Epidemiological Trends of Communicable Diseases in the Baltic Sea and Barents Regions, 2000

  Published: 06.03.06 Updated: 06.03.2006 14:32:28


The 2000 data should be taken with caution in particular the number of TB cases as some of the only clinically diagnosed cases probably later will be excluded. The 1999 data has been revised and it appears that there has been an increase in year 2000 in cases of campylobacteriosis. The reason for this increase is unknown. The decrease of salmonellosis was mainly due to a lower number of S. enteritidis cases. The decrease can be explained by preventive measures particularly in the production. The increase of shigellosis is explained by introduction of a new notification procedure.


In general, the epidemiological situation in Norway remains stable. Few major changes occur in this population of 4.5 million from one year to the next. Major challenges include the prevention of genital chlamydial infections, campylobacteriosis, pertussis, invasive group A streptococcal disease and invasive pneumococcal disease.

Sexually transmitted infections.177 cases of primary HIV infection were reported in 2000, the highest number in any year since 1987 and an increase of 30 cases since 1999. The increase was mainly due to immigrants with HIV-infection. In 2000, 101 of the 177 persons diagnosed with HIV acquired their infection before moving to Norway.

Gonorrhoea and syphilis remain at extremely low levels in Norway. 252 cases of gonorrhoea were reported in 2000 (5.6 per 100, 000) compared to 190 in 1999. Although the highest number since 1993 it is still far from the 14,000 cases reported per year during the mid- 1970s. 40 cases of early syphilis were reported of which many were associated with the outbreak men that started in 1999 among men who have sex with.

Genital chlamydial infections continue to be reported in high numbers, in 2000 at 327 per 100, 000, an increase from 296 per 100,000 in 1999. Most diagnosed cases were among women under 25 years of age.

Enteric infections.Campylobacteriosis remains the most frequently reported bacterial enteric infection with 2,326 cases in 2000 (52 per 100,000) with approximately 55% of the patients infected abroad. Non-typhoid salmonellosis accounted for 1,489 cases (33 per 100.000). Among these, 83% had acquired their infection abroad. So far, Norway has been spared large outbreaks of disease caused by enterohaemorrhagic E. coli. In 2000, only seven cases were reported of which four had been imported.

Cases of giardiasis and entamoebiasis are mainly asymptomatic detected at immigrant screening. Yersiniosis, listeriosis and shigellosis remain rare diseases. Shigellosis is primarily an imported disease in Norway.

Zoonoses. Rabies does not exist in Norway. Other traditional zoonoses such as anthrax, brucellosis, trichinosis, tularaemia, are very rare in Norway. Lyme disease (138 cases) and nephropathia epidemica (36 cases) still cause serious disease in many persons.

Vaccine-preventable diseases. These diseases are under control in Norway with no cases of diphtheria, measles, poliomyelitis and tetanus, and only a handful of cases of mumps, rubella and Haemophilus influenzae-disease being reported in 2000. One notable exception is pertussis. The incidence remained high in 2000 with over 76 cases per 100,000. Most cases occur among pre-school children and adults while very few cases are observed among infants. There are plans to introduce a booster dose of pertussis vaccine at the age of 5-7 years.

Invasive bacterial diseases. The incidence of meningococcal disease is stable with 87 cases (2 per 100,000) in 2000 compared to 80 cases the year before. B remains the dominant serogroup among approximately two thirds of all reported cases.

Fortunately, the incidence of invasive group A streptococcal disease seems to be declining. 145 cases were reported in 2000 compared to 261 cases in 1999. Many cases are very serious with necrotising fasciitis and death.

Pneumococcal disease remains a severe problem, especially among the elderly, with 19 cases per 100,000 reported in 2000.


The situation concerning communicable diseases in Sweden has been relatively stable in 2000. However, some epidemiological trends are noteworthy.

The vast majority of cases of gastrointestinal diseases are still observed among persons returning from abroad. The incidence of Campylobacter continues to increase and it is currently by far the most common notifiable gastrointestinal disease. During 2000 8,405 (2,443 domestic) cases of Campylobacter as compared to 4,845 (691 domestic) cases of salmonella were reported. No major gastrointestinal outbreaks were recorded during 2000.

