[Epidemiological and clinical aspects of diagnosis, treatment and prophylaxis of imported malaria cases in Russian Federation]

Actually one of the main tasks of health workers in the field of the tropical diseases prevention (malaria) is early detection of malaria imported cases and efficacious treatment. In order to prevent the re-establishment of local malaria transmission by Anopheles mosquitoes from imported malaria cases, and fatal cases of disease there is develop and implement the Case Management Protocol of malaria diagnosis and treatment (2014, 2019) based on long-term experience of epidemiologists and clinicians, taking into account recommendations of WHO (2013, 2015). In this article the main principles of diagnosis and treatment of different malaria species Plasmodium falciparumand Plasmodium vivax-malaria, prophylaxis measures of autochthonous cases from imported cases of the word endemic region are discussed.

Optimizing the Intensive Care Treatment of Severe and Complicated Plasmodium falciparum Malaria in Nonimmune Patients

This study analyses the intensive care treatment of 48 patients admitted to the Intensive Care Unit (ICU) at the Infectious Diseases Clinical Hospital No. 2, Moscow, Russia, between 2007 and 2019, with a severe and complicated form of P. falciparum malaria (B50.8 ICD 10). Objective. The aim of this study was to improve the intensive care treatment for severe and complicated P. falciparum malaria. The treatment strategy implemented was aimed at preventing ischaemia-reperfusion injury to organs, as well as haemorrhagic complications. The ICU Case Management Protocol set up indications for transferring patients to the ICU which provide preventive (prior to the development of renal failure) application of extracorporeal hemocorrection methods (continuous venous-venous hemodiafiltration and plasmapheresis in a plasma exchange mode) and mechanical ventilation under a medically induced coma, given impaired consciousness as the initial symptom of patients. Results. Successful treatment outcome in a majority of the patients (93.8%), shorter ICU length of stay (6.67 ± 1.9 days as compared to 94 ± 1.6 before introduction of the protocol), a median parasite clearance time of 37.50 hours (95% CI 36.21-38.18), and a reduced mortality rate from 29.1% to 6.25% support the efficacy of the ICU protocol in managing severe and complicated P. falciparum malaria.

Problems of clinical diagnosis and treatment of P. falciparum malaria in Russian Federation

Aim. To study the causes of falciparum malaria deaths in Russian Federation and to optimize therapy for severe forms of the disease. Materials and methods. The analysis of falciparum malaria cases with deaths recorded in Russian Federation from 2013 to 2017 was conducted. The results of optimization of pathogenetic therapy of severe forms of falciparum malaria for the prevention of adverse outcomes in the intensive care unit of the Infectious Clinical Hospital №2 of Moscow in 44 patients with severe course are presented. Treatment, clinical laboratory and instrumental investigations were carried out in accordance with our intensive care protocol, which took into account the current WHO recommendations. Results. From 2013 to 2017 there were nine deaths from falciparum malaria reported in patients from African countries (6) and India (3). In Russia, due to the lack of effective drugs of artemisinin group, quinine with tetracycline or doxycycline is used for etiotropic therapy of patients with complicated form of falciparum malaria. In the management of such patients, the basis for treatment was the prevention of ischemic, reperfusion injuries of organs and hemorrhagic complications. In the infectious clinical hospital №2 of Moscow, since 2007, the intensive care unit has developed and tested a protocol for intensive therapy in patients with severe and complicated forms of falciparum malaria, including preventive methods of extracorporeal hemocorrection with prolonged veno-venous hemodiafiltration therapy and plasmapheresis, as a result of which the mortality rate decreased from 84 to 6.8% Conclusion. The country's lack of anti-malarial drugs, the insufficient awareness of the population about the risk of infection and measures to prevent malaria, late referral of cases for medical care and errors of clinical diagnosis and treatment annually lead to fatal outcomes. In such situation, the experience of optimizing the treatment of severe falciparum malaria is particularly useful, allowing decreasing the mortality.

