Second ethical comments towards COVID-19 (one year later)

At the beginning of COVID-19 development, when social vulnerability in the face of the global infectious threat became obvious, we presented target information on a key civilizational issue — the role of ethics in epidemic emergencies. The compliance of RF legislation and the world ethical standards analyzed on based on the study of the humanitarian heritage of pandemic management and a review of existing international documents. Today, one year later, it is time to practically evaluate the effectiveness of the ideology of ethical commitment and objectively comprehend the conflicts that have arisen, their causes and consequences. It should be emphasized that this work is not a so-called “moral lesson learned from COVID-19”, but representation of a real picture of how the centuries-old experience of former epidemics and pandemics was taken into account and the unique truth of the ethical content of management decisions and actions was accepted. It is particularly important to have a possibility to present this article as a continuation of our research topic on the bioethics of pandemics, on the pages of such an authoritative, specialized journal, which fully allows us to preserve the integrity of ideas about the humanitarian essence of anti-epidemic measures. This humanitarian parallel starts from the moment of managing a particular patient with infectious pathology until large-scale measures for eradication vaccine-preventable diseases. A comprehensive and dynamic look at the need to find ways and the nature of overcoming ethical conflicts during the ongoing pandemic of the new coronavirus infection could determine the ethical approach of longterm recommendations in the field of public health protection and ensure the stability of social trust in the future

Clinical and laboratory characteristics of influenza infection in hospitalized adult patients during the 2018-2019 epidemic season

Despite the success in prevention and therapy, influenza remains a mass disease with mortality rate up to 0.01—0.2% worldwide.Purpose. Conducting clinical and laboratory analysis of influenza infection cases and evaluating their etiological significance in adult hospitalized patients during 2018—2019 epidemic season. Materials and methods. There were analyzed 569 case histories of patients hospitalized at the Clinical Infectious Diseases Hospital named after S.P. Botkin. Patients were examined by PCR that resulted in verified influenza virus in 260 cases. Nasopharyngeal swabs collected from 36 patients were examined by virological method on MDCK cell culture. 24 influenza virus strains were isolated and identified.Results. The study allowed to identify a viral landscape represented by influenza viruses A and B found in 98.5% and 1.5% cases, respectively. Influenza viruses isolated on cell culture in 50% of cases were identified. Among the influenza viruses isolated on cell culture there were identified serotype A influenza viruses (H1N1) closely related to the pandemic influenza A (H1N1)pdm09. Some isolates (41.7%) belonged to serotype A (H3N2), which were related to strain A/Singapore/16-0019/16. Influenza B virus strain of the Victoria lineage isolated from a hospitalized patient possessed a triple deletion in hemagglutinin gene, which antigenic properties substantially differed from those of the influenza virus strain being included into current influenza vaccines. Upon admission, the condition of most patients was estimated as moderate (males — 48.7%, females — 51.3%). The median patient age was 35 years old, with comorbidities being registered in 50% cases. The clinical picture for 2018—2019 seasonal influenza displayed no distinctive features as compared to previous epidemic seasons. The duration of intoxication and catarrhal syndrome was 4.3±0.13 and 6.9±0.29 days, respectively, with median body temperature ranging within 39.2±0.06°С. All patients received standard pathogenetic therapy. Complications were noted in 86.7% cases such as pneumonia — 11.1%, sinusitis — 6.9%, bronchitis — 56.9%. The bed day length was 5.93±0.29, no lethal outcomes were recorded.Conclusion. It was found that influenza A viruses were dominant in patients observed comprising up to 98.5% cases, whereas influenza viruses B were found in as few as 1.5% patients. The clinical picture was characterized by severe intoxication and catarrhal syndrome, being frequently associated with complications

A herd immunity to measles and rubella viruses in the population of the Republic of Serbia