A trend towards increasing incidences (although at a low level) has been seen for all sexually transmitted infections. A similar trend has been observed for HIV during the last months of 2000.

The highest number of tularaemia cases since 1970 was reported during 2000. A total of 464 cases were reported as compared to 83 in 1999.

The first case of rabies in 26 years was diagnosed in a young woman returning from Thailand.


Respiratory infections. The number of laboratory confirmed Mycoplasma pneumoniae infections for this year exceeded the average number of cases observed during the last 4-5 years. Clinical features included prolonged symptoms compatible with both upper and lower respiratory tract infections. 1,889 RSV cases were reported, clearly suggesting an epidemic during the winter 2000-2001.

Enteric infections. A group of 46 tourists from Northern Finland stayed overnight in a hotel in southeastern Finland near the Russian border. The purpose of the stay was to visit Viborg and some other neighboring sites in Russia. During their stay 12 tourists contracted gastroenteritis. Bacteriological investigations showed that Shigella sonnei was the causative organism. Epidemiological observations suggested that the source of the infection was in the hotel but even a careful outbreak investigation failed to reveal the origin. Twenty years have lapsed since the last domestic outbreak of Shigella in Finland.

HIV. Fifty-three HIV infections associated with injecting drug use were reported. This was less than the previous year. However, a total of 140 HIV infections were reported, almost the same number as for the previous year and clearly above the long-term average of 60-90 cases per year. The increase is mainly due to an increase in sexual transmissions. The virus associated with sexually transmitted infections is different from the virus circulating among drug users.

Tularaemia. This year seems to be an unusually severe tularaemia-year. The number of notified cases was 926, the highest ever in the country. During the previous epidemic year in 1995, 467 cases were notified. An outbreak investigation has been conducted to identify risk factors and other parameters.

Both Borrelia and TBE infections were more numerous than average, the majority of cases being reported in Åland. The total number of TBE cases was 45 while the long-term average has been 3 to 8 cases per year. The situation has stimulated discussions about a new policy concerning TBE vaccination in Åland.

Virological laboratories reported a greater-than-average number of Sindbis-virus infections (Pogosta disease).

Between the 20th of August and 3rd of September an adventure competition was organized in Borneo, Malaysia. More than 300 athletes from 26 different countries challenged each other’s skills and endurance in the tropical forests. One week later the first reports from California started to come from the health authorities in different countries. A disease compatible with haemorrhagic fever had appeared in a few of the participants. Laboratory tests revealed that the disease was leptospirosis and one case was even diagnosed in Finland. This was the first report of a patient with clinical leptospirosis in Finland since the early 1950s.

The Ebola outbreak in the northern Ugandan district Gulu raised some international concerns. Although not particularly transmissible and not a serious candidate for a wide epidemic in any of the western countries, tourists and employees working in the area who may come in contact with infected persons can cause great anxiety.


There were three major trends in the notification of communicable diseases in Iceland during the year 2000.

Firstly, there was a marked reduction in the incidence of campylobacteriosis. During 1999 Iceland experienced a nation-wide epidemic of the disease. Epidemiological investigation indicated that the consumption of campylobacter-contaminated poultry was the main cause of the epidemic. This was confirmed by DNA sequencing of the campylobacter found in chickens and from patients with campylobacteriosis. The increase in the incidence of the disease from 1997 to 1998 was linked to a change in the practise of selling unfrozen "fresh" poultry instead of frozen poultry. Active measures were taken during 2000 to reduce campylobacter contamination in chicken breeding and the sale of contaminated frozen poultry. The number of domestic cases of campylobacteriosis was reduced as a result of these measures.

Secondly, there has been a steady rise in the incidence of sexually transmitted chlamydia infections since 1998. The reason for this is unknown. There is a shortage of primary health physicians in Iceland and thus inadequate access to immediate diagnosis and treatment is inadequate. Consequently, the clinic for sexually transmitted infections in Reykjavik has trouble meeting the increased demand for access and contact tracing.

