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Background: The Turkestan region of Kazakhstan is the natural focus of the Congo-Crimean hemorrhagic fever (CCHF). Every year, some of the patients treated in hospitals are not included in official statistics and remain in the group of possible cases of CCHF. Objectives: This study aimed to verify the genotypes of the CCHF virus (CCHFV) in the Turkestan region and Shymkent City. Methods: Twelve blood samples from patients with CCHF were studied, the diagnosis of which was verified on the basis of positive specific immunoglobulins IgM to the virus. To isolate viral RNA, we used a special MAGNO-sorb kit. To detect RNA, CCHFV was used with a set of Amplisens CCHFV-FL by real-time polymerase chain reaction (PCR) using a Rotor-Gene Q device. For the reverse transcription reaction, we used a set of Reverta-L. Results: The study of the genome sequence of CСHFV from GenBank demonstrated that isolates from the Turkestan region belonged to genetic groups Asia-1 and Asia-2. Conclusions: For the first time in Kazakhstan’s history, a phylogenetic analysis of RNA sequences of viruses from patients with CCHF was performed in the Turkestan region, as a result of which genetic groups Asia-1, reassortant Asia-1, and Asia-2 were established

Background Crimean-Congo hemorrhagic fever (CCHF) is endemic in Africa and in areas below the 50th parallel of north (latitude 50°0' N) in Asia and Europe, but the epidemiology of CCHF needs to be better characterized in most regions. Methods We comprehensively searched scientific databases for studies on CCHF epidemiology in these regions. We used a One Health approach to describe disease burden through human cases, animal and human serology studies, and Crimean-Congo hemorrhagic fever virus (CCHFV) isolation from ticks. In addition, we leveraged a classification scheme tosort countries into five categories based on the level of evidence and the maturity of their CCHF surveillance systems. Results We identified 2,253 CCHF cases that occurred in the region during the period 1944–2021. Central Asian countries reported the majority of cases (1,966). China is the only country in Eastern and South-eastern Asia that reported CCHF cases (287). Six countries (China, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan) were assigned to level 1 or level 2, based on the maturity of their surveillance systems. Two countries (Mongolia and Myanmar) were assigned to level 3, due to conclusive evidence of CCHFV circulation in the absence of reported CCHF cases. Subsequently, 13 countries in Eastern and South-eastern Asia were categorized in levels 4 and 5, based on CCHFV vector prevalence. Conclusion This paper describes past and present status of the CCHF reporting systems to inform international and local public-health agencies to strengthen or establish CCHF surveillance systems and address shortcomings in the region. Disclosures All Authors: No reported disclosures.

It is generally accepted that the course of viral hepatitis A is accompanied by short-term viremia, and the disease itself does not have serious consequences for the person who has recovered. The article describes a clinical case of a protracted course of viral hepatitis A with long-term persistence of the virus. Against the background of the therapy, the patient's condition improved, and by the time of discharge from the hospital on the 38th day of illness and later, with a retrospective examination on the 68th day from the onset of the disease by the method of reverse transcription PCR (RT-PCR in real time), the presence of RNA of the hepatitis A virus was confirmed in feces, which indicated a long persistence of the virus in the body. This observation indicates the need for long-term dispensary observation of patients who have undergone viral hepatitis A.

Background: After the breakup of the Soviet Union, the annual incidence of tuberculosis (TB) in children 15–17 years of age increased in the Russian Federation from 16 per 100 000 population in 1992 to 37 per 100 000 in 2009, and new control measures were implemented. Methods: Children were screened annually for TB exposure with a tuberculin skin test (TST) at age 1–8 years. If positive, they were investigated for active TB. If no active TB was found, they were treated with isoniazid for 4–6 months; they then underwent 6-monthly skin tests (which included two recombinant proteins) until negative and annual skin tests thereafter. From the age of 8 years, the yearly follow-up was performed using the skin test that included two recombinant proteins, either until they became negative, developed active TB, or turned 18 years. Results: The annual incidence of TB in Russian children decreased from 19.1 per 100 000 population in 2001 to 8.3 per 100 000 population in 2018. Conclusions: Annual screening for TB exposure with treatment for latent or active TB has reduced the annual incidence of TB in Russian children aged 15–17 years to 1992 levels. Keywords: Latent tuberculosis, Screening of children and adolescents, Recombinant tuberculosis antigen