Genetic characterization of Plasmodium vivax in the Kyrgyz Republic

At the end of 2016, Kyrgyz Republic was certified by the World Health Organization as a malaria-free country, while only a decade ago this disease posed a serious health threat. The progress achieved by Kyrgyz Republic provides a unique example of tertian (Plasmodium vivax) malaria elimination. This success was based on an integrated approach, including measures for the treatment of infected people and disease prevention, vector control and the development of an effective national epidemiological surveillance system. Lower P. vivax msp-1, msp-3α, csp and dbp_II genes polymorphism was revealed in Kyrgyz Republic in compare with that in Tajikistan. Molecular characterization of the causative agent found that P. vivax populations in Kyrgyz Republic was comprised by several lineages, highly divergent in the south-western and genetically homogeneous in the northern regions of Kyrgyz Republic, d. Such profile in the northern regions was compatible with several recent introductions rather than a long-term endemic circulation of the parasite. A low level of genetic variability suggested that the parasitic systems of tertian malaria, were not adapted, which, along with other factors, largely determined the possibility of malaria elimination in northern Kyrgyz Republic. Other determinants included environmental, social, and epidemiological factors that limited the spread of malaria. South-western Kyrgyz Republic, a region with a high level of interstate migration, requires considerable attention to prevent the spread of malaria.

[(INTRODUCTION OF RESEARCH RESULTS INTO THE TRAINING OF PHYSICIANS IN THE SPECIALTY OF PARASITOLOGY)]

The paper presents the results of theoretical and practical studies into parasitology, which were conducted at the E.I.Martsinovsky Institute of Medical Parasitology, Tropical and Vector-Borne Diseases and then used for the training of specialists with higher medical education at the Department of Tropical Medicine and Parasitic Diseases, I.M.Sechenov First Moscow State Medical University. The need to develop professional skills is related to the increasing learning require- ments due to socioeconomic conditions and the epidemiological situation in the country.

[(THE IMPACT OF MIGRATION PROCESSES ON- BIOSAFETY AND HUMAN HEALTH)]

Infectious diseases are one of the serious threats to biosafety in modern society In recent years, there have been con- siderably increased international migrations: tourism and pilgrimage; labor migration flows; migration of refugees and settlers in times of armed conflicts, household migrations because of family ties and traditions. Since the number of Rus- sian tourists and migrants from endemic countries remains high, these contingents should receive special attention in the malaria epidemiological surveillance system. The paper discusses the risks of possible consequences of population migra- tions and prevention measures.

[(INDUCED MALARIA)]

Induced malaria continues to be one of the most pressing public health problems in malaria-endemic countries. Ma- laria parasites remain viable in stored blood at a temperature of 2-6°C for 3 weeks. The paper presents current problems associated with transfusion-induced malaria. In the USSR and then in the Russian Federation, sporadic cases of induced malaria (Plasniodium vivax, P.malariae, rarely P.falciparum) were notified (230 cases in 1958 to 1990 and only 5 in 1991 to 2016). Current (immunological and molecular) methods for the laboratory diagnosis of malaria do not provide a 100% detection rMfteor its pathogens; therefore, it is necessary to search for highly efficient, rapid, and low-cost diagnostic methods to ensure the biological safety of donation.

[(EXPERIENCE WITH GEOGRAPHIC INFORRMATION SYSTEMS USED IN EPIDEMIOLOGICAL STUDIES (AS AN EXAMPLE OF MALARIA AND DIROFILARIASIS)]

The effective application of GIS against parasitic diseases requires the patterns of spread of parasitic diseases in certain natural, climatic, and socioeconomic conditions of different regions where there are epidemically effective carriers. The epidemiological parameters defining a high risk of an epidemiological process after P.vivax importation into Russia were calculated using the developed HealthMapper controlled module with a database. Analysis of the average long-term air temperatures in the administrative territories of Russia over 78 years, namely July, the warmest month of the year when there are the largest numbers of all types of mosquito vectors and high levels of microfilaria in the peripheral blood of in- fected dogs (definitive hosts), has shown that the northern border of the maximum possible area of dirofilariasis in Russia is most fully described by the +14C July isotherm.

SCIENTIFIC AND PRACTICAL STUDIES OF MALARIA IN THE CIS COUNTRIES AND GEORGIA

The paper presents the scientific studies of malaria pathogens and vectors, which have been specially conducted in the endemic areas of the CIS countries and Georgia for use in an epidemiological surveillance system. The main ones investigate the structure of malaria foci and the level of G-6-PD deficiency among residents, determine the malariogenic potential. of the territory and the risk of infection in the population, and specify the taxonomy, systematics, and spread of major malaria vectors in .the countries ofWHO European Region. In addition, the time and magnitude of manifestations of long-term post-incubation tertian malaria were established; th6 susceptibility of P.vivax to antimalarials and the levels of resistance and irritability of malaria vectors to insecticides were studied. The experience in using a geographic information system for the epidemiological surveillance of malaria is given.

