Source: Belsat TV [in Russian, machine trans., edited]
<https://belsat.eu/ru/news/epidemiya-neyasnogo-proishozhdeniya-v-ulyanovske-kolichestvo-zabolevshih-ehinokokkozom-udvoilos/>

An outbreak [of suspected echinococcosis] among cadets in Ulyanovsk Suvorov Military School, was discovered in early February [2019]. At least, 49 cadets of the military Suvorov school, instead of 26 as reported earlier, are infected with _Echinococcus_.

The Ministry of Defense of Russia excludes that the infection could have been transmitted through the food and believes that it happened by touching contaminated dogs.

Echinococcosis was initially suspected in 5 cadets. Their X-rays showed suspected cysts in the lungs.

On [5 Feb 2019], a criminal case under part 1, article 236 of the criminal code suspected violations of the sanitary and epidemiological rules, which led to mass disease. On [6 Feb 2019], at the Suvorov School, representatives of the Ministry of Defense of the Russian Federation met with the parents of the students. They reported the investigation, rejecting the version of infection through food in the school's canteen. The head of the institution, Vladimir Shkirkov, and the chief parasitologist of the Ministry of Defense, Sergey Kozlov, informed the parents that the cadets could have become ill by stroking an infected dog, Novaya Gazeta newspaper reported. On [14 Feb 2019], the newspaper "Izvestia" published a new version: the students were infected during the use of nasvaya smokeless tobacco mixture made from chicken or camel dung.

The publication refers to an anonymous source close to the investigation, but it gives the opinion of researchers who believe this option unlikely. The newspaper claims to have found several more sick cadets, 2018 graduates. But on [2 Feb 2019] the media reported about disease among staff of the school cafeteria.

The response of the Ministry of Health to [Ulyanovsk Region State Duma Deputy] Alexei Kurinny, it was specified that the ministry had performed a full examination of more than 518 and 305 employees of Suvorov military school.
********************************
Date: Fri 1 Mar 2019
Source: OTR (Public Television of Russia) [in Russian, machine trans.,
abridged, edited]
<https://otr-online.ru/news/v-ulyanovske-ehinokokkozom-zarazilis-49-suvorovcev-121472.html>

As of [20 Feb 2019] it is known about 49 cases in the military Suvorov school.

Foci of infection also have been found in the liver, pancreas, brain, eyes, and spleen.
********************************
Date: Mon 4 Feb 2019
Source: Interfax-Russia [in Russian, machine trans., abridged,
edited]
<http://www.interfax-russia.ru/Povoljie/news.asp?sec=1672&id=1003015>

Initially, echinococcosis was detected during routine examination in 5 cadets after X-ray of the lungs. None of them had health complaints. On [4 Feb 2019], Mass Media published information of already 25 cases among cadets.
=====================
[Infection of humans with _Echinococcus granulosis_ happens when eggs are ingested and hatch in the intestines, penetrate the intestinal wall, and migrate to different organs. The infection can happen through eggs from dog feces contaminating water, greens, and berries.

The notions that the subjects has consumed "nasvaya-tobacco mixture made from chicken or camel dung" does not explain infection with _Echinococcus_ and neither camels nor or chickens excrete _Echinococcus_ eggs in their feces. If the "tobacco" was made from dog feces it could be a source of infection.

The incubation period is usually years, and for instance a study from Kirgyzstan estimated an incubation period of 15 years (Usubalieva J et al. Human alveolar echinococcosis in Kyrgyzstan. Emerg Infect Dis. 2013; 19(7): 1095-7. doi: 10.3201/eid1907.121405).

The news report in item [3] above only mentions chest X-rays, but the article in item [1] mentions "suspected cysts in the lungs" and the article in item [2] mentions that foci of infection [cysts?] have been found in multiple other organs. In 95% of human cases the liver is involved because it receives the blood draining the intestines.

Given the long incubation period of _Echinococcus_, an outbreak involving at least 49 persons developing symptoms within a few months with a common source of infection is highly unlikely if not impossible.

What else can it be?
If the lesions were limited to the lungs TB is much more likely, but an outbreak of pulmonary TB would not be associated with multiple lesions in other organs. Foodborne infections could be caused by _Trichinella_, but _Trichinella_ does not result in cystic lesions; it is a multiorgan infection, it is foodborne, and several outbreaks have been reported from Russia.