International audience; BACKGROUND: Because central line-associated bloodstream infections (CLABSIs) are a significant complication of central venous access, it is critical to prevent CLABSIs through the use of central line bundles. The purpose of this study was to take a snapshot of central venous access bundles in various countries. METHODS: The participants in intensive care units (ICUs) completed a questionnaire that included information about the health center, infection control procedures, and central line maintenance. The countries were divided into 2 groups: those with a low or low-middle income and those with an upper-middle or high income. RESULTS: Forty-three participants from 22 countries (46 hospitals, 85 ICUs) responded to the survey. Eight (17.4%) hospitals had no surveillance system for CLABSI. Approximately 7.1 % (n = 6) ICUs had no CLABSI bundle. Twenty ICUs (23.5%) had no dedicated checklist. The percentage of using ultrasonography during catheter insertion, transparent semi-permeable dressings, needleless connectors and single-use sterile pre-filled ready to use 0.9% NaCl were significantly higher in countries with higher and middle-higher income (P < .05). CONCLUSIONS: Our study demonstrated that there are significant differences in the central line bundles between low/low-middle income countries and upper-middle/high-income countries. Additional measures should be taken to address inequity in the management of vascular access in resource-limited countries.

Background: In this cross-sectional, international study, we aimed to analyze vector-borne and zoonotic infections (VBZI), which are significant global threats. Method: VBZIs’ data between May 20–28, 2018 was collected. The 24 Participatingcountries were classified as lower-middle, upper-middle, and high-income. Results: 382 patients were included. 175(45.8%) were hospitalized, most commonly in Croatia, Egypt, and Romania(P = 0.001). There was a significant difference between distributions of VBZIs according to geographical regions(P < 0.001). Amebiasis, Ancylostomiasis, Blastocystosis, Cryptosporidiosis, Giardiasis, Toxoplasmosis were significantly more common in the Middle-East while Bartonellosis, Borreliosis, Cat Scratch Disease, Hantavirus syndrome, Rickettsiosis, Campylobacteriosis, Salmonellosis in Central/East/South-East Europe; Brucellosis and Echinococcosis in Central/West Asia; Campylobacteriosis, Chikungunya, Tick-borne encephalitis, Visceral Leishmaniasis, Salmonellosis, Toxoplasmosis in the North-Mediterranean; CCHF, Cutaneous Leishmaniasis, Dengue, Malaria, Taeniasis, Salmonellosis in Indian Subcontinent; Lassa Fever in West Africa. There were significant regional differences for viral hemorrhagic fevers(P < 0.001) and tick-borne infections(P < 0.001), and according to economic status for VBZIs(P < 0.001). The prevalences of VBZIs were significantly higher in lower-middle income countries(P = 0.001). The most similar regions were the Indian Subcontinent and the Middle-East, the Indian Subcontinent and the North-Mediterranean, and the Middle-East and North-Mediterranean regions. Conclusions: Regional and socioeconomic heterogeneity still exists for VBZIs. Control and eradication of VBZIs require evidence-based surveillance data, and multidisciplinary efforts.

