The World Health Organization announced on May 4, 2023 that coronavirus infection is no longer a global emergency, but despite this, it proposed a strategy for 2023-2025 that includes the definition of immunization principles by each country, the need for case registrations and surveillance behind the virus. The review article presents data on high-risk groups for a severe course of a SARS-CoV-2 and new approaches to vaccination and revaccination recommended by WHO on depending on risk factors in patients and circulating new strains of the virus.

The literature review highlights modern ideas about the pathogenesis, pathomorphology, and clinical manifestations of central nervous system damage in patients with HIV infection, and also touches on the problems of diagnosis and treatment of these opportunistic infections. Particular attention should be paid to patients with severe immunodeficiency (CD4+T-lymphocyte count < 200 cl/ml) due to the high risk of secondary diseases of the central nervous system. Along with the etiological verification of opportunistic diseases of the central nervous system, magnetic resonance imaging of the brain is important at the initial stage of diagnosis, with the help of which it is possible to identify changes in the brain substance characteristic of certain pathogens. In addition to the basic etiotropic therapy of opportunistic infections in HIV patients, effective antiretroviral therapy and its index of penetration into the central nervous system play a crucial role.

The aim of the review: to present up-to-date scientifically based information about the laboratory parameters of patients associated with severe SARS-CoV-2 infection and internal organ damage. Materials and methods: full-text publications of clinical, randomized and cohort studies, systematic reviews and meta-analyses from scientific databases PubMed, Elsevier, Scopus, Google Scholar, E-library for the period from 2019 to 2022 were analyzed. Results. Specific biomarkers were identified, including inflammatory and immunological parameters (C-reactive protein, procalcitonin, IL6), hematological (number of lymphocytes and neutrophils, NLR, D-dimer, ferritin, RDW), myocardial (troponin, creatinekinase-MB, myoglobin), hepatic (AST, ALT, total bilirubin, albumin) and characterizing lung injury (KL-6), which can be used for risk stratification, as prognostic biomarkers of adverse clinical consequences, including death in patients with COVID-19. The studies demonstrated new biomarkers of inflammatory and systemic manifestations of COVID19: procalcitonin, calprotectin and presepsin.

The aim: to characterize the clinical and etiological features of facial palsy (FP) in children of different ages at the present stage and their correlation with the outcome and duration of the disease.

Materials and methods: the data of 68 children with FP were obtained. The neurological examination with an assessment of the level of facial nerve damage and the severity of FP using the House-Brackmann scale (HB), the concomitant symptoms and the etiological verification of a possible infectious agent were performed to all children. Also, their correlation with the outcomes and duration of the disease were assessed.

Results: in the etiological structure infectious FP are more common in children under 12 years of age, with a predominance of herpesviruses and enteroviruses, whereas, more than half of the cases in children over the age of 12 years are idiopathic (Bell’s palsy), less often herpesviruses. A longer course and the probability of an unfavorable are significantly more often observed in the group of children under 12 years of age. There was also a significant correlation between the severity of FP according to HB with the outcomes and duration of the disease.

Conclusion: The results confirm the importance and necessity of laboratory confirmation of a possible etiological agent associated with the development of FP. The severity of FP doesn’t depend on the age of the child, but correlates with the outcome and duration of the disease, more less with the synkinesia. A promising direction for further research is to clarify the climatic factors affecting the incidence of FP.

All currently existing studies of the hemostasis system  in COVID-19 using thromboelastography (TEG) were performed on the delta strain of SARS-CoV-2, while there is no information in the literature on conducting such studies in patients infected with the current omicron strain.

Research objective. To determine the state of the hemostasis system in hospitalized patients with COVID-19 (omicron strain) using TEG. To assess the relevance of existing guidelines on anticoagulant therapy.

Materials and methods. TEG was performed in 93 hospitalized patients with COVID-19 aged 1 to 88 years, of which 66 patients (group 1) on the first day and 27 patients (group 2) – on the second day. For comparison with the parameters of healthy volunteers, a sample of 30 people was formed. Data analysis was performed using the Statistica, version  12 (StatSoft, USA). To compare the independent variable in more than two samples, a multivariate ANOVA analysis of variance was performed with the calculation of the Kruskal-Wallis test. To assess the relationships between continuous variables, the Spearman direct linear correlation coefficient (r) was determined.

