N. Pshenichnaya

Probable Crimean-Congo hemorrhagic fever virus transmission occurred after aerosol-generating medical procedures in Russia: nosocomial cluster

We report here a fatal case of laboratory confirmed Crimean-Congo hemorrhagic fever (CCHF), which caused nosocomial infection in eight health care workers (HCWs), who had provided medical care for the patient. All the HCWs survived. The report demonstrates that airborne transmission of CCHF is a real risk, at least when the CCHF patient is in a ventilator. During performance of any aerosol-generating medical procedures for any CCHF patient airborne precautions should always be added to standard precautions, in particular, airway protective N95 mask or equivalent standard, eye protection, single airborne precaution room, or a well-ventilated setting.

Dirofilaria repens in the Russian Federation: current epidemiology, diagnosis, and treatment from a federal reference center perspective

BACKGROUND Dirofilariasis is an emerging zoonotic infection in which the human serves as an accidental host. Russia has been one of the most important endemic regions worldwide for Dirofilaria repens, the most prevalent Dirofilaria species in Europe. METHODS Based on a cohort of patients at the Rostov Medical University, we provide an epidemiological description of 236 human cases, reporting common clinical symptoms and treatment options for D. repens infections in humans. The performance of a non-commercial immunoassay was validated in a diagnostic sub-study (diagnostic accuracy 83%). Data from mosquito surveys and cross-sectional surveys of dogs, the main reservoir of D. repens, are also presented. RESULTS Results showed important variations in prevalence depending on sex, geographic location, and the use of dogs (professional service dogs or pets). CONCLUSIONS The particularly high prevalence of Dirofilaria infection in professional dogs used in the police force and armed forces poses a particular problem, since these dogs may serve as epidemiologically important amplifiers within the region of the former Soviet Union.

Current status of Crimean-Congo haemorrhagic fever in the World Health Organization Eastern Mediterranean Region: issues, challenges, and future directions

Summary Crimean-Congo haemorrhagic fever (CCHF) is the most widespread, tick-borne viral disease affecting humans. The disease is endemic in many regions, such as Africa, Asia, Eastern and Southern Europe, and Central Asia. Recently, the incidence of CCHF has increased rapidly in the countries of the World Health Organization Eastern Mediterranean Region (WHO EMR), with sporadic human cases and outbreaks of CCHF being reported from a number of countries in the region. Despite the rapidly growing incidence of the disease, there are currently no accurate data on the burden of the disease in the region due to the different surveillance systems used for CCHF in these countries. In an effort to increase our understanding of the epidemiology and risk factors for the transmission of the CCHF virus (CCHFV; a Nairovirus of the family Bunyaviridae) in the WHO EMR, and to identify the current knowledge gaps that are hindering effective control interventions, a sub-regional meeting was organized in Muscat, Oman, from December 7 to 9, 2015. This article summarizes the current knowledge of the disease in the region, identifies the knowledge gaps that present challenges for the prevention and control of CCHFV, and details a strategic framework for research and development activities that would be necessary to curb the ongoing and new threats posed by CCHFV.

Possible sexual transmission of Crimean-Congo hemorrhagic fever

Three cases of family transmission of laboratory-confirmed Crimean-Congo hemorrhagic fever (CCHF) among spouses are reported. These spouses had sexual contact at the end of the incubation period or during the early stage of the mild form of CCHF, without any hemorrhagic symptoms in the first infected spouse. This report demonstrates that sexual contact may represent a real risk of CCHF transmission, even if the patient only experiences mild symptoms.

Clinical and laboratory features of human dirofilariasis in Russia

The article presents the results of the prospective study of 266 patients with dirofilariasis who received medical and diagnostic assistance in Rostov Scientific Research Institute of Microbiology and Parasitology in Rostov-on-Don, Russia from 2000 to 2016. We have assessed the features of the dynamics of epidemiology of this infection in several territories of the Russian Federation, depending on the social structure of patients. Immature females of dirofilaria were found most commonly in humans (82.9 ± 2.6%), the proportion of maturity females and adult males of worms respectively was 10.5 ± 2.1% and 0.9 ± 0.6%. All mature worms were localized inside a capsule. Peripheral blood eosinophilia was detected only in patients with the migration of helminths (19 of 116 persons – 16.4%). Blood samples of patients examined by the method of concentration in 3% acetic acid for detection of microfilariae, showed negative result in all patients. Our data are consistent with the opinion of KI Skriabin about that human as «dual facultative host» for dirofiliaria. It is rare that parasite in human body is able to develop to the imago stage (according to our observations – 11.4%). The immune response to invasion by dirofiliaria in human is manifested as dense connective tissue which forms a capsule. According to our study the rare cases (22) of detection the sexual mature D. repens (10.4%) were localized inside the capsule. Observations of patients with D. repens infection allowed concluding that human for this helminth is «a biological deadend».

