Eurosurveillance

ECDC

Abstracts from the Regional Epidemiologists' meeting, Oslo 2008

 Rediger
  Published: 17.02.09 Updated: 02.03.2009 08:46:19

 

Tick-Borne Encephalitis in Sweden
A. Blaxhult, Swedish Institute for Infectious Disease Control, Stockholm, Sweden

Citation: Blaxhult A. Tick-Borne Encephalitis in Sweden. EpiNorth. 2008;9(4):125.

The number of reported cases of tick-borne encephalitis (TBE) has gradually increased from around 90 per year in the 1990s to 182 in 2007. Most cases have been detected in the age group 40–60 years, and the disease is most prevalent on the Stockholm archipelago and along the eastern shore of Lake Mälaren.
Previously 75% of cases were reported from Stockholm, Uppsala and Södermanland counties. More recently, however, cases have been found in other areas: on the western shore of Lake Mälaren, on the Swedish south-east coast of the Baltic Sea, in western Sweden and in the Dalcarlia region. There are several possible explanations for the increase:

  1. Climate change, with milder winters and wetter summers, resulting in larger numbers of ticks.
  2. Greater awareness of TBE, resulting in larger numbers of people seeking medical care and being diagnosed.
  3. A shortage of vaccines due to an increased demand for immunization.

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Tick-borne encephalitis and Lyme borreliosis in Belarus Republic, 1998-2007
I.Karaban1, A.Vedenkov2, N.Sebut2

  1. Ministry of Public Health of the Republic of Belarus, Minsk
  2. State Institution “Republican Centre of Hygiene, Epidemiology and Public Health”, Minsk, Belarus

Karaban I.,.Vedenkov A, Sebut N. Tick-borne encephalitis and Lyme borreliosis in Belarus Republic, 1998-2007. EpiNorth. 2008;9(4):126.

The epidemiological situation of tick-borne encephalitis and Lyme disease in Belarus is unstable. The situation depends on climate and ecological conditions that maintain the number of vectors, their viral and bacterial infectivity, as well as on the presence of population in the ticks’ habitats. Natural foci of tick-borne encephalitis were identified in 71,5% of districts of the republic, Lyme disease in 90,7%.

In order to analyze the intensity of the natural foci we introduced in 2005 an intensity measure based on measurements of the density of infected vectors. During the period from 1998 to 2007 the incidence of tick-born encephalitis and Lyme borreliosis increased by 10-20% per year. In the same period, the seasonal number of ticks increased by 2.1%, viral infectivity by 9.7% and bacterial infectivity by 8.1 %. At the same time the system of treatment, prophylactic and antiepidemic measures implemented in health care institutions enabled the prevention of significant number of cases after bites of knowingly infected vectors. This stabilized the epidemiological situation in the republic, providing the decrease in the incidence rate in the population.

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Tick-borne Encephalitis among Travellers in Finland in 2007
M. Asikainen, P. Klemets, P. Ruutu
National Institute for Health and Welfare (KTL), Helsinki, Finland

Citation: Asikainen M., Klemets P., Ruutu P. Tick-borne Encephalitis among Travellers in Finland in 2007. EpiNorth. 2008;9(4):127-8.

Tick-borne encephalitis (TBE) is endemic in parts of Finland: the Åland Islands, the Turku archipelago, the Kokkola archipelago in western Finland and the Lappeenranta region in south-eastern Finland. TBE cases must be reported to the National Infectious Disease Register. The routine data collected by this surveillance system includes the municipality of residence but not the place where the disease was probably contracted. During the past 10 years an annual incidence of 12–41 TBE cases has been reported in Finland as a whole. Up to the end of 2005 approximately two-thirds of them were diagnosed in persons living in the Åland Islands.

A vaccination program was started in the Åland Islands in 2006, which offered permanent residents over seven years of age TBE vaccination free of charge. The vaccination coverage was about 55% in 2006. The aim of the present study was to discover whether the proportion of TBE cases in the population in the Åland Islands had changed since the introduction of the voluntary vaccination program.

In order to discover where the TBE patients were infected by tick bites, we conducted a study based on patient interviews by telephone and information from chart review. The patients’ vaccination status was assessed to detect possible vaccination failures.

Twenty TBE cases were registered in Finland in 2007. Eleven patients had contracted TBE in the Åland Islands. Five (25%) of them lived in Åland; one of these was a case of vaccination failure. The other six who contracted TBE in the Åland Islands were travellers, one of whom was from Sweden.

