Epidemiological and clinical aspects of hemorrhagic fever with renal syndrome at the present stage
AbstractThe purpose of the study is to analyze the epidemiological and clinical features of hemorrhagic fever with renal syndrome (HFRS) in the Volga Federal District.
Material and methods. The HFRS epidemic situation was analyzed based on data from state statistical reporting form No. 2 “Information on infectious and parasitic diseases” for each year of the period 2012–2022, provided by Rospotrebnadzor institutions in the constituent entities of the Russian Federation to the Reference Center for Monitoring HFRS of Kazan Scientific Research Institute of Epidemiology and Microbiology. Small mammals were captured in natural HFRS foci located in HFRS-endemic areas. 2164 rodent lung samples were studied by PCR using the OM-Screen-HFRS-RV test system and by ELISA using the VectoHanta-IgG test system, 4309 blood sera of adults who had not previously had HFRS were analyzed out of 10 subjects of the Russian Federation. Statistical processing of the material was carried out using standard methods of variation statistics using Microsoft Excel 2016. To assess the statistical significance of the differences, Student’s t-test was used. The differences were considered statistically significant at a significance level of p<0.05. Extensive and intensive indicators, average indicator errors and growth rates were calculated.
Results and discussion. Analysis of the clinical course of HFRS confirmed that the main syndromes are intoxication, respiratory, hemodynamic, hemorrhagic, and renal. In dynamics, an assessment of their clinical manifestations is given, the significance of the combination of syndromes in the development of cyclicity and features of the clinical picture of the disease is shown.
The results of molecular genetic studies of samples from the lungs of rodents, a reservoir of HFRS viruses in nature, showed that in the territory of natural foci of HFRS, the Puumala virus predominates in circulation, and in certain areas the Dobrava-Belgrade and Hantaan viruses were identified. In areas where HFRS is endemic, the presence of positive blood sera for HFRS pathogens was noted among people who had not previously had HFRS.
Conclusion. Data from epizootological monitoring of the territories of a number of subjects of the Volga Federal District indicate the active circulation of HFRS pathogens in the population of small mammals, with the predominance of the Puumala virus. The results of serological monitoring indicate the presence of a significant immune layer both in areas with high, medium and low levels of HFRS incidence among the population. The data obtained indicate the widespread distribution of HFRS in the Russian Federation and in particular in the Volga Federal District.
Analysis of the clinical course of patients in the Republic of Bashkortostan in 2022 allowed us to establish the predominance of clinical forms of the disease with moderate severity (80.7%). The results of the clinical characteristics of periods of the disease and the identified changes in laboratory parameters presented in the work make it possible to improve the diagnosis of HFRS, assess the severity of the disease and timely identify complications.
Keywords: hemorrhagic fever with renal syndrome; incidence; clinical picture; serological monitoring; molecular genetic studies
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
Contribution. The concept and design – Savitskaya T.A., Murzabaeva R.T., Valishin D.A.; of the study collection and processing of the material – Trifonov V.A., Agafonova E.V., Tyurin Yu.A., Khusainova R.M.; editing – Reshetnikova I.D., Isaeva G.Sh.
For citation: Savitskaya T.A., Isaeva G.Sh., Reshetnikova I.D., Trifonov V.A., Khusainova R.M., Agafonova E.V., Tyurin Yu.A., Murzabaeva R.T., Valishin D.A. Epidemiological and clinical aspects of hemorrhagic fever with renal syndrome at the present stage. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2024; 13 (2): 59–67. DOI: https://doi.org/10.33029/2305-3496-2024-13-2-59-67 (in Russian)
References
1. Savitskaya T.A., Ivanova A.V., Chumachkova E.A., Pospelov M.V., Isaeva G.Sh., Reshetnikova I.D., et al. Overview of hantavirus infections in the world, the epidemiological situation of hemorrhagic fever with renal syndrome in the Russian Federation in 2021 and forecast for 2022. Problemy osobo opasnykh infektsiy [Problems of Particularly Dangerous Infections]. 2022; (2): 54–63. DOI: https://doi.org/10.21055/0370-1069-2022-2-54-63 (in Russian)
2. Savitskaya T.A., Ivanova A.V., Isaeva G.Sh., Reshetnikova I.D., Trifonov V.A., Ziatdinov V.B., et al. Analysis of the epidemiological situation of hemorrhagic fever with renal syndrome in the Russian Federation in 2022 and forecast of its development for 2023. Problemy osobo opasnykh infektsiy [Problems of Particularly Dangerous Infections]. 2023; (1): 85–95. DOI: https://doi.org/10.21055/0370-1069-2023-1-85-95 (in Russian)
