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Background: From June 13-16, 2022, a regional epidemiological department in Kazakhstan reported an increase in acute gastroenteritis cases among people who consumed food from a wedding at a restaurant. An investigation was initiated to determine factors associated with acute intestinal infection and prevent further illness., Methods: The investigation team conducted a retrospective cohort study among people who consumed event food. Participants were classified as a case if they were acutely ill with diarrhea, vomiting, fever, vomiting, or weakness from June 13-18. We interviewed people to collect information on demographics, symptoms, and food exposures at the event. We calculated food-specific attack rates and estimated adjusted relative risks (aRR) using multivariable Poisson regression, which was adjusted for sex, age, and foods consumed. Patient stool and gastric lavage samples, leftover food, and restaurant environmental samples were collected for bacterial culture and chemical analysis., Results: Of the 138 participants, 66 became ill; the attack rate was 48%. The most reported symptoms were diarrhea (92%), abdominal pain (91%), and fever (89%). Symptom onset occurred between 6 h and 4 days after the event (median = 1 day). Overall, 50 (76%) cases were hospitalized; no deaths were reported. In bivariable analysis, a greater proportion of cases than non-cases ate honey cake (89% vs. 13%, p < 0.01), and 45% of cases ate leftovers compared with 11% of non-cases (p < 0.01). In multivariable analysis, honey cake was the only risk factor associated with illness (aRR = 7.8, 95% confidence interval = 3.5-20.1, p < 0.01). Honey cakes, which use raw eggs in cream layers, had been stored at room temperature for three days before the event. Salmonella enterica serovar Enteriditis (S. Enteritidis) was isolated from all patient stool samples (49/49, 100%) and honey cake samples (2/2, 100%). Staphylococcus aureus was detected in 92% (35/38) of patient gastric lavage samples., Conclusion: S. Enteritidis was this outbreak's most probable etiological agent based on clinical manifestations and isolation from participant and honey cake samples. The improper storage of cakes containing raw eggs was a key contributing factor. Leftover event food was discarded, and the restaurant was closed for disinfection. Future outbreaks could be prevented by increased food safety awareness., Competing Interests: Declarations. Ethics approval and consent to participate: This outbreak investigation was conducted by residents of the Central Asia Field Epidemiology Training Program under a legally authorized mandate from the Ministry of Health of Kazakhstan. This activity was reviewed by the CDC Institutional Review Board, deemed not research, and was conducted consistent with applicable federal law and CDC policy (CGH-WIDB-7/29/22-96394).1 All participants gave written informed consent. Parents or legal guardians gave consent to provide information about their children under the age of 18. Children under 18 years of age were not interviewed; instead, information about children was obtained from parents or legal guardians. Conducted under the principles of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the U. S. Centers for Disease Control and Prevention., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Introduction: The COVID-19 pandemic negatively influenced the availability of tuberculosis (TB) services, such as detection, diagnosis and treatment, around the world, including Kazakhstan. We set out to estimate the COVID-19 pandemic influence on TB treatment outcomes by comparing outcomes among people starting treatment before the pandemic (2018-2019) and during the pandemic (2020-2021) and to determine risk factors associated with unfavorable outcomes., Methods: We conducted a retrospective cohort study among all people newly diagnosed with drug-sensitive pulmonary or extrapulmonary TB at least 18 years old who initiated treatment from 2018 to 2021 in Almaty. We abstracted data from the national electronic TB register. Unfavorable treatment outcomes were ineffective treatment, death, loss to follow-up, results not evaluated, and transferred. We used multivariable Poisson regression to calculate adjusted relative risk (aRR) and 95% confidence intervals (95%CI)., Results: Among 1548 people newly diagnosed with TB during the study period, average age was 43 years (range 18-93) and 52% were male. The number of people initiating treatment was higher before than the pandemic (935 vs. 613, respectively). There was significantly different proportions before compared to during the pandemic for people diagnosed through routine screening (39% vs. 31%, p  < 0.001), 60 years and older (16% vs. 22%, p  = 0.005), and with diabetes (5% vs. 8%, p  = 0.017). There was no difference in the proportion of HIV (8% in both periods). Unfavorable outcomes increased from 11 to 20% during the pandemic (aRR = 1.83; 95% CI: 1.44-2.31). Case fatality rose from 6 to 9% ( p  = 0.038). Risk factors for unfavorable TB treatment outcomes among all participants were being male (aRR = 1.44, 95%CI = 1.12-1.85), having HIV (aRR = 2.72, 95%CI = 1.99-3.72), having alcohol use disorder (aRR = 2.58, 95%CI = 1.83-3.62) and experiencing homelessness (aRR = 2.94, 95%CI = 1.80-4.80). Protective factors were being 18-39 years old (aRR = 0.33, 95%CI = 0.24-0.44) and 40-59 years old (aRR = 0.56, 95%CI = 0.41-0.75) compared to 60 years old and up., Conclusion: COVID-19 pandemic was associated with unfavorable treatment outcomes for people newly diagnosed with drug-sensitive TB in Almaty, Kazakhstan. People with fewer comorbidities were at increased risk. Results point to the need to maintain continuity of care for persons on TB treatment, especially those at higher risk for poor outcomes during periods of healthcare service disruption., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gabdullina, Maes, Horth, Dzhazybekova, Amanova, Zikriyarova and Nabirova.)