Results. 53% of patients had hypocoagulation, 31% had normocoagulation, and 16% had hypercoagulation. Elderly patients (61 [26–72]) more often have developed hypocoagulation. Young patients (24.5 [7–37]) more often have developed hypercoagulation. Routine methods for assessing hemostasis did not reflect its true state. Higher levels of fibrinogen (4.5 [5.8–4] g/l) and D-dimer (1.28 [0.5–2.77] µg/ ml) were observed in patients from the group with normocoagulation. Was revealed a statistical tendency towards an increase in the level of amylase when there was an increase in the coagulation properties of the blood.

Conclusion. With the current course of COVID-19 and early admission of non-severe patients to the hospital, normocoagulation and hypocoagulation predominate. Elderly and senile patients are not recommended to prescribe anticoagulants without TEG. It is necessary to specify the recommendations for prescribing anticoagulants to hospitalized patients. For the diagnosis of hemostasis disorders expand application of TEG.

Objective. To assess durability of antiretroviral therapy in first line in HIV-infected patients in real clinical practice in the Russian Federation and determine association between basic clinical and demographic characteristics and durability of treatment.

Materials and methods. A non-interventional retrospective study was conducted collecting data from primary medical records of HIV-infected patients who signed informed consent form and had started antiretroviral therapy in first line. Patients were enrolled if the third component was a non-nucleoside reverse transcriptase inhibitor (NNRTI) or ritonavir boosted protease inhibitor (PI/r) plus two nucleoside reverse transcriptase inhibitors (NRTIs). Also, patients must have been followed up for at least 96 since start of treatment. Durability of therapy was retrospectively assessed at 48±8 and 96±8.

Results. 536 patients were enrolled. Percentage of patients without change of therapy was approximately 76% and 60%, and the mean duration of therapy without changes was approximately 47 and 79 weeks at 48±8 and 96±8 weeks,  correspondingly. Durability of treatment was not different for NNRTI+2NRTIs and PI/r+2NRTIs. Only age ≥ 40 years as a basic characteristic was associated with ART change prior to 96 weeks: OR=1.391, 95% CI 1.005-1.925.

Conclusions. In real clinical practice in Russia, durability of first-line antiretroviral therapy corresponds published scientific data (in terms of percentage of patients without change of treatment and its duration without change). Durability of treatment and factors associated with its early switch or stop should be investigated in prospective studies further.

Aim. To create algorithm and risk calculator for predicting the lethal outcome in patients with COVID-19.

Materials and methods. Based on machine learning approach mortality risk calculator was developed in Almazov National Medical Research Centre using data of the hospitalised patients with an established diagnosis of COVID-19 (n=4071).

Results. This mathematical model, which includes 11 significant features, has been proposed for estimation of fatal outcomes in the Clinical Infectious Hospital named after S.P. Botkin. Some key features were not assessed in most hospitals according to accepted standards of care for COVID-19. So systematic analysis of factors affecting the course of disease in patients (n=2876) were conducted and «urea» and «total protein» were replaced with «sex» and «BMI». Modified algorithm demonstrated high sensitivity and specificity. Conclusion. This calculator is able to predict hospitalisation outcome with high accuracy in patients infected with different strains of SARS-CoV-2. This decision support system may be used for risk stratification and following correct patients routing.

Purpose: To study the reactogenicity, safety and immunogenicity of the Russian vaccine Flu-M in comparison with Vaxigrip vaccine for influenza prevention in children aged from 6 months to 9 years (phase III).

Materials and Methods. In 2021, a clinical study was conducted in which children aged 6 months to 9 years were immunized with Flu-M vaccine (produced by SPbSRIVS, Russia) and Vaxigrip vaccine (produced by Sanofi Pasteur S.A., France). After randomization one group of children was vaccinated with Flu-M, the other with Vaxigrip, and monitored for 180±3 days after vaccination. Children vaccinated between 3 and 9 years of age were studied in phase I, and between 6 months and 3 years of age in phase II. Tolerability and safety were assessed by the frequency and extent of adverse events, as well as by the assessment of vital signs and physical examination. Immunological efficacy assessment criteria were geometric mean antibody titer, seroconversion level, seroconversion factor, seroprotection level.

Results. Both vaccines (Flu-M and Vaxigrip) were shown to be well tolerated by children of both age groups. No serious adverse events or severe adverse events were reported   in the study. Immunological efficacy criteria were achieved for both vaccines for all strains of influenza virus in children of both age groups at 28 and 56 days after vaccination. No cases of influenza or acute respiratory infections were seen at 180±3 days postvaccination.