Three travellers were infected with TBE on the Turku archipelago. Three patients contracted TBE in the Kokkola area, two patients in the Lappeenranta region and one in the town of Närpes. These six were residents in the area where they contracted the disease.

Närpes is a small town on the west coast of Finland, and is not close to either the Turku archipelago or the Kokkola region. It could therefore be a new TBE-endemic area, but this needs to be confirmed by further studies and surveillance.

TBE in Finland is to some extent travel-related. Nine (45%) of the TBE patients in Finland in 2007 were not living in the area where they contracted the infection. The Åland Islands and the Turku archipelago have the highest travel-rate-associated TBE. This is probably due to the fact that these areas are very popular among Finns as summer vacation destinations.

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Tick-borne diseases in Lithuania
M. Žygutiene, Centre for Communicable Disease Prevention and Control, Vilnius, Lithuania

Citaton: Žygutiene M. Tick-borne diseases in Lithuania. EpiNorth. 2008;9(4):129.

The main vector of tick-borne diseases (TBD) in Lithuania is Ixodes ricinus, which is prevalent in temperate regions in Europe. The largest abundance of ticks (52–129 ticks per 1 flag-kilometre) has been observed in central Lithuania, where the highest incidence of TBE is reported.

In the period 2000–2007 a total of 3012 cases of tick-borne encephalitis (TBE) were registered in Lithuania. A significant rise in morbidity has been reported in the last 15 years (1993–2007). The highest annual number of cases (763) was registered in 2003. Between 656 and 2029 cases of Lyme disease per year have been recorded in the last 15 years, but in 2003 the number of cases reached 3688. TBE virus has been found in ticks collected from 221 localities and B. burgdorferi sensu lato from 150 localities in Lithuania. Besides TBE virus and Borellia burgdorferi sensu lato, Anaplasma bacteria and two species of protozoa belonging to the genera Babesia and Trypanosoma were detected in I. ricinus ticks.

The mean infection rate of I. ricinus ticks by B. burgdorferi sensu lato in Lithuania was 13.4%, with a range of 1% to 35% in different locations. All three Borrelia genospecies were detected in ticks: B. afzelii (9–10%), B. garinii (2.5–5%) and B. burgdorferi sensu stricto (0.4%). The ticks were positive for Ehrlichia/Anaplasma (5%), B. burgdorferi sensu stricto (0.4%), and Babesia divergens (2%). In over 3000 I. ricinus examined in the period 1992–1997. Trypanosoma (amastigote, promastigote and epimastigote) were detected in three individual ticks (0.1% prevalence).

The epidemiological importance of TBD in Lithuania is similar to that in other countries of  Central Europe. Agents of infectious diseases transmitted by ticks, such as TBE virus and B. burgdorferi sensu lato are a serious hazard to human health. Further research on tick-borne diseases is needed to provide more information on the factors influencing the distribution of these zoonoses. Long-term studies are also needed to understand the differences in the fluctuations of tick activity and abundance.

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Provider-initiated routine Medical Examination, Testing and Counselling for Infectious Diseases in Injecting Drug Users
Hans Blystad, Norwegian Institute of Public Health, Oslo, Norway

Citation: Blystad H. Provider-initiated routine Medical Examination, Testing and Counselling for Infectious Diseases in Injecting Drug Users. EpiNorth. 2008;9(4):130-1.

Injecting drug users (IDUs) are through risk behaviour and underlying conditions like poor hygiene, homelessness and poverty vulnerable to a range of infectious and communicable diseases. This leads to higher morbidity and mortality in the group compared with the same age groups in the general population. Infections found more commonly in IDUs are HIV infection, viral hepatitis, tuberculosis, botulism, tetanus, skin and soft tissue infections caused by staphylococci and streptococci and, in some countries, sexually transmitted infections.

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) have in cooperation with the Norwegian Institute of Public Health developed draft guidelines on provider-initiated routine medical examination, testing and counselling for infectious diseases in injecting drug users. The draft can be downloaded from http://www.emcdda.europa.eu/html.cfm/index1375EN.html. Comments to this draft are welcome.

A final version of the guidelines will be published by EMCDDA in early 2009.

Such examinations may be offered by general practitioners, special health services for drug users, prison health care facilities, rehabilitation centres and other drug treatment services, dedicated sexual health clinics and tuberculosis clinics.

