A Rare Human Helminth Infection in Russia.

Currently, more than 500,000 cases of various helminthes in humans are reported annually in the Russian Federation. This figure may not reflect the true incidence of helminthes, as only nine separate nosological forms are compulsory notifiable. The rest of the species of detected helminthes are included in a separate category of "other helminthes" or "rare helminthes". The bulk of the latter is represented by the helminthes with a rate of incidence that does not exceed one case per 100,000 people. This review is based on data derived from publications in the Russian language, both from the Russian Federation and international, as well as data available from various health treatment facilities in Russia. These data largely cover the period of the 1990s-2010s. A total of 15 species of "rare helminthes" are described in this review: anisakiosis, capillariosis, clonorchosis, dioctophymosis, dipylidiosis, echinochasmosis, fasciolosis, gastrodiscoidosis (amphistomiosis), metagonimosis, metorchiosis, nanophyetosis, pseudamphistomosis, sparganosis (spirometrosis), strongyloidosis and trichostrongylosis. Details of their geographical distribution, clinical and epidemiological peculiarities, and the difficulties they pose in diagnosis are provided. The public health importance of "rare helminthes" in Russia at present and in the forthcoming years is stressed.

Global Climate Change and Human Dirofilariasis in Russia.

Human dirofilariasis is a vector-borne helminth disease caused by two species of Dirofilaria: D. repens and D. immitis. The vectors of the helminth are mosquitoes in the family Culicidae. The definitive hosts of Dirofilaria are dogs and, to a lesser extent, cats. Humans are accidental hosts. Dirofilariasis has been reported in the territory of Russia since 1915. Sporadic cases of the disease have been reported occasionally, but the number of cases showed a distinct increasing trend in the late 1980s-early 1990s, when the number of cases reached several hundred in the southern territories of Russia, with geographic coordinates of 43° N-45° N. A comparison of the timing of the global trend of climate warming during the 1990s with the temporal pattern of the incidence of dirofilariasis in the territory of Russia indicated a close association between the two phenomena. At present, the northern range of Dirofilaria includes latitudes higher than 58° in both the European and Asian parts of the country. The phenomenon of climate warming in the territory of Russia has shaped the contemporary epidemiology of the disease. The emerging public health problem of dirofilariasis in Russia warrants the establishment of a comprehensive epidemiological monitoring system.

Prevention of re-establishment of malaria.

The current consensus on prevention of re-establishment of malaria is based on the following principles: (1) Fundamental role of general health services; (2) Surveillance; (3) Vector control; (4) Border actions; (5) Intersectoral collaboration. These principles are critically reviewed, and it is pointed out that alertness of the general health services to suspected malaria (vigilance) needs to be maintained everywhere, while health education is rational only if targeting high-risk sub-populations. It is argued that prevention of re-establishment of malaria transmission should be integrated with prevention of malaria mortality in cases of imported malaria, and that this requires collaboration with entities dealing with travellers' health and the availability of chemoprophylaxis and other measures for travellers to malaria endemic countries.

Anthology of Dirofilariasis in Russia (1915-2017).

Dirofilariasis is a helminths vector-borne disease caused by two species of Dirofolaria-D.repens and D.immitis. The former is overwhelmingly associated with human dirofilariasis. The vector of the worm are mosquitoes of the family Culicidae (largely Culex, Aedes and Anopheles). The definitive hosts of Dirofilaria are dogs and to a lesser extent cats. Humans are an accidental host. A total of 1200 human cases caused by Dirofilaria were registered in the territory of the ex-USSR during the period 1915-2016. Zonal differences have been seen in the prevalence of infected dogs and mosquitoes. Studies undertaken in the southern part of the Russian Federation (RF) revealed the prevalence of Dirofilaria in dogs to be 20.8% with wild variations of larva density. Studies carried out in the central part of the RF found that the prevalence of parasites in dogs was 4.1%. Aedes mosquitoes were infected less than Culex and Anopheles mosquitoes. The latter were infected by D. repens more often than Culex and Aedes. Zonal differences were also traced in regard to Dirofilaria prevalence in humans, thus allowing identification of three zones of risk of infection (low, moderate, and stable), reflected in a series of constructed maps. Although Dirofilariasis was known on the territory of Russia from 1915, only sporadic cases of the disease were reported occasionally. Its number was showed an increasing trend only during the 1980s-1990s, reaching the level of hundreds of cases. The majority of cases were confined to the southern parts of Russia with geographic coordinates of 43°-45° on the northern latitude. Comparison of the timing of the global trend of climate warming during the 1990s with the temporal pattern of Dirofilaria on the territory of Russia during the same period demonstrated a close association between two phenomena. With the continuous process of global climate warming, the incidence of dirofilariasis both in man and dogs goes unabated exemplified by the territorial expansion of the disease northwards and eastwards attaining the latitude of 56°-57° on the northern latitude in the European and Asian parts of Russia. It appears that within the period of the last 20-25 years, the population at risk has doubled. Under these circumstances, dirofilariases in Russia should be considered as an emerging public health problem necessitating the establishment of a comprehensive epidemiological monitoring system with strong entomological and veterinary components. Based on the results obtained, an appropriate control intervention could be developed.

