Foci of nosocomial measles in Russia in the years 2011–2019

Objective. To identify the main causes of nosocomial measles outbreaks and factors that caused stable secondary transmission of this infection in healthcare institutions. Materials and methods. We analyzed 336 nosocomial measles outbreaks according to the data from 1521 ‘Reports of epidemiological investigation of measles cases…’ registered between 2011 and 2019. We performed operational and retrospective epidemiological analysis, as well as evaluation and descriptive analysis. Results. Our retrospective analysis demonstrated that nosocomial measles outbreaks were registered every year with the number of reported cases ranging from 7 (in 2011) to 105 (in 2018). Most frequently, outbreaks were registered in infectious disease hospitals (32%) and departments for infectious diseases in multidisciplinary hospitals among patients with acute respiratory viral infections (28.1%). Less frequently, measles was diagnosed among patients treated in other hospital departments, dispensaries (18.6%), admission departments (11.8%), and polyclinics (9.5%). The factors that contributed to the emergence of nosocomial measles outbreaks included no alertness for measles among doctors and poor epidemic prevention and control in hospitals. Conclusion. To reduce the incidence of nosocomial measles, it is necessary to ensure that patients admitted to hospitals (non-emergency hospitalization) and caregivers have information about measles vaccinations. It is also important to increase the vaccination coverage among healthcare professionals and promote compliance with sanitary and epidemiological control measures in hospitals. © 2021, Dynasty Publishing House. All rights reserved

Characteristics of the epidemiological situation of mumps in the world at the present stage

Relevance. The socio-economic significance of mumps is determined by complications after a previous infection, affecting reproductive function, what entails economic and demographic losses. An important problem today remains the fact that despite high coverage with preventive vaccinations outbreaks of mumps are recorded among children and young adults. Aim. Analyze the epidemic situation with epidemic parotitis in the world according to various literary sources and evaluate measures to control and combat this infection. Conclusions. Outbreaks of mumps have been reported among religious and ethnic groups. Outbreaks were often recorded in organized student and military groups, mainly among persons twice vaccinated. The most affected by the mumps virus were adolescents and young adults, mostly males. Several researchers have shown the possibility of using a third dose of MMR vaccine to control an outbreak, but its short-term effect does not provide conclusive evidence for rethinking two-dose mumps immunization. © Turaeva NV et al

ASSESSING THE 2019 RUBELLA ELIMINATION STATUS IN THE RUSSIAN FEDERATION [ОЦЕНКА СТАТУСА ЭЛИМИНАЦИИ КРАСНУХИ В РОССИЙСКОЙ ФЕДЕРАЦИИ В 2019 г.]

In 2002, the WHO Regional Office for Europe developed the Strategic Program for the Prevention of Measles and Congenital Rubella Infections in the European Region, which was revised in 2004. As a result of the revision, an additional target was set to eliminate endemic rubella in the region by 2010. Rubella is a disease well controlled by vaccination that accounts for a theoretical potential to interrupt its global transmission. Since 2013, the Russian Federation has been implementing the National Rubella Elimination Program. Elimination criteria have been revised as the Program proceeds. Currently, the main criterion for rubella elimination is the absence of endemic (local) virus transmission for at least 36 months, which should be confirmed by molecular genetic research methods. In addition, in the Russian Federation, an incidence rate of less than 1 case per 1 million population is also used as one of the elimination criteria. Since 2013, due to a high (over 95%) coverage of preventive vaccinations a decrease in incidence rates and their stabilization at a level of less than 1 per 1 million population since 2014 state in favor of successfully implemented Program. Genetic monitoring of rubella virus strains circulating in human population noted the termination of endemic virus transmission. While implementing the Elimination Program, the prevailing virus genotypes that circulate in Russia were found to be genotypes 1E and 2B showing a global distribution. The data obtained after molecular genetic monitoring allowed to find that the strains isolated during this period belonged to different clusters accounting for in favor of being imported. Considering the above factors such as high vaccination coverage, low incidence rate and lack of endemic virus transmission, the 2017 WHO Committee on verification of measles and rubella elimination assigned the Russian Federation the status of a country that has achieved rubella elimination. The continuation of the phase of infection elimination is confirmed annually. This article presents the results on comprehensive assessment of rubella elimination status in the Russian Federation by specialists from the National Scientific and Methodological Center for Measles and Rubella and WHO EURO Moscow regional reference laboratory for measles and rubella based on 2019 epidemiological data and molecular genetic studies. © 2022 Saint Petersburg Pasteur Institute. All rights reserved

