№1 (2024)

The review article is devoted to 20 years of experience of the RSPCIC in R & D. The Center was established in 2003 by the Order of the Ministry of Health of the Kyrgyz Republic No. 490 dated 06.11.2003. "On the organization of infrastructure for epidemiological surveillance of nosocomial infections".
The main goal of the Center is to coordinate and organize cross-functional improvement of infection control and medical waste management systems, epidemiological surveillance of infections related to medical care, clinical microbiology and monitoring of antibiotic resistance. The Center has done a lot of work to create a regulatory framework for the national system of infection prevention and control (SIPC). A lot of monitoring and evaluation of SIPC systems at the hospital level was carried out, recommendations were made for their improvement, including staff training. To strengthen the national system, there is extensive experience in successfully attracting funding from donors and international organizations, including in the context of the COVID-19 pandemic.
But at the same time, it should be recognized that there is still a lot of work to be done, since the process of developing regulatory legal acts should be carried out on a regular basis. Guidelines, algorithms and standard operating procedures should be updated at 3 to 5-year intervals, in line with country experience and new WHO recommendations. Monitoring and evaluation of SIPC and medical waste management (MWM) should be carried out at least once every 2-3 years. However, the monitoring process itself is financially expensive, so other approaches should be implemented. In the country, many organizations use infection control monitoring and evaluation checklists (M & E IC), when conducting various types of audits, it would be good if these checklists were transmitted to the Center for analysis and preparation of consolidated analytical reports, with recommendations for strengthening the IC and MWM systems. Support is needed to institutionalize health care feedback and strengthen health care systems directly at the level of institutions providing health care to the population.

Neonatal sepsis is a serious medical and social problem for the Kyrgyz Republic, requiring a comprehensive approach and improvement of infection prevention and infection control measures, diagnosis and treatment. Most often neonatal sepsis develops as a healthcare-associated infection (HAI). According to a cross-sectional study conducted by the Republican Scientific and Practical Center for Infection Control of the National Institute of Public Health (RSPCIC NIOPH) in 2023 in 6 medical organizations, neonatal sepsis as a healthcare-associated infection was detected in 7.3% of 137 newborns examined. Risk factors were the presence of vascular catheters (OR, 6.3 and OR, 7.3) and respiratory manipulation (OR, 4.2 and OR, 6.0). An important factor was that 80% of neonates with sepsis had birth weight less than 2500 grams (RR - 6.4 and OR - 7.6) and gestational age less than 37 weeks (RR - 6.7 and OR - 7.8). To prevent and treat neonatal sepsis, it is necessary to comply with infection control standards, conduct early diagnosis and adequate antibiotic therapy, and take into account the local epidemiologic situation and antibiotic resistance of microorganisms.

The article presents the microbial landscape of urinary tract infections among the population living in Bishkek. Microbiological research in our time is of great importance, since with the development of an infectious process in the urinary tract, the danger lies in the spread of microorganisms throughout all organs and systems. The analysis of the results of a bacteriological study of the urine microbiota was carried out.

The purpose of the scientific work is to study the long-term dynamics and seasonality of viral hepatitis A in the climate and geographical regions of the Kyrgyz Republic. The analysis of the reported statistical data of healthcare organizations of the Kyrgyz Republic on the incidence of HAV for the period 2009-2023 was carried out and the manifestation of seasonality by year was studied. The Kyrgyz Republic is located in a temperate climate zone with clearly defined seasons, in which there are all conditions for the preservation of the hepatitis A virus in the external environment. The share of hepatitis A in the Kyrgyz Republic of the total hepatitis disease in the north is 94.6% and in the south 96.8%. An analysis of average indicators for 2014-2023 by month showed that the season of rising incidence begins from September of the current year to February of the next year, with the peak incidence occurring in November-December. Cyclical rises in incidence are observed annually, with the exception of 2020-2022 during the COVID-19 pandemic, when the prevalence of hepatitis A was at the same level by month, no growth trend was observed and there was no peak incidence.