Toxoplasmosis and mental disorders in the Russian Federation (with special reference to schizophrenia).

The association of latent toxoplasmosis with mental disorders in general and with schizophrenia in particular was noticed in the mid-1950s. In subsequent years, the role of Toxoplasma gondii was established based on its ability to survive for long periods of time in the nerve cells of the brain. The acute manifestations of the infection include psychopathic symptoms resembling those of schizophrenia. In the former USSR, and in other parts of the world, a number of studies were performed with respect to the association of latent toxoplasmosis and schizophrenia. However, with the dissolution of the USSR at the beginning of the 1990s, studies on the subject were halted due to financial problems and have resumed only recently. The reasons for the resumption of such studies in contemporary Russia are related to the progressively increasing incidence of schizophrenia over the last 25-30 years in the country. According to official data, approximately 550 000 persons reported suffering from the disease in 2014. There are reasons to believe that this is only a fraction of the real burden of the disease. Economically, it cost the state no less than approximately US $10 billion. The purpose of the study was to identify the level of toxoplasmosis seroprevalence in patients with verified diagnoses of schizophrenia in comparison to healthy people in Moscow City and in the Moscow region. A total of 155 persons constituted the patients group and 152 healthy people were in the control group. An integrated approach to the diagnosis and comparison of data from the entire spectrum of serological markers of infection was used, including the detection of specific IgM and the determination of IgG concentrations. It was found that among persons with neuropsychiatric disorders, the incidence of cases with latent toxoplasmosis was higher than in the control group. The effect of toxoplasmosis was significant and similar for men and women. Further statistical analyses revealed that among patients with a diagnosis of schizophrenia, the incidence of latent toxoplasmosis was significantly higher than in the control group. These data are in agreement with the results of similar studies in other countries.

Role of malaria partners in malaria elimination in Armenia.

Malaria control and preventive activities in the countries of the World Health Organization Region for Europe (WHO/EUR) were strengthened within the framework of the Regional Roll Back Malaria strategy adopted by the member-states at the beginning of the 2000s. A political document "From control to malaria elimination" known as the "Tashkent Declaration" was unanimously endorsed by the member-states of the WHO/EUR with malaria problems in 2005. Since then, considerable progress has been achieved in the countries of the region, signified by the dramatic reduction of malaria incidence in conjunction with the prevention of re-establishment of infection on the territories where malaria was eliminated earlier. Several countries of the region had been certified by the WHO as free of local malaria transmission as a result of the activities of their National Malaria Elimination Programme, Armenia being one of the first in 2011. One of the main lessons learnt during the implementation of the activities by the National Malaria Elimination Programme in Armenia was that the development of an operational plan for malaria elimination required a comprehensive national effort. Full support, both political and financial, from the highest levels of government to smooth coordination between different government ministries, such as Agriculture, Defense, Finance, Health and Policy and Planning and others, was a prerequisite for operational success. The role and place of various partners in the achievement of malaria elimination in the country is discussed in this review.

A Historical Review of WHO Certification of Malaria Elimination.

A malaria-free world remains the vision of the global community. Malaria elimination within the territory of a country is a pathway to achieving the ultimate goal of eradication. Certification of malaria elimination in a country is the official recognition of this important achievement. The concepts of eradication and elimination, and criteria for certification of malaria elimination, have guided national programs in their efforts to achieve and maintain elimination. They have evolved from the experiences and setbacks of the global eradication program, and on the contemporaneous understanding of the concepts of achieving and maintaining elimination. WHO's certification has been successful, with the majority of certified countries remaining malaria free, but to operationalize the criterion for preventing re-establishment of transmission remains challenging.

Epidemiology and Control of Leishmaniasis in the Former USSR: A Review Article.