According to the WHO Strategic Plan, measles should be eradicated in 2020 in the five WHO Regions including European Region. However, large measles outbreaks are being periodically registered in diverse European countries. In the Republic of Serbia (SRB), 5,076 measles cases were detected in 2018, among which 15 cases were fatal.Aim of the study was to examine herd immunity to measles and rubella viruses in the population of the Republic of Serbia.Materials and methods. Blood serum samples obtained in 2018 and 2019 from conditionally healthy residents of the Republic of Serbia were tested for the presence of IgG antibodies to measles and rubella viruses in five age groups: I — children from 2 to 6 years old, II — children from 8 to 14 years old, III — 15 to 24 years old, IV — 25 to 49 years old and V — over 50 years old. A total of 1000 samples were obtained, 200 sera in each group. Enzygnost® Anti-Measles virus/IgG and Enzygnost® Anti-Rubella virus/IgG ELISA test systems (Siemens Healthcare Diagnostics Products GmbH, Germany) were used according to the manufacturer's instructions.Results. Overall, around 23.0% and 33.7% of the surveyed persons had no or low level of anti-measles IgG antibody (≥ 275.0 — ≤ 1000.0 IU/1). In age group I, 60% children contained no or “low” anti-measles antibodies titer (29.5% and 30.5%, respectively). In addition, low antibody titer level was mainly detected in individuals from age group II and III (p < 0.05). A third of children under 8—14 contained high IgG-antibodies titer against measles (> 3000.0 IU/l) that might serve as an evidence that such subjects recently recovered after measles. Similar results were obtained for IgG antibodies to rubella in the same age groups.Discussion. The study results evidence about altered routine immunization against measles and rubella in children aged 12—15 months (first vaccination) and those at age of 6—7 years (revaccination) with MMR vaccine. The data obtained correlate with official data on coverage with measles and rubella vaccines in the Republic of Serbia

STUDY OF IMMUNITY TO POLIOVIRUSES ON CERTAIN "SILENT" TERRITORIES OF RUSSIA

Abstract. The degree of immunity to polioviruses of three serotypes among children of different ages was analysed on certain "controlled" and "silent" territories of Russia in different periods of Polio Eradication Initiative. It was shown that the levels of immunity of children’s population to polioviruses on "controlled" and "silent" territories had no significant difference. It was stated that on the phase which preceded the certification for the absence of circulation of wild polioviruses, when the National Immunisation Days were conducted in the country, the percentage of eronegative children to polioviruses of different serotypes was low on all the territories of Russia. After Russia as a part of the WHO European region was certified as a polio free country and mass immunisation was stopped thepercentage of seronegative children increased, especially to poliovirus of serotype 3, both on the "controlled" and on the "silent" territories

Evaluation of age-related distribution of measles cases with primary and secondary immune response in Russian Federation, 2010-2016

In 2010—2016, blood serum samples were examined from 5539 patients, aged < 1—60 years, with clinically and laboratory confirmed measles. Primary or secondary type of immune response was determined for all measles cases. Studies were performed with children aged < 1—14 years (2381), adolescents, 15—17 years old (189), and adults aged 18—60 years (2969). Serum measles-specific IgM antibodies were measured by “VektoKor’ IgM” ELISA test system (Russia), concentration and avidity of specific IgG — by using “Anti-Measles Viruses ELISA/IgG” and “Avidity: Anti-Measles Viruses ELISA/ IgG” (Euroimmun, Germany). Primary immune response was identified based on the presence of serum measles-specific low avidity IgM and IgG antibodies, whereas secondary immune response was characterized by detecting high avidity IgM and IgG antibodies at concentration of ≥ 5.0 IU/ml. Analyzing measles-specific IgM antibodies in 2010—2016 demonstrated that measles morbidity was mainly due to children, aged 1—2 years reaching up to 39.9% of the total number of children with measles aged < 1—14 years as well as adults aged 18—40 years old comprising as high as 80.1% total number of patients aged 15—60 years. Serum measles-specific IgG testing showed that in 15.0% of cases they were detected at concentration of ≥ 5.0 IU/ml. Further serum dilution resulted in finding IgG titer ranging within 8.5—45.0 IU/ml (21.4+0.36) and high avidity antibodies in 80—100% (92.5+0.2) cases. The remaining 85.0% cases found low avidity measles-specific IgG antibodies (< 30%) at concentration of 0.2—3.46 IU/ml (1.73+0.03). An age-related analysis of our data demonstrated that all children under 14 with laboratory-confirmed measles developed primary immune response. Moreover, in 73.7% of measles patients aged 15—60 with primary immune response measles might be prevented by timely vaccination, whereas persons with “vaccine failure” comprised 26.3%. In 2010 (0.09 per 100,000 subjects) and 2016 (0.12 per 100,000 subjects), frequency of patients with “vaccine failure” during relative epidemic well-being was 35.3% and 18.2%, respectively, exceeding 9.9% (p < 0.001) serving as a hallmark 2014 high measles incidence rate (3.24 per 100,000 subjects).The data obtained indicate that measles virus circulate among people with “vaccine failure,” which may account for potential to spread and infect unprotected population cohorts as well as cause measles outbreaks during periods of epidemic well-being