Thirdly, the number of salmonellosis cases more than doubled in the year 2000 as compared to previous years. A large outbreak of infections due to multiresistant S. typhimurium DT204b was reported during the autumn of 2000 in Iceland. Epidemiological investigation linked these infections to the import of contaminated lettuce to Iceland. At approximately the same time smaller outbreaks occurred due to the same bacterium in the UK, the Netherlands and Germany. The cause could not be established in these countries.


Effective immunoprophylactics is important. In 2000, 99% of two-year-olds were vaccinated against tuberculosis, 96% against diphtheria, tetanus and poliomyelitis, 95% against pertussis and 93% against measles, mumps and rubella. Vaccine coverage among teenagers against hepatitis B was increased. Seventy-five percent of 14-year-olds were fully vaccinated.

Examination of patients with acute flaccid paralysis provided no indication of circulating wild-type poliovirus in Estonia.

After a two-year interval, two cases of diphtheria were diagnosed among adults in the border city of Narva during 2000. These were most likely imported infections. Following an investigation of risk groups including more than 31,000 people, we concluded that toxic C. diphtheria is not circulating in Estonia.

As a result of vaccination, measles morbidity among children is steadily decreasing. Taking into account the present day level of vaccine coverage for persons among risk groups, it seems feasible that the elimination of measles in the near future may be possible.

The epidemiological situation regarding intestinal infections in Estonia has changed over time. In the period 1996-2000, only one person fell ill with typhoid fever. Shigellosis morbidity steadily decreases. Morbidity due to salmonella remains at a relatively low level. None the less, salmonella is often spread through outbreaks. During 2000, 8 salmonella outbreaks were reported, and those who fell ill during these outbreaks constituted 13% of the total number of patients. The majority of cases were caused by S. enteritidis. Salmonella was isolated from hens’ eggs and different meat products. Lately, rotavirus infections and campylobacteriosis have become the most widespread diseases.

The spread of tuberculosis has decreased somewhat over the last years. However, problems related to tuberculosis have not been solved. The spread of resistant tuberculosis microbes is a major challenge.

The spread of venereal diseases (syphilis, gonorrhoea, chlamydia and trichomonas) has decreased during the last years. In contrast, during the second half of 2000 an explosive spread of HIV-infection among injecting drug users in the age group 15-24 years was observed in Narva, Virumaa and Tallinn. This risk factor also caused the spread of viral hepatitis B and C.


Acute intestinal infectious diseases.

Since 1997 the number of acute intestinal infectious diseases has doubled (123.2 as compared to 216 cases per 100,000 reported in 1997 and 2000, respectively). In addition, there has been a substantial increase in the number of reported outbreaks. While 9 outbreaks including 5 or more patients were reported in 1997, 33 outbreaks were registered in 2000. An increase in morbidity has been observed for acute intestinal infections caused by various pathogens including S. enteritidis (793 cases or 27%), shigellosis caused by S. flexneri (158 cases or 10%), virus infections (881 cases or 65%) and diarrhoea in which the cause was not confirmed by laboratory analysis (2,074 cases or 37%).

Diphtheria. Since 1993 Latvia has experienced a diphtheria epidemic. During the period from 1993 to 2000 1,197 cases were registered of which 92 were lethal. A significant rise in the number of diphtheria cases has been observed during recent years. Twice as many cases (264) were registered in 2000 as compared to 1999. A large proportion of the population is not vaccinated against diphtheria.

Mumps. Due to the vaccination program established during the late 1980s, morbidity due to mumps has decreased 55 times. However, a current outbreak of mumps began at the end of 1999. During this outbreak 5, 732 cases have been reported primarily among youth that were vaccinated more than 10 years ago.

Tick born encephalitis. Most of Latvia is highly endemic for tick born encephalitis, reporting the highest morbidity in Europe. Between 1993 and 2000 7, 031 cases of TBE were registered of which 52 were lethal. A vaccination program for children in highly endemic areas was established in 1997 following which a rapid decrease in TBE morbidity among vaccinated children was noted.