[MALARIA IMPORTATION BY RUSSIA'S CITIZENS AND FOREIGNERS, INTO THE CITIES AND TOWNS OF THE RUSSIAN FEDERATION]

A total of 436 malaria cases, including 12 from the CIS countries and 424 from far foreign countries (of Africa and Central and South-East Asia), were imported into the Russian Federation in 2010-2014. Most (96.6%) cases were notified in the urban areas of 52 administrative subjects of Russia. The largest number of the imported cases were seasonal workers (39.2%), tourists (31.3%), students and foreign postgraduate students (19.5%), and ship or aircraft crews (10%). During a short malaria transmission season (June to August), there were 150 cases of different types, out of them there were only 63 cases of tertian malaria (its pathogen is Plasmodium vivax, to which malaria mosquitoes of Russia's fauna are susceptible). The relatively small number of infection sources in the short transmission (June to August) season of malaria, its importation into low-susceptibility large towns, and a small proportion of imported vivax malaria cases substantially reduce the risk of malaria in the highrisk areas of the country.

[COMPLEX LABORATORY DIAGNOSIS OF MALARIA PATHOGENS IN THE PRE ELIMINATION PERIOD]

An immunological survey of 8,000 dwellers from 4 districts of Tajikistan failed to detect malaria pathogens by CareStartMalariaHPR2/PLDH (P. falciparum/P. vivax) COMBOGO161 AccessBio tests and showed the possibility of their further use under the Republic's conditions, particularly in the mountain villages and the human settlements bordering on Afghanistan. The results of examining 750 blood samples from the dwellers of sanitized foci in Tajikistan's areas, by applying molecular diagnosis via polymerase chain reaction, indicated no signs of parasites. A set ofthree methods, such as microscopic, immunological, and molecular diagnostic ones, was used to prove the absence of reliable malaria infection and local transmission sources.

[Spread of tropical malaria in the Republic of Tajikistan (1994-2008)]

Tropical malaria occurred in the Republic of Tajikistan in 1994 after 40-year absence and spread in 28 regions of Tajikistan and in 3 cities (Dushanbe, Kulyab, and Kurgan-Tyube), peaking in 2000 (831 cases). A total of 3585 cases of tropical malaria were notified in 602 foci during a 15-year period. Migrants imported the pathogenic agent by the route of Pakistan-Afghanistan-Tajikistan during armed conflicts and in trading activities continually.The emergence of Asian Plasmodium falciparum phenotypes was accompanied by the clinical complications of the disease: the high percentage of moderate and severe forms of the disease was observed in preschool children in the absence of fatal outcomes. The rising incidence of malaria was associated with not only with the intensive import of the infection and the flight of infected malaria mosquitoes, but also with the active examination of the population during homestead rounds and with the timely laboratory diagnosis of malaria pathogens. The long-term goal antimalarial measures in the Republic of Tajikistan in 2009 resulted in the pause in the local transmission of tropical malaria, which meant its elimination in the country.

[The current status of the resistance of malaria pathogens to antimalarials]

The review presents the results of trials of the clinical efficacy of a test antimalarial drug for each malarial parasite species, which were published in 2000-2013 and supplemented by the data of in vitro studies or investigations using the molecular markers of resistance. There are data on the resistance of each medicament since many of the drugs are used in combination with artermisinin derivatives.

[The current malaria situation in the CIS countries (2011-2012)]

In the last 3 years, the malaria situation has considerably improved in the CIS countries: Three CIS countries, such as Turkmenistan, Armenia, and Kazakhstan, received the malaria-free status (in 2010, 2011, and 2012, respectively) confirmed by the WHO certificate; Azerbaijan, Kyrgyz Republic, Uzbekistan, and Tajikistan are in the elimination period. Despite the continuing intensive migration of CIS citizens to Russia, its malaria situation has been favorable, which is associated with the significant reduction of imported infection cases among migrants.

[The specific features of the epidemiology of tertian (Plasmodium vivax) malaria in the Republic of Tajikistan]

The specific features of the functioning of parasitic systems of tertian malaria were found in the elimination period when the number of foci and patients were drastically reduced. Despite the sporadic cases of tertian malaria, in 2009-2012 each of the 9 areas of the Kurgan Tyubin zone, Khatlon Region notified 12 of the 43 active foci with single manifestations of malaria after a long incubation period in the following spring or March-April a year later. The results of these investigations should be borne in mind when planning and implementing antimalarial measures.