Implementation of the program of measles elimination in the WHO African region

The review is devoted to the analysis of the available literature on the elimination of measles. The review focuses on the current measles epidemic situation in the African Region (AFR) and the implementation of the WHO strategic plan for the elimination of measles in AFR by 2020. Measles in the AFR is characterized by a severe course with a high risk of death due to malnutrition, vitamin A deficiency, concomitant bacterial and viral infections, and malaria. In 2015, 105,256 cases of measles were reported in the WHO African Region, most of them among children under 5 years old, 79% of whom were not vaccinated or had unknown vaccine status. Initially, the strategy for implementing the measles elimination program in AFRs was based on a combination of immunization campaigns for children under 14 years of age (coverage of more than 90%) and routine vaccination of at least 90% of children aged 9–15 months. It was recommended to repeat the campaign of mass immunization of children aged 9 months up to 4 years every 3–5 years. The use of this strategy has reduced the number of measles cases by 83–97% during the first year of additional immunization programs. The recommended age of routine measles vaccination in AFRs is 9 months — a strategy to reduce infant mortality, including that due to complications of measles. In 2016, measles vaccination was introduced into the national immunization schedule in all AFR countries, and 24 countries introduced revaccination. Currently, the measles elimination program in a number of AFR countries is based on two-dose immunization (MCV1 and MCV2). The measles prevention program in a number of AFR countries was disrupted due to the Ebola epidemic. There are some common problems in the realization of the program in AFR countries. All AFR countries are committed to the measles elimination program. The review provides information on strategies and successes in overcoming challenges to achieve the goals set for the WHO African Region in the implementation of the programme of measles elimination