Conclusion. The results of the clinical study show that the Flu-M and Vaxigrip vaccines are comparable in both age groups of children.The trial is registered at ClinicalTrials.gov (NCT 05470582).

Aim: The analysis of the incidence of hepatitis B in the Republic of Dagestan (RD) and clinical and epidemiological characteristics of HBV/HDV coinfection in the region.

Materials and Methods. The dynamics of the hepatitis B incidence rates and the coverage of vaccination against this infection in the RD in 2008-2022 were analyzed based on the data from of the statistical forms of Rospotrebnadzor. The clinical and epidemiological characteristics of delta hepatitis were analyzed in 371 patients under dispensary observation at the Republican Center for Infectious Diseases named after S.-А.М. Magomedov.

Results. Over the past 10 years, the incidence of CHB in the RD has increased more than 4.5 times, from 1.4 per 100 thousand population in 2008 to 6.7 per 100 thousand population in 2022. A decrease in the rates of hepatitis B child immunization in the RD is observed since 2009. Hepatitis B vaccination coverage rates in adult population fell sharply after 2010, both in the RD and in the Russian Federation  on average. The frequency of HDV co-infection in persons infected with HBV in the RD is 13.8%, but reaches 15% in some regions of the republic, indicating the moderate level   of endemicity. Patients with HBV/HDV coinfection are predominantly males aged 25–45 years with advanced fibrosis or cirrhosis. All cases of HDV infection in the RD are caused by viral genotype 1.

Conclusions. The obtained results testify to the significance of the problem of hepatitis B and delta in the RD. The number of identified patients and, accordingly, the rate of co-infection, apparently, will increase with the expansion of screening for markers of HDV infection, when patients who were registered as HBsAg carriers will be examined according to the patient routing guidelines. The late diagnosis of delta hepatitis in RD and the limited possibilities of antiviral therapy are another significant issues.

Goal. Characteristics of innate, cellular and adaptive immunity in patients of the older age group with COVID19.

Materials and methods. Blood leukocytes were induced by Newcastle disease virus (α-interferon), phytohemagglutinin (γ-interferon), SARS CoV 2: RBD antigens and S-protein; interferon activity in human fibroblast culture and enzyme immunoassay were evaluated. In serum, IgG antibodies to SARS CoV2 and autoantibodies to interferon and to the endothelium of blood vessels were determined using a mono-layer of human umbilical vein cells. Statistical processing was performed in Excel 2016.

Results. A decrease in the production of  α-interferon and γ-interferon was revealed: 1 week -74.2±15.1; 3 week-144.0±35.7 (p=0.01); control – 266.6 ±82 (relative to 3 weeks p=0.004) and IFN γ: 1 week -6.8±2; 3 week – 14.4 ±3.5 (p=0.03); control – 28.87.15 (relative to 3 weeks (p=0.007). Decreased production of γ-interferon by leukocytes of patients with induction by SARS CoV2 RBD and S-trimer anti-gens was revealed. Antibodies to SARS CoV2 were detected starting from the 2nd week of the disease, a large spread of indicators was noted. Autoantibodies to α2-interferon and to vascular surface antigens were detected.

Conclusion. The state of innate immunity in patients of the older age group with severe and moderate COVID-19 was characterized by a decrease in the activity of the interferon system. Decreased activity of cellular immunity to SARS CoV2 antigens was noted. Adaptive immunity was characterized by the development of an imbalance in the form of the appearance of autoantibodies to α-interferon and vascular endothelium.

Objective: to estimate the prevalence of antibiotic resistance genes in the resistome of adult residents of Arkhangelsk with regard to the severity of the novel coronavirus infection (COVID-19).

Materials and methods. A cross-sectional study was conducted between October and November 2022 (2.5 years after the start of the COVID-19 pandemic) on a random sample (N=455) of Arkhangelsk population aged 42-76 years. The data collection involved a questionnaire survey, assessment of immunoglobulins G to S-, S2, N-proteins of SARS-CoV-2 and detection of antibiotic resistance genes in fecal samples by polymerase chain reaction.

