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"Actual Infectology" 4 (9) 2015

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Modern Features of Epidemic Hemorrhagic Fever with Renal Syndrome in the Central Orenburg Region

Authors: Sankov D.I., Korneev O.H., Pankov O.S., Aminev R.М. - State Budgetary Educational Institution of Higher Professional Education «Orenburg State Medical University» of the Ministry of Healthcare of the Russian Federation, Orenburg, Russian Federation

Categories: Infectious diseases

Sections: Clinical researches

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Summary

Актуальность. В Оренбургской области, как и в Российской Федерации в целом, геморрагическая лихорадка с почечным синдромом, вызванная вирусом Пуумала, занимает лидирующую позицию среди природно-очаговых заболеваний.
Цель исследования — выявить эпидемиологические особенности эпидемического процесса геморрагической лихорадки с почечным синдромом среди населения Оренбургского района в сравнении с проявлениями эпидемического процесса этой инфекции на других территориях области.
Материалы и методы. Изучалась заболеваемость в Оренбургском районе Оренбургской области, являющемся территорией размещения отдельных воинских частей. Заболеваемость анализировалась по данным Роспотребнадзора за 1970–2014 гг.
Результаты. С 1997 г. выявлена тенденция к снижению заболеваемости в области. Определено начало эпидемического года в сентябре. 7 районов определены как территории риска. Отмечена неблагополучная эпидемиологическая ситуация в соседнем (Переволоцком) с изучаемым районе. Выявлена тенденция к стабилизации заболеваемости в Оренбургском районе и тесная корреляционная связь между заболеваемостью населения Оренбургского и Переволоцкого районов.
Обсуждение. Отличие сезонности в Оренбуржье от таковой в России в целом объясняется ландшафтными особенностями. Оренбургский и Переволоцкий районы со степным ландшафтом характеризуются развитием эпидемического процесса в схожих условиях. Тенденция к росту заболеваемости населения Переволоцкого района является настораживающим предвестником развития эпидемиологической ситуации в Оренбургском районе, где сегодня эпидситуация благополучная. 2015 г. следует считать годом стабилизации или годом спада заболеваемости.
Заключение. Определена гетерогенность территории Оренбургской области по уровню и многолетней тенденции заболеваемости. Оренбургский район не является территорией риска. Сезонные проявления в районе характеризуются параметрами, специфичными для лесостепных и степных ландшафтов.

Актуальність. В Оренбурзькій області, як і в Російській Федерації в цілому, геморагічна лихоманка з нирковим синдромом, викликана вірусом Пуумала, займає лідуючу позицію серед природно-вогнищевих захворювань.
Мета дослідження — виявити епідеміологічні особливості епідемічного процесу геморагічної лихоманки з нирковим синдромом серед населення Оренбурзького району в порівнянні з проявами епідемічного процесу цієї інфекції на інших територіях області.
Матеріали і методи. Вивчалася захворюваність в Оренбурзькому районі Оренбурзької області, що є територією розміщення окремих військових частин. Захворюваність аналізувалася за даними Росспоживнагляду за 1970–2014 рр.
Результати. Із 1997 р. виявлена тенденція до зниження захворюваності в області. Визначено початок епідемічного року у вересні. 7 районів визначені як території ризику. Відзначена неблагополучна епідемічна ситуація в сусідньому (Переволоцькому) з досліджуваним районі. Виявлена тенденція до стабілізації захворюваності в Оренбурзькому районі і тісний кореляційний зв’язок між захворюваністю населення Оренбурзького і Переволоцького районів.
Обговорення. Відмінність сезонності в Оренбуржжі від такої в Росії в цілому пояснюється ландшафтними особливостями. Оренбурзький і Переволоцький райони зі степовим ландшафтом характеризуються розвитком епідемічного процесу в схожих умовах. Тенденція до зростання захворюваності населення Переволоцького району є насторожливим передвісником розвитку епідеміологічної ситуації в Оренбурзькому районі, де сьогодні благополучна епідситуація. 2015 р. слід вважати роком стабілізації або роком спаду захворюваності.
Висновок. Визначено гетерогенність території Оренбурзької області за рівнем і багаторічною тенденцією захворюваності. Оренбурзький район не є територією ризику. Сезонні прояви в районі характеризуються параметрами, специфічними для лісостепових і степових ландшафтів.