BACKGROUND: All types of the Old World's leishmaniasis were endemic on the territory of the South regions of ex-USSR. Epidemiological situation was well under control during the USSR era, due to implementation of complex anti-leismaniasis measures. These interventions were dramatically stopped as a result of the collapse of the USSR. METHODS: Most relevant publications on epidemiology and control of leishmaniases in the Republics of Central Asia and Transcaucasia of the ex-USSR were screened. RESULTS: Within the endemic area, the foci of different kinds of leishmaniasis are often overlapped thus calling for deployment of integrated measures. The anthroponotic cutaneous leishmaniasis (ACL) was reported in settlements and towns of Central Asia and Transcaucasia of the ex-USSR. The natural foci of cutaneous leishmaniasis were widespread in the desert of Turkmenistan, Uzbekistan, Kazakhstan and Tajikistan. The northern boundary of the zoonotic cutaneous leishmaniasis (ZCL) area coincided with the northern boundary of the distribution of great gerbils - the main reservoir of this infection in the ex-USSR. Visceral leishmaniasis (VL) occurred in the Central Asian Republics and in the republics of the Transcaucasia. Holistic approach was adopted by the programs targeting the source of infection, vector(s) and man. CONCLUSION: The presence rise in the number of cases of different types of leishmaniasis in the ex-USSR strongly necessitates that health authorities should consider these diseases as an important public health problem. The immediate task would be rebuilding a comprehensive surveillance system consisting of active and passive case detection mechanism along with immediate treatment of the patients.

On the epidemiology of Plasmodium vivax malaria: past and present with special reference to the former USSR.

Presently, many malaria-endemic countries in the world are transitioning towards malaria elimination. Out of the 105 countries with ongoing malaria transmission, 10 countries are classified as being in the pre-elimination phase of malaria control, and 9 countries are in the malaria elimination stage, whereas 7 countries are classified as being in the prevention of introduction phase. Between 2000 and 2015, 17 countries eliminated malaria (i.e., attained zero indigenous cases for 3 years or more). Seven countries were certified by the WHO as having successfully eliminated malaria. The purpose of this review was to analyse the epidemiological characteristics of vivax malaria during the various stages of malaria eradication (elimination) programmes in different countries in the past and present. Experiences of the republics of the former USSR with malaria are interesting, particularly since the data overwhelmingly were published in Russian and might not be known to western readers. Among the most important characteristics of Plasmodium vivax epidemiology at present are changes in the ratio of the short-incubation P. vivax to long-incubation P. vivax, the incidence of severe P. vivax cases, the increased numbers of asymptomatic P. vivax cases, the reduced response to anti-malarials and a few others. Various factors contributing towards the peculiarities of P. vivax epidemiology are discussed.

Significance of chronic toxoplasmosis in epidemiology of road traffic accidents in Russian Federation.

Studies carried out in Moscow residents have revealed that the prevalence of chronic toxoplasmosis is very close to those in countries of Eastern and Central Europe. Our findings also demonstrated a statistically significant relationship between the rate of traffic accidents and the seroprevalence of chronic toxoplasmosis in drivers who were held responsible for accidents. The latter was 2.37 times higher in drivers who were involved in road accidents compared with control groups. These results suggest that the consequences of chronic toxoplasmosis (particularly a slower reaction time and decreased concentration) might contribute to the peculiarities of the epidemiology of road traffic accidents in the Russian Federation and might interfere with the successful implementation of the Federal Programme named "Increase road traffic safety". Suggestions for how to address overcome this problem are discussed in this paper.

Elimination of Plasmodium falciparum malaria in Tajikistan.

Malaria was eliminated in Tajikistan by the beginning of the 1960s. However, sporadic introduced cases of malaria occurred subsequently probably as a result of transmission from infected mosquito Anopheles flying over river the Punj from the border areas of Afghanistan. During the 1970s and 1980s local outbreaks of malaria were reported in the southern districts bordering Afghanistan. The malaria situation dramatically changed during the 1990s following armed conflict and civil unrest in the newly independent Tajikistan, which paralyzed health services including the malaria control activities and a large-scale malaria epidemic occurred with more than 400,000 malaria cases. The malaria epidemic was contained by 1999 as a result of considerable financial input from the Government and the international community. Although Plasmodium falciparum constituted only about 5% of total malaria cases, reduction of its incidence was slower than that of Plasmodium vivax. To prevent increase in P. falciparum malaria both in terms of incidence and territory, a P. falciparum elimination programme in the Republic was launched in 200, jointly supported by the Government and the Global Fund for control of AIDS, tuberculosis and malaria. The main activities included the use of pyrethroids for the IRS with determined periodicity, deployment of mosquito nets, impregnated with insecticides, use of larvivorous fishes as a biological larvicide, implementation of small-scale environmental management, and use of personal protection methods by population under malaria risk. The malaria surveillance system was strengthened by the use of ACD, PCD, RCD and selective use of mass blood surveys. All detected cases were timely epidemiologically investigated and treated based on the results of laboratory diagnosis. As a result, by 2009, P. falciparum malaria was eliminated from all of Tajikistan, one year ahead of the originally targeted date. Elimination of P. falciparum also contributed towards speedy reduction of P. vivax incidence in Tajikistan.