Корь и краснуха на Северо-Западе России на этапе их элиминации

Aim: To evaluate the epidemic situation on measles and rubella and to carry out the laboratory diagnostics of these infections in the North-West of Russia in the period of elimination.Materials and Methods. In 2016-2019 a total of 534 blood serum samples from patients with measles diagnosis, 210 – from patients with rubella diagnosis and 1251 – from patients with exanthema were studied by ELISA using “VectoMeasles-IgM” and “EIA-Rubella-IgM” test-systems.Results. Measles incidence in NWR varied from 0 to 0.96 per 100,000 in 2016 and 2019, respectively. Among measles patients the proportion of children and adults changed in 2018-2019, adults constituted 65.9%. Patients not vaccinated against measles and those with the unknown vaccination status were mainly involved in epidemic process (85%). High level of patients with revaccination status was revealed in 2018 (18.4%). These patients demonstrated high levels of IgG (>3.0 IU/ml) as well as high percentage of IgG avidity (>94.3%) on 4-7th day of rash onset thus evidencing secondary immune response. Molecular studies of the samples from patients revealed the circulation of D8 and B3 genotypes of measles virus. Strains of D8 and B3 genotypes were represented by 3 and 4 variants, respectively. Rubella incidence did not exceed 0.13 per 100,000. Strains of rubella virus of genotype 1E were detected.Conclusion. The data of annual measles incidence and molecular studies of circulating wild type measles viruses prove the on-going measles elimination process in the NorthWest of Russia. For rubella, the persistent phase of elimination was demonstrated in the region. Цель. Изучение эпидемиологии кори и краснухи на Северо-Западе России на этапе их элиминации.Материалы и методы. В 2016–2019 гг. были исследованы 534 сыворотки крови от больных с диагнозом «Корь», 210 сывороток крови от больных с диагнозом «Краснуха», 1251 сыворотка крови от больных с экзантемными заболеваниями в ИФА c помощью тестсистем «ВектоКорь IgM» и «ИФА-Краснуха-IgM».Результаты. Заболеваемость корью на Северо-Западе России колебалась от 0 в 2017 г. до 0,96 на 100 000 населения в 2019 г. В 2018–2019 гг. изменилось соотношение детей и взрослых среди больных, на долю взрослых приходилось 65,9%. Эпидемический процесс поддерживали непривитые лица и лица с неизвестным анамнезом (85,0%). В 2018 г. отмечен высокий процент больных, имевших ревакцинацию (18,4%). У этой группы больных на 4–7-й дни был выявлен высокий уровень антител класса IgG к вирусу кори (более 3,0 МЕ/мл), а также высокий процент авидности IgG-корь антител (более 94,3%), что свидетельствует о вторичном иммунном ответе. Молекулярно-биологический мониторинг циркуляции диких штаммов вируса кори показал, что на Северо-Западе России в этот период циркулировали вирусы кори двух генотипов: D8 и B3. Штаммы, относящиеся к генотипу D8, были представлены 3 вариантами, к генотипу B3 – 4 вариантами. Заболеваемость краснухой носила спорадический характер и не превышала 0,13 на 100 000 населения. При молекулярно-генетическом исследовании биологического материала были идентифицированы штаммы вируса краснухи генотипа 1Е.Заключение. Данные по ежегодной заболеваемости корью и результаты генотипирования циркулирующих диких штаммов вируса кори свидетельствуют о том, что территории находятся в процессе элиминации кори. В отношении краснухи все показатели подтверждают, что на территориях Северо-Запада России сохраняется устойчивая фаза элиминации краснухи.

For the question about Molecular Epidemiology of Hepatitis B Virus Infection in the Republic Sakha (Yakutia)

Objective: To estimate the prevalence of genetic variants and features of the molecular epidemiology of HBV in Yakutia residents suffering from HBV.Materials and methods: The study involved 35 patients with chronic hepatitis B from urban and rural areas of Yakutia while most of the group were representatives of the autochthonous population. In the present study we used genotyping by direct sequencing of the Pre-S1 / Pre-S2 / S region of HBV DNA.Results: Based on the phylogenetic analysis of the isolates showed that among patients examined HBV identified only D genotype, which is the most common genotype of HBV in the Russian Federation. It is shown prevalence of HBV subtype D2 (85,8%) compared to the HBV subtype D3 (14,2%).Conclusion: We identified clearly clustered group of HBV isolates and close ties within the group, which suggests the existence of at least four permanent sources of infection, acting for a few years and decades. The systematic application of complex molecular, virological, epidemiological methods and molecular phylogenetics could contribute to the current understanding of the epidemiology of HBV and improve the quality of the traditional methods of supervision in Russia

