West Nile Fever in the Rostov Region: Ecological and Epidemiological Peculiarities of the Outbreak in 2010

This paper describes the outbreak of West Nile fever in the Rostov Region in 2010 and evaluates its ecological and epidemiological peculiarities. From 15th of July till 22nd of September 2010, detected were the 64 cases (1, 4800/0000) of the disease, which were characterized by vector-born mechanism of transmission. Peak of morbidity coincided with mass breeding of Culicidae, increase in the number of Culex mosquitoes, and reoccurring growth of Aedes mosquito population. Diffuse type of the epidemiological process, higher rates of the cases among urbanites, infected in the country-side area, were the characteristic features of that outbreak. West Nile virus antigen was detected by means of IFA in samples taken from An. maculipennis and Cx. pipiens mosquitoes, wild and synanthropic birds, Rh. rossicus ticks, house and wood mice, which facilitates identification of the core factors for the agent circulation and West Nile fever natural focus formation

Participation of bats (Chiroptera, Mammalia) and their ectoparasites in circulation of pathogens of natural focal infections in the South of Russia

To determine the species composition of ectoparasites, 65 individuals of 6 species of vesper bats (Chiroptera: Vespertilionidae) were examined. Altogether, 521 specimens of 11 species of arthropods (gamasid mites, soft ticks, and fleas) were collected, of which Steatonyssus noctulus and Nycteridopsylla eusarca were recorded for the first time from Rostov Province. As the result of laboratory studies of the bats and ectoparasites associated with them in Rostov Province, DNA of Borrelia burgdorferi s. l., genospecies Borrelia afzelii was detected in samples of Pipistrellus pipistrellus, P. pygmaeus, P. kuhlii, Eptesicus serotinus, Carios vespertilionis, Steatonyssus periblepharus; DNA of Borrelia spp. was detected in samples of Macronyssus flavus; DNA of Ehrlichia spp., in samples of P. pipistrellus and P. kuhlii; DNA of Anaplasma phagocytophilum, in samples of Nyctalus noctula. Participation of bats and their ectoparasites in the epizootic process of tularemia was recorded for the first time, by detection of Francisella tularensis DNA in samples of P. pipistrellus, N. noctula, P. kuhlii, and Cimex ex gr. pipistrelli. Markers of the Crimean-Congo hemorrhagic fever virus were discovered for the first time in samples of N. noctula and P. pipistrellus

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally