Emerging infectious diseases in Russia, 1990-1999.

His research interests include the molecular evolution and pathology of human RNA viruses, vaccine development, and the molecular epidemiology of viral hepatitis. Russia, the world's largest country, has a population of approximately 145 million and an area of 17,075 km 2 , encompassing 7 geographic, 10 time, and 3 climatic zones (1). This diversity, along with socioeconomic changes in the 1990s, substantially influences the country's infectious disease rates. We discuss infectious disease data collected since 1990 because data for earlier years are not available from officially published sources. The system of health and epidemic surveillance in Russia, which was organized in the 1920s, has been successful in eradicating some infectious diseases and decreasing the rate of others. When epidemiologists graduate from medical school, they are assigned to sanitary epidemiologic surveillance stations throughout Russia, in oblast (state), county, and city offices. Surveillance, disease reporting, sanitation inspections , and outbreak investigations are their main functions. In 1993, the Central Moscow office of regional sanitary epidemiologic surveillance stations began publishing the monthly bulletin Population Health and Environment with collated data that are distributed within and outside Russia (www.fcgsen.ru). However, data collection is limited by inaccurate information from private clinics and diagnostic laboratories (especially those dealing with sexually transmitted diseases and HIV infection), which sometimes do not report all the results of their analyses and diagnoses. Availability of medical statistics in hospitals and regional sanitary epidemiologic surveillance centers is still limited by shortage of personal computers, incompatible software, and slow communications, which affect the speed, reliability , and validity of data. In addition, diagnosis in polyclinics and hospitals, especially for gas-trointestinal and respiratory infections, is usually based on clinical signs and symptoms rather than laboratory identification of the infectious agents or their markers. For example, data for rotaviral infections have been included in disease statistics since at least 1990, although no laboratory reagent kits have been purchased for testing for markers of these infections in most regions and no data were entered in regional reports. Another example is influenza: immuno-fluorescent diagnostics are performed selectively and only during outbreaks. When the number of positive samples reaches a certain level, an influenza epidemic is declared. Influenza is the diagnosis recorded in the medical charts of all patients with similar symptoms, and statistics are coded accordingly. Russia does not yet participate in the European network for gastrointestinal diseases, the Enternet (2), although international cooperation in surveillance for …