Hepatitis B and Hepatitis C. Since 1997 the epidemiological situation of hepatitis B has worsened dramatically. While 375 cases were reported in 1997 718 cases were reported in 2000. The greatest morbidity due to hepatitis B is observed among the age group 15 to 29 years. A very rapid increase in hepatitis C morbidity has also been reported. In 2000, 297 cases were registered, 2.3 times greater than the number of cases reported during the previous 5 years. The high hepatitis B and hepatitis C morbidity is attributed to the spread of infection among intravenous drug users.

HIV/AIDS. During 2000, 467 cases of HIV-infection were registered, 5 times greater than the average number of cases reported during the last 5 years. Compared to 1999, the number of reported HIV infections increased by 89 % in 2000. Twenty-four cases of ADS were registered in 2000.  The main risk factor for HIV infection is intravenous drug use.

Tuberculosis. A rapid increase in morbidity due to tuberculosis has been observed since 1990 (27.4 as compared to 70.2 cases per 100,000 inhabitants in 1990 and 2000, respectively). Tuberculosis morbidity has increased among children as well.
From 1999 to 2000 an increase in morbidity due to other infections was reported including whooping cough (5,773 cases or 38%), Lyme disease (472 cases or 68%), chicken pox (5,773 cases or 38%), infectious mononucleosis (266 cases or 27%), trihinelosis (91 cases or 128%), toxocariasis (77 cases or 88%), inherent infections and parasitic diseases (129 cases or 24%).


In Lithuania, 626,315 cases of communicable diseases were registered during 2000. Approximately 90 of the cases were due to influenza and acute upper respiratory infections, 7 to parasitic diseases, and 2 to acute intestinal diseases. Hospital infections are also a current problem. It has been reported that 5 to 10% of all in-patients contract hospital infections. About 20 cases of leptospirosis are registered in Lithuania every year. Some of these cases are fatal.

In 2000, 11,850 cases of food-borne diseases were registered in Lithuania including 1,202 cases (10.1) of salmonellosis, 1,042 (9.0) of shigellosis, 1,436 (12.1) of specified bacteriological intestinal infections, 5,985 (50.5) of unspecified bacteriological intestinal infections, 1,485 (12.5%) of viral intestinal infections and 702 (6.0) of toxic infections. In 2000 as compared to 1999, the incidence of acute intestinal diseases decreased. The incidence of salmonellosis decreased by 17.7, shigellosis by 32.6, other specified bacteriological intestinal diseases by 17.6, unspecified bacteriological intestinal diseases by 13,7, specified viral infections by 10.9, unspecified viral infections by 14.3, food-borne infections toxic in nature by 10.8 and hepatitis A by 3.5 times.

More than 44000 cases of parasitic diseases were registered in Lithuania during 2000. Most common (99.0) was helminthiasis including enterobiasis, ascariasis, trichocephaliasis and toxocariasis. Since 1990 an increase in the morbidity of enterobiasis, ascariasis and trichocephaliasis has been observed. The high incidence may be due to lack of hygiene at home as well as in public places and the lack of available treatment.

An increase in the size and spread of the tick population has resulted in an increase in TBE and Lyme disease. As compared to 1999, TBE morbidity increased by 2.5 times and Lyme disease morbidity by 2.2 times in 2000. Since 1991 TBE and Lyme disease morbidity have increased by 30 and 29 time, respectively.

Arkhangelsk Region

During 2000, 442,900 cases of infectious and parasitic diseases were registered in the Archangels Region. Total morbidity decreased by 7%. Influenza and acute respiratory viral infections constitute 86 % of all reported infectious diseases.

There were no cases of paratyphoid, diphtheria, tetanus, poliomyelitis, cytomegalovirus infection, tularaemia and post-vaccination complications registered in 2000.

A trend towards decreased morbidity was observed for 11 nosological forms, including a reduction by 19 times for measles, 2.8 times for rubella and mumps, 19% for Lyme disease, 40.7 % for influenza, 19% for scabies, 14.4% for syphilis and 4.1% for shigellosis.