[Epidemiological alertness as a component of the malaria surveillance system]

Malaria vigilance is a continuation of the functions of the malaria surveillance system in the countries that have achieved malaria elimination on their territories. The main function of the malaria vigilance during the post-elimination period is a continuous monitoring and evaluation and implementation of necessary prevention measures against the possible re-establishment of local malaria transmission due to the importation of malaria from its endemic countries by residents and/or migrants. Various epidemiological aspects of malaria vigilance, such as standard identification of a malaria case during the post-elimination period; notification procedures and reporting systems; training of personnel; free access to malaria diagnosis and treatment; mandatory laboratory confirmation of malaria diagnosis; and prompt efficacious treatment, are discussed. Other aspects include epidemiological classification of cases, seasonal pattern of imported cases, its territorial confinement, time-lag between the detection of a case, its diagnosis and treatment initiation, evaluation of the efficacy of individual chemoprophylaxis and treatment.

[Tropical malaria in children in the Republic of Tajikistan]

The complications of tropical malaria were noted in 25 (9.4%) of 196 pediatric patients followed up. These included cerebral malaria in 8 (3%), severe hemolytic anemia in 15 (5.7%), hemoglobinuric fever in 1 (0.37%), and malarial hepatitis in 1 (0.37%). The occurrence of complications was associated with the late referral of patients to a health care facility and untimely treatment, as well as with preliminary misdiagnoses (acute respiratory viral infection, typhoid-parathyphoid fever, meningitis, acute enteric infection, viral hepatitis, sepsis). The main reasons for late diagnosis were the absence of malarial paroxysm at the onset of disease in infants and the wrong type of a temperature curve.

[The tasks to maintain the achieved results of malaria elimination in the post-elimination period]

The experience of the countries who have achieved malaria elimination on their territories suggests that the main tasks of a malaria program in the post-elimination period are as follows: to maintain healthcare workers' alertness for possible malaria importation from outside and for a risk of its renewed transmission in the malaria-free area; to preserve the medical staff and to improve its professional skills in malaria diagnosis, treatment, and prevention in both the public and private sectors; to maintain malaria alertness among the population, among higher-risk population groups in particular; to elaborate and implement an effective program for collaboration with neighboring malaria-endemic countries, in the boundary regions in particular. The national governments' determination to continue long-term financial support of the prevention program of malaria in its elimination period is the guarantee of successful solution of the tasks set.

[The vivax malaria causative agent Plasmodium ovale: the present global area, intraspecies polymorphism, importation to the Russian Federation (1992-2011)]

The global area for Plasmodium ovale is small as compared with that for other species of human malaria pathogens. It has expanded in Asian areas and remained as before in the African ones. In the past 20 years, there have been 2129 malaria cases imported from far abroad to Russia, including 84 (4%) cases of vivax malaria (P. ovale). The patients were most foreign citizens: 70 from 20 African countries and 7 from two countries of Oceania, such as Papua New Guinea and Indonesia. The other 7 patients were Russia's people who had returned from different countries of Africa. For this period there have been a total of 5 cases of mixed infection: tropical P. falciparum malaria + vivax P. ovale malaria. The mission of detected new sympatric subspecies (P. ovale curtisi and P. ovale wallikeri) inhabiting the tropical countries with continuous local transmission remains unclear. Only a thorough study of these subspecies will be able to effectively apply preventive measures and to carry out their elimination in future.

[Global trends in malaria control. Progress and topical tasks in malaria control programs]

This communication is the first in the series consisting of two publications describing the present state of malaria control and elimination in the world. The global malaria situation in 2009-2010 demonstrated a considerable situation as compared to the previous years. This improvement is associated with a considerable global increase of investments made by both national governments and world society to the malaria control programs. Spectacular progress has been achieved even in the areas of the most infection-affected African countries situated to the south of the Sahara Desert. It has been estimated that malaria cases in the world declined from 233, 000,000 in 2000 to 225,000,000 in 2009. Malaria mortality decreased from 985,000 in 2000 to 781,000 in 2009. To maintain the results achieved and to further reduce the problem of malaria worldwide, it is necessary to ensure a long-term political and financial support for malaria control programs at the national and international levels.