ProMED will be happy to post more information including more information on the X-ray and CT results, and whether the patients had eosinophilia (sign of a helminth infection). - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Russia:
<http://healthmap.org/promed/p/13794>]
Date: Fri, 26 Oct 2018 11:57:59 +0200

Moscow, Oct 26, 2018 (AFP) - Six people died in floods in southern Russia which also damaged regional infrastructure including an oil pipeline, authorities said Friday, as emergency workers were struggling to provide food and water to the victims.   Flash floods affected parts of the Krasnodar region, including the area around the Black Sea resort city of Sochi, where Moscow hosted the Winter Olympics in 2014.

Russia's emergencies ministry said it had recovered the bodies of six people while clearing rubble and two people were hospitalised.   Kremlin spokesman Dmitry Peskov told journalists that all the government services are "working in emergency mode" to battle the "ruthless elements."   The emergencies ministry said over 2,300 houses were flooded in the region.   Flash floods frequently cause devastating damage in the area wedged between the Black Sea and the Caucasus mountain range as mountain rivers swell and destroy settlements below.

Similar floods in 2012 killed over 150 people around Krymsk, another town in the region.  A regional subsidiary of Russian oil transport company Transneft said Friday that the flash floods and resulting landslides "damaged a pipeline" in the region's Tuapse district causing "a spill of five cubic metres of oil."   The company is working to keep the oil from getting into the Tuapse river, a major source of water for the town of Tuapse, home to over 60,000 people.

The floods also damaged a major railway line and roads, authorities said. Russian Railways, the country's rail monopoly, said Thursday that 31 passenger trains were stopped due to the damage, and passengers were being bussed to the nearest stations to continue their journeys.
Date: Wed, 25 Jul 2018 18:25:40 +0200

Moscow, July 25, 2018 (AFP) - Russia on Tuesday announced that it will stop running all long-distance trains across its 11 time zones on Moscow time (GMT+3), ending a frequent cause of confusion for travellers.   Russian Railways, the state monopoly, said it made the move to "improve the quality of service for passengers."   From August 1, at all stations, all information boards, clocks and loudspeaker anouncements on the time on arrival and departure of long-distance trains will use the local time, the railway company said.   Since May, the railway company has been printing train tickets for August and beyond showing both the local time and Moscow time.

Currently the time for a train departing from the Pacific city of Vladivostok at the end of the Trans-Siberian route, will be shown on station timetables, display boards and tickets according to Moscow time, even though there is a seven-hour time difference.   This rule was introduced in the Soviet era to achieve consistency across the network and so passengers don't have to keep changing their watches.   But it often causes confusion for passengers joining trains in cities across Russia who may not be familiar with the current Moscow time.   The time difference can even mean that passengers need to buy tickets for a different date than they were expecting.   Under the Soviet Union, all trains across all the republics ran according to Moscow time.    Russia has recently tinkered with its time zones, cutting them down to nine in 2011 and then going back to 11 in 2014.   It has also been on permanent winter time since 2014 after a failed experiment to put the nation on summer time all year round.
Date: Thu 21 Jun 2018
Source: N Engl J Med [edited]
<https://www.nejm.org/doi/full/10.1056/NEJMicm1716138>
Citation Kartashev V and Simon F. Migrating Dirofilaria repens. N Engl J Med. 2018;378(25):e35. doi: 10.1056/NEJMicm1716138.

A 32-year-old woman presented to an ophthalmologist with a 2-week history of nodules that moved around her face. She had first noted a nodule below her left eye (Panel A) [for images see URL]. Five days later, it had moved to above her left eye (Panel B), and 10 days after that to the upper lip (Panel C). She documented these changes by taking photographs of her face (i.e., "selfies"). The nodules occasionally caused a localized itching and burning sensation, but otherwise she had no symptoms.

She had recently travelled to a rural area outside Moscow and recalled being frequently bitten by mosquitoes. A physical examination showed a superficial moving oblong nodule at the left upper eyelid. A parasite was fixed with forceps and removed surgically (Panel D). The parasite was identified by means of a polymerase-chain-reaction assay as _Dirofilaria repens_, which is a zoonotic filarial nematode.

Dogs and other carnivores are the definitive hosts, and mosquitoes serve as vectors. Humans can become aberrant hosts. Surgical excision of the worm is curative. After removal of the worm, the patient had a full recovery. -- Communicated by: ProMED-mail <promed@promedmail.org> [Human infections with _D. repens_ is well known in Russia and a recent review included data from 236 human patients (Ermakova LA, Nagorny SA, Krivorotova EY, Pshenichnaya NY, Matina ON. _Dirofilaria repens_ in the Russian Federation: current epidemiology, diagnosis, and treatment from a federal reference center perspective. Int J Infect Dis. 2014 Jun;23:47-52. doi: 10.1016/j.ijid.2014.02.008).