Introduction: The number of patients with COVID-19 is increasing rapidly, but the relationship between comorbidity and hospitalization of patients with COVID-19 is still not clearly defined. Aim: To analyze the structure of comorbidity of patients with COVID-19 and its impact on hospitalization. Methods: The analysis of monitoring data of patients with COVID-19 with various comorbidities was carried out in the period from March to November 2020 in the Russian Federation. Results: A total of 90077 patients with comorbidities were identified among patients with COVID-19. Diseases of the cardiovascular system accounted for 50.54% (45713), diseases of the bronchopulmonary system - 14.14% (12791), diseases of the endocrine system - 9.26% (8375), oncology - 4.59% (4151), other diseases 21.47% (19047). Hospitalization of patients with the following comorbidities dominated: diseases of the cardiovascular system - 65.5% (OR 1.36; 95% CI 1.32-1.40), the endocrine system - 57.3% (OR 0.83; 95 % CI 0.79-0.87), bronchopulmonary system - 56.6% (OR 0.79; 95% CI 0.76-0.82), oncological diseases - 54.0% (OR 0.72; 95 % CI 0.68-0.77). The presence of bronchopulmonary diseases in patients did not increase the chances of hospitalization of patients with COVID-19. The frequency of hospitalization of patients with diseases of the cardiovascular system was significantly higher (p Conclusions: Patients with cardiovascular pathology had the highest risk of hospitalization. It is necessary to pay special attention to patients with concomitant cardiovascular pathology at the outpatient stage.

CITATION: Petersen, E. et al. 2020. COVID-19 travel restrictions and the International Health Regulations : call for an open debate on easing of travel restrictions. International Journal of Infectious Diseases, 94:88–90, doi:10.1016/j.ijid.2020.04.029.

Eighty years after the last published record of human leishmaniasis from Dagestan, Russian Federation, we report two recent cases which were most probably acquired locally: one case of visceral leishmaniasis in a 2-year old child, and one cutaneous leishmaniasis case in a 39-year-old man co-infected with HIV, both resident in Dagestan. Keywords: Visceral leishmaniasis, Cutaneous leishmaniasis, HIV infection, Dagestan, Russian Federation