Among the objectives of the routine examination are to improve testing and treatment for infections, increase vaccination coverage, make drug users more actively engaged in their own health care, and improve surveillance of HIV infection, hepatitis and other infections in this group.

The consultation should include a medical history and physical examination, pre-test counselling, testing for infections, prevention counselling and vaccination. The patients may be offered testing for HIV, viral hepatitis A, B and C, syphilis, gonorrhoea, genital chlamydiosis, and tuberculosis (x-ray and tuberculin skin test).

Intravenous drug users should be vaccinated against hepatitis A and B, diphtheria and tetanus (every 5-10 year), and influenza (annually).

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Diphtheria morbidity in Latvia
I. Lucenko, State Agency “Public Health Agency”, Riga, Latvia

Citation: Lucenko I. Diphtheria morbidity in Latvia. EpiNorth. 2008;9(4):132.

During the period from 1947 to 1950 more than 1000 cases of diphtheria were registered annually in Latvia. Since 1953, after mass immunisation was introduced, morbidity has been decreasing gradually. From 1968 to 1985 no cases of diphtheria were registered in Latvia. During the pre-epidemic period from 1986 to 1989, 51 persons acquired diphtheria. The disease spread across Latvia. Morbidity reached its peak in 1995 and 2000.
From 2002 to 2007 between 18 and 45 cases were registered annually in Latvia. The cases were registered mainly in Riga, Riga district and Jurmala. The disease develops in children and adults of all ages. The incidence per 100,000 inhabitants was higher among children in the 0 to 9 years age group, as well as among adults aged from 50 to 59 years. The morbidity in women was slightly higher than in men. Among the adult patients, 30 % were unemployed, 25% were retired persons, 34 % were office employees and 15 % were workers. Adult patients developed more severe clinical manifestations of diphtheria (generalized and combined forms).

During six years 15 persons died from diphtheria: 4 children (3-7 years) and 11 adults (40-77 years). None of them were vaccinated against diphtheria. The percentage of bacteriologically confirmed cases increased from 56% in 2002 to 100% in 2006. Among the children who developed disease 29% were not vaccinated against diphtheria, among adults 89% were not vaccinated. In Latvia the vaccination coverage in children of different age is 96-99%, and in adults is 60% at the average. The lowest vaccination coverage is registered in Riga at 36 %.

Conclusions
Latvia has the highest diphtheria incidence in Europe. The risk of developing the disease is higher in socially vulnerable groups. Diphtheria is registered mainly in Riga, Riga district and Jurmala. The proportion of vaccinated persons among the patients is 24.5 % (children – 70.3 % and adults – 10.7 %). The vaccination coverage among adults in Latvia is insufficient (60 %).
In 2008 no tendency towards decreasing morbidity was observed. During the first 8 months of 2008, 20 persons developed the disease (7 children and 13 adults) in Riga, Riga district and Jurmala. Two adults aged over 50 years died.

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Background for vaccination against human papilloma virus (HPV) infection and malignant tumors associated with HPV in North-West Russia
L. Lyalina (1), E. Katkyavichene (3), E. Kasatkin (2), R. Garloev (4), G. Vyatkina (5)

  1. Pasteur Research Institute of Epidemiology and Microbiology, Saint-Petersburg
  2. Dermatovenerologic Dispensary №8, Saint-Petersburg
  3. Republican Dermatovenerologic Dispensary, Petrozavodsk, Republic of Karelia
  4. Republican Clinical Hospital, Petrozavodsk, Republic of Karelia
  5. Municipal Perinatal Centre, Pskov

Citation: Lyalina L., Katkyavichene E., Kasatkin E., Garloev R., Vyatkina G. Background for vaccination against human papilloma virus (HPV) infection and malignant tumors associated with HPV in North-West Russia. EpiNorth. 2008;9(4):133-4.

Human papilloma virus (HPV) infection and cervical carcinoma are ranked as socially significant diseases in the Russian Federation. During the last years vaccination against HPV has become a reality. However, immunization of the population presupposes knowledge of regional situations, including baseline and other epidemiological data related to HPV infection and associated malignant tumors.

