Prevalence of HIV, HCV and HBV in Central Asia and the Caucasus: A systematic review.

BACKGROUND: Human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) are substantial public health threats in the region of Central Asia and the Caucasus, where the prevalence of these infections is currently rising. METHODS: A systematic review of MEDLINE, Embase and PsycINFO was conducted with no publication date or language restrictions through October 2019. Additional data were also harvested from national surveillance reports, references found in discovered sources, and other "grey" literature. It included studies conducted on high-risk populations (people who inject drugs (PWID), female sex workers (FSW), men who have sex with men (MSM), prisoners, and migrants) in Central Asia: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan; and the Caucasus: Armenia, Azerbaijan, Georgia, and Northern Caucasus region of the Russian Federation. RESULTS: Wide ranges were noted for HIV prevalence: PWID 0-30.1%, MSM 0-25.1%, prisoners 0-22.8%, FSW 0-10.0%, and migrants 0.06-1.5%, with the highest prevalence of these high-risk groups reported in Kazakhstan (for PWID), Georgia (for MSM and prisoners) and Uzbekistan (for migrants). HCV prevalence also had a wide range: PWID 0.3-92.1%, MSM 0-18.9%, prisoners 23.8-49.7%, FSW 3.3-17.8%, and migrants 0.5-26.5%, with the highest prevalence reported in Georgia (92.1%), Kyrgyzstan (49.7%), and migrants from Tajikistan and Uzbekistan (26.5%). Similarly, HBV prevalence had a wide range: PWID 2.8-79.7%, MSM 0-22.2%, prisoners 2.7-6.2%, FSW 18.4% (one study), and migrants 0.3-15.7%. CONCLUSION: In Central Asia and the Caucasus, prevalence of HIV, HCV and HBV remains exceedingly high among selected populations, notably PWID and MSM.

Epidemiology of Taenia saginata taeniosis/cysticercosis: a systematic review of the distribution in central and western Asia and the Caucasus.

BACKGROUND: The zoonotic parasite Taenia saginata transmits between humans, the definitive host (causing taeniosis), and bovines as the intermediate host (causing cysticercosis). Central and western Asia and the Caucasus have large cattle populations and beef consumption is widespread. However, an overview of the extent of human T. saginata infection and bovine cysticercosis is lacking. This review aims to summarize the distribution of T. saginata in this region. METHODS: A systematic review was conducted, that gathered published and grey literature, and official data concerning T. saginata taeniosis and bovine cysticercosis in central and western Asia and the Caucasus published between January 1st, 1990 and December 31st, 2018. Where no data were available for a country within this period, published data from 1985-1990 were also accessed. RESULTS: From 10,786 articles initially scanned, we retrieved 98 full-text articles from which data were extracted. In addition, two unpublished datasets were provided on the incidence of human taeniosis. Data for human taeniosis and bovine cysticercosis were found for all countries except Turkmenistan. Human taeniosis prevalence varied from undetected to over 5.3%, with regional variations. Where bovine cysticercosis was detected, prevalences varied from case reports to 25%. CONCLUSIONS: The public health burden of T. saginata is assumed to be small as the parasite is of low pathogenicity to humans. However, this review indicates that infection continues to be widespread and this may result in a large economic burden, due to the resources utilized in meat inspection and condemnation or processing with subsequent downgrading of infected carcasses.

Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study.

BACKGROUND: The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance. METHODS: We retrospectively reported and compared the DR-TB treatment outcomes of HIV-positive and HIV-negative patients treated with an individualized regimen based on WHO guidelines in seven countries: Abkhazia, Armenia, Colombia, Kenya, Kyrgyzstan, Swaziland and Uzbekistan. RESULTS: Of the 1,369 patients started DRTB treatment, 809 (59.1%) were multi-drug resistant (MDR-TB) and 418 (30.5%) were HIV-positive. HIV-positive patients were mainly from African countries (90.1%) while HIV-negative originated from Former Soviet Union (FSU) countries. Despite a higher case fatality rate (19.0% vs 9.4%), HIV-positive MDR-TB patients had a 10% higher success rate than HIV-negative patients (64.0% vs 53.2%, p = 0.007). No difference in treatment success was found among polydrug-resistant (PDR-TB) patients. Overall, lost to follow-up rate was much higher among HIV-negative (22.0% vs. 8.4%). Older age and not receiving ART were the only factors associated with unfavorable treatment outcome among HIV-positive patients. CONCLUSIONS: As already known for HIV-negative patients, success rate of DR-TB HIV-positive patients remains low and requires more effective DR-TB regimen using new drugs also suitable to HIV-infected patients on ART. The study also confirms the need of ART introduction in HIV co-infected patients.

The TB Portals: an Open-Access, Web-Based Platform for Global Drug-Resistant-Tuberculosis Data Sharing and Analysis.