This is the twelfth version (eleventh update) of the living guideline, replacing earlier versions (available as data supplements). New recommendations will be published as updates to this guideline.What is the role of drugs in the treatment of patients with covid-19?The evidence base for therapeutics for covid-19 is evolving with numerous randomised controlled trials (RCTs) recently completed and under way. The emerging SARS-CoV-2 variants (such as omicron) and subvariants are also changing the role of therapeutics. This update provides updated recommendations for remdesivir, addresses the use of combination therapy with corticosteroids, interleukin-6 (IL-6) receptor blockers, and janus kinase (JAK) inhibitors in patients with severe or critical covid-19, and modifies previous recommendations for the neutralising monoclonal antibodies sotrovimab and casirivimab-imdevimab in patients with non-severe covid-19.• Remdesivir: a conditional recommendation for its use in patients with severe covid-19; and a conditional recommendation against its use in patients with critical covid-19. • Concomitant use of IL-6 receptor blockers (tocilizumab or sarilumab) and the JAK inhibitor baricitinib: these drugs may now be combined, in addition to corticosteroids, in patients with severe or critical covid-19. • Sotrovimab and casirivimab-imdevimab: strong recommendations against their use in patients with covid-19, replacing the previous conditional recommendations for their use.When moving from new evidence to updated recommendations, the Guideline Development Group (GDG) considered a combination of evidence assessing relative benefits and harms, values and preferences, and feasibility issues. For remdesivir, new trial data were added to a previous subgroup analysis and provided sufficiently trustworthy evidence to demonstrate benefits in patients with severe covid-19, but not critical covid-19. The GDG considered benefits of remdesivir to be modest and of moderate certainty for key outcomes such as mortality and mechanical ventilation, resulting in a conditional recommendation. For baricitinib, the GDG considered clinical trial evidence (RECOVERY) demonstrating reduced risk of death in patients already receiving corticosteroids and IL-6 receptor blockers. The GDG acknowledged that the clinical trials were not representative of the world population and that the risk-benefit balance may be less advantageous, particularly in patients who are immunosuppressed at higher risk of opportunistic infections (such as serious fungal, viral, or bacteria), those already deteriorating where less aggressive or stepwise addition of immunosuppressive medications may be preferred, and in areas where certain pathogens such as HIV or tuberculosis, are of concern. The panel anticipated that there would be situations where clinicians may opt for less aggressive immunosuppressive therapy or to combine medications in a stepwise fashion in patients who are deteriorating. The decision to combine the medications will depend on their availability, and the treating clinician's perception of the risk-benefit balance associated with combination immunosuppressive therapy, particularly in patient populations at risk of opportunistic infections who may have been under-represented in clinical trials. When making a strong recommendation against the use of monoclonal antibodies for patients with covid-19, the GDG considered in vitro neutralisation data demonstrating that sotrovimab and casirivimab-imdevimab evaluated in clinical trials have meaningfully reduced neutralisation activity of the currently circulating variants of SARS-CoV-2 and their subvariants. There was consensus among the panel that the absence of in vitro neutralisation activity strongly suggests absence of clinical effectiveness of these monoclonal antibodies. However, there was also consensus regarding the need for clinical trial evidence in order to confirm clinical efficacy of new monoclonal antibodies that reliably neutralise the circulating strains in vitro. Whether emerging new variants and subvariants might be susceptible to sotrovimab, casirivimab-imdevimab, or other anti-SARS-CoV-2 monoclonal antibodies cannot be predicted.• Recommended for patients with severe or critical covid-19—strong recommendations for systemic corticosteroids; IL-6 receptor blockers (tocilizumab or sarilumab) in combination with corticosteroids; and baricitinib as an alternative to IL-6 receptor blockers, in combination with corticosteroids. • Recommended for patients with non-severe covid-19 at highest risk of hospitalisation—a strong recommendation for nirmatrelvir/ritonavir; conditional recommendations for molnupiravir and remdesivir. • Not recommended for patients with non-severe covid-19—a conditional recommendation against systemic corticosteroids; a strong recommendation against convalescent plasma; a recommendation against fluvoxamine, except in the context of a clinical trial; and a strong recommendation against colchicine. • Not recommended for patients with non-severe covid-19 at low risk of hospitalisation—a conditional recommendation against nirmatrelvir/ritonavir. • Not recommended for patients with severe or critical covid-19—a recommendation against convalescent plasma except in the context of a clinical trial; and a conditional recommendation against the JAK inhibitors ruxolitinib and tofacitinib. • Not recommended, regardless of covid-19 disease severity—a strong recommendations against hydroxychloroquine and against lopinavir/ritonavir; and a recommendation against ivermectin except in the context of a clinical trial.This living guideline from the World Health Organization (WHO) incorporates new evidence to dynamically update recommendations for covid-19 therapeutics. The GDG typically evaluates a therapy when the WHO judges sufficient evidence is available to make a recommendation. While the GDG takes an individual patient perspective in making recommendations, it also considers resource implications, acceptability, feasibility, equity, and human rights. This guideline was developed according to standards and methods for trustworthy guidelines, making use of an innovative process to achieve efficiency in dynamic updating of recommendations. The methods are aligned with the WHO Handbook for Guideline Development and according to a pre-approved protocol (planning proposal) by the Guideline Review Committee (GRC). A box at the end of the article outlines key methodological aspects of the guideline process. MAGIC Evidence Ecosystem Foundation provides methodological support, including the coordination of living systematic reviews with network meta-analyses to inform the recommendations. The full version of the guideline is available online in MAGICapp and in PDF, with a summary version here in The BMJ. These formats should facilitate adaptation, which is strongly encouraged by WHO to contextualise recommendations in a healthcare system to maximise impact.Recommendations on anticoagulation are planned for the next update to this guideline.