Infection prevention and control practice for Crimean-Congo hemorrhagic fever—A multi-center cross-sectional survey in Eurasia

Background Crimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers. Aim Evaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia. Methods A cross-sectional CCHF IP&C survey was designed and distributed to CCHF centers in 10 endemic Eurasian countries in 2016. Results Twenty-three responses were received from centers in Turkey, Pakistan, Russia, Georgia, Kosovo, Bulgaria, Oman, Iran, India and Kazakhstan. All units had dedicated isolation rooms for CCHF, with cohorting of confirmed cases in 15/23 centers and cohorting of suspect and confirmed cases in 9/23 centers. There was adequate personal protective equipment (PPE) in 22/23 facilities, with 21/23 facilities reporting routine use of PPE for CCHF patients. Adequate staffing levels to provide care reported in 14/23 locations. All centers reported having a high risk CCHFV nosocomial exposure in last five years, with 5 centers reporting more than 5 exposures. Education was provided annually in most centers (13/23), with additional training requested in PPE use (11/23), PPE donning/doffing (12/23), environmental disinfection (12/23) and waste management (14/23). Conclusions Staff and patient safety must be improved and healthcare associated CCHF exposure and transmission eliminated. Improvements are recommended in isolation capacity in healthcare facilities, use of PPE and maintenance of adequate staffing levels. We recommend further audit of IP&C practice at individual units in endemic areas, as part of national quality assurance programs.

Crimean-Congo hemorrhagic fever in pregnancy: A systematic review and case series from Russia, Kazakhstan and Turkey.

Highlights • CCHF in pregnancy is rare but has high rates of maternal (34%) and fetal mortality (59%).• Maternal hemorrhage is associated with maternal and fetal/neonatal death.• Nosocomial transmission of CCHF from 6/37 index pregnant cases resulted in 38 cases.• Early recognition and risk-assessment allows appropriate IP & C precautions and supportive care provision.

Availability of hepatitis C diagnostics and therapeutics in European and Eurasia countries

Background Treatment with direct acting antiviral agents (DAAs) has provided sustained virological response rates in >95% of patients with chronic hepatitis C virus (HCV) infection. However treatment is costly and market access, reimbursement and governmental restrictions differ among countries. We aimed to analyze these differences among European and Eurasian countries. Methods A survey including 20‐item questionnaire was sent to experts in viral hepatitis. Countries were evaluated according to their income categories by the World Bank stratification. Results Experts from 26 countries responded to the survey. As of May 2016, HCV prevalence was reported as low (≤1%) in Croatia, Czech Republic, Denmark, France, Germany, Hungary, the Netherlands, Portugal, Slovenia, Spain, Sweden, UK; intermediate (1–4%) in Azerbaijan, Bosnia and Herzegovina, Italy, Kosovo, Greece, Kazakhstan, Romania, Russia, Serbia and high in Georgia (6.7%). All countries had national guidelines except Albania, Kosovo, Serbia, Tunisia, and UK. Transient elastography was available in all countries, but reimbursed in 61%. HCV‐RNA was reimbursed in 81%. PegIFN/RBV was reimbursed in 54% of the countries. No DAAs were available in four countries: Kazakhstan, Kosovo, Serbia, and Tunisia. In others, at least one DAA combination with either PegIFN/RBV or another DAA was available. In Germany and the Netherlands all DAAs were reimbursed without restrictions: Sofosbuvir and sofosbuvir/ledipasvir were free of charge in Georgia. Conclusion Prevalence of HCV is relatively higher in lower‐middle and upper‐middle income countries. DAAs are not available or reimbursed in many Eurasia and European countries. Effective screening and access to care are essential for reducing liver‐related morbidity and mortality. HighlightsPrevalence of HCV is relatively higher in lower‐middle than in upper‐middle income countries.DAAs are not available in European and Eurasia countries for treatment of acute HCV.DAAs are not available or reimbursed in many European and Eurasia countries for treatment of chronic hepatitis C.Effective screening and access to care are essential for avoiding liver‐related morbidity and mortality.

Periorbital Dirofilaria repens imported to Denmark: A human case report

Dirofilaria repens, a filarial nematode of dogs and other carnivores, can accidentally infect humans. The infection occurs widely throughout Europe. We report a case of D. repens in a Danish woman who had been traveling to Crete. A nematode was visualized on examination and ELISA was positive for antibodies against D. repens.

Genetic Diversity of the Hepatitis B Virus and Its Epidemiological Significance

Hepatitis B virus classification into serological subtypes based on the antigenic properties of HBsAg and genotypes/subgenotypes based on genetic sequence heterogeneity is described. Current criteria for assignment of HBV strains to genotype and subgenotype, recent findings and discrepancies of subgenotype identification are discussed. Characteristic global geographical distribution of HBV genotypes and subgenotypes is reviewed. Available data on relationship between vaccine protection and HBV genotypes is presented. Issues of HBV genetic variants associated with transmission routes and their relevance for epidemiology and virus evolution are addressed.