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Original Researches
UDK 616.9-053.2:615.281.8
S.I. Doan1, N.G. Malysh2
1 Kyiv Medical University, Kyiv, Ukraine
2 Sumy State University, Sumy, Ukraine
Epidemiological features of diarrheal infections
in Ukraine
For cite: Aktual'naya Infektologiya. 2017;5(4):172-176. doi: 10.22141/2312-413x.5.4.2017.115729
Abstract. According to the official statistical reports of the Ministry of Health in Ukraine using descriptive and analytical methods of epidemiological researches, epidemic process intensity in acute intestinal infections under the current conditions in Ukraine has been studied. It was found that epidemiological situation of acute intestinal infection incidence is unfavourable. The highest rates were registered in the administrative territories adjacent to the Black and Azov Sea as well as in Kharkiv region. Acute intestinal infections of unknown etiology and those caused by viruses and opportunistic pathogens prevail in the nosological structure. Epidemiological situation of acute intestinal infections becomes more complicated due to cases of outbreaks that are more often caused by salmonella and occur in public food facilities.
Keywords: acute intestinal infections; incidence; salmonellosis; outbreaks
TJA' Jsüllillskyl
Инфектояогия
DOI: 10.22141/2312-413x5.4.2017.115729
Introduction
Infectious diseases continue causing the significant damage to humanity. 1.7 billion cases of diarrheal diseases are reported in the world every year [1]. About 2.2 million of people, mostly children, die due to these infections.
Rotavirus infection (RVI) holds a special place in the structure of intestinal infections as under the current conditions, it is one of the most popular intestinal infections in the world causing social and economic damage [2]. The researchers state the increasing role of opportunistic microorganisms (OP) as the agents of diarrheal infections and food poisonings of bacterial etiology [3]. They are endemic in the environment, and are the resident representatives of normal human flora. Salmonellosis are assuming greater significance year by year.
The current system of epidemiological surveillance in Ukraine is limited to the monitoring of acute enteric infections (AEI) cases and environmental culturing of patients or, more rarely, environmental media. At the same time there is no virologic diagnostics of diarrheal infections and no control of environmental media. That's why many issues of intestinal infection epidemiology, caused by viruses and OP, remain understudied.
The purpose of the study is to explore the features of epidemic process of AEI in Ukraine in order to optimize preventive activities.
Materials and methods
AEI incidence in 2001—2015 in Ukraine was analyzed based on the official statistical reports. According to the information given by SI "The Ukrainian Center for Disease Control and Monitoring of the Ministry of Health in Ukraine" the investigation was held on the nature of AEI epidemic outbreaks in 2015, based on the ways of agent transmission, groups of affected quota, etiological agents.
The descriptive and analytical approaches of epidemio-logical methods of researches, statistical methods were used in the paper.
Results and discussion
Under the current conditions in Ukraine AEI take the major part in the infectious diseases structure. According to the official statistical reports of MOH in Ukraine, annual incidence of diarrheal infections is beaten only by the incidence of acute respiratory tract infections of multiple or unspecified localization. From 95,624 to 105,254 cases of AEI were recorded in Ukraine every year during 2011—2016, that exceeded the amount of any other reported cases of infectious diseases, except for acute respiratory diseases.
It was established that specific gravity of the reported cases oftyphoid fever, paratyphoid fevers A, B, C, cholera, campylobacteriosis and intestinal yersiniosis didn't exceed 0.1 %, shigellosis — 1.8 %, salmonellosis and rotavirus en-
© «Actual Infectology», 2017 © «Актуальна шфектолопя», 2017
© Publisher Zaslavsky O.Yu., 2017 © Видавець Заславський О.Ю., 2017
For correspondence: S.I. Doan, Privat Higher Education Institution "Kyiv Medical University of UAFM", Lva Tolstogo st., 9, Kyiv, 01004, Ukraine; e-mail: [email protected]
Для кореспонденцп: Доан С.1., Приватний вищий навчальний заклад «Ки'1'вський медичний уыверситет УАНМ», вул. Льва Толстого, 9, м. КиТв, 01004, Укра'Тна; e-mail: [email protected]
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Acute enteric infections of undetermined significance Acute enteric infections caused by other pathogens
Intestinal yersiniosis 10,1 Campylobacteriosis 10,1 RVE Shigellosis Salmonellosis Cholera
Paratyphoid fevers A, B, C Typhoid fever
2,5
0 5 10 15 20 25 30 35 40
Figure 1. Specific gravity of diarrheal infection incidence in Ukraine in 2011-2016
teritis (RVE) — 10.3 i 12.5 % accordingly. Each third case of AEI within Ukraine was etiologically undeciphered, and almost 39 % was caused by other agents, besides the ones listed above (fig. 1).
Salmonellosis — one of the most common acute enteric infections — has a global reach and is relevant for the majority of countries all over the world [4, 5]. Continuous processes of globalization, changes in food production technology, stereotypes of consumatory behaviour of the population, intensive growth of international commodity exchange, migration and tourism contribute to widespread salmonella in the world. In the period under investigation the incidence in Ukraine ranged from 18.5 per 100 thousand people in 2011 to 24.1 in 2013 (median incidence 19.84 per 100 thousand people). Herewith, it was found that the highest rates were registered in Kharkiv (median incidence — 53.4), Khmel-nytskyi (29.9), Cherkasy (30.2) regions. The lowest ones were in Kherson and Ternopil regions (median incidence 8.4 and 4.7 per 100 people accordingly) (fig. 2).
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The incidence of AEI caused by other pathogens (AEICOP) in Ukraine ranged from 115.5 in 2012 to 123.27 in 2015 (median incidence — 118.32 per 100 thousand people). The highest incidence rates are in Zaporizhzhia (median incidence — 320.7 per 100 thousand people), Odesa (165.1), and Kharkiv (150.1 per 100 thousand people) regions. The lowest rates are in Ternopil and Zakarpattia regions (median incidence is 43.0 and 37.6 per 100 thousand people accordingly) (fig. 3).
The AEICOP group includes the cases of rotavirus enteritis (RVE), campylobacteriosis, intestinal yersiniosis, which are separately registered in Ukraine. Their specific gravity varies in AEICOP structure in different regions, but the prevailing number of AEICOP was caused by opportunistic microorganisms, diarrheal Escherichia and Rotaviruses.
Nowadays RVI is the most massive intestinal infection almost all over the world [6]. RVI registration in Ukraine has been started since 1995. Since then, the incidence rates have been constantly increasing due to the improvement of AEI diagnostics laboratory. In 2011—2016 the incidence rate of RVI in Ukraine varied within 18.97-30.95 per 100 thousand people (median incidence — 24.66 per 100 thousand people) (fig. 4).
The highest rates were in Zaporizhzhia, Dnipropetrovsk, Odessa regions (median incidence 125.9; 35.8; 33.6 per 100 thousand people accordingly). The lowest were in Ternopil and Kirovohrad regions (6.5 and 3.5 per 100 thousand people accordingly).
Over recent years the researchers found that campylo-bacteriosis has taken a significant place in the AEI struc-
Figure 4. RVE incidence in Ukraine
ture, and Campylobacter bacteria are its etiological agents. This microorganism has been discovered relatively recently, but its responsibility for disease development of livestock and poultry puts it in the category of veterinary pathology problems. Globally, the proportion of campylobacteriosis in diarrheal disease structure is 8.4 % (the 4th place) (after rotavirus, typhoid and cryptosporidiosis). The true frequency of gastroenteritis caused Campylobacter spp. is difficult to accurately determine due to underreporting, particularly in Low- and Middle-income countries. In Ukraine the cases of campylobacterial enteritis were reported only in 6 regions (Zaporizhzhia, Dnipropetrovsk, Vinnytsia, Volyn, Odesa and Chernihiv) and in Kyiv. And its incidence indicators ranged from 0.06 to 6.25 per 100 thousand people.
The incidence level of intestinal yersiniosis is higher in highly developed countries with high economic level and well-developed food industry. In the Russian Federation the incidence varies from 1.38 to 2.75 per 100 thousand people,
Figure 5. Acute enteric infections outbreaks distribution in Ukraine in 2015 (%)
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and in some areas the incidence is 40-50 and even reaches 138 per 100 thousand people [7], in the Republic of Belarus it is 3.8 per 100 thousand people [8]. In Ukraine, in 2011— 2016 the incidence of enteritis, caused by Yersinia entero-colitica varied within 0.17—0.22 per 100 thousand people.
It is common knowledge, that the situation with acute enteric infections may be much more complicated because of the emergence of disease flare-up. 95 outbreaks of AEI were reported in Ukraine for 12 months of 2015, which is almost 1.8 times more than in 2014, 2.7 times more than in 2013 and 4.5 times more than in 2012. Most of AEI outbreaks were reported in Kyiv, Cherkasy, Lviv and Kharkiv regions (fig. 5), some few outbreaks — in Vinnytsia and Dni-propetrovsk regions.