The TB Portals program is an international consortium of physicians, radiologists, and microbiologists from countries with a heavy burden of drug-resistant tuberculosis working with data scientists and information technology professionals. Together, we have built the TB Portals, a repository of socioeconomic/geographic, clinical, laboratory, radiological, and genomic data from patient cases of drug-resistant tuberculosis backed by shareable, physical samples. Currently, there are 1,299 total cases from five country sites (Azerbaijan, Belarus, Moldova, Georgia, and Romania), 976 (75.1%) of which are multidrug or extensively drug resistant and 38.2%, 51.9%, and 36.3% of which contain X-ray, computed tomography (CT) scan, and genomic data, respectively. The top Mycobacterium tuberculosis lineages represented among collected samples are Beijing, T1, and H3, and single nucleotide polymorphisms (SNPs) that confer resistance to isoniazid, rifampin, ofloxacin, and moxifloxacin occur the most frequently. These data and samples have promoted drug discovery efforts and research into genomics and quantitative image analysis to improve diagnostics while also serving as a valuable resource for researchers and clinical providers. The TB Portals database and associated projects are continually growing, and we invite new partners and collaborations to our initiative. The TB Portals data and their associated analytical and statistical tools are freely available at https://tbportals.niaid.nih.gov/.

Improving family and community health in eastern Europe--the lifecycle approach at WHO.

There are great differences in the health status of young children in the European Region. Central Asia and the Caucasus are the worst-off areas. After reviewing under-five mortality in the eight countries of this part of Eastern Europe, a new WHO strategy to improve child survival is presented. Adopted in late 2005, the strategy has four main principles: a lifecycle approach, youth participation, equity and intersectoral collaboration.

Factors involved in the re-emergence of malaria in borderline of Iran, Armenia, Azerbaijan and Turkey.

The borderline of Iran with Azerbaijan, Armenia and Turkey had been considered a malaria free region. However, in 1991, after the independence of the southern countries of the former Soviet Union, a new threat of malaria importation emerged from those countries into Iran, which was affected by serious epidemics of Plasmodium vivax malaria. Various factors can affect malaria resurgence in this region, such as socioeconomic conditions, especially the displacement of massive populations from war-stricken zones in the Republic of Azerbaijan. Accordingly, in some parts of West-Azerbaijan, East-Azerbaijan, Ardebile and Gilan provinces of Iran, several malaria foci were observed. Construction of dams, people traveling from neighboring countries to Iran, urbanization, irrigation projects, lack of malaria vector control, shortage of drug supplies are also major factors in malaria outbreaks in the region. An investigation was carried out on the bionomics of the main malaria vectors in the region. The result showed that Anopheles sacharovi plays an important role in malaria transmission and An. maculipennis and An. superpictus can be secondary vectors. Larvae were found in slow flowing water and channels with water plants. They were more abundant in June. The parity rate of blood-fed females was high in May. An. sacharovi is active from May to October with two peaks of activity, which occur in August and October. The population of this species is higher in animal shelters with a zoophicity of 95%. About 90% of bites took place in the second half of the night. A CDC light trap can also catch this species. Susceptibility testing using the WHO-recommended diagnostic doses of insecticides, revealed that this species is resistant to DDT and dieldrin, but susceptible to malathion, fenitrothion, propoxur, bendiocarb, lambdacyhalothrin, permethrin, cyfluthrin, etofenprox and deltamethrin.

A qualitative assessment of the risk of introducing foot and mouth disease into Russia and Europe from Georgia, Armenia and Azerbaijan.

A qualitative risk assessment was performed to evaluate the risk of introducing foot and mouth disease (FMD) virus into Russia and the rest of Europe from the countries of Transcaucasia (Armenia, Azerbaijan and Georgia). The assessment was based on data collected during a three-week mission to these countries by the Food and Agriculture Organization, the European Union and the Office International des Epizooties in March 1999. Due to the strong involvement of the local veterinary services, much information was obtained. Although the data were not sufficient to allow a quantitative risk assessment to be performed, the investigation served as a useful initial approach, prior to undertaking a quantitative risk assessment. The risk of FMD virus infection is a function of two elements, namely: the probability of the hazard (virus infection) occurring, and the magnitude of the consequences. The probability of the hazard occurring is the product of the probability of entry of the virus and the probability of exposure to the virus. These elements were assessed using the following parameters: prevalence of infection; volume of trade; capacity of the virus to survive; and potential for infection. The magnitude of the consequences is derived from the probability of transmission and spread. Combining these parameters, the probability of occurrence of the hazard was rated as 'moderate'. Economic consequences of potential transmission and spread of FMD, in the local context, were rated as 'negligible'. As a result, the overall risk of introducing FMD virus into Russia and the rest of Europe from Trancaucasia was rated as 'low' at the time of evaluation. The method and results are presented to serve as a basis for further discussion.

Malaria in the WHO European Region (1971-1999).