Introduction. The bacteriological method of purulent-inflammatory diseases remains the gold standard for diagnosis. The sensitivity of the method is influenced by the characteristics of the clinical material, sampling technique, nutrients used and study conditions.
Therefore, antibacterial therapy is often empirical.
The purpose of the study was to determine the etiological structure of purulent-inflammatory diseases.
Materials and methods. The objects of analysis were the results of the study of clinical samples for 2019-2021. The samples were examined by the classical bacteriological method using conventional and chromogenic nutrient media in accordance with existing guidelines.
Results and discussions. Analysis of the structure of the studied samples showed that 25.55% of urine tested for bacteriuria, blood for sterility - 22.5%, and wound discharge, throat smear, sputum were examined less frequently; 10.86% , 3.87% and 2.84% respectively. The relatively high rate of culture from sputum (99.15%) and throat smear (97.28%) is apparently associated with natural contamination of sputum during passage through the respiratory tract. Positive results were found in the study of wound discharge (36.7%), urine ( 44.23%).The relatively low inoculation rate of blood culture studies (28.96%) is associated with a single collection of blood samples after antibiotic therapy.
Conclusion. The most frequently performed microbiological tests are urine for bacteriuria 25.55%, blood for sterility 22.5%, wound discharge, throat smear, sputum are less frequently examined; 10.86%, 3.87% and 2.84% respectively. The cause of inflammatory processes are often bacteria of the family Enterobacterales (34.9%), staphylococci (27.7%) and less commonly streptococci (13.9%), Pseudomonas aeruginosa (4.50%) and other microorganisms (19.10%). The use of sensitive and special chromogenic agars and microbiological analyzers will provide reliable and timely results.

Introduction: Infection prevention and control (IPC) is a systems approach to preventing infections in healthcare organizations. This practice includes all levels of health care, from policy development to medical personnel. It has universal relevance to patient safety and quality of care. With the increasing number of patients and antibiotic resistance, the relevance of IPC increases. WHO has proposed a global strategy in response to these challenges. Ineffective infection prevention measures in health care settings are a major factor in increasing antimicrobial resistance and health care-associated infections. However, there is potential to prevent a significant proportion of such infections, which is supported by the development of a WHO global strategy for strategies to reduce their spread. The aim of this study is to analyze, identify the main aspects of IPC monitoring and evaluation, and discuss the results and their importance in modern medical practice. Materials and methods. Monitoring and evaluation of IPC was carried out in the city of Bishkek and Chui region from 10/10/2023 to 11/06/2023 using the direct observation method. The assessment was carried out using a developed assessment checklist for hospitals and primary care. Statistical data processing was performed in MS office Excel 365, including methods of statistical observation, correlation and regression analysis. Results and discussion. The results of the assessment of IPC in the city of Bishkek and the Chui region revealed high efficiency in a number of components. The highest performance criteria were achieved in the following components: “Safety of medical procedures” (84.9%), “Medical waste management” (82.4%), “Central sterilization department” (77.5%), “Hospital hygiene” (76.2%). Average effectiveness of measures in administrative support (66.5%), isolation system (60.2%), and baseline (25-50)% in health staff training (26%) and surveillance (33.5%). These results highlighted the need to improve thetraining of health care personnel and the surveillance of HCAI. Conclusion. Moderate levels of effectiveness were found in administrative support (66.5%) and isolation systems (60.2%), as well as low effectiveness in training of medical personnel (26%) and in epidemiological surveillance (33.5%) for HCAI. This indicates the need to include more development activities in PH plans. Recommendations include improving administrative support, isolation systems, strengthening training of health personnel and improving surveillance of HCAIs.

The article presents the results of the analysis of outbreaks of measles in the Kyrgyz Republic. The obtained data testify to the constant circulation of the virus in the territory of the republic. Risk areas are Bishkek where the number of cases of measles is 1,8 times more than in Chui region, 2,4 times in Osh region, 2,0 times in Jalal-Abad region and 10,0 times in Batken region. In the long-term dynamics of the outbreak of measles, there is a widespread distribution in all regions of the republic and periodic rises at intervals of 2 to 3 years, as in the epidemic process of the pre-vaccination period, which indicates the constant circulation of the virus. One of the risk factors for the incidence of measles was the formation of nosocomial measles foci. The unvaccinated children contributed to the formation of foci of measles infection.