[Evaluation of the efficiency of rapid tests to detect malaria patients and parasite carriers in Tajikistan]

The sensitivity of a rapid test versus microscopy of blood samples was studied while examining 7983 dwellers from the republic's endemic areas. The results of blood testing in the Pyanj and Shurobod districts showed agreement with those of blood microscopy. However, its sensitivity in two other districts was as high as 1.9%. Only one of 53 positive tests was verified by microscopy examination. The findings suggest that it is impossible to use the examined tests (Access Bio Inc. Care Start Malaria pLDH 2 line test) under the conditions of Tajikistan; all the more they identify malaria without differentiation in its pathogen types.

[Urgent tasks of malaria elimination programs]

The state-of-the-art of malaria elimination programs worldwide and the advances made in the past decade were analyzed and assessed. The factors contributing to or reducing the achievement of the final objective of malaria elimination--to interrupt the local transmission of the infection and to steadily maintain the achieved successes are given. Technical problems are defined at the final stages of a malaria elimination program. The problems include difficulties in identifying patients and asymptomatic parasite carriers due to the low level of malaria transmission and the absence of highly effective methods for detecting malaria parasites with low parasitemia, as well as mixed malaria infections requiring the use of different treatment regimens and antimalarial drugs. Large-scale uncontrolled population migration is noted to be of importance in spreading the infection in a malaria-free area. The solution of urgent tasks is to improve the existing methods and develop new ones for the detection and treatment of the infection and a package of antimalarial measures.

[Prospects for malaria elimination in Azerbaijan]

Epidemiological analysis of the malaria in the Republic of Azerbaijan has revealed that: 1. In the past year, malaria problem has considerably improved in reducing morbidity and the number of active foci of malaria in the republic. 2. All active foci of malaria have been in its endemic area. 3. Despite the presence of favorable climatic preconditions for malaria in a large part of the republic, socioeconomic preconditions are considerably decreased, causing the malariogenic potential to substantially reduce. 4. All sets a favorable stage for possible interruption of local malaria transmission on the whole territory of the republic provided that financial support for the national malaria elimination program will be increased from the country's government and other sources in conjunction with the implementation of revised malaria control strategy and with the use of current methods for the detection, diagnosis, treatment, and prevention of malaria.

[Plasmodium vivax malaria imported from tropic African countries]

According to the World Malaria Report (2008), Plasmodium vivax cases in Africa are registered and laboratorily confirmed in Ethiopia and Erithrea only. However, foreigners (students, businessmen, etc.) and Russian citizens (tourists, diplomats, businessmen, etc.) annually import P. vivax from African countries to Russia. In 1984 to 1992, a total of 152 patients with P. vivax infection were detected, of which 55 and 57 cases were infected in West African and East Africa, respectively. In 1994-2009, there were 145 P. vivax cases, of which 3 cases were mixed infection: two cases of P. vivax + P. falciparum and one case of P.vivax + P. ovale. The probability of P. vivax infection appears to exist in Equatorial Africa countries. This communication can be regarded as important to study P. vivax distribution in the World.

[Widespread use of primaquine for control of Plasmodium vivax epidemics in a population with varying degrees of G6PD deficiency]

The major benefit of mass primaquine administration in the Republic of Azerbaijan and the Democratic People's Republic of Korea was a considerable reduction in malaria case load in the situation where there is acute inadequacy of various means for malaria control, as well as in the containment of a large-scale malaria epidemic caused exclusively by P. vivax in a relatively short period of time. Success of mass treatment can be achieved only through high coverage (about 90% of the target population), the elaboration of clear instructions for all categories of the personnel engaged in the treatment, with the provision of regular efficient supervision, the accessibility of first medical aid at the site in case of probable severe side effects. Adherence to these prerequisites results in the safety of the treated population with very high degree of G6PD deficiency.

[Why has malaria not been rooted in present-day Russia?]

At present, a favorable malaria situation that contributes to the elimination of local vivax malaria transmission has established in Russia by 2010 due to the following factors: 1) a considerable reduction in the number of imported cases ofvivax malaria from endemic CIS countries; 2) a low malariogenic potential of the territory of the Moscow region where the basic importation of malaria occurs; 3) a higher awareness about the prevention of malaria in the population; 4) medical workers' alertness and timely detection of patients with malaria; 5) failure for sporadic cases of vivax malaria to be rooted in the urban area due to episodic carriage of various pathogenic phenotypes.