These outbreaks affected 1439 people, including 675 children or 46.9 %. The outbreaks were recorded among the population of certain areas locally as well as in organized groups (pre-school institutions, secondary schools, summer health institutions, healthcare organizations, industries) (table 1).
Month distribution of diarrheal infection outbreaks is characterized with discretisation. Months of outbreak registration peaks were in September (17.8 %), January (10.5 %), August (10.5 %), June (9.5 %). The least peaks were recorded in February (4.2 %), October (5.3 %) and November (5.3 %).
The AEI outbreaks were caused by S. enteritidis, S. ty-phimurium, rotaviruses, conditionally pathogenic bacteria (table 2). In 37 cases (38.9 %) AEI outbreaks or AEI of unknown etiology or mixed (Salmonella, viruses, OP) were reported.
The outbreaks of salmonella etiology predominated. The largest number of salmonella outbreaks was registered in Kharkiv region — 7 niduses (14.6 % of the total number), 5 (10.4 %) — in each Cherkasy and Lviv regions, 4 (8.3 %) — in each Zhytomyr and Chernihiv regions, 3 (6.3 %) — in each Vinnytsia, Khmelnytskyi and Volyn regions and 2 (4.2 %) — in each Zaporizhzhia, Dnipropetro-vsk and Kyiv regions. 89.6 % cases of outbreaks were caused by S. enteritidis, 2.1 % — S. typhimurium, 6.2 % — S. bleg-dam, 2.1 % — S. glostrup.
RVI outbreaks were registered in 8 regions: Volyn, Dni-propetrovsk (2 outbreaks), Donetsk, Mykolaiv, Odesa, Rivne, Ternopil (2 outbreaks) and Cherkasy (4 outbreaks) regions. In 66.7 ± 12.2 % of RVI cases the outbreaks were detected in pre-school institutions (PSI), in 20.0 ± 10.3 % — in schools and colleges, in 13.3 ± 8.8 % cases — among the population which used polluted water. The number of children suffering from RVI in the nidus, which appeared in child welfare institutions, varied from 3 to 10 people.
Conclusions
The obtained results indicate an unfavorable epidemio-logical AEI situation in Ukraine. The highest rates were reported in the areas adjacent to the Black and Azov Seas and in the areas that are the most populated in Ukraine. AEI caused by other observed agents and AEI of unknown etiology prevail in the AEI incidence structure. Despite of the selectivity of rotaviruses investigation, RVE median incidence is the highest. The AEI situation becomes more complicated with increase in diarrheal infection outbreaks. Every third case of disease outbreak is connected with pub-
Table 1. Outbreaks distribution by location of their emergence
Location of the emergence Number of outbreaks Number of affected people Nidus index
Total % Total %
Among the population of certain areas 26 27.4 499 34.7 19.2
Public catering 30 31.6 487 33.8 16.2
Pre-school institutions 24 25.3 263 18.3 10.9
Schools 4 4.2 45 3.1 11.2
Vocational schools 2 2.1 42 2.9 21
Summer health events 4 4.2 56 3.9 14
Healthcare organizations 1 1.0 7 0.5 7
Industrial enterprises 4 4.2 40 2.8 10
Total 95 100 1439 100 15.1
Table 2. Outbreaks distribution by etiology
Etiology Number of outbreaks Number of affected people Nidus index
Total % Total %
S. enteritidis 43 45.3 527 36.6 12.3
Rotavirus 13 13.7 97 6.7 7.5
BFP of staphylococcal etiology 2 2.1 114 7.9 57.0
Viruses, salmonella, OP 30 31.5 645 44.8 21.5
Shigella, OP 1 1.1 7 0.5 7.0
Unknown etiology 6 6.3 49 3.5 8.2
Total 95 100 1439 100 15.1
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lic food facilities, every fourth is connected with PSI. Most often outbreaks were caused by salmonella and were of mixed outbreak nature. Almost 20 % of all AEI outbreaks were registered in August. The above mentioned shows that epidemiological surveillance of AEI must be improved by developing preventive measures, which would be based on incidence rates in each separate territory, finding the dominant transmission ways and factors, and strengthening the elective care of sanitary and epidemiological authorities for public food facilities and children pre-school institutions.