Last year salmonella morbidity increased by 11.9% and viral hepatitis by 98.9%. Morbidity due to viral hepatitis A increased by 31 times and viral hepatitis C by 2.4 times.

Problems related to viral hepatitis remain rather topical for the region. Morbidity due to acute viral hepatitis B increased by 41.6% as compared with 1999. In 2000 the case rate for acute viral hepatitis B was 15.08 per 100,000 inhabitants. The marked increase of hepatitis B morbidity is related to the growing epidemic among 15-29 year olds.

Pertussis morbidity remained at the same level as 1999 and constituted 21.4 cases per 100,000 inhabitants. The majority of pertussis cases were reported among children with a case rate as high as 96%.

Shigellosis constituted 30.5% (as compared to57% in 1999) and acute intestinal infections 69.5 % of all intestinal infections.

Despite a decrease in the rubella case rate by 2.8 times (428.8 per 100,000 inhabitants) as compared with 1999, the situation regarding this infection is still considered to be rather serious in the region. Children accounted for 93 % of those taken ill.

In 2000 tuberculosis morbidity increased by 12.2 %. The pulmonary TB case rate increased by 13.8 % and cases with the discharge of Mycobacterium tuberculosis increased by 14.8 %.

During the last five years morbidity due to natural focus infections has been registered sporadically and does not exceed average Russian indexes. In 2000 natural focus infections included leptospirosis (0.6 per 100,000 inhabitants), tick-borne borreliosis and tick-borne encephalitis (2.3 per 100,000) and yersiniosis (7.3 per 100,000). The pseudotuberculosis case rate increased from 6.0 per 100,000 inhabitants in 1996 to 16.1 per 100,000 inhabitants in 2000 over the entire region.

Murmansk Region

During 2000, more than 348,000 cases of infectious diseases were registered in the Murmansk region. The overall morbidity as compared to the previous year decreased by 3%. Influenza and acute respiratory infections constituted 90.5% of the infections.

Diphtheria morbidity decreased 2 times, mumps 9 times and rubella 1.7 times. An overall decrease in venereal diseases was registered including syphilis by 12%, gonorrhoea by 4%, acute dysentery by 23% and scab by 19.5%. No morbidity due to typhoid fever, paratyphoid fever, poliomyelitis, rabies, tetanus, measles, tick-borne spring-summer encephalitis, rikettsiosis, tularaemia or viral haemorrhargic fever was registered. No cases of post-vaccination complications were registered.

In 2001, increases in morbidity due to salmonellosis by 12.4%, other acute intestinal infections by 11%, acute viral hepatitis A by 6 times and viral hepatitis C by 27% were registered. In addition, there was a 50% rise in the number of hepatitis B carriers. Among the vaccine-preventable diseases, pertussis morbidity increased by 1.3% and has continued to rise for two years. According to data from the regional Centre for Prophylactics and Fight against AIDS, HIV-infections increased by 1.4 times.

Vaccine-preventable diseases. Beginning in 1995, a steady decrease in diphtheria morbidity has been observed in the Murmansk region. During 2000, 7 cases of diphtheria were registered providing an indicator of 0.7 per 100,000 inhabitants. An indicator of 1.4 per 100,000 was registered in 1999. All the patients, 6 adults and one teen-ager, had been vaccinated against diphtheria. Among children up to 14 years of age no diphtheria morbidity was registered. Every year serologic monitoring is performed to order to document immunity against diphtheria and tetanus. The level of collective immunity was 93.3% and 98.4% in adults and children, respectively.

In comparison to 1999, pertussis morbidity increased 1.9 times in 2000 providing a morbidity indicator of 34.4 per 100,000 inhabitants. The corresponding indicator was 18.4 in 1999.

The majority of patients with pertussis were children (56% among 7-14 year olds and  20% among 4-6 year olds) who were vaccinated at an early age with a vaccine that lacked the pertussis component. The bacteriological diagnosis was confirmed in 17%, and the serological in 37.8% of the cases. In general, niduses with 2 or 3 cases were registered in children’s educational institutions. Despite a reduction in rubella morbidity by 42.2% during 2000, the epidemiological situation in the region remains unfavourable. Ninety-three percent of the cases are among children and teen-agers.

