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The epidemic situation and etiological factors of enterovirus infection in Russia and Vietnam were analysed and compared. The identified strains of enteroviruses of 47 types, which circulated in Russia in 2018–2019, belonged to different species: Enterovirus species A (CV-A2, CV-A4, CV-A6, CV-A8, CV-A10, CV-A16, EV-A71), as well as Enterovirus species B and Enterovirus species C. The strains isolated from 87 children from southern Vietnam hospitalised in 2018–2019 into infectious hospitals while having enterovirus infection with exanthema were also studied. All identified strains were represented by Enterovirus species A: EV-A71 — 59 strains, CV-A10 — 20 strains, CV-A16 — 5 strains, CV-A6 — two strains and CV-A2 — one strain. Out of 59 viruses EV-A71, 53 strains belonged to genotype C4 and 6 strains belonged to genotype B5. The sequences of EV-A71 strains of genotype C4 from South Vietnam formed a monophyletic cluster with the sequences of EV-A71 viruses which circulated during 2016–2018 in different provinces of China, and they were very close to EV-A71 strains of the same genotype from the Yunnan Province. These strains were genetically different from Russian viruses and Vietnamese viruses identified in the years 2003–2005 and 2011– 2012. Most of the cases of enterovirus infection from southern Vietnam (78%) caused by EV-A71 virus of genotype C4 were reported in three provinces located in southern Vietnam in the Mekong Delta. The epidemic process and the etiology of enterovirus infection in Russia and Vietnam have common features. At the same time, the epidemic situation in these countries is not the same. The incidence of enterovirus infection is influenced by geographic, climatic, economic and demographic factors that differ in two countries. In the majority of territories of Russia, the climate is temperate or cold, seasonal rises in the incidence rates of enterovirus infection usually occur in the summer, when people go on vacation, spend a lot of time outdoors and swim in open reservoirs. In Vietnam, a constant high-level temperature, a high population density and a large proportion of children determine the higher incidence of enterovirus infection, especially in the southern provinces of Vietnam, compared to Russia. The fact that more than 20% of the Vietnamese population lives in the Mekong Delta, which is the largest river in Indochina, has a significant impact on the epidemic process of enterovirus infection in South Vietnam. The Mekong River which flows through China, Laos, Thailand, Cambodia and Vietnam, and carries huge streams of water, including rainstorm waters and sewages, from all of these countries into the southern provinces of Vietnam, which have the highest incidence rates of enterovirus infection in the country. The results of the research underline the importance of active epidemiological and virological surveillance of enterovirus infection, which plays the key role in informing the public health authorities about the changes in the epidemic situation in order to take appropriate measures and develop the prevention strategies. The goal of anti-epidemic and preventive measures is to reduce the incidence of enterovirus infection and the economic burden of this infection for Russia and Vietnam.

In the presented clinical case, the combination of two pathogens (enterovirus and streptococcus) caused a severe and atypical course of the hand-foot-mouth syndrome in a child of primary school age. EVI from the first days of the disease represented by the typical localization of the primary elements of the rash and the characteristic intoxication syndrome was confirmed by the detection of enterovirus RNA in the feces. The course of the disease was undulating. In the first wave, skin rashes accompanied by soreness and itching corresponded to the classical EVI in terms of the nature of the elements, their localization and were combined with lesions of the epithelium of the oral mucosa. Starting from the 5th day of the disease, against the background of an increase in the severity of intoxication syndrome, bullous elements appeared on the skin of the extremities, an excess of the permissible values of antistreptolysin-O was found 12 times, and when sowing material from cracks in the corner of the mouth, Streptococcus pyogenes 106 KUO was isolated, which indicated a combination of the syndrome Hand-foot-mouth with streptococcal infection. Onychomadesis in the period of convalescence retrospectively testified to the dominant role of enterovirus in the presented clinical case.

