Predictive thresholds for plague in Kazakhstan

In Kazakhstan and elsewhere in central Asia, the bacterium Yersinia pestis circulates in natural populations of gerbils, which are the source of human cases of bubonic plague. Our analysis of field data collected between 1955 and 1996 shows that plague invades, fades out, and reinvades in response to fluctuations in the abundance of its main reservoir host, the great gerbil (Rhombomys opimus). This is a rare empirical example of the two types of abundance thresholds for infectious disease-invasion and persistence- operating in a single wildlife population. We parameterized predictive models that should reduce the costs of plague surveillance in central Asia and thereby encourage its continuance.

Plague dynamics are driven by climate variation

The bacterium Yersinia pestis causes bubonic plague. In Central Asia, where human plague is still reported regularly, the bacterium is common in natural populations of great gerbils. By using field data from 1949-1995 and previously undescribed statistical techniques, we show that Y. pestis prevalence in gerbils increases with warmer springs and wetter summers: A 1 degrees C increase in spring is predicted to lead to a >50% increase in prevalence. Climatic conditions favoring plague apparently existed in this region at the onset of the Black Death as well as when the most recent plague pandemic arose in the same region, and they are expected to continue or become more favorable as a result of climate change. Threats of outbreaks may thus be increasing where humans live in close contact with rodents and fleas (or other wildlife) harboring endemic plague.

Attitudes toward wife beating: a cross-country study in Asia

Using demographic and health surveys conducted between 1998 and 2001 from seven countries (Armenia, Bangladesh, Cambodia, India, Kazakhstan, Nepal, and Turkey), the study found that acceptance of wife beating ranged from 29% in Nepal, to 57% in India (women only), and from 26% in Kazakhstan, to 56% in Turkey (men only). Increasing wealth predicted less acceptance of wife beating, except in Cambodia and Nepal. Higher education level was negatively associated with acceptance in Turkey and Bangladesh. Younger respondents justified wife beating more often, with some exceptions, showing persistent intergenerational transmission of gender norms. Working women were equally or more likely to justify wife beating compared to nonworking women. Men were significantly more likely to justify wife beating in Armenia, Nepal, and Turkey. Targeted proactive efforts are needed to change these norms, such as improving female literacy rates and other enabling factors.

Helicobacter pylori infection in Kazakhstan: effect of water source and household hygiene

The epidemiology of Helicobacter pylori infection and risk factors associated with its transmission are not well understood. Kazakhstan is country with two ethnic groups, Asian (Kazakhs) and Western (Russians), living under similar socioeconomic conditions. The aim of this study was to examine the seroepidemiologic pattern of H. pylori and hepatitis A among the same individuals from both ethnic groups, with emphasis on water source and household sanitation practices. This was a cross-sectional seroepidemiologic study conducted among unrelated healthy individuals in Kazakhstan. From May through August 1999, individuals between the ages of 10 and 60 years from Almaty, Kazakhstan, were invited to participate. Demographic information, socioeconomic factors, living conditions, and various aspects of the local household environment including access to water were collected. A clean water index (CWI) was created based on combined factors, consistency of boiling water before drinking, frequency of storing and reusing water, and frequency of bathing and showering. H. pylori and hepatitis A antibodies were assessed by enzyme-linked immunosorbent assay. Two hundred eighty-eight individuals between the ages of 10 and 60 years participated. The prevalence of H. pylori infection was almost identical among the two ethnic groups (Russians 79% and Kazakhs 80%). H. pylori infection was inversely correlated with the CWI (i.e., 56%, 79%, and 95% for high, middle, and low, respectively (P < .05). Drinking river water had highest risk of H. pylori infection (OR = 13.6, 95% CI = 1.8-102.4; P < .01, compared with tap water). Crowding showed no significant effect on H. pylori prevalence. Anti-HAV antibodies were found in 86% of the population, 90% among the Russians versus 82% among the Kazakhs (OR = 1.8, 95% CI = 1.1-3.8, P = .05). Although the two infections were highly correlated (P < .001), antibody to both infections were present simultaneously in only 74%. The prevalence of H. pylori infection in Kazakhstan is very high. The data suggest that transmission of H. pylori can be water borne, related to poor sanitary practices, or both. The high prevalence of antibodies to H. pylori and HAV among this population is a marker for poor sanitation and hygienic practices. Reducing the rate of H. pylori transmission will require improvements in overall sanitation including clean water, waste disposal, as well as in household hygienic practices.