A herd immunity to rubella virus in selected geographical regions

Since 2017, the incidence rate of rubella in the Russian Federation has been below 1 case per million total population. In addition, no circulation of endemic strains of the rubella virus is recorded evidencing about achieving infection elimination phase. In modern conditions, it is important to constantly monitor the level of herd immunity to the rubella virus to identify epidemically significant population groups, especially in countries lacking rubella vaccination or featured with insufficient disease control. Purpose: to study herd immunity to the rubella virus in selected countries in Eurasia and Africa. Materials and methods. Between 2018 and 2021, 15,594 samples of blood sera were tested for IgG and IgM antibodies to the rubella virus from subjects of different ages obtained from regional measles and rubella surveillance centers in the Northwestern Federal District (NWFD) of the Russian Federation, the Republic of Serbia, South Vietnam, and the Republic of Guinea. The “Anti-Rubella Virus ELISA (IgМ)” and “Anti-Rubella Virus ELISA (IgG)” (Euroimmun, Germany) test kits were used. Statistical data processing was carried out using the MS Excel, Prizm 5.0 (GraphPad Software Inc.), and Statistica 8.0 (StatSoft Inc.) software package. Results. During the observation period (2018–2020) the population seroprevalence of the to the rubella virus in the NWFD of the Russian Federation was 96.6–97.7% and fluctuated slightly both in separate years and among individual age groups evidencing about high coverage of rubella vaccination. In the Republic of Serbia conducting two-fold immunization against rubella the overall seroprevalence rate was lower than in the Russian Federation and comprising 86.8%. The minimum number of IgGpositive sera was recorded in the 2–4-year-old age group pointing to the shortcomings of routine vaccination. In South Vietnam, children aged 1–3 years (41.9%) predominated among those recovering from rubella, i.e. the age cohort that should be protected by vaccination at the age of 18 months. No rubella vaccination is carried out in Guinea. The total proportion of seropositive individuals was 75%; herd immunity to the rubella virus was established mainly among children and adolescents, reaching 90% only in the older age group. 30% of unprotected subjects of the most active reproductive age were identified among the females surveyed in Guinea. Conclusion. Insufficient herd immunity to the rubella virus, identified in a number of countries, may contribute to the maintenance of the infectious process and the spread of infection. Globalization contributes to the virus importation into regions being at the stage of measles and rubella elimination. The results obtained suggest about a need to continue efforts aimed at maintaining epidemiological wellbeing regarding rubella in diverse countries of the world.Начиная с 2017 г. в Российской Федерации показатель заболеваемости краснухой находится на уровне ниже 1 случая на 1 млн населения. Также отсутствует циркуляция эндемичных штаммов вируса краснухи. Это свидетельствует о достижении фазы элиминации инфекции. В современных условиях важным является постоянный мониторинг уровня коллективного иммунитета к вирусу краснухи для выявления эпидемически значимых групп населения, особенно в странах, где вакцинация против краснухи не проводится или контроль недостаточен. Цель исследования: изучение коллективного иммунитета к вирусу краснухи в ряде стран Евразии и Африки. Материалы и методы. В период с 2017 по 2021 г. на IgG- и IgM-антитела к вирусу краснухи исследовано 15 594 образца сывороток крови лиц разного возраста, полученные из региональных центров по надзору за корью и краснухой в СЗФО РФ, Республике Сербия, в Южном Вьетнаме, в Гвинейской Республике. Использовали ИФА тест-наборы «Anti-Rubella Virus ELISA IgМ» и «Anti-Rubella Virus ELISA (IgG)» (Euroimmun, Германия). Статистическая обработка результатов проводилась с помощью пакета программ MS Excel, Prizm 5.0 (GraphPadSoftware Inc.), Statistica 8.0 (StatSoft Inc.). Результаты. В СЗФО РФ за период наблюдения серопревалентность населения к вирусу краснухи составляла 96,6–97,7% и колебалась незначительно как по отельным годам, так и среди отдельных возрастных групп, что свидетельствуют о высоком охвате вакцинацией против краснухи. В Республике Сербия общий показатель серопревалентности оказался ниже, чем в РФ, и составил 86,8%. Наименьшее количество IgG-положительных сывороток регистрировали в возрастной группе 2–4 года, что говорит о недостатках плановой вакцинации. В Южном Вьетнаме среди переболевших краснухой преобладали дети в возрасте 1–3 года (41,9%), то есть та группа, которая должна быть максимально защищена плановой прививкой против краснухи в 18 месяцев. В Гвинее специфическая профилактика краснухи не проводится. Общая доля серопозитивных лиц составила 75%, коллективный иммунитет к вирусу краснухи формировался, в основном, среди детей и подростков, достигая 90% лишь в старшей возрастной группе. Среди обследованных женщин Гвинеи выявлено 30% незащищенных лиц наиболее активного репродуктивного возраста. Заключение. Недостаточный уровень коллективного иммунитета к вирусу краснухи, выявленный в ряде стран, может способствовать распространению инфекции, а условия глобализации — импортированию вируса в регионы, находящиеся на этапе элиминации кори и краснухи. Полученные результаты свидетельствуют о необходимости продолжения усилий, направленных на поддержание эпидемиологического благополучия в отношении краснухи в разных странах мира