The aim of this work is to study the etiological and epidemiological features of infectious hemocolites (IG) in hospitalized children of different ages.Materials and methods of research. An analysis of the results of a survey of 3103 children admitted to hospital treatment for acute intestinal infections (AII) from January to December 2018, among which patients with IG were identified. The etiology of the disease was determined based on the results of the bacteriological method, PCR studies of faeces with Amplicens ® OKI screen-FL reagents, serological and immunological methods. Microscopic examination of faeces was performed to identify protozoa. Patients were divided into age groups: infant (n=78; 30%); early (n=74; 28,5%); preschool (n=63; 24,2%), school (n=45; 17,3%).Results. The incidence of IG in hospitalized children with AII was 8,4%. Bacterial pathogens of IG were detected in 66,5% of children, IG of unspecified etiology was diagnosed in 24,2%. Viral and bacterial infections were rarely detected (9,2%). Among intestinal viruses, rotavirus (37,5%), norovirus (29,2%) and enterovirus (20,8%) were more frequently detected in hemocolitis of combined viral and bacterial etiology. In the IG age structure, infants (30%), young children (28,5%) and pre-school children (24,2%) made up the majority. The maximum number of IG patients was detected in the summer (10,9% of all cases of AII). Salmonellosis was more often detected in autumn (31,6%), campylobacteriosis – in summer (17.9%) and autumn (24,1%), escherichiosis and shigellosis – in summer (11,5% and 6,4%, respectively). The maximum detection of IG in infants was observed in June (14,1%) and October (12,8%), in young children – in July (17,6%), in preschoolers – in June (12,7%) and November (15,9%), in schoolchildren in May (13,3% of cases) and in October (15,6%).Conclusion. The incidence of infectious hemocolites in hospitalized children with acute intestinal infections was 8,4%. The bacterial etiology of the disease was detected in 66,5% of children. The age structure of the IG was dominated by children of infant, early and preschool age. The maximum detection of patients with IG was observed in the summer.

Aim. To study the relationship of the incidence of infectious and non-infectious diseases of the digestive system.Materials and methods. A retrospective epidemiological analysis of the incidence of the population of the Russian Federation by diseases of the digestive system of an infectious and non-infectious nature for the period of 2002-2019. The data were sampled from state statistics forms No. 2, No. 23; determining the relationships between these disease groups using Pearson correlation methods and linear regression. A case-control study by questioning a sample of 107 people.Results. A parallel increase in the incidence of diseases of the digestive system of a non-infectious and infectious nature is observed. The most pronounced increase is in the incidence of viral infections. Strong correlation exists between rotavirus infection and diseases of the liver, pancreas, intestines; between norovirus infection and diseases of the liver, pancreas; enterovirus infection and pancreatic disease; as well as hepatitis A and gallbladder diseases. Patients suffering from chronic non-infectious diseases of the digestive system, with a reliably high chance, often suffer from acute intestinal infections, rotavirus infection, hepatitis A, and are also better aware of their etiology than those who do not have such diseases.Conclusion. Prevention of infectious diseases of the digestive system will reduce the incidence of noncommunicable diseases associated with them.

