Oral health status and indicators in children of Armenia based on the national surveys.

BACKGROUND: The aim of this study was to determine the dynamics and the structure of dental morbidity of the children population of the Republic of Armenia, in order to improve the system of methods of therapeutic and preventive measures. METHODS: In recommended children's key age groups, 5879 WHO assessment forms (1997) were analyzed. Calculated prevalence and intensity of dental caries, the Significant Index of Caries (SiC) and European dental health indicators, and the condition of periodontal tissues were determined with the help of the community periodontal index (CPI) and oral hygiene by OHI-S. The statistical analysis was performed within the SPSS 19 (SPSS Inc., Chicago, IL, USA). The obtained data were statistically processed in the STATISTICA 6.0 (StataCorp LLC, College Station, TX, USA) for Excel program (Microsoft Corp., Redmond, WA, USA). RESULTS: The prevalence of caries of temporary teeth was 91.7% on the average. In 12-year-old schoolchildren the average prevalence of caries of permanent teeth rate was 87.5%. The prevalence of periodontal lesions in children was 47.8% on the average. CONCLUSIONS: In Armenia there was an increase in dental morbidity during the 2009-2019 period, which presumably would be continued unless the factors affecting the development of diseases will be changed. To improve dental health at the population level not only specialists but also health authorities should make efforts introducing appropriate prevention programs.

Emergency Medical Services Preparedness in Dual Disasters: War in the Era of COVID-19 in Armenia.

INTRODUCTION: Emergency Medical Services (EMS) is a critical part of Disaster Medicine and has the ability to limit morbidity and mortality in a disaster event with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training in the country. As a result, EMS physicians are trained in a variety of specialties.Armenia is also a country prone to disasters, and recently, the Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War broke out in the midst of the SARS-CoV-2/coronavirus disease 2019 (COVID-19) pandemic. STUDY OBJECTIVE: This study aims to assess the current state of disaster preparedness of the Armenian EMS system and the effects of the simultaneous pandemic and war on EMS providers. METHODS: This was a cross-sectional study conducted by anonymous survey distributed to physicians still working in the Yerevan EMS system who provided care to war casualties and COVID-19 patients. RESULTS: Survey response rate was 70.6%. Most participants had been a physician (52.1%) or EMS physician (66.7%) for three or less years. The majority were still in residency (64.6%). Experience in battlefield medicine was limited prior to the war, with the majority reporting no experience in treating mass casualties (52.1%), wounds from explosives (52.1%), or performing surgical procedures (52.1%), and many reporting minimal to no experience in treating gunshot wounds (62.5%), severe burns (64.6%), and severe orthopedic injuries (64.6%). Participants had moderate experience in humanitarian medicine prior to war. Greater experience in battlefield medicine was found in participants with more than three years of experience as a physician (z-score -3.26; P value <.01) or as an EMS physician (z-score -2.76; P value <.01) as well as being at least 30 years old (z-score -2.11; P value = .03). Most participants felt they were personally in danger during the war at least sometimes (89.6%). CONCLUSION: Prior to the COVID-19 pandemic and simultaneous 2020 Nagorno-Karabakh War, EMS physicians in Armenia had limited training and experience in Disaster Medicine. This system, and the frontline physicians on whom it relies, was strained by the dual disaster, highlighting the need for Disaster Medicine training in all prehospital medical providers.

Impact of the COVID-19 pandemic on routine immunization services in Yerevan and vaccinations against COVID-19 in Armenia.

INTRODUCTION: The coronavirus disease (COVID-19) has led to millions of deaths around the world. The indirect effects of the pandemic, include disruption of routine immunization services. METHODOLOGY: We conducted a retrospective review to assess the impact of the pandemic on routine immunization in Yerevan and the vaccinations against COVID-19 in Armenia. We compared the number of administered doses of DPT/VHB/HIB/IPV1,2,3, Pneumococcal1,2,3, Rotarix1,2, and MMR1 vaccines in target groups in 2020 and 2021 and the total vaccination coverage in 2019, 2020, and 2021. We also analyzed the number of COVID-19 vaccines administered in Armenia from 17 May 2021 to 6 February 2022. RESULTS: There was a decline in the number of administered doses of vaccines at the beginning of the pandemic due to restrictive quarantine measures: 16 ± 4.5 (95% CI, 11.8-20.2), p < 0.05, during the second wave 18 ± 2.6 (95% CI, 15.6-20.4), p < 0.05 and during the interruption due to COVID-19 vaccine delivery 16 ± 7.4 (95% CI, 9.1-22.9), p < 0.05. There was no significant decrease in the number of vaccinations during the first, third, and fourth pandemic waves (p > 0.05) Overall, the COVID-19 vaccination process was slow and only 30% of the population were vaccinated. CONCLUSIONS: The COVID-19 pandemic led to disruptions in the routine immunization process, but there was no significant decrease in the total vaccine coverage due to rapid scaling up of the vaccination services and catch-up vaccinations. Thus, the restrictions imposed during the pandemic did not affect the overall progress of vaccination.

Molecular Analysis of SARS-CoV-2 Lineages in Armenia.