This research aimed at studying clinical and epidemiological characteristics of HPV infection and cervical carcinoma in the regions of the North-Western region of Russia. HPV testing by PCR among groups at high risk included 5237 gynecological, urological (men) and dermatovenerologic patients (both sexes) in St. Petersburg, Republic of Karelia and Pskov Oblast in 2002-2007. Oncogenic HPV types 16, 18, 31, 33, 35, 45 and 56 were detected in colposcopy and cytology samples obtained from 83 patients. Histological examination of cervical biopsy samples was conducted in 18 cases when leukoplakia was detected or cervical intraepitelial neoplasi (CIN) suspected. Clinical and epidemiological investigations of the distribution of cervical carcinoma included an analysis of the long-term morbidity data among different age groups of the female population collected between 1990 and 2007 in the mentioned regions.

The results of this study revealed that dermatovenerologic and gynecological patients constitute a high risk group for HPV infection and spread in the North-Western region of Russia. The detection rate of highly oncogenic HPV types was 34.6 per 100 examined persons. When the number of sexual partners was equal to or greater than 10 from the time of sexual debut the detection rate increased to 77. 1%.  HPV types 16 and 18 were widely spread among patients seeking medical attention from gynecologists, urologists and dermatovenerologists. The detection rate of HPV type 16 was 10.1 and 15.5 per 100 examined persons in the Republic of Karelia and Pskov Oblast, respectively. The detection rate of HPV type 18 in the same regions was 6.4% and 4.7%. Co-infection with HPV types 16 and 18 was identified in 2.4% of the cases. In all regions people aged 15 to 29 years are considered to be a risk group for spreading HPV. Mixed infections are a serious problem. Oncogenic HPV types 16, 18, 31, 33, 35, 45 and 56 among patients with gonorrhoea, urogenital trichomonosis and chlamydia were detected in 19.2%, 39.1% and 33.3% per 100 examined persons, respectively. Highly oncogenic HPV types were detected in 34.4% of patients with condylomatosis of the outer genitals. The asymptomatic HPV infection rate reached 17.5 per 100 examined persons without any other sexually transmitted infections.

The results of the histological tests detected cervicitis (38.9%), leukoplakia (44.4%), СIN I (6%) and CIN III (11%) among the patients. Cervical carcinoma was diagnosed among three patients. A tendency for an increase in the incidence of cervical carcinoma was observed and a significant increase in morbidity was identified among women of reproductive age.

The results of this study indicate an urgent need to develop a national prevention programme including vaccination against HPV and malignant tumors associated with this infection.

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Additional immunisation of the population in Saint-Petersburg as part of the National Priority Project in Public Health
O. Parkov, Directorate of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-being in the City of Saint-Petersburg (Rospotrebnadzor), Saint-Petersburg, Russia

Citation: Parkov O. Additional immunisation of the population in Saint-Petersburg as part of the National Priority Project in Public Health. EpiNorth. 2008;9(4):137

Underfunding of the national vaccination programme in 1998-2004 was one of the reasons for starting a programme of additional immunisation.
Additional immunisation of the population against hepatitis B, rubella, measles, influenza, poliomyelitis (with inactivated vaccine) became one of the important measures to decrease the morbidity of these vaccine-preventable infections. The main objectives of the programme were to decrease the incidence of hepatitis B to 3.0 per 100 000 and rubella to 10.0 per 100 000 inhabitants, to eliminate measles, to prevent complications resulting from the use of live vaccine against poliomyelitis, and to protect risk groups against seasonal influenza.
The work was organised into several steps:

  • The Chief State Sanitary Doctor of Saint Petersburg passed a resolution and started collaboration with all relevant officials.
  • The size of the relevant age cohorts were measured and sufficient quantity of vaccines procured.
  • The polyclinics were provided with refrigerators and consumables and a database was created for them. Monitoring of the programme’s progress was organized.
  • The city took part in the European immunisation week and in a survey of the implementation of the national project.

Preliminary results of the programme indicate the decrease in incidence of hepatitis B and rubella, and only a few cases of measles have been registered.

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National hand hygiene campaign in Norway
Nina Sorknes, Norwegian Institute of Public Health, Oslo, Norway

Citation: Sorknes N. National hand hygiene campaign in Norway. EpiNorth.2008;9(4):138.

Introduction
In 2005 the Norwegian Institute of Public Health (NIPH) launched a national hand hygiene campaign. The aim was to improve hand hygiene in general and to alter the primary method of hand hygiene from hand washing to hand disinfection.