Background. Atrial fibrillation (AF) is combined with an inflammatory process that occurs in the myocardium. Diagnosis of histological changes, including inflammatory changes, in the myocardium is a complex task in the field of modern medicine. The only reliable way of determining the inflammatory changes in the myocardium is endomyocardial biopsy (EMB). As per our literature review, there are no data on the effect of histological changes in the myocardium on the efficacy of interventional treatment for AF. Moreover, assessing the dynamics of EMB results allows us to approach the treatment of patients in greater detail, thereby lowering the risk of the development and progression of serious cardiac pathologies, particularly AF.Aim. To study the effectiveness of catheter treatment for ‘idiopathic’ AF, depending on the dynamics of histological changes in the myocardium.Methods. We enrolled 48 patients with an ‘idiopathic’ form of AF; the median patient age was 39.0 y (33.5–48.0 y). Of these, 42 (87.5 %) were men and 6 (12.5 %) were women. The median duration of arrhythmic history was 4.0 y (2.0–7.0 y). All the patients underwent radiofrequency isolation of the pulmonary veins (Rcil) and EMB from the right ventricle. Histological tests, using the criteria of Cristina Basso, and immunohistochemical (IHC) tests were performed to determine the antigens of the following viruses: herpes simplex virus (HSV) types 1, 2 and 6, enterovirus (EV), Epstein-Barr, adenovirus and parvovirus (PV). After 6 mon, EMB, histological and IHC studies were repeated. Depending on the clinical form of AF, the patients are divided into the following three groups: group 1—paroxysmal form [21 (43.7 %) patients], group 2—persistent [13 (27.1 %) patients], group 3—long-term persistent [14 (29.2 %) patients]. Based on the results of the observation and evaluation of effectiveness, all the groups were divided into the following three subgroups: a—absence of AF during 12 mon of observation, b—early arrhythmia recurrences were registered during the first 3 mon of observation, c—presence of late arrhythmia recurrence after 3 mon of observation.Results. According to the histological criteria for active lymphocytic myocarditis identified in the subgroups, there were 5 patients (35.7 %) in 1a, 2 (50 %) in 1b, 6 (75 %) in 2a, 2 (66,7 %) in 2b, 7 (70 %) in 3a, 2 (66.7 %) in 3b, and 1 (100 %) in 3c. The rest of the patients showed signs of lymphocytic infiltration. After 6 mon, only in group 2a, there was a significant reduction in the number of patients with active lymphocytic myocarditis (p < 0.05). All the patients showed fibrotic changes and expression of HSV 6 and EV antigens of varying severity; this persisted till after 6 mon. The overall effectiveness of the surgical treatment was 66.7 % for paroxysmal, 61.5 % for persistent and 71.4 % for long-term persistent forms of AF during 12 mon of follow-up.Conclusion. Patients with ‘idiopathic’ AF show inflammatory changes in the myocardium, and 48.7 % met the criteria for myocarditis. All the patients showed the expression of viral antigens and the development of fibrosis that met the criteria for post-inflammatory changes. A repeat study that was conducted after 6 mon showed no significant dynamics of inflammatory and fibrotic changes. Despite the presence of inflammatory changes in the myocardium, the effectiveness of catheter treatment was 66.7 % for paroxysmal, 61.5 % for persistent and 71.4 % for long-term persistent forms of AF.Received 29 April 2020. Revised 1 June 2020. Accepted 3 June 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and design: A.E. Shelemekhov, R.E. BatalovData collection and analysis: A.E. Shelemekhov, Yu.V. Rogovskaya, S.Yu. Usenkov, E.A. Archakov, M.S. Rebenkova Drafting the article: A.E. ShelemekhovStatistical analysis: A.E. Shelemekhov, A.M. GusakovaCritical revision of the article: R.E. Batalov, Yu.V. Rogovskaya, A.M. GusakovaFinal approval of the version to be published: A.E. Shelemehov, R.E. Batalov, Yu.V. Rogovskaya, S.Yu. Usenkov, E.A. Archakov, A.M. Gusakova, M.S. Rebenkova

In recent years, enterovirus infection (EVI) retains its cyclical nature with an increase in the incidence rate in the Russian Federation in 2000, 2006, 2009, 2013 and 2017. Observation of 41 patients with laboratory-confirmed enteroviral meningitis (EVM) in 2000, 54 children in 2013, and 56 patients in 2018 revealed the clinical and laboratory features of this clinical form of the disease, mainly concerning changes in hemo- and liquorogram parameters, which allowed to trace the evolutionary changes during this infection in children.

Relevance . Annual elevation of enterovirus infection (EVI) incidence in the Russian Federation as well as in the Sakhalin region determine a necessity of continuous surveillance involving molecular-genetic methods and phylogenetic analysis. Objective : to highlight epidemiological and molecular-genetic peculiarities of EVI in the Sakhalin region during 2016-2018 years. Materials and methods . Analysis of enterovirus incidence were based on official statistical reporting forms. The structure of enterovirus types was evaluated by means of molecular methods and followed by phylogenetic analysis. Results and discussion . A deterioration of epidemic situation concerning EVI that began in 2016 in the Sakhalin region included elevation of incidence and registration of enterovirus outbreaks in childcare facilities triggered by introduction of new enterovirus types or those that were not circulating for a long time such as Coxsackievirus A-6, Coxsackievirus A-10, Coxsackievirus A-16, ECHO-9. The phylogenetic analysis of Coxsackievirus A-16 detected in the Sakhalin region revealed their similarities with two genovariants of B genogroup (В1а и В1b) that were continuously circulating in Russia and China. In addition, enterovirus ECHO-9 that was also circulating in other constituent entities of the Russian Federation was isolated in Sakhalin region from patients suffering from viral meningitis including two children from two different infection cites of EVI group incidence. Conclusion . An unfavorable epidemic situation concerning EVI was revealed in the Sakhalin region during the last three years of surveillance. It was caused by introduction and further spread among population of Coxsackieviruses A-6, 10, 16 and ECHO-9 that presumably have Russian or foreign origin.

