The number of tick borne diseases is increasing in the world. More than 100000 tick borne encephalitis, tick borne encephalitis cases were registered every year. It occurred in 29 Europien, 4 Asian countries and became public health concern [1]. In our country, virus, tick detection started since 1980 with collaboration Russian scientists. From 1998, collaborative team of Public Health Institute (PHI), National centre for communicable diseases (NCCD), National center for infectious diseases with natural foci (NCIDNF) and Rssian scientists started study of tick prevalence and infection of tick borne encephalitis in Khuvsgul, Khentii, Bulgan, Orkhon, Tuv province. In study of B.Byambaa, M.Dash (1994), 18 species tick were found in Mongolia. Ticks found in 27 soums of 7 provinces. TBE virus infection of tick was 1.2-16.7% in I.persulcatus, 13.7-20% in D.nutalli. Far eastern subtype founded from patient, Siberian subtype founded from tick in Bulgan province of Mongolia. TBEV infection was 1.1-39% among population; highest infection was in Bugan, Khuder soum of Selenge province, Dadаl soum of Khentii provinces. 57.2-59.4% of population was tick bitten and 21-73.7% of them were developed clinical symptoms during surveillance. Symptoms include redness, fever, headache, skin rash, join paint. Most TBE cases were developed fever, headache, vomiting, stiff neck, paralysis. 96% of them typical, 4.4% of them atypical, 60% of them fever, 13.3% meningial, 10% meningoencephalitis among 90 cases in 1998-2004. In review, clinical symptoms of TBE cases that occurred Mongolia similar to cases caused Sibirein subtype.

Results of tick-borne encephalitis vaccination / Монголын Анагаах Ухаан

Objective: To evaluate efficacy of vaccination against tick-born encephalitis by determination of specific antibody titer. Materials and Methods. 224 vaccinated residents (77 females, 147 males) of Selenge aimag with mean age of 33.1(6- 60), 20 worker of Ulaanbaatar with mean age of 36 (23-53) were enrolled to the study. We used Avidity determination of antibodies againt TBE Virus ELISA (Ig G) manufactured by the EUROIMMUN.Result:At 2-6 months after first dose RAI% was in low (29.4-32%), at 1 month after second dose RAI% was in equivocal (53.9%-55.6%), at 6 months after third vaccination RAI% was in high (72.5%-79.8%) avidity antibodies in two groups. That mean RAI% is increasing depend from repetition doses in both schedule. These differences were statistically significant for all post vaccination evaluation days (60,90; p0.05) level of RAI% in 6 months after second dose with compared two schedule. But it getting high level of RAI% was developed in short time (before 90 days) with the accelerated schedule than conventional schedule.Antibody titer of 2-200 RU/ ml were observed in all attendants of Selenge aimag. But only 34% of them show a protective titer. In details 62.8% of people vaccinated in 2002-2004, 55.8% of people vaccinated in 2005-2007 and 50.2% of people vaccinated in 2007-2009 year have demonstrated a protective titer. Only 21.7% and 13.4% of people vaccinated by rapid scheme and people received only first dose, respectively, have a protective immunity against TBE.Conclusion:1. The level of RAI% is increasing depends from repetition doses of vaccine TBE with accelerated and conventional schedule.2. The high level of RAI% is getting at 6 months after second dose with accelerated and conventional schedule.3. Complete dose of TBE vaccine develop a better action for establishment of specific protective immunity.