[Study of the pathogen populations of tertian malaria and possibilities of its establishment in Kyrgyzstan]

A genetic analysis has indicated that the population of the tertian malaria causative agents Plasmodium vivax in Kyrgyzstan is heterogeneous and consists of various isolates resulting from multiple carriages of the pathogens from the areas of the neighboring countries. Low genetic variability and a weak gene flow between the isolates do not contribute to the establishment of malaria in this area. Experience in controlling the epidemic outbreaks shows that active and residual foci are easily sanitized when antimalaria measures are timely and qualitatively implemented. This creates the necessary for eliminating tertian malaria in the Republic of Kyrgyzstan in the near future.

[Results of epidemiological supervision of malaria vectors in the open water reservoirs of Moscow]

In the past 2 years, the malaria epidemiological situation has drastically improved in Moscow: only sporadic cases of local transmission of tertian (Plasmodium vivax) malaria have been notified, which sets a task to eradicate malaria in the megalopolis in 2010. In this connection, the surveillance of the malaria vectors Anopheles mosquitoes is assuming prime importance. The results of entomological monitoring have shown its efficiency on the territory of the megalopolis. Main efforts have been directed to the application of safe controlling methods against the mosquitoes and to hydraulic engineering actions to reduce "area susceptibility". Entomological observations have demonstrated benefits from the correctly chosen and constantly performed hydraulic engineering measures that guarantee a long-term and positive impact on the malaria situation.

[Efficiency of a package of therapeutic and preventive measures in the Republic of Tajikistan in the malaria postepidemic period (2000-2007)]

In 2005, Tajikistan joined the Move of Elimination of Tropical Malaria in 2010 and Tertian Malaria to 2015 (Tashkent Declaration, WHO European Office for European). To achieve the targets and goals, it is necessary to evaluate the efficiency of therapeutic and preventive measures in 2000-2007, i.e. in the postepidemic period preceding elimination (pre-elimination according to the WHO terminology). Investigations were conducted in the Gorno-Badakhstan Autonomous Region, Khatlon and Sogdiysk Regions, in the districts under the Republic's jurisdiction, and in the city of Dushanbe. The results of the investigations has shown that a small proportion of the population has red blood cell glucose-6-phosphate dehydrogenase deficiency, which does not preclude mass preventive treatment with primaquine that is responsible for a 2.5-fold reduction in the number of foci (783 foci of different types). Foci should be typified for the rational use of a package of therapeutic and preventive measures in the endemic areas. Differentiated packages of therapeutic and preventive measures correspondingly to the National Malaria Strategy of the Republic of Tajikistan should be implemented depending on the type of a focus.

[Malaria in Moscow (2006-2007): monitoring of the situation and assessment of antimalaria measures]

The malaria situation in Moscow in 2007 versus 2006 improved--the cases of malaria reduced by 16.3%. A total of 30 new cases of malaria were notified (46 cases in 2006), of them there were 34 imported cases and 4 secondary cases to imported ones. In 2007, the proportion of tertian malaria cases reduced to 55.3% versus 60.9% in 2006. As compared with 2005, in 2007 the cases of locally transmitted malaria decreased by 5 times--from 20 to 4, only 1 case of infection occurred in Moscow (Central Administrative District) and 3 cases took place in the Moscow Region (Ramensky, Stupinsky, and Dmitrovsky districts). Cases of malaria were notified in all administrative districts, with their largest number in the South-Western Administrative District of Moscow due to the detection of ill students from the Russian University of People's Friendship who had come to study from African countries. In accordance to the performed certification of water reservoirs in 2007, a total of 722 Moscow water reservoirs of an area of 1569 ha were registered at the Administration of the Russian Agency for Consumer Surveillance. The examination frequency of all water reservoirs was about 13 per season, including 20 anopheles-containing ones. The larvae of bloodsucking mosquitoes inhabited 541 (75%) water reservoirs, including 461 (63%) water reservoirs occupied by the malaria vector. As compared with 2006, the area of treatments increased by 351 ha. In the summer, a total of 2133.3 ha ofwater reservoirs were treated, including 2009.5 ha against larvae of malaria mosquitoes. The bulk of water reservoirs were exposed to triple-quadruple treatments.