Evidence for cryptic speciation of Leucocytozoon spp. (Haemosporida, Leucocytozoidae) in diurnal raptors

Species of Leucocytozoon (Haemosporida, Leucocytozoidae) traditionally have been described based on morphological characters of their blood stages and host cells, with limited information on their avian host specificity. Based on the current taxonomy, Leucocytozoon toddi is the sole valid species of leucocytozoids parasitizing falconiform birds. Using a nested polymerase chain reaction protocol, we determined the prevalence of Leucocytozoon infection in 5 species of diurnal raptors from California. Of 591 birds tested, 177 (29.9%) were infected with Leucocytozoon toddi. Subsequent phylogenetic analysis of the cytochrome b gene revealed that distinct haplotypes are present in hawks of these genera. Haplotypes present in Buteo spp. are not found in Accipiter spp., and there is a 10.9% sequence divergence between the 2 lineage clades. In addition, Leucocytozoon sp. from Accipiter spp. from Europe group more closely with parasites found in Accipiter spp. from California than the same California Accipiter species do with their sympatric Buteo spp. Similarly, a Leucocytozoon haplotype from a Common Buzzard (Buteo buteo) from Kazakhstan forms a monophyletic lineage with a parasite from B. jamaicensis from California. These results suggest that Leucocytozoon toddi is most likely a group of cryptic species, with 1 species infecting Buteo spp. and 1 or more species, or subspecies, infecting Accipiter spp.

Modelling the transmission dynamics of Echinococcus granulosus in dogs in rural Kazakhstan

Cystic echinococcosis, caused by Echinococcus granulosus, is an emerging disease in many parts of the world and, in particular, in eastern Europe and the former Soviet Union. This paper examines the abundance of infection of E. granulosus in the definitive host in southern Kazakhstan. Observed data are fitted to a mathematical model in order to decide if the parasite population is partly regulated by definitive host immunity and to define parameters in the model. Such data would be useful to develop simulation models for the control of this disease. Maximum likelihood techniques were used to define the parameters and their confidence limits in the model and the negative binomial distribution was used to define the error variance in the observed data. The results indicated that there were 2 distinct populations of dogs in rural Kazakhstan which had significantly different exposures to E. granulosus. Farm dogs, which are closely associated with livestock husbandry, particularly sheep rearing, had a relatively high mean abundance of 631 parasites per dog and a prevalence rate of approximately 23%. The best fit to the model indicated that there was significant herd immunity in the dog at this infection pressure. In contrast, village dogs which were more likely to be kept as pets had a much lower mean abundance of parasites of only 27 parasites per dog and a lower prevalence of 5-8%. With this village population of dogs, the best fit indicated negligible herd immunity.

Modelling the transmission dynamics of Echinococcus granulosus in sheep and cattle in Kazakhstan

Cystic echinococcosis, caused by Echinococcus granulosus, is an emerging disease in many parts of the world and, in particular, in eastern Europe and the former Soviet Union. This paper examines the abundance and prevalence of infection of E. granulosus in cattle and sheep in Kazakhstan. Observed data are fitted to a mathematical model in order to determine if the parasite population is partly regulated by intermediate host immunity and to define parameters in the model. Such data would be useful to develop simulation models for the control of this disease. Maximum likelihood techniques were used to define the parameters and their confidence limits in the model and the negative binomial distribution was used to define the error variance in the observed data. The results indicated that there are significant variations in the infection pressure to sheep depending on their location. In particular sheep from Almaty Oblast and from central and northern Kazakhstan appeared to have a greater exposure than sheep from Jambyl or South Kazakhstan Oblasts. The infection pressure to cattle was somewhat lower in comparison. In common with other similar studies, there was no evidence of parasite-induced immunity in sheep or cattle in Kazakhstan due to natural infection. The highest abundance and prevalence were seen in the oldest age classes of animals.

Child mortality estimation: appropriate time periods for child mortality estimates from full birth histories

BACKGROUND

Child mortality estimates from complete birth histories from Demographic and Health Surveys (DHS) surveys and similar surveys are a chief source of data used to track Millennium Development Goal 4, which aims for a reduction of under-five mortality by two-thirds between 1990 and 2015. Based on the expected sample sizes when the DHS program commenced, the estimates are usually based on 5-y time periods. Recent surveys have had larger sample sizes than early surveys, and here we aimed to explore the benefits of using shorter time periods than 5 y for estimation. We also explore the benefit of changing the estimation procedure from being based on years before the survey, i.e., measured with reference to the date of the interview for each woman, to being based on calendar years.