The sequencing of SARS-CoV-2 provides essential information on viral evolution, transmission, and epidemiology. In this paper, we performed the whole-genome sequencing of SARS-CoV-2 using nanopore and Illumina sequencing to describe the circulation of the virus lineages in Armenia. The analysis of 145 full genomes identified six clades (19A, 20A, 20B, 20I, 21J, and 21K) and considerable intra-clade PANGO lineage diversity. Phylodynamic and transmission analysis allowed to attribute specific clades as well as infer their importation routes. Thus, the first two waves of positive case increase were caused by the 20B clade, the third peak caused by the 20I (Alpha), while the last two peaks were caused by the 21J (Delta) and 21K (Omicron) variants. The functional analyses of mutations in sequences largely affected epitopes associated with protective HLA loci and did not cause the loss of the signal in PCR tests targeting ORF1ab and N genes as confirmed by RT-PCR. We also compared the performance of nanopore and Illumina short-read sequencing and showed the utility of nanopore sequencing as an efficient and affordable alternative for large-scale molecular epidemiology research. Thus, our paper describes new data on the genomic diversity of SARS-CoV-2 variants in Armenia in the global context of the virus molecular genomic surveillance.

SARS-CoV-2 detection by extraction-free qRT-PCR for massive and rapid COVID-19 diagnosis during a pandemic in Armenia.

COVID-19 pandemic severely impacted the healthcare and economy on a global scale. It is widely recognized that mass testing is an efficient way to contain the spread of SARS-CoV-2 infection as well as aid in the development of informed policies for disease management. However, the current COVID-19 worldwide infection rates increased the demand for rapid and reliable screening of infection. We compared the performance of qRT-PCR in direct heat-inactivated (H), heat-inactivated and pelleted (HC) samples against RNA in a group of 74 subjects (44 positive and 30 negative). Then we compared the sensitivity of HC in a larger group of 196 COVID-19 positive samples. Our study suggests that HC samples show higher accuracy for SARS-CoV-2 detection PCR assay compared to direct H (89 % vs 83 % of the detection in RNA). The sensitivity of detection using direct samples varied depending on the sample transport and storage media as well as the viral loads (as measured by qRT-PCR Ct levels). Altogether, all the data suggest that purified RNA provides more accurate results, however, direct sample testing with qRT-PCR may help to significantly increase testing capacity. Switching to the direct sample testing is justified if the number of tests is doubled at least.

Violation of the Global Ceasefire in Nagorno-Karabagh: A Viral Amplification of Aggression.

On March 23, 2020, the United Nations (UN) made an "Appeal for a Global Ceasefire following the Outbreak of Coronavirus." Despite this appeal, the Nagorno-Karabagh war was instigated on September 27, 2020. This Guest Editorial frames the conflict in the context of the UN appeal and by introducing a figure that plots seven-day average coronavirus disease 2019 (COVID-19) cases overlaid with key inflection points to illustrate the clear impact that conflict has had on pandemic spread in Armenia. The conflict in Nagorno-Karabagh provides a timely, concise, and illustrative example of conflict and its impact on health. Finally, an argument is made that the ability to enforce the UN "Appeal for a Global Ceasefire" is essential to ensure global health and security.

Surveillance Metrics of SARS-CoV-2 Transmission in Central Asia: Longitudinal Trend Analysis.

BACKGROUND: SARS-CoV-2, the virus that caused the global COVID-19 pandemic, has severely impacted Central Asia; in spring 2020, high numbers of cases and deaths were reported in this region. The second wave of the COVID-19 pandemic is currently breaching the borders of Central Asia. Public health surveillance is necessary to inform policy and guide leaders; however, existing surveillance explains past transmissions while obscuring shifts in the pandemic, increases in infection rates, and the persistence of the transmission of COVID-19. OBJECTIVE: The goal of this study is to provide enhanced surveillance metrics for SARS-CoV-2 transmission that account for weekly shifts in the pandemic, including speed, acceleration, jerk, and persistence, to better understand the risk of explosive growth in each country and which countries are managing the pandemic successfully. METHODS: Using a longitudinal trend analysis study design, we extracted 60 days of COVID-19-related data from public health registries. We used an empirical difference equation to measure the daily number of cases in the Central Asia region as a function of the prior number of cases, level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: COVID-19 transmission rates were tracked for the weeks of September 30 to October 6 and October 7-13, 2020, in Central Asia. The region averaged 11,730 new cases per day for the first week and 14,514 for the second week. Infection rates increased across the region from 4.74 per 100,000 persons to 5.66. Russia and Turkey had the highest 7-day moving averages in the region, with 9836 and 1469, respectively, for the week of October 6 and 12,501 and 1603, respectively, for the week of October 13. Russia has the fourth highest speed in the region and continues to have positive acceleration, driving the negative trend for the entire region as the largest country by population. Armenia is experiencing explosive growth of COVID-19; its infection rate of 13.73 for the week of October 6 quickly jumped to 25.19, the highest in the region, the following week. The region overall is experiencing increases in its 7-day moving average of new cases, infection, rate, and speed, with continued positive acceleration and no sign of a reversal in sight. CONCLUSIONS: The rapidly evolving COVID-19 pandemic requires novel dynamic surveillance metrics in addition to static metrics to effectively analyze the pandemic trajectory and control spread. Policy makers need to know the magnitude of transmission rates, how quickly they are accelerating, and how previous cases are impacting current caseload due to a lag effect. These metrics applied to Central Asia suggest that the region is trending negatively, primarily due to minimal restrictions in Russia.

Frozen conflict in the midst of a global pandemic: potential impact on mental health in Armenian border communities.

Armenia has been in a conflict with its neighbor, Azerbaijan, since 1988. Civilians in Tavush Province are regularly affected by ceasefire violations along the armed border with recent escalations further threatening the population's safety. In the midst of the COVID-19 pandemic, concerns regarding the mental health of border village residents in Armenia are prevalent. We present context-related factors of psychiatric illness, the prevalence of mental health disorders, and the state of mental health services in Armenia. We recommend directing greater attention towards the mental health status of civilians residing in conflict zones during the ongoing COVID-19 pandemic.