Population immunity and structure of measles cases in the Russian Federation

Relevance. In recent years, in Russia, against the background of a stable high (no less than 95%) coverage of live measles vaccine (GI) inoculations of decreed groups of the population for almost twenty years, increases in morbidity have been registered, reaching the indicators of 3.3(2014) and 3.1 (2019) per 100 ths population and local outbreaks involving the child population. This situation has raised doubts among a number of researchers about the reliability of high vaccination coverage in children and adults. In this regard, some researchers assumed the loss of post-vaccination immunity and suggested revaccination against measles every 10 years for people up to 50 years old. Others suggested serological examination of certain cohorts of the adult population without taking into account the vaccination history for timely detection and vaccination of individuals with primary post-vaccination failures and who have lost post-vaccination immunity. The purpose of the work: to assess the state of population immunity for some manifestations of the epidemic process of measles infection and the feasibility of changing the tactics of vaccination against measles. Materials and methods. The work uses epidemiological operational and retrospective analysis. The research is based on the analysis of official statistics № 2, № 5, № 6, reports of regional centers, «maps of the surveillance of a case of suspected measles…», information and analytical bulletins of the National scientific and methodological center for the supervision of measles and rubella (NNMC). A total of 18,750 documents were analyzed. The average values, the average standard error, the correlation coefficient of the series, the reliability of the correlation coefficient, and the regression coefficient were calculated. Results and discussion. One of the indirect indicators of the state of population immunity is the ratio of vaccinated and not vaccinated against measles in the structure of patients. The analysis showed a steady trend towards the prevalence of cases not vaccinated against measles in the structure: since 2011, more than 70%, and since 2017 – more than 80%. The percentage of vaccinated people is decreasing from 12.8% to 5.4% (2017) and has stabilized in the last 2.5 years at the level of 5.4–7.2%. Over the past 2 years, there has also been some stabilization of the proportion of people twice vaccinated – 9.4–9.8%. Intensive indicators of morbidity confirmed the General trend of extensive indicators. In addition, over the past 3 years, the intensive incidence rate of those vaccinated is 14 times lower than that of those not vaccinated against measles. All this testifies to the lack of accumulation of susceptible individuals due to the loss of post-vaccination immunity and confirms the adequacy of the strategy and tactics of vaccination against measles in our country. The calculation of the regression coefficient showed that with an increase in vaccination coverage of the entire population by one percent, the incidence of measles among unvaccinated people will increase by 1.34 per one hundred thousand unvaccinated people against measles. The prevalence of foci without infection spread (more than 80%) during the analyzed period, and the restriction of secondary measles spread by the second generation of infection reproduction in foci with two or more cases of measles, multiple circulation of genotypes and subtypes of the measles virus also characterizes a fairly high population immunity. Conclusion. The steady predominance of lesions 1 case, limiting secondary spread of infection in outbreaks, the maintenance of the epidemic process of measles through an unvaccinated population indicate adequate tactics and strategy for measles immunization in our country. At the same time, the achieved 74.1% vaccination coverage of the entire population is clearly not enough to prevent sustained endemic transmission of the measles virus, since the reproductive index R<1 can be maintained with vaccination coverage of at least 95%. To increase population immunity, it is necessary to search for new forms of work of pediatricians and therapists with the population to form a commitment to immunization, as well as to legislate responsibility for the consequences of refusing vaccinations, as is done in a number of States. © Tsvirkun OV et al