The number of autochthonous reported cases of malaria fell from 90 506 to 37 170 between 1996 and 1999 in the WHO European Region. There has been, however, an eight-fold increase in imported cases since the 1970s: 1500 cases were reported in 1972, 13 000 cases in 1999. France, Germany, Italy, and the United Kingdom are the west European countries with the largest numbers of cases.

Tuberculosis control in the Caucasus: successes and constraints in DOTS implementation.

SETTING: The pilot projects for tuberculosis (TB) control, supported by the World Health Organization (WHO) and based on the WHO recommended control strategy, directly-observed treatment, short-course (DOTS) in the Caucasian countries (Armenia, Azerbaijan, Georgia). OBJECTIVE: To evaluate the results 2 years after the implementation of the pilot projects. METHODS: Analysis of data on case detection, sputum conversion and treatment outcome reported quarterly to the WHO from the Ministries of Health in each country. RESULTS: Since the establishment of the project, 1330, 764 and 4866 new cases and relapses, respectively, of TB have been detected in the pilot areas of Armenia, Azerbaijan and Georgia. In Armenia and Azerbaijan, respectively 46% and 57% of all cases were smear positive, whilst in Georgia, the corresponding figure was only 12%. After 3 months' treatment, 93% of new smear-positive patients had become smear-negative. The sputum conversion rate for relapses and other retreatment cases (failure, treatment interrupted) was 85%. In Armenia, 78.1% of new smear-positive patients were treated successfully (cured or completed treatment). The corresponding percentages for Azerbaijan and Georgia were 87.9% and 59.6%. Treatment success rates among retreatment cases was generally low, at respectively 46%, 64%, and 35%, in Armenia, Azerbaijan, and Georgia. CONCLUSION: The results of the implementation of the WHO TB control pilot projects in Armenia, Azerbaijan and Georgia suggest that the DOTS strategy is feasible in emergency situations in general, and in the Caucasus in particular.

[Characteristics of the blood lipoprotein spectrum in truck drivers from the rural Northern Caucasus areas]. / Kharakteristika lipoproteidnogo spektra krovi u voditelei avtotransporta sel'skikh raionov Severnogo Kavkaza.

Studies were performed of the blood lipoprotein spectrum in 20-59-year-old truck-drivers working in Northern Caucasus rural areas, depending on the age, duration of work in the profession and nationality, in comparison with male workers of other professions in the same areas. It was established that, in indigenous male workers of other than truck-driver's profession, the average levels of different cholesterol lipoproteids were lower than in other ethnic groups, whereas the hypoalfacholesterolemia occurrence was two-fold. In truck-drivers of both indigenous and non-indigenous groups, the lipoprotein spectrum age-related changes were similar. In the non-indigenous drivers' group, hypercholesterolemia was highly prevalent, and hyperalfacholesterolemia was less prevalent than in other professional groups. Also, IHD cases were more characteristic of the indigenous drivers' group. The data obtained witnessed in favour of a differentiated approach in the planning of preventive activities with due account of the population's ethnic and occupational characteristics.

[Study of prevalence and structure of cerebrovascular disorders in different regions of the USSR based on simultaneous epidemiological examinations]. / Rasprostranennost' i struktura tserebrovaskuliarnykh zabolevanii v razlichnykh regionakh SSSR po dannym adnomomentnogo épidemio- logicheskogo issledovaniia.

The authors describe the data of the screenings of the representative random samples from the open male population aged 20 to 54 years, carried out in accordance with the common program in 6 cities of this country. The prevalence of definite cases of cerebrovascular diseases (CVD) ranged from 7.7% in Moscow to 12% in Irkutsk. As to the structure of cerebrovascular injuries, the initial manifestations of brain blood supply insufficiency accounted for 68%. The prevalence of CVD turned out to be the greatest in Western Siberia, the least in the European region. The transcaucasian republics occupy an intermediate position.

[Patterns in the distribution of visceral leishmaniasis in Transcaucasia]. / Zakonomernosti rasprostraneniia vistseral'nogo leishmanioza v Zakavkaz'e.

The paper considers the regularities of the spreading of visceral leishmaniasis (VL) and present state of its foci in the Transcaucasia, where sporadic cases of the disease occur now in some regions of the Georgian and Azerbaijan SSRs, which is associated with the natural foci. The number of Phlebotomus kandelakii, Ph. transcaucasicus, Ph. balcanicus, Ph. brevis--the most probable vectors of the VL causative agents--is still rather high at the foot of the Great Caucasus, in the Ararat valley, in some regions of the Georgian SSR to the south of Tbilisi and some other regions with natural foci of the VL causative agent. The established regularities are reflected on the map, comparing the landscape-determined mosquitoes accumulation sites with VL distribution among human population at the peak of the disease. The public health system should pay special attention to the areas of distribution of mosquitoes throughout the entire natural foci area with respect to visceral leishmaniasis.