Latent tuberculosis infection in children and adolescents in Russia.

BACKGROUND: After the breakup of the Soviet Union, the annual incidence of tuberculosis (TB) in children 15-17 years of age increased in the Russian Federation from 16 per 100 000 population in 1992 to 37 per 100 000 in 2009, and new control measures were implemented. METHODS: Children were screened annually for TB exposure with a tuberculin skin test (TST) at age 1-8 years. If positive, they were investigated for active TB. If no active TB was found, they were treated with isoniazid for 4-6 months; they then underwent 6-monthly skin tests (which included two recombinant proteins) until negative and annual skin tests thereafter. From the age of 8 years, the yearly follow-up was performed using the skin test that included two recombinant proteins, either until they became negative, developed active TB, or turned 18 years. RESULTS: The annual incidence of TB in Russian children decreased from 19.1 per 100 000 population in 2001 to 8.3 per 100 000 population in 2018. CONCLUSIONS: Annual screening for TB exposure with treatment for latent or active TB has reduced the annual incidence of TB in Russian children aged 15-17 years to 1992 levels.

Epidemiological and etiological features of travel-related febrile illnesses in hospitalized Russian children and adults: A single-centre, retrospective analysis in Moscow.

BACKGROUND: A number of factors can lead to differences in infectious disease morbidity in children versus adults after a trip abroad. We aimed to investigate the epidemiological and etiological features of infectious diseases in children after international travel. METHODS: we analyzed the medical records of 2135 patients (416 children) who were hospitalized during the period 2009-2017 after return from international travel. RESULTS: Hospitalized children were under the age of 1 year in 8.7% of cases, 1-3 years - 39.4%, 4-6 years - 17.3%, 7-11 years - 16.8%, 12-17 years - 17.8%. Children were hospitalized after visiting the following main destinations: Turkey (15%), Egypt (12%), Central Asia microregion [11%] and Thailand (9%). Hospitalizations among children occurred mainly in summer (38.0%; CI 33.3-42.4). In adults there were no significant seasonal differences. Children were more likely to have acute diarrhea (18.3 vs 11.1%), acute respiratory tract infections (51.2 vs 41.2%) and enterovirus infections (8.2 vs 3.1%). Among the non-endemic infections for Russia, 8 children were diagnosed with dengue fever, 1 with typhoid, 1 with malaria, and 1 with wild-poliovirus excretion. CONCLUSION: children were mainly hospitalized during summer. Among hospitalized children, almost half was under 3 years old. In children acute respiratory infection and intestinal infections predominated, while in adults, vector-borne diseases were more frequently observed.

Recent autochthonous cases of leishmaniasis in residents of the Republic of Dagestan, Russian Federation.

Eighty years after the last published record of human leishmaniasis from Dagestan, Russian Federation, we report two recent cases which were most probably acquired locally: one case of visceral leishmaniasis in a 2-year old child, and one cutaneous leishmaniasis case in a 39-year-old man co-infected with HIV, both resident in Dagestan.

The application of proteomic methods (MALDI-toff MS) for studying protein profiles of some nematodes (dirofilaria and ascaris) for differentiating species.

INTRODUCTION: Matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-toff MS) is a reliable method for diagnosing a number of bacterial and fungal infections. It is also effective as a method of rapid diagnosis of several parasitic agents. We used MALDI-toff MS to study the protein profiles of four nematodes: Dirofilaria repens, Dirofilaria. immitis, Ascaris suum and Ascaris lumbricoides. METHODS: We studied the protein profiles of dirofilaria (five of each species: D. repens and D. immitis) and ascaris (five of each species: A. suum and A. lumbricoides), using a proteomic analysis based on MALDI-toff MS. RESULTS: Analysis of protein extracts of dirofilaria and ascaris showed spectra with high-intensity peaks in the range of 2-20 kDa. The quality of the spectra (clear graphical reflection of mass/charge to luminous intensity, consistent in repeated analyzes) and the intensity of the spectral peaks were consistent in all samples of the same species. The spectra profiles of D. repens and D. immitis differed in eight major peaks which makes it possible to differentiate species according to the protein profile. The spectra profiles obtained from A. suum and A. lumbricoides proteins differed slightly in 3 major peaks in both species and were discovered in m/z 13000; 13400 and 14400. The protein peaks in diapason 3000 kD-7300 kD specific for all genus ascaris are constant. CONCLUSIONS: MALDI-toff MS-based proteomic analysis can serve as an effective taxonomic tool for parasitological studies.

Availability of hepatitis C diagnostics and therapeutics in European and Eurasia countries.