As a result of the emphasis that has been placed on increasing vaccine-coverage among children in the region, the WHO criteria (higher than 95% coverage) were successfully reached among children in designated age groups.

Shigellosis constituted 16.6% of the total number of acute intestinal infections, whereas other intestinal infections were responsible for 83.2% of acute intestinal infections in 2000. The corresponding figures for 1999 were 21.4% and 78.6% for shigellosis and other infections, respectively.

HIV infection and viral hepatitis remain topical to the region. In 2000, 64 HIV infections were registered as compared to 39 in 1999.

Viral hepatitis B morbidity, transmitted in an analogous way, comprised 59.0 per 100,000 during 2000 as compared to 34.1 in 1999. The figure for 2000 exceeds the morbidity indicator of the Russian federation by 1.4 times. The majority of infections, 88.4%, were registered among young people 15-29 years of age. Drug use and sexual transmission are responsible for the high HIV, hepatitis B and hepatitis C morbidity among young people. A very topical problem for the region is the lack of funding for vaccination against hepatitis B among persons from 12-18 years of age.

Tuberculosis morbidity has stabilised in the region. The indicator for bacillar forms was 11.8 per 100,000 inhabitants in 2000 as compared to 11.5 in 1999. Effective measures against tuberculosis have been organised in the region as a result of the allocation of resources from federal and local budgets. In addition, medical treatment for patients with tuberculosis has reached high levels using the DOTS strategy as recommended by the World Health Organisation.

Natural nidus infections including leptospirosis (0.3 per 100,000 inhabitants) and yersiniosis (12.9) were registered at a sporadic level in Murmansk region. Pseudo-tuberculosis exceeded the morbidity registered in 1999 by 1.5 times owing to two outbreaks in children’s educational institutions. The indicator was 24.2 per 100,000 inhabitants in 2000 as compared to 9.5 in 1999.

St. Petersburg

The number infectious diseases registered during 2000 corresponds to the 1999 level. Eughty five percent of all registered infections are due to influenza or acute respiratory viral infections (ORVI).

Morbidity due to basic nosological forms was at the same level or showed a decreasing tendency as compared to 1999.

During 2000, a 6-fold increase in the number of hepatitis A cases was registered.

Diphtheria morbidity increased by 67%. This increase was observed primarily among the adult population who were not vaccinated were vaccinated many years ago.

Leningrad Region

The general number of notified communicable diseases has not increased in comparison with 1999. For the most of infections, the morbidity was lower in the Leningrad region than in the Russian Federation as a whole. Regardless of the situation was considered to be complicated.

There was observed an increase in HIV and parental viral hepatitis infections. It was established by epidemiological investigations, that 90% of HIV infections and more than 50% of hepatitis B and C infections were among drug-users. The morbidity was highest in the age groups 15-19 and 20-29 years. The prognosis for 2001 was not favourable.

The importance of socially conditioned communicable diseases as tuberculosis and STDs has not diminished. Among those people who were diagnosed with tuberculosis for the first time, 58% were unemployed. Disintegration of lungtissue was observed in half of the patients and mycobacterium positive were 40%. Only 18% of the patients had a clinically favourable for treatment tuberculosis.

The morbidity of vaccine preventable diseases had stabilised with the exception of diphtheria. No cases of measles were registered in the region in 2000. The morbidity of whooping-cough was reduced by 20%. Primary attention was given the preparations for certification of the region as poliomyelitis-free. An acute flaccid paralysis surveillance system was introduced in order to meet the requirements for childhood vaccination coverage as recommended by WHO.

The epidemiological situation of nature foci infections was favourable. Only tick-borne encephalitis and Lyme disease morbidity increase reflected the recurrent situation of high number of tick-carriers in an environment. The natural foci of haemorrhagic fever with kidney-syndrome, tularemia, Q-fever and leptospirosis continued to exist in the region with sporadic cases of the diseases.

