Spatial and temporal patterns of haemorrhagic fever with renal syndrome (HFRS) and the impact of environmental drivers in a border area of the Russian Far East.

AIMS: Haemorrhagic fever with renal syndrome (HFRS) is a significant zoonotic disease transmitted by rodents. The distribution of HFRS in the European part of Russia has been studied quite well; however, much less is known about the endemic area in the Russian Far East. The mutual influence of the epidemic situation in the border regions and the possibility of cross-border transmission of infection remain poorly understood. This study aims to identify the spatiotemporal hot spots of the incidence and the impact of environmental drivers on the HFRS distribution in the Russian Far East. METHODS AND RESULTS: A two-scale study design was performed. Kulldorf's spatial scan statistic was used to conduct spatiotemporal analysis at a regional scale from 2000 to 2020. In addition, an ecological niche model based on maximum entropy was applied to analyse the contribution of various factors and identify spatial favourability at the local scale. One spatiotemporal cluster that existed from 2002 to 2011 and located in the border area and one pure temporal cluster from 2004 to 2007 were revealed. The best suitability for orthohantavirus persistence was found along rivers, including those at the Chinese-Russian border, and was mainly explained by land cover, NDVI (as an indicator of vegetation density and greenness) and elevation. CONCLUSIONS: Despite the stable incidence in recent years in, targeted prevention strategies are still needed due to the high potential for HRFS distribution in the southeast of the Russian Far East.

Spatial patterns of tuberculosis in Russia in the context of social determinants.

Our study investigated the spatial distribution of tuberculosis and the influence of social determinants in Russia between 2006 and 2018 using the regional incidence of multi-drug resistance tuberculosis, HIV-TB coinfection, and mortality data. The "space-time cube" method identified the uneven geographical distribution of the tuberculosis burden. There is a clear distinction between a healthier European Russia, where a statistically significant stable trend towards a decrease in incidence and mortality was found, and the eastern part of the country, where there is no such trend. Generalized linear logistic regression analysis found that the challenging situation was associated with HIV-TB coinfection incidence, with a high incidence rate being detected even in more prosperous regions of European Russia. HIV-TB coinfection incidence was determined by a set of socioeconomic variables, out of which the influence of income and urbanization were the most pronounced. The influence of crime could indicate the spread of tuberculosis in socially disadvantaged regions.

Spatial patterns of West Nile virus distribution in the Volgograd region of Russia, a territory with long-existing foci.

Southern Russia remains affected by West Nile virus (WNV). In the current study, we identified the spatial determinants of WNV distribution in an area with endemic virus transmission, with special reference to the urban settings, by mapping probable points of human infection acquisition and points of virus detection in mosquitoes, ticks, birds, and mammals during 1999-2016. The suitability of thermal conditions for extrinsic virus replication was assessed based on the approach of degree-day summation and their changes were estimated by linear trend analysis. A generalized linear model was used to analyze the year-to-year variation of human cases versus thermal conditions. Environmental suitability was determined by ecological niche modelling using MaxEnt software. Human population density was used as an offset to correct for possible bias. Spatial analysis of virus detection in the environment showed significant contributions from surface temperature, altitude, and distance from water bodies. When indicators of location and mobility of the human population were included, the relative impact of factors changed, with roads becoming most important. When the points of probable human case infection were added, the percentage of leading factors changed only slightly. The urban environment significantly increased the epidemic potential of the territory and created quite favorable conditions for virus circulation. The private building sector with low-storey houses and garden plots located in the suburbs provided a connection between urban and rural transmission cycles.

Health disparities in Russia at the regional and global scales.

BACKGROUND: The capacity for health comparisons, including the accurate comparison of indicators, is necessary for a comprehensive evaluation of well-being in places where people live. An important issue is the assessment of within-country heterogeneity for geographically extensive countries. The aim of this study was to assess the spatial and temporal changes in health status in Russia and to compare these regional changes with global trends. METHODS: The index, which considers the infant mortality rate and the male and female life expectancy at birth, was used for this purpose. Homogeneous territorial groups were identified using principal component analysis and multivariate ranking procedures. Trend analysis of individual indicators included in the index was also performed to assess the changes over the past 20 years (1990-2017). RESULTS: The study indicated a trend towards convergence in health indicators worldwide, which is largely due to changes in infant mortality. It also revealed that the trend of increasing life expectancy in many regions of Russia is not statistically significant. Significant interregional heterogeneity of health status in Russia was identified according to the application of typological ranking. The regions were characterized by similar index values until the mid-1990s. CONCLUSIONS: The strong spatial inequality in health of population was found in Russia. While many regions of Russia were comparable to the countries in the high-income group in terms of GDP, the progress in health was less pronounced. Perhaps this can be explained by intraregional inequality, expressed by significant fluctuations in income levels. TRIAL REGISTRATION: Not applicable.

Intraurban social risk and mortality patterns during extreme heat events: A case study of Moscow, 2010-2017.