METHODS AND FINDINGS

Jackknife variance estimation was used to calculate standard errors for 207 DHS surveys in order to explore to what extent the large samples in recent surveys can be used to produce estimates based on 1-, 2-, 3-, 4-, and 5-y periods. We also recalculated the estimates for the surveys into calendar-year-based estimates. We demonstrate that estimation for 1-y periods is indeed possible for many recent surveys.

CONCLUSIONS

The reduction in bias achieved using 1-y periods and calendar-year-based estimation is worthwhile in some cases. In particular, it allows tracking of the effects of particular events such as droughts, epidemics, or conflict on child mortality in a way not possible with previous estimation procedures. Recommendations to use estimation for short time periods when possible and to use calendar-year-based estimation were adopted in the United Nations 2011 estimates of child mortality.

Accounting for shared and unshared dosimetric uncertainties in the dose response for ultrasound-detected thyroid nodules after exposure to radioactive fallout

Dosimetic uncertainties, particularly those that are shared among subgroups of a study population, can bias, distort or reduce the slope or significance of a dose response. Exposure estimates in studies of health risks from environmental radiation exposures are generally highly uncertain and thus, susceptible to these methodological limitations. An analysis was published in 2008 concerning radiation-related thyroid nodule prevalence in a study population of 2,994 villagers under the age of 21 years old between August 1949 and September 1962 and who lived downwind from the Semipalatinsk Nuclear Test Site in Kazakhstan. This dose-response analysis identified a statistically significant association between thyroid nodule prevalence and reconstructed doses of fallout-related internal and external radiation to the thyroid gland; however, the effects of dosimetric uncertainty were not evaluated since the doses were simple point "best estimates". In this work, we revised the 2008 study by a comprehensive treatment of dosimetric uncertainties. Our present analysis improves upon the previous study, specifically by accounting for shared and unshared uncertainties in dose estimation and risk analysis, and differs from the 2008 analysis in the following ways: 1. The study population size was reduced from 2,994 to 2,376 subjects, removing 618 persons with uncertain residence histories; 2. Simulation of multiple population dose sets (vectors) was performed using a two-dimensional Monte Carlo dose estimation method; and 3. A Bayesian model averaging approach was employed for evaluating the dose response, explicitly accounting for large and complex uncertainty in dose estimation. The results were compared against conventional regression techniques. The Bayesian approach utilizes 5,000 independent realizations of population dose vectors, each of which corresponds to a set of conditional individual median internal and external doses for the 2,376 subjects. These 5,000 population dose vectors reflect uncertainties in dosimetric parameters, partly shared and partly independent, among individual members of the study population. Risk estimates for thyroid nodules from internal irradiation were higher than those published in 2008, which results, to the best of our knowledge, from explicitly accounting for dose uncertainty. In contrast to earlier findings, the use of Bayesian methods led to the conclusion that the biological effectiveness for internal and external dose was similar. Estimates of excess relative risk per unit dose (ERR/Gy) for males (177 thyroid nodule cases) were almost 30 times those for females (571 cases) and were similar to those reported for thyroid cancers related to childhood exposures to external and internal sources in other studies. For confirmed cases of papillary thyroid cancers (3 in males, 18 in females), the ERR/Gy was also comparable to risk estimates from other studies, but not significantly different from zero. These findings represent the first reported dose response for a radiation epidemiologic study considering all known sources of shared and unshared errors in dose estimation and using a Bayesian model averaging (BMA) method for analysis of the dose response.

Epidemiologic response to anthrax outbreaks: field investigations, 1950-2001

We used unpublished reports, published manuscripts, and communication with investigators to identify and summarize 49 anthrax-related epidemiologic field investigations conducted by the Centers for Disease Control and Prevention from 1950 to August 2001. Of 41 investigations in which Bacillus anthracis caused human or animal disease, 24 were in agricultural settings, 11 in textile mills, and 6 in other settings. Among the other investigations, two focused on building decontamination, one was a response to bioterrorism threats, and five involved other causes. Knowledge gained in these investigations helped guide the public health response to the October 2001 intentional release of B. anthracis, especially by addressing the management of anthrax threats, prevention of occupational anthrax, use of antibiotic prophylaxis in exposed persons, use of vaccination, spread of B. anthracis spores in aerosols, clinical diagnostic and laboratory confirmation methods, techniques for environmental sampling of exposed surfaces, and methods for decontaminating buildings.