The reservoir are dogs and the infection is transmitted to humans by mosquitoes and is also described from other European countries (Miterpáková M et al. Heartworm on the rise-new insights into _Dirofilaria immitis_ epidemiology.

Parasitol Res. 2018 Jul;117(7):2347-2350. doi: 10.1007/s00436-018-5912-9;  Blaizot R et al.
Systemic Infection With _Dirofilaria repens_ in Southwestern France.
Ann Intern Med. 2018 Feb 6;168(3):228-229. doi: 10.7326/L17-0426). - ProMED Mod.EP]
===============================
[Until 2014 human dirofilariasis in the Russian Federation was considered as a rare helminthiasis. According to information by the Center of Hygiene and Epidemiology of Rospotrebnadzor, at the end of 2012, 1093 cases infected by _D. repens_ have been recorded in Russian Federation (since 1915, where the 1st case in Russia was recorded). But now, due to the sudden increase of infectious cases, the human dirofilariasis is recording separately from other Helminthiasis in the official statistical reports.

Due to the favorable natural and climatic conditions, as well as the high affection of definitive (dogs and other animals of the family of canines and felines) and intermediate hosts (mosquitoes), the territory of the South of Russia is a risk area for sustainable transmission of infestation. The incidence of human infestation correlated with the extent of infestation in final and intermediate hosts.

Dogs are the most important source for human transmission. The largest number of cases was revealed in the Rostov, Volgograd and Nizhny Novgorod regions. At the beginning of 2013, 242 patients with dirofilariasis were recorded in the Rostov region. This is 22.1 percent of all cases recorded in the Russian Federation. Often patients addressed for medical assistance in hospital due to detection under the skin dense fixed formations, up to 1.5 cm, or in cases of the visualization of thread like moving worms under the skin in various localization.

A migration of the parasite we observed in 43.6 percent of patients. In 17.7 percent of cases, worms moved considerable distances: from the knee to the groin area; lower back, upper eyelid or from periorbital region to shin and buttocks. Common localizations of _Dirofilaria_ were head and neck (most often in the periorbital area, and conjunctivitis (face, scalp and forehead), or more rarely in the area of the trunk and extremities. In 6 patients (2.3 percent), worms were found in the external genitals. - ProMED Mod.NP]
 
[HealthMap/ProMED-mail map Russia:
<http://healthmap.org/promed/p/98>]
Date: Mon 18 Jun 2018 8:53 UTC+3
Source: Tass Russian News Agency [edited]
<http://tass.com/society/1009933>

Russia's federal service for the oversight of consumer rights protection, Rospotrebnadzor, has called on the Russians to get vaccination for measles before trips abroad, as the disease is spearing in a number of regions of the world.

"Rospotrebnadzor calls public attention to the reports [on the spread of measles] and notes separately that vaccination offers the only reliable preventive protection against measles," the agency said in a warning at its website. "Therefore we make a recommendation to the people who have not been vaccinated and have not been down with measles previously to get vaccination at least 14 days before the scheduled trip," the report said.

Rospotrebnadzor quoted information from the World Health Organization, which pointed out a notable increase in the incidence of measles in 28 South American countries -- Argentina, Brazil, Ecuador, Colombia, Mexico, Peru, Venezuela, and also in the US and Canada.

"The Center for Public Health at the Healthcare Ministry of Ukraine points out the level of incidence of measles in Ukraine in 2017 exceeded the figures for 2016 by a factor of 70," the report said. "In all, as many as 20 553 cases of measles have been registered there since the beginning of this year, including 8331 cases among adults and 12 222 cases among children."

"Eleven people have died from complications caused by the disease," the agency said.

As the root-cause of the situation, it pointed out the low levels of vaccination among the rank-and-file people.
============================
[HealthMap/ProMED-mail map of Russia:
<http://healthmap.org/promed/p/98>.]
******************************
Russia: FIFA World cup, PAHO/WHO
Date: Fri 1 Jun 2018
Source: PAHO/WHO [edited]
<https://www.paho.org/hq/index.php?option=com_content&view=article&id=14394>

The Pan American Health Organization/World Health Organization (PAHO/WHO) has recommended that all those travelling to the 2018 FIFA World Cup ensure that they're up-to-date with all their vaccinations, including the measles, mumps, and rubella vaccine (also known as MMR). The 2018 World Cup will be hosted this year by Russia between 14 Jun and 15 Jul.

The increase in international travel and the mass movement of people during events such as the World Cup increases the risk of transmission of diseases. It also increases the likelihood of travellers returning to their countries with diseases such as measles, which is highly contagious and can have grave consequences on the health of unvaccinated populations.
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