Republic of Karelia

In the year 2000, an increase in the morbidity of acute intestinal infections, whooping-cough, scarlet fever, rubella, epidemic parotitis (but less intensive than previous years), viral hepatitis A, acute hepatitis B and C with parental mechanism of transmission and HIV-infection was registered in the Republic of Karelia. HIV infection as well as hepatitis B and C infection was primarily found among young persons in the Republic of Karelia. The main risk factor for infection was intravenous drug-use.

The morbidity regarding natural focus and zoonotic infections is stable. No cases of tularaemia, anthrax or tetanus were reported during 2000. Only sporadic cases of leptospirosis and haemorrhagic fever accompanied by kidney syndrome were registered. However, the situation for tick-borne encephalitis and tick-borne borreliosis has worsened. For the first time in 12 years two patients were registered with brucellosis.

Kaliningrad Region

The number of infectious diseases in the region decreased by 20,211 cases (9%) during 2000 as compared to 1999.

Vaccine-preventable diseases. The coverage as indicated by the national vaccine calendar for prophylactic vaccination of the population against infections was accomplished by 97.0%. This allowed for the prevention of measles and diphtheria, a reduction in the number of patients with tetanus to sporadic cases, a decrease in mumps by 31 times in comparison to 1999 due to the re-vaccination of young people, and a reduction of influenza cases by almost 2 times.

Viral hepatitis. During recent years the morbidity indicators for acute forms of viral hepatitis have on average been 50% lower than the analogous indicators for the Russian Federation as a whole, especially regarding hepatitis A. The degree of morbidity not verified etiologically has stabilised at 11.7%. Hepatitis B infection is most intensively marked in the age-group 15-19 years. In the age group 15-39 years, 44.3% are infected through injecting drug use. Hepatitis C – 49.4% and hepatitis B – 37.1%, constitute a significant share in the structure of chronic viral hepatitis.

Infections originating in nature. According to data from entomological monitoring, an increase in the population size of natural hosts has been observed. The general number of ixodus ticks has increased, and a greater number of ticks carry TBE- and borellia-virus.

Rabies has not been registered among the population of the region since 1974. In 2000, the epizootic situation deteriorated sharply. While 61 cases of rabies among animals were confirmed over the last 10 years, 44 cases primarily among foxes were confirmed in 2000 alone. Many people still seek medical attention for animal bites.

A stable high number of sporadic cases of leptospirosis were registered. The lethality of this disease remains high, between 10 to 19% in some years.

Socially conditioned infections. Morbidity due to tuberculosis rose by 18% as compared to 1999, and exceeded the federal indicator by 33.6%. Among those diagnosed with tuberculosis for the first time, 53% were not employed. The significant proportion of bacilli form amounted to 32.6%. The growth in mortality has exceeded the growth in morbidity since 1998. Primary resistance to antibacterial medications totalled 49.5 % and secondary resistance 80.9%.

Beginning in 1998, a decrease in the number of primary HIV-infections has been registered. During 2000, the number of persons infected with HIV decreased by 20.3% in comparison to 1999. The number of infections detected through screening programs decreased by 7.9%. The most affected age group remains 20-29 years in which 57.1% of all cases are registered. The highest number of HIV-infections was reported in Kaliningrad City and the adjacent administrative territories. HIV-infections among injecting drug users constitute 71.7% of the total number of cases. The number of persons infected by HIV through sexual contacts (26.7%) has grown by 4%. In 2000, 6 cases of AIDS were registered (0.8 per 100,000 inhabitants).

Among registered cases of sexually transmitted infections, trichomonosis (39.4%), syphilis (25.1%), chlamydia (18.2%) and gonorrhoea play the most significant role. In 2000, the morbidity indicator for “new generation” infections constituted 531.1 per 100, 000.

Acute intestinal infections. In 2000 a decrease in the morbidity level of acute intestinal infections by 20.0% was achieved, 2.0% lower than anticipated. A decrease in dysentery morbidity by 12.6% among the adult population and 16% among children was registered. An even greater decrease, 37%, was reported among children under 1 year of age. The proportion of enterocolitis that was not confirmed etiologically decreased over.