Introduction. In the Orenburg region, as well as in the Russian Federation as a whole, hemorrhagic fever with renal syndrome caused by Puumala virus occupies a leading position among the natural focal diseases.
The objective of research — to identify the epidemiological features of the epidemic hemorrhagic fever with renal syndrome among the population of the Orenburg region in comparison with the manifestations of the epidemic process of this infection in the other areas of the region.
Materials and methods. We have studied the morbidity in the Orenburg district of the Orenburg region, which is the territory of stationing of some military units. The incidence was analyzed according to the data of Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing for the 1970–2014.
Results. Since 1997, it showed a trend toward a decrease of morbidity in the region. The beginning of the epidemic year in September was determined. 7 areas were identified as areas of risk. We have noted the unfavorable epidemiological situation in neighboring (Perevolotsk) region. The tendency towards stabilization of morbidity in the Orenburg region and the close correlation between the morbidity of the population of Orenburg and Perevolotsk areas was shown.
Discussion. The differences of seasonality in the Orenburg region from that of in Russia as a whole are due to landscape features. Orenburg and Perevolotsk areas with steppe landscape are characterized by the development of the epidemic process in similar conditions. The upward trend in morbidity of the population of Perevolotsk district is alarming harbinger of the epidemiological situation in the Orenburg region, where today the epidemiological situation is safe. 2015 should be considered as a year of stabilization or a year of the incidence decrease.
Conclusion. There was determined the heterogeneity of the Orenburg region in terms of the level and long-term trend of morbidity. Orenburg district is not a risk area. Seasonal manifestations in the region are characterized by parameters specific to the forest steppe and steppe landscapes.


Keywords

геморрагическая лихорадка с почечным синдромом, заболеваемость, Оренбургский район.

геморагічна лихоманка з нирковим синдромом, захворюваність, Оренбурзький район.

hemorrhagic fever with renal syndrome, morbidity, Orenburg district.

Introduction. In the Orenburg region hemorrhagic fever with renal syndrome (HFRS) caused by Puumala virosomes, occupies a leading position among the natural focal diseases. There are 4 independent natural foci of HFRS. Of particular interest is the Orenburg district, located in the middle of the Orenburg region in the territory covering 45% of the population. The area is not part of the official field of natural foci. However, there are recorded cases of HFRS annually.

Objective. The purpose of research - to identify the epidemiological features of the epidemic of hemorrhagic fever with renal syndrome in the population of the Orenburg district in comparison with the manifestations of the epidemic process of the infection to other areas of the region.

Materials and Methods. Studied the incidence of Orenburg district Orenburg region, where troops are located. A study commissioned by the Ministry of Defence. The incidence was analyzed according to Rospotrebnadzor for the 1970-2014 biennium.

There was a retrospective epidemiological analysis. It expects average annual growth rate of long-term trend (LTT). In determining the incidence of the risk areas of the urban population was not considered because they do not get infected in the territory of residence. We used chi-square and Pearson correlation.

Results. The incidence of HFRS recorded since 1970. Mean annual average regional incidence rate was 10,6 ± 0,6 cases per 100 thousand. It was divided into two periods: 1. the period of low incidence (1970-1996 years - 4,4 ± 0,6 cases per 100 thousand); 2. the period of high incidence (1997-2014 years - 20,3 ± 1,0 cases per 100 thousand; χ2 = 6014,0; p <0,05). The first period lasted 27 years and was characterized by a stable notification rates with little upward trend (LTT = + 1,2%; χ2 = 37,2; p <0,05). Second, the modern period was characterized by a tendency to decrease the incidence (LTT = -3,7%; χ2 = 463,3; p <0,05). For years, the incidence of recovery were 2003, 2005, 2009 and 2012. And the recession years 2002, 2004, 2007, 2010 and 2013. The greatest practical interest submitted a second (modern) period.

In the first period in which the cyclical determined only in 1984 and was characterized by cycles lasting 1-2 of the second period should be allocated 4 cycles: the first from 2001 to 2004 (positive phase from 2001 to 2003, negative - from 2004), the second from 2005 to 2007 (positive phase from 2005 to 2006, negative - 2007), and the third from 2008 to 2010 (positive phase from 2008 to 2009, negative - 2010), and the fourth from 2011 to 2013 (positive phase from 2011 to 2012, negative - 2013). The duration of the cycles in the modern period, compared with the previous increase of 2-3 years.

The modern period was characterized by the fall-winter season during the recession years of lifting and morbidity. Years rise of morbidity - epidemic year starts in September; the maximum value registered in December - 7,33 ± 0,6 cases per 100 thousand; the average level - 1,3 ± 0,2 cases per 100 thousand; month of the season lifting - September, November, December - 81.0% of cases. Years of recession - highest incidence was registered in January - 1,44 ± 0,3 cases per 100 thousand; annual average - 0,43 ± 0,1 cases per 100 thousand; month of the season lifting - September-February - 85.5% of cases.