The characteristic of measles epidemic process in kyrgyz republic

Relevance. In the Kyrgyz Republic, the measles and rubella elimination program has been implemented in accordance with the strategy of the World Health Organization (WHO) for 20 years, which uses a two-fold immunization tactic against measles at the age of 12 months and 6 years, which is complemented by clean-up campaigns. Despite the high coverage of vaccinations with both the first and second doses, there are epidemic rises in infection, reaching in 2018 (15.9), 2019 (36.4) and 2020 (11.2) per one hundred thousand population. In the years of recent epidemic ups, a high incidence among young children revealed. The epidemiological situation with measles that has developed in recent years has made it necessary to study the state of specific measles immunity in different age groups, to determine the vulnerable population group and assess the quality of vaccination work. The aim of the work: to assess the epidemic process of measles at the present stage and the state of specific immunity in the population of the Kyrgyz Republic to identify groups at high risk of infection. Materials and methods. In the course of the work, descriptive-evaluative and analytical epidemiological research methods are used. The materials are statistical reporting data on the incidence of measles from 1987 to 2020 and 568 blood serum samples taken from residents of Bishkek and Jalal-Abat region in the following indicator age groups: 1-4 years old n = 122; 5-9 years old n = 108; 10-14 years old n = 114; 15-19 years old n = 77; 20-29 years old n = 103; 30 years and older n = 44. The level of anti-measles antibodies is determined by enzyme-linked immunosorbent assay (ELISA) using the VectorMeasles-IgG test system manufactured by VEKTOR BEST, Russia. The method of retrospective analysis of the incidence of measles in the Kyrgyz Republic in long-term dynamics, by age groups, according to vaccination history is used. The method of retrospective analysis of the incidence of measles in the Kyrgyz Republic in long-term dynamics, by age groups, according to vaccination history is used. The data obtained statistically processed using the Excel program. The critical level of significance is p = 0.05. Descriptive statistics – mean and standard error of the mean (data are presented as M ± m) for quantitative variables, for qualitative variables – determination of proportion. Results and Discussions. The introduction of specific prophylaxis of measles led to decrease the incidence of measles, 15 times on average, mortality also decreased, however, despite the effectiveness of vaccination, cyclical increases in infection persisted, seasonality in intra-annual dynamics, school-age children began to get sick more often. To change the situation, including in order eliminating primary post-vaccination failures, in 1986 a second dose of vaccine introduced into the vaccination schedule for children 6 years old, which led to decrease the incidence to single case and in some years to the complete absence of measles cases. However, in 2018, the importation of measles from bordering countries led to an epidemic outbreak with the number of cases of 1004. The incidence rate increased from 0.1 in 2017 to 15.9 per 100 thousand population in 2018. At the subnational level, a clean-up campaign carried out among children aged two to five years. However, due to the lack of vaccine, the target group covered less than 50% and the increase in the incidence of measles in 2019 continued to 2377 people (36.4 per 100 thousand population). A slight decrease in the incidence of measles outlined in 2020, when 733 cases were registered. The highest percentage of cases is among children under one year old, 43.3% (2019) and 52.7% (2020), who are not vaccinated by age. In second place in importance is the age group of children from one to four years old, an extensive incidence rate is 29.5% (2019) and 39.3% (2020). The data of serological studies confirmed the formation of a high-risk group for measles infection among preschool children, where the proportion of seronegatives is 36%; this is probably due to not post-vaccination failures, but rather to a high proportion of children who are not vaccinated for various reasons. This hypothesis confirmed by the high percentage of unvaccinated children of this age in the structure of the sickindividuals. All this casts doubt on the official data on the coverage of children of this age with preventive vaccinations (95.7%) and indicates the accumulation of contingents susceptible to measles. The results of our research are consistent with the data obtained by other researchers. Conclusion. The analysis showed the need for regular monitoring of the organization of the vaccination work to control the reliable accounting of the child contingent needed to immunization, based on the population census, as well as to identify the validity of medical withdrawals. To prevent the growth of refusals from vaccinations, it is advisable to expand the forms of work with the population to develop commitment to vaccination. We believe that in combination, this will increase the real coverage of measles vaccinations for children, reduce the number of sources of infection and indirectly reduce the risk of infection in children of the first year of life. © 2021, Numikom. All rights reserved

Tea Utensils [028]

Photograph of jar, JapanJa

Gardens, Chinese: Wang Shi Yuan Garden, Suzhou, China [068]

Photograph of a screen with image of bamboo, Wang Shi Yuan Garden, Suzhou, ChinaScreen detail with image of bamboo, Wang Shi Yuan Garden, Suzhou, China