Method
An invitation to participate in the campaign, together with information, instructions and printed material explaining the advantages of hand disinfection was sent to the management of every health care facility in Norway (70 hospitals and 1000 long term care facilities for the elderly (LTCFs). Surveys were carried out before and after the campaign to discover 1) the individual institution’s guidelines for hand hygiene, 2) the consumption of hand hygiene products and 3) knowledge and attitudes about hand hygiene among the staff. All questions were answered electronically on the campaign website, www.renomsorg.no. The site coordinators at each health care facility were responsible for conducting the survey at their facility, entering the data and checking it for errors and inconsistencies. Figures for quarterly sales quantities of hand disinfection liquid were compiled from the six main distributors in Norway.

Results
Sixty-six hospitals and 240 LTCFs participated in the campaign. The post-campaign survey showed that the attitudes of health care personnel in LTCFs and hospitals to the best method for hand hygiene had changed in favour of hand disinfection by 35% and 34% respectively. The survey also showed that 47% of health care personnel in LTCFs and 32% in hospitals believed hand disinfection at the patient’s bedside made it easier to perform hand hygiene. The consumption of hand disinfection products had increased by 38% in hospitals and 451% in LTCFs. One year after the campaign, the quarterly sales of hand disinfection products to the Norwegian health care service had tripled, from 40 000 litres/quarter to 120 000 litres/quarter.

Conclusion
The campaign demonstrated that it was possible to alter the behaviour of health care personnel by making hand disinfection products more available and by providing information that hand disinfection is the preferred method of hand hygiene.

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Epidemiological surveillance system for surgical site infections in Ukraine
A. Salmanov, Ministry of Health of Ukraine, Kiev, Ukraine

Citation: Salmanov A.G. Epidemiological surveillance system for surgical site infections in Ukraine. – EpiNorth.2008;9(4):139.

The outcome of surgical treatment of 2356 patients admitted to the hospitals of Kiev in 2004–2006 was analyzed on the basis of patient case notes and other medical documentation. The aim was to study the causes of infectious diseases after surgery and to develop an epidemiological surveillance system for surgical site infections (SSI) in Ukraine.

We made an active search of patients with SSI based on our own criteria. The rate of SSI was on average 27.1 per 100 operations: 36.3 after herniotomy,  20.7 after appendectomy and 36.4 after cholecystectomy. The main etiological agents reported were Staphylococcus aureus, S. epidermidis, Enterococcus spp., Escherichia coli, Enterobacter spp., Acinetobacter spp., Pseudomonas aeruginosa, and Proteus spp. The main risk factors for infection were: patient’s condition, preoperative, operative and postoperative factors, and the internal hospital environment.

On the basis of these findings we developed an epidemiological surveillance system consisting of three interrelated functional sub-systems: information, diagnosis and management. The system was approved by the Ministry of Health of Ukraine. The system is practiced at two levels: the national and the hospital level. Epidemiological surveillance at the national level is conducted by the institutions of the state sanitary and epidemiological service, and at the hospital level by hospital epidemiologists on the basis of epidemiological surveillance data on the patients and active detection of SSI cases.

Epidemiological surveillance of these infections is based on the results of bacteriological, epidemiological and clinical examinations. It depends on reliable diagnosis and registration of all clinical forms of SSI, and monitoring of the main etiological agents isolated from patients, personnel and the hospital environment. Registration and reporting of the diseases are based on the anatomic localization of the pathological process.

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Implementation of the International Health Regulations is an opportunity to develop capacities that serve domestic and global public health security
M. Kivi, World Health Organization, International Health Regulations Contact Point for the European Region, World Health Organization Regional Office for Europe, Copenhagen, Denmark

Citation: Kivi M. Implementation of the International Health Regulations is an opportunity to develop capacities that serve domestic and global public health security. EpiNorth.2008;9(4):140.

The revised International Health Regulations (IHR) requested by member states of the World Health Organization (WHO) entered into force in June 2007. The IHR are legally binding and aim to prevent and control the international spread of disease. They apply to biological, chemical and radiation hazards. The WHO Regional Office for Europe assists states parties in the region in the IHR implementation process.

Under the IHR, member states designate a national IHR Focal Point (NFP) which notifies the WHO IHR Contact Point of unusual health events and public health risks. Implementing the IHR depends on dialogue and transparency between sectors, subnational agencies and states parties. From June 2007 to September 2008, about 140 events were assessed by the regional WHO IHR Contact Point. They were attributed to hazards related to: communicable diseases (~45%), zoonoses (~20%), food safety (~20%), chemicals (~10%), radiation (<5%) and pharmaceuticals (<5%). Responses to the events included joint risk assessment, international information-sharing and response-related assistance.