Conflicts of interests. Authors declare the absence of any conflicts of interests that might be construed to influence the results or interpretation of their manuscript.
References
1. World Health Organization. Diarrhoeal disease: fact sheet 330. Available from http://www.who.int/mediacentre/factsheets/fs330/en/
2. Hu Y, Gui L, Chang J, Liu J, et al. The incidence of infants with rotavirus enteritis combined with lactose intolerance. Pak J Pharm Sci. 2016 Jan;29(1 Suppl):321-3. PMID: 27005498.
3. Malysh NG, Doan SI, Holodilo EN, Chemych ON, Poddub-naya AI. Nosological structure of acute intestinal infections, endogenous risk factors. Immunopatologiya, allergologiya, infektologiya. 2015;3:40-46. doi: 10.14427/jipai.2015.3.40.
4. Lal A, Baker MG, French NP, Dufour M, Hales S. The epidemiology of human salmonellosis in New Zealand, 1997- 2008. Epidemiol Infect. 2012 Sep;140(9):1685-94. doi: 10.1017/ S0950268811002470.
5. World Health Organization. Salmonella (non-typhoidal): fact sheet 139. Available from http://www.who.int/mediacentre/fact-sheets/fs139/en/. Updated: Aug, 2013.
6. Jackowska T, Pawlik K. Prevention of nosocomial infections in pediatric ward-own experiences. Dev Period Med. 2015 Apr-Jun;19(2):225-34. PMID: 26384127. (in Polish)
7. Martyinova GP, Bogvilene YaA, Saybel IV, Vaytsel EV. Clinical and epidemiological characteristics of iersiniosis infection in Krasnoyarsk children. Sibirskoe meditsinskoe obozrenie. 2012;4(76):66-69.
8. Lebedkova NV. Long-term dynamics of morbidity of infections caused by y enterocolitica and y pseudotuberculosis in belarus from 1996 to 2011 years. Meditsinskiy zhurnal. 2012;1(39):57-59.
Received 30.08.2017 ■
Доан С.И.1, Малыш Н.Г.2
1Киевский медицинский университет, г. Киев, Украина 2Сумский государственный университет, г. Сумы, Украина
Эпидемиологические особенности
Резюме. Тяжесть инфекционного процесса при острых кишечных инфекциях в современных условиях в Украине изучалась согласно официальным статистическим отчетам Министерства здравоохранения Украины с использованием описательных и аналитических методов эпидемиологических исследований. Установлено, что эпидемиологическая ситуация по заболеваемости острыми кишечными инфекциями неблагоприятна. Самые высокие показатели были зарегистрированы на административных территориях, прилегающих к Черному и Азовскому мо-
диарейных инфекций в Украине
рям, а также в Харьковской области. В нозологической структуре преобладают острые кишечные инфекции неизвестной этиологии и те из них, которые вызваны вирусами и условно-патогенными микроорганизмами. Эпидемиологическая ситуация по острым кишечным инфекциям осложняется вспышками, чаще всего вызываемыми сальмонеллой и возникающими на предприятиях общественного питания.
Ключевые слова: острые кишечные инфекции; частота; сальмонеллез; вспышки
Доан С.1.1, Малиш Н.Г.2
1Ки!вський медичний yHiBepcmeT, м. Кит, Украна 2Сумський державний yHiBepcmeT, м. Суми, Украна
Етдемюлопчы особливост
Резюме. Тяжшсть шфекцшного процесу при гострих кишкових шфекщях у сучасних умовах в Украш вивчалася згвдно з офщшними статистичними звиами Мшстерства охорони здоров'я Украши з використанням описових й аналиичних методiв епвдемюлопчних дослвджень. Установлено, що епщемюлопчна ситуащя i3 захворюваноси на гострi кишковi шфекци несприятлива. Найвищi показ-ники були зареестроваш на адмшстративних територ1ях, прилеглих до Чорного й Азовського морiв, а також у Хар-
дiарейних Ыфекцм в УкраУн
швськш обласп. У нозолопчнш структурi переважають го-стрi кишковi шфекци невщомо! етюлоги i ri з них, що ви-кликаш вiрусами й умовно-патогенними мшрооргашзма-ми. Етдемюлопчна ситуащя з гострих кишкових шфекцш ускладнюеться спалахами, що найчастше викликаються сальмонелою i виникають на пщприемствах громадського харчування.
K™40Bi слова: гострi кишковi шфекци; частота; сальмоне-льоз; спалахи
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