[The malaria situation in the Russian Federation (1997-1999)].

Profound socio-economic changes within the CIS countries in the 1990s brought a lot of negative changes in malaria prevention in targeted countries. The previously stable connection and cooperation in prophylactic activities have been interrupted. Supply of antimalarials, insecticides and equipment had been stopped. Many qualified cadres in the sanitary-epidemiological services in the countries were lost. Because of difficult economic situation they had to change their occupation and place of job. After prolonged period of a stable benign epidemiological situation within Russia the number of imported cases started to grow up. The sharp increase of imported malaria cases from Azerbaijan and Tajikistan had been noticed since 1994 (Tab. 1). For the first time in the history of malaria registration the number of cases imported from the CIS countries has been exceeded the number of malaria cases imported from all other countries in the world in 1995. Later in the end of the 1990s the imported malaria cases has been registered in Russia from some other CIS countries apart from Azerbaijan and Tajikistan. There were malaria cases imported from Armenia (13 cases), Moldavia (2), Turkmenistan (2), and Uzbekistan (2) in 1998. The number of imported malaria cases in Russia in 1999 (Jan-July) is 437. There is no information about introduced or indigenous malaria cases registered until now] within Russia. There were 13 introduced malaria cases as the result of numerous imported ones. 13 introduced cases have been registered in 10 oblasts (administrative regions of Russia). This number has been increased to 53 (!) in 1998 in 20 oblasts. There was one local outbreak of P. vivax malaria in Izberbash settlement (Dagestan). Number of indigenous malaria cases were 5 (1996), 18 (1997), 1 (1998). The contra-epidemic measures in Izberbash have included active cases detection and treatment indoor insecticide spaying and one tour of mass primaguine treatment during interseasonal period of time. Additional indigenous cases after imported and introduced ones have been detected in Krasnodar (1 cases), Samara (1), Tolyaty (1), and Cherkessk (5) in 1998. One induced P. falciparum malaria case has been detected Moscow in 1998. Medical nurse from urological branch of the Moscow hospital No. 29 has penetrated by syringe needle her hand after performing of intravenous injection to the patient with imported P. falciparum malaria. No other induced cases have been detected. Because of local administrative problems with primaquine supply not all P. vivax malaria cases have received complete treatment. As the result of these events there was malaria relapsed cases registered every year. The actual number was 20 (1993), 37 (1994), 45 (1995), 59 (1996), 99 (1997). Due to late appearance of patient with P. falciparum malaria before medical staff and as a result late diagnosis and late and some time inappropriate treatment there were several lethal malaria cases registered [table: see text] every year. Inappropriate treatment means that treatment of P. falciparum malaria cases was consisted of chloroquine only. The cumulative number of lethal cases in 1994-1997 was 12, and the same number in 1998 was 6. One should mention that one lethal case in 1998 in Volgograd was due to P. vivax. The subject was chronic alcoholic and combination with P. vivax malaria brings him to death. Some calculation reveals the risk of resurgence of malaria in Russia. If one analyses all P. vivax imported cases from the point of view of time and place of detection the following picture would be emerged: 83% of all imported cases has been localized within cities, and 17% only--in rural areas. Half of the latter has been appeared during cold part of years when transmission was impossible. The result of approximately 200 imported cases has been appeared in a right time and place there were 75 introduced cases.