Background.Infectious and non-infectious diseases of the digestive system are common in Russia and worldwide and have major social and economic significance, yet the importance of infectious diseases in development of chronic digestive disorders is not adequately studied. The study aims to define epidemiologic charateristics of non-infectious diseases of the digestive system and to assess the influence of enteric infections on chronic digestive disorders development.Materials and methods.The authors conducted a retrospective epidemiologic analysis of incidence and prevalence of infectious and non-infectious digestive diseases in Russia in the period between 2002 and 2017 and in-depth for 2010–2017. Statistical analysis was done using least square method, Pearson correlation and regression analysis and statistical processing was performed using the Microsoft Excel and IBM SPSS Statistics software. Findings. During the incidence growth period for non-infectious diseases (2010–2015) in Russia a strong positive correlation is detected between incidences of infectious and non-infectious digestive diseases. In particular, Hepatithis A, Enterovirus, Rotavirus and Norovirus infections have to most significant impact on liver, biliary tract diseases, pancreas and intestinal diseases.Conclusion.Enteric infections increase the risk of development of chronic digestive diseases. Prevention of infectious diseases will allow to decrease incidence of chronic digestive diseases

Aim: Characteristics of enterovirus infection morbidity and study of peculiarities of enterovirus circulation on some territories of Russia in 2017. Materials and methods: We investigated more than 5000 samples from the patients with enterovirus infection. The isolation and identification of enteroviruses were conducted by virological method and by partial sequencing of the genome region VP1. Phylogenic trees were constructed according to the method of Bayesian Monte Carlo Markov Chain. Results: Epidemic process and clinical picture of enterovirus infection were not the same on different territories. Peculiarities of the circulation of different types of enteroviruses on the territories were also different. In Saratov region 65% of cases were represented by enterovirus meningitis. In Murmansk region and in the Komi Republic enterovirus infection with exanthema prevailed, 95% and 60% correspondingly. In Saratov region enterovirus ECHO18 was the etiological agent of enterovirus meningitis. In Murmansk region and in the Komi Republic the cases were connected mainly with Coxsackieviruses A6. The strains of enterovirus ECHO18 were distributed to three clusters. The strains which provoked enterovirus meningitis in Saratov region belonged to cluster 3, they were formed separately from other strains of this enterovirus type and differed from the stains of ECHO18 which circulated in the North-West of Russia. The strains of Coxsackieviruses A6 identified in the North-West of Russia belonged to three sub-genotypes 5, 6, 8 of pandemic genotype of CoxsackievirusesA6. The majority of the strains belonged to sub-genotypes 6 and 8 which in 2017 dominated in the structure of Coxsackieviruses A6 in the North-West of Russia and in Russia. Conclusion: Epidemic peaks of enterovirus infection represented by different clinical forms of the disease were provoked by different types of enteroviruses. Enterovirus ECHO18 was the etiological agent of enterovirus meningitis. The main etiological factors of enterovirus infection with exanthema were Coxsackieviruses A6 of different sub-genotypes.

Aim. To characterize the epidemic situation and the clinical course of enterovirus (neolio) infections in the Krasnodar Territory. Materials and methods. Retrospective analysis of manifestations of the epidemic process and clinical characteristics of non-poliomyelitis enterovirus infections from 2002 to 2017 in the territory of the Krasnodar Territory. Results. The incidence of enterovirus infections, the structure of clinical forms, the landscape of enteroviruses isolated from the environment and the biological material of patients was demonstrated. The clinical course of enterovirus infection in 170 hospitalized patients was characterized. Conclusion. Enterovirus (nepolio) infection in the Krasnodar Territory in many years of dynamics demonstrates growing relevance. A variety of enterovirus serotypes circulating in the environment and in the human population are preserved, the spectrum of which varies. In the structure of clinical forms of enterovirus infections, the number of diseases without affecting the central nervous system increases, which indicates an improvement in the quality of diagnosis and an increase in the diagnostic motivation of doctors. Further measures for epidemiological surveillance, as well as training of physicians of various specialties, are expedient, which will help to increase the effectiveness of diagnosis and treatment of enterovirus (nepolio) infection.