There is currently an increase in the number of heat waves occurring worldwide. Moscow experienced the effects of an extreme heat wave in 2010, which resulted in more than 10,000 extra deaths and significant economic damage. This study conducted a comprehensive assessment of the social risks existing during the occurrence of heat waves and allowed us to identify the spatial heterogeneity of the city in terms of thermal risk and the consequences for public health. Using a detailed simulation of the meteorological regime based on the COSMO-CLM regional climate model and the physiologically equivalent temperature (PET), a spatial assessment of thermal stress in the summer of 2010 was carried out. Based on statistical data, the components of social risk (vulnerabilities and adaptive capacity of the population) were calculated and mapped. We also performed an analysis of their changes in 2010-2017. A significant differentiation of the territory of Moscow has been revealed in terms of the thermal stress and vulnerability of the population to heat waves. The spatial pattern of thermal stress agrees quite well with the excess deaths observed during the period from July to August 2010. The identified negative trend of increasing vulnerability of the population has grown in most districts of Moscow. The adaptive capacity has been reduced in most of Moscow. The growth of adaptive capacity mainly affects the most prosperous areas of the city.

Re-introduction of vivax malaria in a temperate area (Moscow region, Russia): a geographic investigation.

BACKGROUND: Between 1999 and 2008 Russia experienced a flare-up of transmission of vivax malaria following its massive importation with more than 500 autochthonous cases in European Russia, the Moscow region being the most affected. The outbreak waned soon after a decrease in importation in mid-2000s and strengthening the control measures. Compared with other post-eradication epidemics in Europe this one was unprecedented by its extension and duration. METHODS: The aim of this study is to identify geographical determinants of transmission. The degree of favourability of climate for vivax malaria was assessed by measuring the sum of effective temperatures and duration of season of effective infectivity using data from 22 weather stations. For geospatial analysis, the locations of each of 405 autochthonous cases detected in Moscow region have been ascertained. A MaxEnt method was used for modelling the territorial differentiation of Moscow region according to the suitability of infection re-emergence based on the statistically valid relationships between the distribution of autochthonous cases and environmental and climatic factors. RESULTS: In 1999-2004, in the beginning of the outbreak, meteorological conditions were extremely favourable for malaria in 1999, 2001 and 2002, especially within the borders of the city of Moscow and its immediate surroundings. The greatest number of cases occurred at the northwestern periphery of the city and in the adjoining rural areas. A significant role was played by rural construction activities attracting migrant labour, vegetation density and landscape division. A cut-off altitude of 200 m was observed, though the factor of altitude did not play a significant role at lower altitudes. Most likely, the urban heat island additionally amplified malaria re-introduction. CONCLUSION: The malariogenic potential in relation to vivax malaria was high in Moscow region, albeit heterogeneous. It is in Moscow that the most favourable conditions exist for vivax malaria re-introduction in the case of a renewed importation. This recent event of large-scale re-introduction of vivax malaria in a temperate area can serve as a case study for further research.

Potentially toxic elements in urban topsoils and health risk assessment for the mining W-Mo center in the Baikal region.

The main threats to health are associated with the entry of potentially toxic elements (PTEs) into human bodies. The aim of this study is to assess the impact of the Zakamensk W-Mo deposit development on soil surface horizons and the health of the local population. The results of the geochemical survey of 2012 revealed the spatial distribution patterns and abundances of 15 PTEs. The elements bulk contents were determined by ICP-MS and ICP-AES. The impact of geochemical situation on the health of the population of Zakamensk was also assessed using the mortality rates from diseases of the digestive and respiratory organs, neoplasms, including malignant tumors of the digestive and respiratory organs in 2008-2012. The tailing dumps have increased concentrations of W, Cd, Pb, Sb, Mo, Cu, Zn, Sn, As, and Co due to petrochemical characteristics of the ore. The soils of the industrial zone accumulate W, Cd, Mo, Pb, Sb, Zn, Cu, and Sn due to the waste storage sites deterioration and the thermal power plant and the foundry emissions. The multi-story residential zone soils accumulate W, Cd, Pb, Zn, and Mo. Tungsten, Pb, Sb, Co, V, and Cr cause the greatest harm to adults and children and together account for 92-96% of the hazard index. Cadmium and Cr are the most dangerous carcinogenic elements in Zakamensk. Despite the closure of DTMP more than 15 years ago, the level of the total risk of developing malignant diseases indicates a catastrophic environmental situation.

Effects of Climate Change and Heterogeneity of Local Climates оn the Development of Malaria Parasite (Plasmodium vivax) in Moscow Megacity Region.

