Monday, September 26, 2016

Russia: Reports Of Early `Flu' Outbreaks


Last winter - when Europe, North America, and much of the rest of the world skated by with a very mild flu season -  Russian and parts of Eastern Europe were hit particularly hard by H1N1.
In early February, Rospotrebnadzor - the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing - described the epidemic as `still rising', and reported 11,470 schools, 2,298 kindergartens, 578 colleges,72 universities completely closed due to the epidemic.
Although some of the reports coming out of Russia were confused and incomplete (see Updating Russia's Flu Outbreak) they were concerning enough that early February we saw the release of an ECDC Risk Assessment : Reports Of Severe A(H1N1)pdm09 In Europe, which warned:
There are strong indications from some EU/EEA countries that the A(H1N1)pdm09 virus is responsible for the hospitalisation of a large number of severe cases. This includes hospitalisations for severe outcomes for both risk groups and otherwise healthy young adults. A similar pattern of severity is likely to be observed in other countries as the season progresses.
Despite the ECDC warning, and a HAN advisory for severe flu expected in the United States, Western Europe and North America managed to avoid a severe flu season.  

Almost a month ago, I wrote about the Russian plan to increase flu vaccinations by 20% this year (see Russia Gears Up To Fight Flu), including setting up vaccination kiosks in the Russian Subway.
Normally we don't begin seeing flu reports out of Russia until October, but over the past week Russian media and government sites have started reporting heavy influenza-like activity.
The WHO National Influenza Centre Of Russia doesn't start releasing epidemiological reports for another couple of weeks (week 40), so we have limited information and no characterization of the virus behind this outbreak.
Note: In Russian reporting the acronym SARS (ОРВИ) is used to describe any severe acute respiratory infection, and should not be confused with the SARS coronavirus.  Additionally, the `Epidemic Threshold' for influenza in Russia is 69.5 per 10,000 people.

It seems likely that this sudden upsurge in seasonal `flu-like' activity is linked to, and has been exacerbated by, the recent letting in of school for the fall semester. There are already scattered reports of school closures.

It is far from clear whether these outbreaks are due to influenza, parainfluenza, a rhinovirus, an enterovirus or some other viral pathogen.  Likely it will turn out to be a mixture of viruses.

So, with that caveat, a brief tour of some of the `flu reports' coming out of Russia today.

Hardest hit, at least in terms of percentage of people infected, appears to be the sparsely populated-far northern Nenets Autonomous District, which only two weeks ago was below the epidemic threshold, and is now running more than double the threshold. 

On the epidemiological situation of the population incidence of SARS in 38 week 2016

According to monitoring the incidence of SARS and influenza in the Nenets Autonomous District with 19.09.2016 till 09.25.2016 year (38 weeks) reported 919 cases of SARS, including children - 706 cases.

The incidence rate of SARS county population was 211.9 per 10 thousand people, the epidemic threshold in 2 times (children 0-2 years exceeded by 62.5%, 3 - 6 years - in 2,9 times, 7-14 years - 2.5 times, from 15 years and older - 92%).

In the city of Naryan-Mar and n Seekers incidence rate exceeds the threshold value of 2.3 times (children 0-2 years exceeded by 55.1%, 3-6 years - by 2.7 times, 7-14 years - 98.9%, from 15 years and above - 2 times).

From the Perm region, we get this report showing ARIs (Acute Respiratory Infections) running 20% over the epidemic threshold.

During the period from 19 to 25 September 2016 in the Perm region registered 22,180 cases of SARS disease, the incidence rate was 84.9 per 10 thousand. Population, which is higher than the weekly epidemic threshold of 20.7%. The increased incidence of acute respiratory viral infection is associated with the formation of new groups (pre-school and educational institutions).

Hospitalized in treatment - preventive organization 462 people including the edge 427 children.

From Yekaterinburg  the fourth-largest city in Russia , we get the following report which suggests that Rhinovirus and parainfluenza may be behind their outbreaks. 
September 26, 2016, 16:38         

12 thousand patients: incidence of SARS in Yekaterinburg reached the level of the winter

Most often, children are ill, who go in kindergartens and schools.
In Yekaterinburg in quarantine closed two classes and 11 groups in kindergartens.

Only in the last week of 12.5 thousand Yekaterinburg became ill with acute respiratory viral infections. According E1.RU chief epidemiologist of the city, Alexander Kharitonov, is 42% higher than epidporog.
And in Udmurtia the story is much the same.

The incidence of SARS in Udmurtia exceeded the epidemic threshold of 36%
September 20, 2016 9:00

The highest rise was registered among schoolchildren and adults.
During the period from 12 to 18 September in the population of the republic incidence of acute respiratory infection (ARI) was above the epidemic threshold for 36%, which corresponds to the level of disease in 2015, the press service of Rospotrebnadzor in the Udmurt Republic.

In just the last week of SARS ill 8709 residents of Udmurtia. Weekly incidence of SARS remained below epidporoga only among children aged 0 to 2 years. Excess week epidporoga reported among adults - 12.2%, among students - 32.4% among children 3-6 years - by 9.7%. The incidence of respiratory diseases on total population increased compared to the previous week by 50%. 

Last week Moscow was still below the epidemic threshold, but we haven't seen this week's numbers yet. There are reports, however, that Moscow's subway system is installing air disinfection systems and UV lamps in their trains.
  In the capital's subway preparing fully prepared to meet the season of colds and flu and to prevent the spread of viruses. To this end, the subway cars will disinfect the air. Regular disinfection will be exposed and handrails of escalators.

It is impossible to say, based on these reports, anything about the source or the severity of these outbreaks, but they are appearing early enough in the year to warrant mention.

We'll keep an eye on these reports, and hopefully will start getting a more complete epidemiological update in the next couple of weeks.

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