Introduction: Vaccination is a critical public health intervention, and vaccine hesitancy is a major threat. Globally, confidence in COVID-19 vaccines has been low, and rates of routine immunizations decreased during the COVID-19 pandemic. Because healthcare providers are a trusted source of information on vaccination in Kazakhstan, it was vital to understand their knowledge, attitudes and practices (KAP) related to both routine and COVID-19 vaccines., Methods: From March to April 2021, we conducted a cross-sectional study among the healthcare providers responsible for vaccination in 54 primary care facilities in three cities in Kazakhstan. All consenting providers anonymously completed structured online questionnaires at their place of work. A provider was classified as having COVID-19 vaccine confidence if they planned to get a COVID-19 vaccine, believed that COVID-19 vaccines are important to protect their community and either believed the vaccine was important to protect themselves or believed that getting a vaccine was safer than getting COVID-19. Statistical analysis included chi-square, Spearman's rank correlation coefficient, and Poisson regression., Results: Of 1,461 providers, 30% had COVID-19 vaccine confidence, 40% did not, and 30% would refuse vaccination. Participants were mostly female (92%) and ≤ 35 years old (57%). Additionally, 65% were nurses, 25% were family physicians, and 10% were pediatricians. Adequate KAP for routine vaccines was low (22, 17, and 32%, respectively). Adequate knowledge was highest among pediatricians (42%) and family physicians (28%) and lowest among nurses (17%). Misconceptions about vaccines were high; 54% believed that influenza vaccines cause flu, and 57% believed that there is a scientifically proven association between vaccination and autism and multiple sclerosis. About half (45%) of the practitioners felt confident answering patient vaccine-related concerns. In adjusted models, COVID-19 vaccine confidence was positively associated with adequate knowledge of vaccines (prevalence ratio: 1.2, 95% confidence interval: 1.0-1.4) and adequate attitudes related to routine vaccines (3.1, 2.7-3.6)., Conclusion: Our study uncovers critical areas for interventions to improve KAP related to routine immunizations and COVID-19 vaccine confidence among providers in Kazakhstan. The complex relationship between KAP of routine vaccines and COVID-19 vaccine confidence underscores the importance of addressing vaccine hesitancy more broadly and not focusing solely on COVID-19., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Nabirova, Horth, Kassabekova, Henderson, Yesmagambetova, Alaverdyan, Nuorti and Smagul.)

Background: In February 2021 Kazakhstan began offering COVID-19 vaccines to adults. Breakthrough SARS-CoV-2 infections raised concerns about real-world vaccine effectiveness. We aimed to evaluate effectiveness of four vaccines against SARS-CoV-2 infection., Methods: We conducted a retrospective cohort analysis among adults in Almaty using aggregated vaccination data and individual-level breakthrough COVID-19 cases (≥14 days from 2nd dose) using national surveillance data. We ran time-adjusted Cox-proportional-hazards model with sensitivity analysis accounting for varying entry into vaccinated cohort to assess vaccine effectiveness for each vaccine (measured as 1-adjusted hazard ratios) using the unvaccinated population as reference ( N  = 565,390). We separately calculated daily cumulative hazards for COVID-19 breakthrough among vaccinated persons by age and vaccination month., Results: From February 22 to September 1, 2021, in Almaty, 747,558 (57%) adults were fully vaccinated (received 2 doses), and 108,324 COVID-19 cases (11,472 breakthrough) were registered. Vaccine effectiveness against infection was 79% [sensitivity estimates (SE): 74%-82%] for QazVac, 77% (SE: 71%-81%) for Sputnik V, 71% (SE: 69%-72%) for Hayat-Vax, and 70% (SE: 65%-72%) for CoronaVac. Among vaccinated persons, the 90-day follow-up cumulative hazard for breakthrough infection was 2.2%. Cumulative hazard was 2.9% among people aged ≥60 years versus 1.9% among persons aged 18-39 years ( p  < 0.001), and 1.2% for people vaccinated in February-May versus 3.3% in June-August (p < 0.001)., Conclusion: Our analysis demonstrates high effectiveness of COVID-19 vaccines against infection in Almaty similar to other observational studies. Higher cumulative hazard of breakthrough among people ≥60 years of age and during variant surges warrants targeted booster vaccination campaigns., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Nabirova, Horth, Smagul, Nukenova, Yesmagambetova, Singer, Henderson and Tsoy.)

From March to May 2020, 1306 oilfield workers in Kazakhstan tested positive for SARS-CoV-2. We conducted a case-control study to assess factors associated with SARS-CoV-2 transmission. The cases were PCR-positive for SARS-CoV-2 during June-September 2020. Controls lived at the same camp and were randomly selected from the workers who were PCR-negative for SARS-CoV-2. Data was collected telephonically by interviewing the oil workers. The study had 296 cases and 536 controls with 627 (75%) men, and 527 (63%) were below 40 years of age. Individual factors were the main drivers of transmission, with little contribution by environmental factors. Of the twenty individual factors, rare hand sanitizer use, travel before shift work, and social interactions outside of work increased SARS-CoV-2 transmission. Of the twenty-two environmental factors, only working in air-conditioned spaces was associated with SARS-CoV-2 transmission. Communication messages may enhance workers' individual responsibility and responsibility for the safety of others to reduce SARS-CoV-2 transmission.