The IHR oblige states parties to maintain a core capacity for surveillance and response. States must assess their national resources and develop national action plans by June 2009 to ensure that core capacities are functioning by June 2012. In a state party self-assessment conducted in the European region between January and June 2008, most NFPs reported that surveillance and response capacities had been fully (n=18/36, 50%) or partially (n=12/36, 33%) assessed. The IHR are a valuable instrument in the continuous process of developing capacities and mobilizing resources based on assessment and lessons learned.

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The sanitary-epidemiological situation in the Russian Federation – current main problems and priority preventive activities
A. Melnikova, Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor), Moscow, Russia

Citation: Melnikova A.А. The sanitary-epidemiological situation in the Russian Federation – current main problems and priority preventive activities. EpiNorth.2008;9(4):141-4.

The large scale socioeconomic reorganizations in the Russian Federation over the years led to an improvement of the sanitary-epidemiological situation in the country. In 2007, a decrease of the incidence rate was noted for 30 infectious diseases, especially for diseases that can be controlled by specific prophylactic measures.

Vaccine-preventable diseases
The National Priority Project in Public Health was implemented in the Russian Federation since 2006. Its most important constituent is additional immunisation of the population against hepatitis B, rubella, poliomyelitis and seasonal influenza. The project has the following aims and measures:

  • Hepatitis B: At least a threefold decrease in the incidence by 2009. Twenty-five million persons will be vaccinated in 2006-2007 and 14 million in 2008-2009.
  • Rubella: About a tenfold decrease in incidence and elimination of the congenital rubella syndrome. Vaccination will be given to 11.6 million persons.
  • Poliomyelitis: Prevention of vaccine-associated cases. Each year in 2006-7, 150 000 children < 1 year with a history of somatic disease will be vaccinated with inactivated polio vaccine (IPV). From 2008, all children less than one year old will receive IPV.
  • Seasonal influenza: Decrease in incidence of influenza, in number of cases of influenza-associated complications and deaths. Each year in 2006-7, 22 million persons belonging to certain risk groups (children attending preschool and educational institutions, medical and educational institutions staff, and persons older than 60 years old) will be vaccinated; in 2008-9 at least 27 million.

The additional vaccination against hepatitis B resulted in a 25% decrease of the incidence in 2007 compared to 2006, and among children the reduction was fourfold.

As the result of additional immunization in 2006-2007 the vaccination coverage against rubella of children aged 8-18 years increased at the average by 30-50% in each age group in comparison to 2005. The incidence of rubella decreased 4.2 times in 2007 compared to 2006, and in 29 regions the disease incidence rate did not exceed 5 per 100 000 population.

A complete immunization course of IPV was given for almost 100% of those targeted.

These trends continued in 2008. A 21% reduction of hepatitis B incidence was recorded during the first eight months of 2008, including a 50% decrease in children. The rubella incidence rate decreased by 3.1 times, including 3.5 times in children.

The Russian Ministry of Public Health and Social Development through Regulation №673 from 30.10.2007 made changes to the national vaccination schedule in order to improve the prevention of vaccine-preventable diseases, decrease the risk of post-vaccinal complications and increase herd immunity against these infections. The main amendments were the changes in the hepatitis B vaccination schedule for healthy children of the first year with doses at 0, 3 and 6 months and inclusion of vaccination against seasonal influenza and measles.

A pilot project of vaccination of children of the first year with the Hiberix vaccine against Haemophilus influenzae type b (Hib-disease) is carried out in Murmansk and Yaroslavl regions. The purpose is to get a basis for a reasoned decision about the inclusion of this vaccine in the national vaccination schedule.

The high vaccine coverage against diphtheria, whooping cough, measles, and mumps contributed to significant decrease in the incidence of these infections. The incidence of measles was 1.1 cases per 1 million population and approached measles elimination criterion (less than 1 case per 1 million population). The number of cases has been reduced six fold. Comparative analysis of measles virus strains isolated in the Russian Federation in 2007 showed that 38% of registered cases were imported. There is evidence of significant progress towards measles elimination.