According to World Health Organization (WHO) information, the main deaths from blood-borne viral hepatitis are observed among young people aged 20 - 40 years. In this regard, the purpose of the article is to analyze the prevalence of blood-borne viral hepatitis B and C among young people (18-49 years old) living in the Kyrgyz Republic. For the analysis, data from the electronic application Center Ministry of Health of the Kyrgyz Republic and the Department of Public Health Protection and State Sanitation of the Ministry of Health of the Kyrgyz Republic for the period from 1998 to 2021 were used. For indicators of registration of new cases of acute viral hepatitis B and C, moderate trends in decreasing incidence were identified (T<5%). The most significant group are persons aged 18 to 49 years. Their share in the age structure was, for acute hepatitis B - 80,6%, acute hepatitis C- 67,9%. The majority of registered cases of blood-borne viral hepatitis are chronic hepatitis - 66,2%, and they are detected for the first time in the age group of 18 - 49 years. In the structure of blood-contact chronic hepatitis, the proportion of young people ranges from 72,5% to 83,7%. Even taking into account that existing government statistics do not reflect real situations, it can still be concluded that the age group from 18 to 49 years is key. To compile a complete epidemiological picture, additional research should be conducted to study the risk factors for the spread of blood-borne viral hepatitis in this population.

One of the functions of the health care system of the Kyrgyz Republic is the implementation of tuberculosis infection control measures in health care organizations. Proper implementation of TB infection control measures prevents the nosocomial spread of TB from patients to health care workers or cross-infection between patients. The implementation of TB infection control measures was assessed in all 25 (100%) TB hospitals in the country and in 895 PHC organizations (49.9%) in all regions of the country. Evaluation results were interpreted according to three criteria (excellent, good and satisfactory). All TB hospitals in the country were rated satisfactory according to this criterion, with a score of 70% or more. Of the PHCs covered by the assessment of the organization of health care, only 41.3% meet the indicator - satisfactory (70% or more).

The COVID-19 pandemic has spread widely in all countries of the world, including Kyrgyzstan. Inadequate protection and infection control measures in health care organizations led to an increase in morbidity among health care workers. A cross-sectional study was conducted in 2020 based on surveillance of infection control practices in healthcare organizations and management of COVID-19 cases, suspected COVID-19 cases, pneumonia, and interview of healthcare personnel in medical hospitals with deployment of 80 beds and above and outpatient hospitals with deployment of 100 beds and above. The purpose of the study was to evaluate infection control measures, identify deficiencies and make recommendations. The assessment was conducted in 16 health care organizations (22 departments) (OZ), of which 2 organizations were converted from social facilities and functioned as day outpatient hospitals in Bishkek, Osh and Chui oblast. Analysis of the data revealed insufficient administrative measures, lack of engineering and technical measures and ineffective use of personal protective equipment.

Introduction. Currently, the COVID-19 pandemic is one of the key challenges for healthcare systems around the world. Social distancing, home isolation, and reduced outpatient visits as precautionary measures during the pandemic have inevitably led to disruptions in the provision of sexual and reproductive health (SRH) services. Historical experience has shown that pandemics can have a significant impact on the reproductive health of the population, especially the reproductive health of women. Materials and methods. In order to assess whether the introduction of measures to combat COVID-19 has affected women’s reproductive health, we collected available data from various sources: the National Statistical Committee (NSC KR), the Electronic Health Center (EHC) under the Ministry of Health of the KR, the Department of Prevention diseases and sanitary and epidemiological surveillance services (DPDSaESS) and other open data sources. Also published reviews of scientific research data related to the impact of the COVID-19 pandemic on women’s reproductive health both in Kyrgyzstan and around the world. Studies were retrieved using PubMed, Google Scholar and the National Medical Library of Kyrgyzstan databases. Results and its discussion. From the analysis of available data, it is clear that the COVID-19 pandemic has had a significant negative impact on women's reproductive health in Kyrgyzstan. Access to health care during the pandemic has also had an impact on women's reproductive health. Many women face difficulties in obtaining necessary health care, such as contraception and medical care. According to the statistical committee, there are significant changes in the mortality rate both throughout Kyrgyzstan and in its individual regions. Conclusion. Analysis of available data confirmed both direct and indirect adverse effects of COVID-19 on female reproductive health. COVID-19-related deaths among pregnant women statistically significantly changed the overall maternal mortality rate in the country. The pandemic also affected the availability of health services such as contraceptive counseling, safe termination of unwanted pregnancies, and diagnosis and treatment of pregnancy complications.