Results. Almost all participants (98.5%) had at least one antibiotic resistance gene, the resistance determinants to three classes of antibiotics simultaneously were detected in 5.6%. The prevalence of resistance genes to macrolides was 98.5%, to beta-lactams – 29.0%, and to glycopeptides – 16.0%. Antibiotic resistance genes to beta-lactams were more prevalent among participants who had previously been hospitalized for COVID-19 (44.8%) and among those having had frequent acute respiratory infections (50.0%). Individuals vaccinated against SARS-CoV-2 (26.6%) and participants with cardiovascular diseases (17.0%) were less likely to have beta-lactam resistance genes.

Conclusion. The high prevalence of antibiotic resistance genes has been revealed in the resistome of adult residents of Arkhangelsk. We determined the association between resistance to beta-lactams and COVID-19 severity. The study results could be used to improve the protocols of antibiotic therapy and to guide a decision-making related to the antibiotic prescription in adults.

The urgency of the problem of community-acquired pneumonia in children is due to the high incidence rate. In the etiological structure of bacterial pneumonia, Streptococcus pneumoniae and Mycoplasma pneumonia (Mp) prevail.

Purpose: to identify clinical, laboratory and instrumental features of mycoplasmal pneumonia in children.

Materials and methods. A retrospective,  single-center cohort study  of  266  case  histories  of  children  aged  4 months to 17 years who were in Children’s City Clinical Hospital No. 9 in 2019 with a referral diagnosis of pneumonia was carried out. To verify the diagnosis of pneumonia, the method of chest X-ray was used, for the etiological diagnosis, the method of PCR swabs from the nasopharynx, ELISA for the detection of antibodies of the IgM and IgG classes was used. Results. The diagnosis  of  pneumonia was confirmed in 190 children. The diagnosis of pneumonia caused by M. pneumoniae (MpP) was established in 76 (40%) children, they made up the 1st group. The remaining 114 (60%) children with community-acquired pneumonia of another etiology (CAP) made up the 2nd group – comparisons. The diagnosis of MpP was confirmed in 46 (60.5%) children by the detection of IgM, in 12 (15.8%) by the detection of Mp genetic material, and in  18  (23.7%) by positive both IgM and PCR. The median age of children in the group with MpP was 9.6 years, in the comparison group – 4 years (p<0.01). Significantly more often MpP occurs in children aged 11–17 years (p < 0.01), and CAP – up to 7 years (p < 0.01). With MpP, catarrhal phenomena in the form of hyperemia of the oropharynx, nasal congestion, and unproductive cough are observed less frequently than with CAP. With MpP, rales in the lungs are heard more often than with CAP, they are significantly more often wet (p<0.01). Respiratory failure and dyspnea are less common in MpP than in CAP. Bilateral lesions and lesions of the upper lobe of the lungs are more often detected in MpP, and in CAP – right-sided lesions. In the general blood test, leukocytosis, incl. above 15  thousand/µl,  as well as leukopenia below 4 thousand/µl were significantly more frequent in the group of patients with CAP (p<0.01). Conclusion. No clear clinical and laboratory criteria for mycoplasmal etiology of pneumonia have been obtained, which dictates the need for laboratory confirmation for the choice of therapy tactics.

Listeriosis mainly affects immunocompromised people, including pregnant women. Listeriosis is 17 times more common in pregnancy than in the population and lead to severe complications for the fetus or newborn. In Russia 644 cases of listeriosis were registered from 2005 to 2017. Every case  of listeriosis in pregnant women requires a special analysis. This will increase the alertness of doctors and their awareness of the features of this disease and its treatment in pregnant women.

Aims – to study the features of listeriosis in the third trimester of pregnancy, the outcomes of the disease for the pregnant woman and the fetus.

Materials and methods. We studied 4 cases of listeriosis in the third trimester of pregnancy, identified in the Clinical Infectious Hospital named after S.P. Botkin in the period from 2020 to 2021.

Results. All patients were admitted to the hospital in the third trimester of pregnancy with suspected acute respiratory viral infection, from 1 to 4 days after the onset of the disease. The leading symptom was fever. Leukocytosis was in a clinical blood test, and the value of C-reactive protein and procalcitonin were increased. L. monocytogenes was identified after childbirth during bacteriological examination of mothers and newborns. All the women gave birth during the first day after admission to the hospital. Two women had vaginal deliveries, and two women delivered by cesarean section. All children were born alive, but they all were transferred to the children’s hospital for additional treatment. Finally, one child died, and the other three recovered.