Isolated areas of the region in which the average annual incidence rate exceeded the district average rate (29,9 ± 0,3 cases per 100 thousand .; χ2 from 3171.8 to 68470.1; p <0.05) in the modern period. Accordingly, 7 of the 35 areas are defined as areas of risk. These areas have no common borders with the Orenburg district.

The long-term upward trend in the incidence was observed only in Novosergievsk фтв Tashlinsky districts and in the modern period (TTL = + 0,7% and 0.4%, respectively). The downward trend in the incidence was observed in other areas (TTL from -3.1% to -15.4%).

In the 4 districts of the region did not reveal a single case of the disease. They, too, had no common borders with the Orenburg district.

Areas with prevalence less than the average district indicator: Perevolotsk district is characterized by long-term upward trend in the incidence of (12,0 ± 4,9 case per 100 thousand; LLT = 4,6%; χ2 = 4,9; p <0,05). The other 23 districts were characterized by stable disease (p> 0.05).

The tendency towards stabilization morbidity Orenburg region (χ2 = 0,4; p> 0,05). Average annual rate (1997-2014 years) - 18,8 ± 4,7 cases per 100 thousand and did not exceed the district average rate (χ2 = 0,31; p> 0.05).

Average long-term morbidity of the population of the Perevolotsk and Orenburg districts are different (1997-2014 years; χ2 = 10,3; p <0,05). There is a strong correlation between the incidence of the population of these regions (r = 0,82; p <0.05).

There were cyclical fluctuations in the incidence of HFRS population of the Orenburg region. 4 cycles allocated: 1. 2002-2004; 2. 2005-2007; 3. 2008- 2010; 4. 2011-2013. The first cycle - positive phase was observed from 2002 to 2003, negative phase - 2004; second cycle - the positive phase was observed in 2005, the negative phase - 2006-2007; third cycle - has been positive phase during 2008-2009, negative phase - 2010; fourth round - was positive phase for 2011-2012, the negative phase - 2013. The duration of cycles ranged from 2 to 4 years.

Structure of patients residents of the Orenburg district: the fishermen (52,2 ± 0,8%), drivers (10,5 ± 1,0%), unemployed (11,2 ± 0,9%), mushroom pickers (8,2 ± 1, 0%), hunters (6,6 ± 1,2%), the other group (11,3 ± 0,9%). It was characteristic of the years of the rise and decline of morbidity. However, there is only sporadic cases of disease among women and children during the recession of morbidity in the modern period. Risk groups - men (20-55 years) - 81,8 ± 2,1% (p <0.05).

Conclusions. Change of long-term trends in the incidence of HFRS population of the region has occurred in the Orenburg region in 1997. The changing nature of the intensity of the epidemic process and confirmed extension of long-term cycles. Results of the analysis suggest there will rise in the incidence of the regional population in 2015 due to cyclical fluctuations.

Seasonality HFRS incidence of the region's population does not correspond to the seasonality of HFRS-Puumala European part of Russia. There is the beginning of the epidemic - April-May. This is due to the rise of small mammals - the sources of hantavirus. Natural and social factors influence the display of epidemic process during the year. They have their own characteristics in the Orenburg region. For example, is dominated by people infected with hantavirus in the result of their stay in the natural focus - fishing, mushroom picking (70-75%). These passions are in the Orenburg steppe and steppe autumn. In the autumn of the activation of the air-dust path of transmission. Therefore, an epidemic year in the Orenburg region starts autumn.

Spent a territorial analysis of the incidence of the rural population of the Orenburg region can distinguish four groups of areas:

• districts - areas of risk for HFRS incidence;

• districts with a tendency to increase in the incidence of long-term dynamics;

• districts with stabilization of disease;

• and the districts in which the incidence is not registered.

Modern epidemiological situation in the Orenburg region (third group) -blagopoluchnaya. 2015 - a year of stabilization of disease.

Thus, the heterogeneity identified in the Orenburg region in terms or long-term trends of the incidence of HFRS - in the area have long-term downward trend in incidence, but in some areas there is a tendency to its growth. Orenburg district is not a risk area. There long-term trend towards stabilization of the disease in it. But it is geographically bordered by Perevolotsk distrikt in which there is a tendency to increase. The close correlation between the incidence of the population of two districts shows the development of the epidemic process of HFRS in these areas in similar conditions. Seasonal display of epidemic process of HFRS in the Orenburg region are characterized by parameters specific to the forest steppe and steppe landscapes.


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