Clinical question What is the role of drugs in preventing covid-19? Why does this matter? There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. Recommendations The second version of this living guideline reiterates the previous strong recommendation against the use of hydroxychloroquine and includes a new conditional recommendation against the use of tixagevimab-cilgavimab in individuals who do not have covid-19. How this guideline was created This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provides methodological support. A living systematic review with network analysis informs the recommendations. An international guideline development group (GDG) of content experts, clinicians, patients, an ethicist and methodologists produces recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Understanding the recommendations The living network meta-analysis informing this guideline included 12 trials (8379 participants) comparing hydroxychloroquine to standard care/placebo, and one trial (5197 participants) comparing tixagevimab-cilgavimab to standard care/placebo. When moving from evidence to the continued strong recommendation against the use of hydroxychloroquine, the GDG emphasised additional evidence suggesting no or little effect on mortality and hospital admission, and an increased risk of adverse effects. For the new conditional recommendation against the use of tixagevimab-cilgavimab, the GDG emphasised in vitro evidence reducing the applicability of available trial data. While trial results demonstrated modest reduction in the occurrence of laboratory confirmed symptomatic covid-19, lack of in vitro neutralisation of new SARS-CoV-2 sub-lineages was considered to have rendered these results obsolete. Updates This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. Readers note This is the second version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19 and living guidance regarding covid-19 related clinical management. When citing this article, please consider adding the update number and date of access for clarity.

Background: Understanding the impact of geographical aspects and population density on the incidence rate (IR) of respiratory infections in Russia is necessary for successful control under the epidemic. Aim: to estimate the increase in IR of respiratory infections in 2020 compared to the same period of 2016-2019 Materials and methods: a retrospective study of IR of COVID-19, ARI, influenza and community acquired pneumonia (CAP) in summarily (respiratory infections and COVID-19 morbidity) in the first half of 2020 in comparison with morbidity of ARI, influenza and CAP (respiratory infections morbidity) the same period of 2016-2019 in 85 regions was performed. Additionally the influence of climate on COVID-19 morbidity were estimated. Results: The highest excess of respiratory infections and COVID-19 morbidity in 2020 versus the average respiratory infections morbidity in 2016-2019 was observed in Buryatia-107.61%; Zabaykalsky Krai -134.09%; Tuva – 166.34%; the Kaliningrad region – 1023.41%; the Republic of Altai – 1212.78%; Dagestan – 2030.27%. Buryatia, Tuva, Altai and Zabaykalsky Krai are located next to the China, and also border each other. The Kaliningrad region borders on the EU countries. Dagestan has a maritime border with 3 states, including Iran, where the epidemic COVID-19 began earlier. In 43 of the 85 regions of Russia, this excess was 10-50%; in 35 subjects varied from 50% to 100%. The correlation between the incidence of COVID-19 and the population density in the regions was weak (r=0.26). The air pollution, has also a weak relationship (r=0.26) to the incidence rate. Moderate relationship was observed between the severity of negative temperatures in winter and the level of morbidity(r=-0.51). Milder climate probably contributed to the longer persistence of the virus in the environment and social activity. Conclusion: Russian regions bordering the PRC, the EU, Central Asia and the Middle East demonstrated the highest IR of influenza, ARI, CAP and COVID-19in summarility in the first part of this year versus the morbidity of influenza, ARI, CAP in average in first half of 2016-2019. IR of COVID-19 has weak correlation with population density and air pollution and moderate negative correlation with winter temperature.

The epidemic process with local transmission began in Russia in March 2020. Aim of study: to estimate the dynamics of epidemic process in Russia. Data analysis of report form #970 of Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing about COVID-19 cases during the first half of 2020. Russia has specific characteristics of the epidemic process with significal differences of epidemic curves in the MaMR and other regions due to less strong restrictive measures outside of MaMR.

Active epidemic process in Russia started in the March, 2020 after beginning the local transmission. At the end of June approximately 650 thousands COVID-19 cases were recorded in Russia. Aim of study: epidemical characteristics of patients with COVID-19 in Russia Materials and methods: statistic analysis of database of COVID-19 in Russia during the first half of 2020. Majority of cases in a group aged 0-17 years old was mild. Patients > 65 years and above were registered with a moderate and severe forms of COVID-19, what shows that this group needs a special attention. The biggest part of all the cases was in a group of people of employable age. This fact shows that control of restrictive measures has to be performed as a main stream in this group. In case of delayed initial medical service COVID-19 had more moderate and severe forms.