3. Tkachenko E.A., Dzagurova T.K., Bernsteyn A.D., Korotina N.A., Okulova N.M., Mutnykh E.S., et al. Hemorrhagic fever with renal syndrome (history, problems and perspectives of the study). Epidemiologiya i vaktsinoprofilaktika [Epidemiology and Vaccine Prophylaxis]. 2016; 15 (3): 23–34. DOI: https://doi.org/10.31631/2073-3046-2016-15-3-23-34 (in Russian)
4. Dzagurova T.K., Tkachenko E.A., Bashkirtsev V.N., Okulova N.V., Apekina N.S., Korotina N.A., et al. Isolation and identification of hantavirus strains – HFRS pathogens in the European part of Russia. In: Materials of the 10th Congress of VNPOEMP. Moscow, April 12–13, 2012: 137 p. (in Russian)
5. Tkachenko E.A., Morozov V.G., Dzagurova T.K., Yunicheva Yu.V., Pilikova O.M., Zavora D.L., et al. Etiological and clinical epidemiological features of HFRS in the Krasnodar Territory. Epidemiologiya i infektsionnye bolezni [Epidemiology and Infectious Diseases]. 2016; 21 (1): 22–30. (in Russian)
6. Kabwe E., Davidyuk Y., Shamsutdinov A., Garanina E., Martynova E., Kitaeva K., et al. Orthohantaviruses, emerging zoonotic pathogens. Pathogens. 2020; 9 (9): 775. DOI: https://doi.org/10.3390/pathogens9090775
7. Avšič-Županc T., Saksida A., Korva M. Hantavirus infections. Clin Microbiol Infect. 2019; 21: e6–16. DOI: https://doi.org/10.1111/1469-0691.12291
8. Laboratory diagnosis of dangerous infectious diseases: A practical guide / Edited by Academician of the Russian Academy of Medical Sciences G.G. Onishchenko, Academician of the Russian Academy of Medical Sciences V.V. Kutyrev. Ed. 2nd revised and expanded. Moscow: ZAO “Shiko”, 2013.360 p. (in Russian)
9. Tarasov M.A., Popov N.V., Velichko L.N., Kuznetsova A.A., Yakovlev S.A., Matrosova A.N., et al. Landscape and geobotanical features of the manifestation of the activity of HFRS foci in the territory of the Volga Federal District. Problemy osobo opasnykh infektsiy [Problems of Particularly Dangerous Infections]. 2007; (1): 43–6. (in Russian)
10. Tkachenko E.A., Bernsteyn A.D., Dzagurova T.K., Korotina N.A. Actual problems of the current stage of the study of HFRS in Russia. Dezinfektsionnoe delo [Disinfection Affairs]. 2007; (4): 26–33. (in Russian)
11. Mutnykh E.S., Bernsteyn A.D., Kalinkina E.V., Dzagurova T.K., Tkachenko E.A. Features of foci of hemorrhagic fever with renal syndrome in different regions of the European part of Russia. In: A.N. Kulichenko (ed.). Actual Problems of Diseases Common to Humans and Animals [Electronic resource]. Materials of the II All-Russian Scientific and Practical Conference. Stavropol’, 2017; 62–3. (in Russian)
12. Ivanova A.V., Safronov V.A., Popov N.V., Kuklev E.V. Epidemiological zoning of the territory of the Volga Federal District according to the level of potential epidemic danger of natural foci of hemorrhagic fever with renal syndrome. Problemy osobo opasnykh infektsiy [Problems of Particularly Dangerous Infections]. 2020; (1): 91–6. DOI: https://doi.org/10.21055/0370-1069-2020-1-91-96 (in Russian)
13. Salukhov V.V., Kovalenko A.N., Rudakov Yu.V., Shelukhin V.A., Nagibovich O.A., Kan E.A. Contemporary view about the pathogenesis of Hantavirus nephropathy (Literature rewiew). Nefrologiya [Nephrology]. 2021; 25 (4): 23–32. (in Russian)
14. Savitskaya T.A., Ivanova A.V., Isaeva G.Sh., Reshetnikova I.D., Kabve E., Trifonov V.A., et al. Overview of hantavirus infections in the world, the epidemiological situation of hemorrhagic fever with renal syndrome in the Russian Federation in 2020 and forecast for 2021. Problemy osobo opasnykh infektsiy [Problems of Particularly Dangerous Infections]. 2021; (2): 62–70. DOI: https://doi.org/10.21055/0370-1069-2021-2-62-70 (in Russian)
15. Valishin D.A., Murzabaeva R.T., Galimov R.R., Galieva A.T., Galieva R.A., Shaykhullina L.R., et al. Clinical and laboratory parallels in case of new coronavirus infection COVID-19 and hemorragic fever with renal syndrome. Meditsinskiy vestnik Bashkortostana [Medical Bulletin of Bashkortostan]. 2020; 3 (87): 86–90. (in Russian)
16. Manakhov K.M., Sarksyan D.S., Dudarev M.V., Tolstolutskaya T.O., Ponomarenko N.S., Maleev V.V. Molecular genetic characteristics of hemostasis in hemorrhagic fever with renal syndrome. Kazanskiy meditsinskiy zhurnal [Kazan Medical Journal]. 2020; 101 (6): 812–9. (in Russian)
17. Sirotin B.Z. Hemorrhagic fever with renal syndrome. Khabarovsk, 1994: 302 p. (in Russian)
18. Koehler F.C., Di Cristanziano V., Späth M.R., Hoyer-Allo K.J.R., Wanken M., Müller R.U., et al. The kidney in hantavirus infection-epidemiology, virology, pathophysiology, clinical presentation, diagnosis and management. Clin Kidney J. 2022; 15 (7): 1231–52. DOI: https://doi.org/10.1093/ckj/sfac008 PMID: 35756741; PMCID: PMC9217627.