Aim: Characteristics of the peculiarities and the etiological factor of enterovirus infection on some territories of Russia in 2016. Materials and methods: We investigated 2138 samples from the patients with enterovirus infection. The isolation and identification of enteroviruses were conducted by the virological method and by partial sequencing of the genome region VP1. Phylogenic trees were constructed according to the method of Bayesian Monte Carlo Markov Chain. Results: Epidemic peaks of enterovirus infection were fixed on some territories of Russia. In Saratov region the morbidity index of enterovirus infection in 2016 was twice as high as the median morbidity index over previous years. The morbidity level of enterovirus meningitis – 3, 21 for 100000 of the population (77% from all the cases of enterovirus infection) was higher than on the other territories. In Kostroma region the morbidity index of enterovirus infection in 2016 was 11 times higher than the index of the previous year. On both territories the rise of morbidity depends on the active circulation of enterovirus ЕСНО 30. Enteroviruses ECHO30 from Saratov region belonged to two phylogenic groups of genotype h. To one of them belonged viruses ECHO30 from Kostroma region. In Murmansk and Leningrad regions in 2016 most cases of enterovirus infection were represented by hand, foot and mouth disease (HFMD). The grouped foci of infection were registered in some preschool institutions. The etiological factor of this clinical form was Coxsackieviruses A6 belonging to different genetic variants. Conclusion: Epidemic peaks of enterovirus infection with the prevalence of different clinical forms of the disease were provoked by different etiological factors. On territories where enterovirus meningitis prevailed strains of enterovirus ECHO30 belonging to different variants of genotype h were detected. In patients with clinical picture of HFMD from territories where this form was leading the etiological factor of infection was Coxsackievirus A6 of different genetic variants.

The article presents the results of research on the study of etiology, the logical structure of viral diarrhea in Baku (Azerbaijan) in 2015. It was found that more than half (62.6%), gastroenteritis in children of viral etiology, of which the leading role as an etiological factor, have a company — and adenoviruses, among infants astroviruses. But-roviral gastroenteritis and enterovirus takes only insignificant-tive percentage of cases. There were no significant differences in the proportion of virustion of diarrhea depending on the age of the patients was not revealed.

There has been observed a tendency to increment of enterovirus morbidity rate over the past seven years. Foci of this infection have been formed in the area from time to time, with minor forms of the disease being predominant in clinical findings. Genetically enteroviruses circulating in the Amur Region have been characterized as homogenous; however there is a genetic relation among them with and, consequently, epidemiologic connection to enteroviruses originated from China. However, since May, 2013 there has been detected a boost activation of epidemic process as regards enteroviral infection, followed by the formation of two major foci with clustered infection, due to importation from Thailand as well. Emergency situation under conditions of flood (August-September, 2013) has contributed to aggravation of epidemiological situation on enteroviral infection. It has led to the increase in numbers of the exposed up to the maximum level for the past few years. In the territory of the temporal accommodation sites, where affected by high water and exposed to the infection population was placed, registered have been the cases of clustered enterovirus infection.

Long-term manifestations of epidemiological process of enterovirus infection in the Jewish Autonomous Region were similar to those in the Khabarovsk Territory, though with a lower intensity. After establishment of emergency situation regime, in view of the rainfall flooding in 2013, enterovirus morbidity rate had been increasing within three weeks duration, then started to fall rapidly. Clustered cases of enterovirus infection were not registered. Viral serous meningitis ratio was insignificant as minor forms of the disease prevailed; coxsackie virus A-9 and echovirus-6 dominated. During the flood period isolated from samples of patients with minor forms of enteroviral disease were three enterovirus strains, type 71, sub-genotype C4a, possessing a high degree of genetic similarity to the Chinese ones, 2010-2011. All in all impact of the natural disaster on the epidemiological situation on enteroviral infection in the Jewish Autonomous Region turned to be insignificant.

The paper contains the data on the role of high waters (2013) in changing epidemiological situation on enterovirus infections in the Khabarovsk Territory. The incidence rate in the region was characterized by the significant increase even before the flood, 2013. Thus, two peaks of enterovirus morbidity curve were identified for the period of a week: one - more intensive, another - coincident with flood outbreak. Enterovirus epidemiological process was notified by the changes in clinical picture among the infected population and cohort age-related structure. The percentage of the patients with enterovirus infections in the foci clusters and the index of people infected due to possible exposure to shattering impact of the flood, turned out to be low. However, revealed was high rate of heterogeneity of the circulating enterovirus strains, non-specific for the Khabarovsk territory and mostly originating from countries of Asia-Pacific region - coxsackie A viruses, which might stand for a possible cause of unfavorable epidemiological situation in 2013.