BACKGROUND: Treatment with direct acting antiviral agents (DAAs) has provided sustained virological response rates in >95% of patients with chronic hepatitis C virus (HCV) infection. However treatment is costly and market access, reimbursement and governmental restrictions differ among countries. We aimed to analyze these differences among European and Eurasian countries. METHODS: A survey including 20-item questionnaire was sent to experts in viral hepatitis. Countries were evaluated according to their income categories by the World Bank stratification. RESULTS: Experts from 26 countries responded to the survey. As of May 2016, HCV prevalence was reported as low (≤1%) in Croatia, Czech Republic, Denmark, France, Germany, Hungary, the Netherlands, Portugal, Slovenia, Spain, Sweden, UK; intermediate (1-4%) in Azerbaijan, Bosnia and Herzegovina, Italy, Kosovo, Greece, Kazakhstan, Romania, Russia, Serbia and high in Georgia (6.7%). All countries had national guidelines except Albania, Kosovo, Serbia, Tunisia, and UK. Transient elastography was available in all countries, but reimbursed in 61%. HCV-RNA was reimbursed in 81%. PegIFN/RBV was reimbursed in 54% of the countries. No DAAs were available in four countries: Kazakhstan, Kosovo, Serbia, and Tunisia. In others, at least one DAA combination with either PegIFN/RBV or another DAA was available. In Germany and the Netherlands all DAAs were reimbursed without restrictions: Sofosbuvir and sofosbuvir/ledipasvir were free of charge in Georgia. CONCLUSION: Prevalence of HCV is relatively higher in lower-middle and upper-middle income countries. DAAs are not available or reimbursed in many Eurasia and European countries. Effective screening and access to care are essential for reducing liver-related morbidity and mortality.

Crimean-Congo hemorrhagic fever in pregnancy: A systematic review and case series from Russia, Kazakhstan and Turkey.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is acute viral infection and a major emerging infectious diseases threat, affecting a large geographical area. There is no proven antiviral therapy and it has a case fatality rate of 4-30%. The natural history of disease and outcomes of CCHF in pregnant women is poorly understood. OBJECTIVES: To systematically review the characteristics of CCHF in pregnancy, and report a case series of 8 CCHF cases in pregnant women from Russia, Kazakhstan and Turkey. METHODS: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. PubMed, SCOPUS, Science Citation Index (SCI) were searched for reports published between January 1960 and June 2016. Two independent reviewers selected and reviewed studies and extracted data. RESULTS: Thirty-four cases of CCHF in pregnancy were identified, and combined with the case series data, 42 cases were analyzed. The majority of cases originated in Turkey (14), Iran (10) and Russia (6). There was a maternal mortality of 14/41(34%) and fetal/neonatal mortality of in 24/41 cases (58.5%). Hemorrhage was associated with maternal (p=0.009) and fetal/neonatal death (p<0.0001). There was nosocomial transmission to 38 cases from 6/37 index pregnant cases. CONCLUSION: Cases of CCHF in pregnancy are rare, but associated with high rates of maternal and fetal mortality, and nosocomial transmission.

Possible sexual transmission of Crimean-Congo hemorrhagic fever.

Three cases of family transmission of laboratory-confirmed Crimean-Congo hemorrhagic fever (CCHF) among spouses are reported. These spouses had sexual contact at the end of the incubation period or during the early stage of the mild form of CCHF, without any hemorrhagic symptoms in the first infected spouse. This report demonstrates that sexual contact may represent a real risk of CCHF transmission, even if the patient only experiences mild symptoms.

Probable Crimean-Congo hemorrhagic fever virus transmission occurred after aerosol-generating medical procedures in Russia: nosocomial cluster.

We report here a fatal case of laboratory confirmed Crimean-Congo hemorrhagic fever (CCHF), which caused nosocomial infection in eight health care workers (HCWs), who had provided medical care for the patient. All the HCWs survived. The report demonstrates that airborne transmission of CCHF is a real risk, at least when the CCHF patient is in a ventilator. During performance of any aerosol-generating medical procedures for any CCHF patient airborne precautions should always be added to standard precautions, in particular, airway protective N95 mask or equivalent standard, eye protection, single airborne precaution room, or a well-ventilated setting.

Periorbital Dirofilaria repens imported to Denmark: A human case report.

Dirofilaria repens, a filarial nematode of dogs and other carnivores, can accidentally infect humans. The infection occurs widely throughout Europe. We report a case of D. repens in a Danish woman who had been traveling to Crete. A nematode was visualized on examination and ELISA was positive for antibodies against D. repens.

Dirofilaria repens in the Russian Federation: current epidemiology, diagnosis, and treatment from a federal reference center perspective.

BACKGROUND: Dirofilariasis is an emerging zoonotic infection in which the human serves as an accidental host. Russia has been one of the most important endemic regions worldwide for Dirofilaria repens, the most prevalent Dirofilaria species in Europe. METHODS: Based on a cohort of patients at the Rostov Medical University, we provide an epidemiological description of 236 human cases, reporting common clinical symptoms and treatment options for D. repens infections in humans. The performance of a non-commercial immunoassay was validated in a diagnostic sub-study (diagnostic accuracy 83%). Data from mosquito surveys and cross-sectional surveys of dogs, the main reservoir of D. repens, are also presented. RESULTS: Results showed important variations in prevalence depending on sex, geographic location, and the use of dogs (professional service dogs or pets). CONCLUSIONS: The particularly high prevalence of Dirofilaria infection in professional dogs used in the police force and armed forces poses a particular problem, since these dogs may serve as epidemiologically important amplifiers within the region of the former Soviet Union.