Introduction. Among newly identified people living with HIV, the number of migrant cases is increasing annually. Thus, the number of migrants among HIV-positive people from 2010 to 2019 increased 37 times (from 55 to 2042 people). At the beginning of 2020, the proportion of migrants out of the total number of HIV positive people amounted to 22.41%. In order to study the situation among labor migrants, in 2023, for the first time in the Kyrgyz Republic, an integrated biobehavioral study among labor migrants was conducted. Methods. To form a sample of labor migrants, we used the method of Respondent-driven sampling (RDS). The study invited a labor migrant who had stayed outside the country for the last 24 months for the purpose of earning money. The study participants were interviewed with a semi-structured questionnaire and tested for: HIV, Hepatitis C (HCV), Hepatitis B (HBV) and Syphilis. Results and Discussion. A total of 945 labor migrants participated in the study: Jalal-Abad city (n=212), Osh city (n=167, Nookat (n=284) and Sokuluk (n=282). The highest HIV prevalence is observed among Sokuluk migrants 1.5%. HCV is more frequently detected among migrants from Osh (13.4%) and Sokuluk (4.3%) and HBV in Nookat (7.04%). Antibodies to syphilis were more frequently detected in migrants from Osh (4.3%) and Sokuluk (4%). Conclusion. According to the results of the study, labor migrants can be referred to a separate category that can be defined as a high-risk group in the context of the HIV epidemic. It is recommended to develop prevention programs for labor migrants and further study of the situation.

The purpose of the scientific work is to study the prevalence and risk factors of viral hepatitis A in the climate and geographical regions of the Kyrgyz Republic. As a result of the high level of registration of viral hepatitis A have seen an increase in incidence in September, a peak in December and a sharp decline in February, and during the pandemic there was virtually no seasonal cyclicity. The prevalence of acute hepatitis A was studied by survey method among the population of the Kyrgyz Republic by investigating the presence of IgM-marker of HAV in persons who consented to participate in the study and risk factors. According to the results, it was found that 1.5% of the sample had IgM in the blood sera. The smoothed seasonality of hepatitis A during the COVID-19 pandemic is due to the fact that in the republic as a whole, 93.1% of the population complied with preventive measures and government requirements for restrictive measures. Of the respondents, only 14.6% consumed unwashed fruits and vegetables; more than half of the respondents consumed raw, unboiled water. One fifth of the population consumed fast food, with the population of Bishkek and Osh cities consuming the most, 84.9% and 90.0%, respectively. 84.6% of the population of the Kyrgyz Republic used tap water for household needs, 79.6% of respondents answered that the water was clear and 12.9% was cloudy, about 7% did not answer.

This research work presents an analysis of the infection control system in healthcare organizations based on self-assessment data from 2023 and external monitoring from 2021, respectively. The overall infection control (IC) indicator at the level of healthcare organizations in 2023 was 86.2%, exceeding the results of the external assessment in 2021 (78%) by 8.2%. Internal monitoring in 2023 highly rated blocks such as the safety of medical procedures (95.5%) compared to external monitoring, which stood at 88.2%, exceeding it by 7.3%; management of medical waste (95%) and staff training (89.2%) compared to external monitoring (73%), exceeding it by 12.2%. Higher ratings in internal monitoring compared to external assessment raise questions about the objectivity of internal assessments, necessitating the development of additional tools for effective implementation of self-assessment of IC.

The article presents data on the distribution of Brucella species among humans and farm animals circulating in the Kyrgyz Republic. According to the results of molecular genetic analyses performed by different authors, Brucella cultures isolated from humans were attributed only to B. melitensis species, while isolates from farm animals indicated circulation of both Brucella species. Out of the 443 strains obtained from small ruminants, 427 (96.3%) were identified as B. melitensis, and 16 (3.6%) strains were assigned to B. abortus. Upon typing of 30 Brucella strains from cattle, 11 (37%) were attributed to B. abortus, and 19 samples (63%) were attributed to B. melitensis. Additionally, data on the migration of B. melitensis to cattle and B. abortus to small ruminants are presented. And according to the results of the conducted full genome sequences isolated from humans were identified as B. melitensis and confirmed the identity of strains of the causative agent of brucellosis, with strains circulating in the Eastern Mediterranean countries with the greatest similarity to strains from Turkmenistan, Iran and Turkey.