The article presents the results of a spatio-temporal analysis of the changes of the favorability of climatic conditions for the transmission of vivax malaria in the Moscow megacity and its surroundings during the period from 1977 to 2016. Using the historical temperature records at urban and rural weather stations, we calculated the key indicators of climate favorability for malaria transmission, viz. the sum of effective temperatures, the duration of the season of effective infectiveness, and a new integral index of climate favorability. We demonstrated a dramatic increase of all three indicators, which accelerated after 1984, and a high spatial heterogeneity among them. Due to the urban heat island effect, the degree of climatic favorability is especially high in the densely urbanized areas of Moscow megacity compared with the suburban and rural areas. Climatic conditions for vivax malaria in Moscow are better now than before. The season of effective infectiveness continues in the central part of the city for 25 days longer, and the integral index of climate favorability is 85% higher in comparison to mean values over the rural surroundings. The study contains an alert regarding the risk of malaria resurgence in the Moscow region in the case of the sufficient importation of cases from abroad.

Сardiovascular mortality during heat waves in temperate climate: an association with bioclimatic indices.

The authors studied the relative predictive powers of several bioclimatic indices as predictors of population mortality during heat waves. Daily mean and maximum values of air temperature, Humidex, apparent, and physiological equivalent temperatures (PETs) were examined. The numbers of daily deaths and daily meteorological data in Rostov-on-Don (southern Russia) were used. The study period spanned April-September between 1999 and 2011. The eight selected bioclimatic indices were used to identify heat waves and calculate the expected increases in mortality during such events from Poisson generalized linear model of daily death counts. All of the bioclimatic indices considered were positively and significantly associated with mortality during heat waves. The best predictor was chosen from a set of similar models by maximization of relative mortality risk estimates. Having compared the relative increases and their significance levels in several cause- and age-specific mortality rates, the authors concluded that PET was the most powerful predictor.

Health risks facing travelers to Russia with special reference to natural-focal diseases.

BACKGROUND: Russia, an enormous country almost completely located within temperate latitudes, has a broad spectrum of natural landscapes which attract increasing numbers of tourists, from arctic deserts in the north to steppes and deserts in the south. Currently, tourism is undergoing active development in Russia: new travel routes, including ones that involve visiting the wilderness, are steadily appearing. Among the multitude of infectious diseases that can endanger travelers, natural-focal diseases, whose agents and/or carriers are integral to natural landscapes, are especially prominent. Some of the results of the study of natural-focal infections and parasitoses, which are necessary to evaluate the recreational and travel potential of the Russian Federation, are presented and discussed in this article. METHOD: A cartographical and statistical analysis of infectious and parasitic natural-focal diseases, spanning more than a decade (1997-2013), is the basis of this article. RESULTS: This analysis, along with that of additional cartographical and textual sources, reveals that natural-focal infections are most diverse between 48° N and 60° N and least diverse in the northern regions of the Far East of Russia. Different regions have different numbers of nosoforms and different morbidity level, which signifies an irregularity in the distribution of parasitic diseases. CONCLUSIONS: This medico-geographical information may be useful both for individual tourists planning trips to Russia and tour agencies organizing tour groups. It also can be used by health advisers when they consult people before a trip, to assess the actual risks, suggest a number of precautions and pick the particular diseases out of those listed that actually constitute a risk in certain regions, and suggest a suitable preventative treatment if needed.

Natural-focal diseases: mapping experience in Russia.

BACKGROUND: Natural-focal diseases constitute a serious hazard for human health. Agents and vectors of such diseases belong to natural landscapes. The aim of this study is to identify the diversity and geography of natural-focal diseases in Russia and to develop cartographic approaches for their mapping, including mathematical-cartographical modeling. Russian medico-geographical mapping of natural-focal diseases is highly developed regionally and locally but extremely limited at the national level. To solve this problem, a scientific team of the Faculty of Geography at Lomonosov Moscow State University has developed and implemented a project of a medico-geographical Atlas of Russia "Natural-Focal Diseases". METHODS: The mapping is based on medical statistics data. The Atlas contains a series of maps on disease incidence, long-term dynamics of disease morbidity, etc. In addition, other materials available to the authors were used: mapping of the natural environment, field data, archival materials, analyzed satellite images, etc. The maps are processed using ArcGIS (ESRI) software application. Different methods of rendering of mapped phenomena are used (geographical ranges, diagrams, choropleth maps etc.). RESULTS: A series of analytical, integrated, and synthetic maps shows disease incidence in the population at both the national and regional levels for the last 15 years. Maps of the mean annual morbidity of certain infections and maps of morbidity dynamics and nosological profiles allow for a detailed analysis of the situation for each of 83 administrative units of the Russian Federation. The degree of epidemic hazard in Russia by natural-focal diseases is reflected in a synthetic medico-geographical map that shows the degree of epidemic risks due to such diseases in Russia and allows one to estimate the risk of disease manifestation in a given region. CONCLUSIONS: This is the first attempt at aggregation and public presentation of diverse and multifaceted information about natural-focal diseases in Russia. Taken in entirety, the maps that have been prepared for the Atlas will enable researchers to evaluate the stability of epidemic manifestation of individual diseases and the susceptibility of a given territory to disease transmission. The results can be used for sanitary monitoring and disease prevention.