Особенности клинического течения риновирусной инфекции у госпитализированных взрослых больных в эпидемический сезон 2017–2018 гг.

Purpose. Rhinovirus infection has in the past been perceived as a disease capable of causing mild respiratory symptoms in most cases in children. Modern clinical and epidemiological studies have shown that rhinovirus infection in adults and children and has a moderate and severe course. The aim of this study was to conduct a clinical and laboratory analysis of cases of rhinovirus infection in adult hospitalized patients and evaluate the etiological role of rinoviruses in the epidemic season of 2017/18.Materials and methods. 1013 case histories of patients admitted to the hospital with a diagnosis of SARS were studied. These patients were taken nasopharyngeal swabs were investigated by PCR for the detection of respiratory pathogens. A positive result was obtained with rhinovirus infection of 51 patients.Results. Of the examined patients, 41,6% had influenza, 45,8% had no viruses and 12,6% had other viral infections, of which 40% were due to rhinovirus infection. Among them, young patients prevailed: the median age for men was 31,0 years, for women-27,5 years. The disease occurred in a moderate form – 78,8%, severe course was observed in 5,3% of patients and was accompanied by infectious and toxic shock. Most often the disease occurred with complications acute bronchitis – 22,1%, pneumonia joined in 15,7% of cases.Conclusion. rhinovirus infection ranks first (40%) among non-influenza causes of viral respiratory tract infection in the examined patients. It was registered mainly in young people. In most cases, it proceeded in a moderate form and had a complicated course, including pneumonia.Цель. Риновирусная (РВ) инфекция в прошлом воспринималась как заболевание, способное вызывать легкие респираторные симптомы в большинстве случаев у детей. Современные клинико-эпидемиологические исследования показали, что РВ-инфекция у взрослых и детей имеет среднетяжелое и тяжелое течение. Целью настоящего исследования было проведение клинико-лабораторного анализа случаев риновирусной инфекции у взрослых госпитализированных больных и оценка этиологического значения риновирусов в эпидемический сезон 2017–2018 гг.Материалы и методы. Изучено 1013 историй болезни пациентов, обследованных методом ПЦР, из них 51 с РВ инфекцией.Результаты. Из обследованных больных у 41,6% выявлен грипп, у 45,8% вирусы не обнаружены и у 12,6% выявлены другие вирусные инфекции, из которых 40% приходится на РВ. Среди них преобладали пациенты молодого возраста: медиана для мужчин – 31,0 лет, для женщин – 27,5 лет. Заболевание протекало в среднетяжелой форме – 78,8%, тяжелое течение было отмечено у 5,3% больных и сопровождалось инфекционно-токсическим шоком. Заболевание наиболее часто осложнялось острым бронхитом – 22,1%, в 15,7% случаев присоединялась пневмония.Заключение. РВ-инфекция занимает первое место (40%) среди негриппозных причин вирусного поражения респираторного тракта у обследованных пациентов. Она регистрировалась преимущественно у лиц молодого возраста. В большинстве случаев протекала в среднетяжелой форме и имела осложненное течение, в том числе пневмонией.