HIV infection and viral hepatitides
The HIV situation in the Russian Federation is still unfavourable. As of 1 September 2008, 429264 HIV-infected persons are registered, of which some 44.5 thousands were newly registered in 2007. About 80% of the HIV-infected persons are 15-30 years old, and the proportion of women has increased up to 40% in some regions.

Thus, the National Priority Project in Public Health includes a component regarding prevention of HIV-infection, hepatitis B, and hepatitis C and increased case-finding and treatment of HIV-infected persons. The purposes of the project in 2006-2007 were:

  • Examination of at least 44 millions persons for HIV infection.
  • Treatment and laboratory monitoring of at least 30 000 HIV-patients needing treatment.
  • Increase of the number of HIV-infected persons that undergo regular prophylactic medical examinations.
  • Provision of full course of chemoprophylaxis to pregnant women to prevent vertical transmission of HIV.
  • Increase of the level of population awareness about routes of transmission of HIV and measures to prevent infection.
  • Increase of the proportion of risk groups reached by prophylactic programmes.
  • Start of hepatitis B and hepatitis C treatment within the framework of pilot projects.

11.9 billion roubles from the federal budget were intended for the National Priority Project during 2006-2007, including 400 millions for prophylactic programmes. The main purposes were achieved.

Tuberculosis
Tuberculosis is a significant problem and threat to the sanitary-epidemiological wellbeing of the population of the Russian Federation. The number of newly diagnosed cases of active tuberculosis exceeded 110 000 in 2007 at an incidence rate of 82.8 per 100 000 population. This incidence has remained stable at high levels for the last five years. In 2007, 40% of newly diagnosed cases were of bacillar form.

A significant increase in the number of foreign citizens arriving to the country influences negatively on the epidemiological situation regarding HIV-infection, tuberculosis and other infectious diseases. The number of foreign labour force increased eight times in 2007 compared to 2004. In 2007 only among legal working immigrants were detected 1676 HIV-infected persons, 5188 persons with sexually transmitted infections, 3360 patients with tuberculosis and 2665 patients with other infectious diseases. Their social conditions often make them a source of infection for others.

Nosocomial infections
The problem of nosocomial infections control still remains very relevant. The incidence rate is on average 0.8-0.9 cases per 1000 patients throughout the country, but this number does not reflect the true situation because of significant underreporting of these infections. Several factors contribute to the emergence and spread of nosocomial infections, such as significant increase of invasive interventions during diagnostic and treatment procedures; the spread of antibiotic resistant bacterial strains in hospitals; and delayed execution of anti-epidemic measures.

Other diseases
During the last years there have been notable changes in the enteric infections, especially for those “traditional” to our country: The incidence of typhoid fever, dysentery, and salmonellosis decreased significantly. In addition a significant increase in number of rotavirus infected patients is registered, mainly among children up to 7 years old. This is explained by both the introduction of available and effective diagnostic methods and intensive virus circulation among the preschool children due to high number of undetected infection sources.

Main tasks in 2008
The main tasks of the Federal Service in 2008 are to:

  1. Ensure sanitary-epidemiological wellbeing of the population of Russian Federation and to develop new and correct functioning regional programmes of prophylaxis of infectious and parasitic diseases.
  2. Fulfil the National Priority Project in Public Health in the area of vaccine preventable infectious diseases, including prevention and treatment of HIV/AIDS and viral hepatitis B and C.
  3. Decrease the annual incidence rate to the following levels:
  • Viral hepatitis B: not more than 3.0 per 100 000 population.
  • Rubella: not more than 10 per 100 000 population.
  • Whooping cough: not more than 4 per 100 000 population.
  • Measles: not more than 1 case per 1 million population.
  • Mumps: not more than 3 cases per 100 000 population.
  • Diphtheria: only sporadic cases
  • Malaria: elimination of domestic cases
  • Ascariasis and opisthorchiasis: decrease of intensity of endemic foci

     4. Improve the organization of activities and implement new technologies in state sanitary-epidemiological surveillance, as well as conduct social-hygienic monitoring, using modern information technology, new methods of detecting pollutants and agents causing infectious diseases.
     5. Provide a national system of biological and chemical safety in the Russian Federation.
     6. Further development and improvement the legal and methodological procedures for implementation of state sanitary and epidemiological surveillance and consumer rights protection.
     7. Create a permanently acting system for providing public health information and promotion on individual and public disease prevention measures and healthy lifestyle.


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