Background: WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans. Objectives: Our main objective was to investigate retrospectively West Nile virus neuroinvasive disease (WNND) cases hospitalized during 2010–2017 and identified factors that can influence prognosis. Study design: We documented the demographic, epidemiologic, clinical and laboratory data of WNND and identified factors that can influence prognosis. The data were recruited through Infectious Diseases International Research Initiative (ID-IRI), which serves as a network for clinical researches. Results: We investigated 165 patients with WNND in 10 countries from three continents. 27 patients died and the mortality rate was 16.4%. In an univariate analysis age, congestive heart failure, neoplasm and ischemic heart disease (p < 0.001), neuropsychiatric disorders (p = 0.011), chronic hepatitis (p = 0.024) and hypertension (p = 0.043) were risk factors for death. Fatal evolution was also correlated with ICU addmission, disorientation, speech disorders, change in consciousnes, coma, a low Glasgow coma score, obtundation, confusion (p < 0.001), history of syncope (p = 0.002) and history of unconsciousness (p = 0.037). In a binomial logistic regresssion analysis only age and coma remained independent prediction factors for death. We created an equation that was calculated according to age, co-morbidities and clinical manifestations that may be used to establish the prognosis of WNND patients. Conclusions: WNND remain an important factor for morbidity and mortality worldwide, evolution to death or survival with sequelae are not rare. Our study creates an equation that may be used in the future to establish the prognosis of WNND patients. © 2019 Elsevier B.V., PN-III-P1.2-PCCDI-2017-0005/2018, “The research of the Romanian patients was funded through CCCDI-UEFISCDI project PN-III-P1.2-PCCDI-2017-0005/2018, Romania.”

We performed a systematic review and meta-analysis on the effectiveness of ribavirin use for the prevention of infection and death of healthcare workers exposed to patients with Crimean-Congo hemorrhagic fever virus (CCHFV) infection. Splashes with blood or bodily fluids (odds ratio [OR] 4.2), being a nurse or physician (OR 2.1), and treating patients who died from CCHFV infection (OR 3.8) were associated with healthcare workers acquiring CCHFV infection; 7% of the workers who received postexposure prophylaxis (PEP) with ribavirin and 89% of those who did not became infected. PEP with ribavirin reduced the odds of infection (OR 0.01, 95% CI 0-0.03), and ribavirin use

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».

International audience

Highlights • Rare localization of Dirofilaria repens in human. • Description of dirofilariasis caused by D. repens in the inguinal lymph node. • Difficulties in the diagnosis of D. repens in the inguinal lymph node., D. repens is the causative agent of subcutaneous dirofilariasis in canine animals. In recent years, human invasion by this vector-borne helminthiasis has been recorded in many countries with temperate climate, but the localization of this helminth in the cavities of the human body is extremely rare. Cases of atypical localization of D. repens are described in the organs of the chest, cervical lymph node, in the spermatic cord and epididymis. It is usually requires differential diagnosis with neoplastic or metastatic processes. We report a case of the detection of Dirofilaria repens in the right inguinal lymph node in a 56-year-old woman. Helminth was identified by parasitological and molecular biological methods. A morphological study of cross sections of the nematode in histological preparations and molecular biological method, the polymerase chain reaction (PCR) of scrapings of histological material, were used in parallel.

The article discusses the issues of consolidation of rural communities, which is one of the most important conditions for the successful development of the village. Based on the study of various theories of solidarity, the article analyzes the value, projective, cognitive, practical aspects of the perception by the mass consciousness of villagers of the idea of consolidating society in the countryside. The empirical basis of the article was the results of a sociological study “Features of the processes of consolidation of rural municipal communities”, which was conducted by the Department of Social Technologies and Public Service of the National Research University “BelSU” in 2020 among the rural population of the municipal districts of the Belgorod region. The data obtained in the course of the study allow us to assert that, although subjectively, rural residents have a predisposition to perceive the idea of consolidation, and it has undoubted attractiveness, the research participants realistically and pragmatically assess the possibilities of the practical implementation of this process, which will undoubtedly act as a significant demotivator in the event of initiating a consolidation strategy in a particular region. Thus, the complexity of the consolidation process and its uncertainty are emphasized.