Conclusions. Listeriosis of pregnant women is a severe infectious disease that leads to perinatal losses. The search for laboratory techniques that could be widely and routinely used in pregnant women with fever for early identification of L. monocytogenes is relevant. Early identification of this pathogen will make it possible to reasonably choose antibiotics and their dosages, improve prognoses for mother and child.

Aim: To identify regional epidemiological features of dengue fever and substantiate approaches to conducting epidemiological surveillance for this infection taking into account the regional features of its distribution and risk factors affecting its formation.

Materials and methods: Retrospective epidemiological analysis of dengue incidence in the provinces of the Socialist Republic of Vietnam from 2017 to 2022. To conduct the epidemiological analysis of dengue incidence, a free version of the GIS Axioms (ГИС Аксиомы) program and the Google Earth application were used.

Results: It was noted that cases of dengue fever were registered in all 63 provinces of the country, however, the dynamics of incidence levels had wide spatial and temporal ranges. Excepting Hanoi (189.6 0/0000), dengue incidence in the northern provinces are lower than those in the southern provinces. The highest average long-term incidence of dengue fever was observed in Da Nang (659.8 ⁰/₀₀₀₀), Binh Duong (623.3 ⁰/₀₀₀₀), Quang Binh (565.5 ⁰/₀₀₀₀), Ba Ria-Vung Tau (554.6 ⁰/₀₀₀₀) and Khanh Hoa (544.8 ⁰/₀₀₀₀). The results of a comparative analysis of dengue incidence and the main factors influencing it in the adjacent, the incidences of dengue fever of which are significantly different from each other, are shown. The application of geoinformation systems for epidemiological analysis has been demonstrated. It has been established that the distribution of the population of Vietnam differs greatly between the administrative regions of the country, and the use of population density for epidemiological analysis and forecasting of the epidemiological situation of infectious diseases, including dengue fever, can lead to incorrect results.

Conclusion: The epidemiological situation of dengue fever in Vietnam is characterized by high incidence rates, their wide ranges of spatial and temporal variability, and geographical heterogeneity. The use of GIS technologies is one of the promising approaches for epidemiological analysis and monitoring of dengue fever, as well as other infectious diseases.

This clinical case describes the manifestation of acute myeloid leukemia (AML) against the backdrop of severe COVID-19 infection in a teenage patient. The patient’s examination data, medical history, and available scientific literature on the relationship between COVID-19 and leukemia manifestation were studied and analyzed. COVID-19 infection in the context of AML was severe, with respiratory failure and involvement of more than 90% of the lungs according to computed tomography data. Changes observed in peripheral blood did not have specific alterations and only indirectly indicated an unfavorable premorbid background. This clinical case reflects the likelihood of the simultaneous presence of COVID-19 and other acute severe illnesses.

The article describes a clinical case of serous meningitis in a patient with confirmed hemorrhagic fever with renal syndrome (HFRS). Despite the moderate-severe course of the disease with moderate hemorrhagic syndrome, the patient had the development of acute renal failure with the simultaneous occurrence of a rare complication – inflammation of the meningeal membranes caused by hantavirus.

A description of a laboratory confirmed clinical case of generalized Varicella Zoster infection in a patient with lymphogranulomatosis after bone marrow transplantation is presented.

Detection of the Varicella Zoster virus in biological material was carried out by real-time PCR using the RealBest DNA VZV test system manufactured by Vector-BEST, Russian Federation. Isolation of viral DNA from biological material was performed using the ArtRNA MiniSpin kit (ArtBioTech, Belarus) or QIAamp DNA mini kit (QIAGEN, Germany).

The disease had an atypically severe course with a multiorgan lesion, represented not only by lesions  of  the  skin and mucous membranes, but also by the development of encephalitis, myocarditis, and pneumonia. The disease was characterized by an acute onset, with a pronounced intoxication syndrome, signs of pancreatitis with the appearance  of a widespread vesicular rash on the trunk and extremities, prone to fusion, located, including on the scalp, on the feet and palms. The disease was complicated by a secondary bacterial infection, in connection with which the patient received both antiviral treatment and broad-spectrum antibiotic therapy.

The virus was assigned to clade 3 (or E2 genotype according to the old classification), the same genotype as the viruses circulating in Minsk. This case is the first described case of generalized VZV infection in the Republic of Belarus, confirmed by laboratory using molecular genetic methods.