Prophylactic efficacy of primaquine for preventing Plasmodium falciparum and Plasmodium vivax parasitaemia in travelers: A meta-analysis and systematic review.

BACKGROUND: With increased international travel over the world the need for safe and effective chemoprophylaxis for malaria is as great as ever. The choice of regimen is difficult, as effectiveness should be weighted against potential adverse effects. Although, some studies have reported high prophylactic efficacy of primaquine, there is no comprehensive evidence comparing its prophylactic effectiveness as well as toxicity. To fill the gap, this systematic review and meta-analysis study was carried out. METHODS: Using MeSH terms, 756 records were detected through searching "Pubmed", "Embase","Web of Science"and "Cochrane" databases. From these,7 relevant full-text articles with 14 comparisons for final quantitative meta-analysis were included in our review. In order to make a comparison between the studies, Risk Ratios(RRs) and their 95% confidence intervals(CIs) were estimated. RESULTS: Overall,74% reduction in the incidence of parasitaemia by primaquine versus other prophylactic regimens was estimated(RRoverall = 0.26, CI 95%:0.16-0.41--RRvivax = 0.16, CI 95%:0.07-0.36--RRfalciparum = 0.31, CI 95%:0.18-0.55). The incidence rate ratios for adverse effects showed no statistically significant difference between primaquine and control groups (p > 0.05). CONCLUSIONS: For persons without G6PD deficiency, who are not pregnant, primaquine is the most effective presently available prophylactic for P. vivax malaria and comparable to such regimens as doxycycline, mefloquine and atovaquone-proguanil for the prevention of P. falciparum malaria.

Mass primaquine treatment to eliminate vivax malaria: lessons from the past.

Recent successes in malaria control have put malaria eradication back on the public health agenda. A significant obstacle to malaria elimination in Asia is the large burden of Plasmodium vivax, which is more difficult to eliminate than Plasmodium falciparum. Persistent P. vivax liver stages can be eliminated only by radical treatment with a ≥ seven-day course of an 8-aminoquinoline, with the attendant risk of acute haemolytic anaemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Primaquine is the only generally available 8-aminoquinoline. Testing for G6PD deficiency is not widely available, and so whilst it is widely recommended, primaquine is often not prescribed. In the past, some countries aiming for vivax malaria eradication deployed mass treatments with primaquine on a massive scale, without G6PD testing. In Azerbaijan, Tajikistan (formerly USSR), North Afghanistan and DPR Korea 8,270,185 people received either a 14-day "standard" or a 17-day "interrupted" primaquine treatment to control post-eradication malaria epidemics. These mass primaquine preventive treatment campaigns were conducted by dedicated teams who administered the drugs under supervision and then monitored the population for adverse events. Despite estimated G6PD prevalences up to 38.7%, the reported frequency of severe adverse events related to primaquine was very low. This experience shows that with careful planning and implementation of mass treatment strategies using primaquine and adequate medical support to manage haemolytic toxicity, it is possible to achieve high population coverage, substantially reduce malaria transmission, and manage the risk of severe acute haemolytic anaemia in communities with a relatively high prevalence of G6PD deficiency safely.

Peculiarities of a malaria case imported from Myanmar to Moscow (Russian Federation).

An imported case of presumably Chesson strain Plasmodium vivax from Myanmar to Moscow is presented. In the absence of radical treatment with primaquine the patient experienced a series of 5 subsequent relapses after treatment with Delagil (chloroquine). The period between relapses ranged from 47-61 days. It is concluded that importation of Chesson-like strains with high relapse frequencies, in conjunction with their relative tolerance to primaquine and the absence of adequate treatment with this drug, might result in the re-establishment of local transmission in areas free of malaria but with high receptivity.