Throughout history, humans have experienced epidemics. The balance of living in nature encircled by microorganisms is delicate. More than 70% of today’s emerging infections are zoonotic, i.e., those in which microorganisms transmitted from animals infect humans. Species are on the move at speeds never previously recorded, among ongoing climate change which is especially rapid at high latitudes. This calls for intensified international surveillance of Northern infectious diseases. Russia holds the largest area of thawing permafrost among Northern nations, a process which threatens to rapidly disrupt the balance of nature. In this paper, we provide details regarding Russian health infrastructure in order to take the first steps toward a collaborative international survey of Northern infections and international harmonization of the procured data.

Background A number of factors can lead to differences in infectious disease morbidity in children versus adults after a trip abroad. We aimed to investigate the epidemiological and etiological features of infectious diseases in children after international travel. Methods: we analyzed the medical records of 2135 patients (416 children) who were hospitalized during the period 2009–2017 after return from international travel. Results Hospitalized children were under the age of 1 year in 8.7% of cases, 1–3 years - 39.4%, 4–6 years – 17.3%, 7–11 years – 16.8%, 12–17 years – 17.8%. Children were hospitalized after visiting the following main destinations: Turkey (15%), Egypt (12%), Central Asia microregion [11%] and Thailand (9%). Hospitalizations among children occurred mainly in summer (38.0%; CI 33.3–42.4). In adults there were no significant seasonal differences. Children were more likely to have acute diarrhea (18.3 vs 11.1%), acute respiratory tract infections (51.2 vs 41.2%) and enterovirus infections (8.2 vs 3.1%). Among the non-endemic infections for Russia, 8 children were diagnosed with dengue fever, 1 with typhoid, 1 with malaria, and 1 with wild-poliovirus excretion. Conclusion children were mainly hospitalized during summer. Among hospitalized children, almost half was under 3 years old. In children acute respiratory infection and intestinal infections predominated, while in adults, vector-borne diseases were more frequently observed.

In this chapter the global distribution and contemporary trends of the prevalence of hepatitis B in the different regions of the world were described. Analysis of the relationship between HBV prevalence and income, also vaccination campaign of infants and children under 5 years old, is presented. Specific attention was paid on the distribution of hepatitis B among risk groups (intravenous drug users, men who have sex with men, indigenous peoples and minorities, prisoners, migrants, blood donors, health-care workers, coinfection with HIV infection and hepatitis C). Gaps and problems in the study of hepatitis B epidemiology and prophylaxis and future trends and prognosis of the spread of HBV in the world are discussed.

SummaryThree 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.

Leblebicioglu, Hakan/0000-0002-6033-8543; yanik yalcin, tugba/0000-0001-5996-8639; atilla, aynur/0000-0001-8027-1991; Beeching, Nicholas/0000-0002-7019-8791; Fletcher, Tom/0000-0002-3712-415X; Kilic, Suleyman sirri/0000-0003-1255-9939 WOS: 000410001100007 PubMed: 28886039 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. Wellcome TrustWellcome Trust [104480/Z/14/Z]; UK Ministry of Defence; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections; University of Liverpool, Liverpool School of Tropical Medicine and Public Health England (PHE) There was no specific funding for this study. TF is funded by Wellcome Trust (104480/Z/14/Z) and the UK Ministry of Defence. NJB is partially supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections, a partnership between the University of Liverpool, Liverpool School of Tropical Medicine and Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of their respective institutions or Ministries of Health.; There was no specific funding for this study. TF is funded by Wellcome Trust (104480/Z/14/Z) and the UK Ministry of Defence. NJB is partially supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections, a partnership between the University of Liverpool, Liverpool School of Tropical Medicine and Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of their respective institutions or Ministries of Health.