Radiation exposure due to local fallout from Soviet atmospheric nuclear weapons testing in Kazakhstan: solid cancer mortality in the Semipalatinsk historical cohort, 1960-1999

Little information is available on the health effects of exposures to fallout from Soviet nuclear weapons testing and on the combined external and internal environmental exposures that have resulted from these tests. This paper reports the first analysis of the Semipalatinsk historical cohort exposed in the vicinity of the Semipalatinsk nuclear test site, Kazakhstan. The cohort study, which includes 19,545 inhabitants of exposed and comparison villages of the Semipalatinsk region, was set up in the 1960s and comprises 582,750 person-years of follow-up between 1960 and 1999. Cumulative effective radiation dose estimates in this cohort range from 20 mSv to approximately 4 Sv. Rates of mortality and cancer mortality in the exposed group substantially exceeded those of the comparison group. Dose-response analyses within the exposed group confirmed a significant trend with dose for all solid cancers (P < 0.0001) and for digestive and respiratory cancers (P = 0.0255 and P < 0.0001), whereas no consistent dose-response trend was found for all causes of death (P = 0.4296). Regarding specific cancer sites, a significant trend with dose was observed for lung cancer (P = 0.0001), stomach cancer (P = 0.0050), and female breast cancer (P = 0.0040) as well as for esophagus cancer in women (P = 0.0030). The excess relative risk per sievert for all solid cancers combined was 1.77 (1.35; 2.27) based on the total cohort data, yet a selection bias regarding the comparison group could not be entirely ruled out. The excess relative risk per sievert based on the cohort's exposed group was 0.81 (0.46; 1.33) for all solid cancers combined and thus still exceeds current risk estimates from the Life Span Study. Future epidemiological assessments based on this cohort will benefit from extension of follow-up and ongoing validation of dosimetric data.

The emerging epidemic of echinococcosis in Kazakhstan

Since independence from the Soviet Union in 1991 the annual surgical incidence of cystic echinococcosis in Kazakhstan has increased from 1.4 cases/100,000 in 1991 to 5.9 cases/100,000 in 2000. In some regions the annual surgical incidence is now over 10 cases/100,000. Twenty-nine percent of recorded cases in 2000 were in children aged < 14 years, which indicates recent transmission. Most of the cases are occurring in the regions where the sheep industry is concentrated, indicating that the zoonotic sheep strain of Echinococcus granulosus is the likely cause of the problem. The gross domestic product (GDP) of Kazakhstan has declined by nearly 50% since independence. Concurrently there has been decreased health spending with decreases in the numbers of hospitals, hospital beds and physicians. This situation suggests that an increase in the diagnosis of echinococcosis is an unlikely explanation for the epidemic but that there is an increase in transmission to the human population.

Effects of a couple-based intervention to reduce risks for HIV, HCV, and STIs among drug-involved heterosexual couples in Kazakhstan: a randomized controlled trial

OBJECTIVE

Project Renaissance is a randomized controlled trial of an HIV/hepatitis C virus (HCV)/sexually transmitted infection (STI) prevention intervention conducted in Almaty, Kazakhstan. We hypothesized that couples assigned to the intervention of interest will have lower incidence of HIV, HCV, STIs, rates of unprotected sex, and unsafe injection over the 12-month follow-up period compared with those assigned to an attention control arm.

DESIGN

A total of 300 couples (600 participants) where one or both partners reported injecting drugs in the past 90 days were randomized to 1 of 2 arms: (1) a 5-session HIV/HCV/STI prevention intervention (risk reduction: RR) or (2) a 5-session Wellness Promotion (WP) intervention.

RESULTS

Over the 12-month follow-up period, assignment to RR compared with WP significantly lowered the incidence of HCV infection by 69% [incidence rate ratios (IRR) = 0.31, 95% (CI) confidence interval: 0.10 to 0.90, P = 0.031]. Although differences were not statistically significant, RR participants had a lower incidence of HIV infection by 51% (IRR = 0.49, 95% CI: 0.16 to 1.48, P = 0.204) and any STI by 37% (IRR = 0.63, 95% CI: 0.21 to 1.93, P = 0.418) than WP participants. RR participants reported significantly fewer numbers of unprotected vaginal sex acts with their study partners (IRR = 0.58, 95% CI: 0.36 to 0.93, P = 0.024) and more consistent condom use (odds ratios = 2.30, 95% CI: 1.33 to 4.00, P = 0.003) over the entire follow-up period compared with WP participants.

CONCLUSIONS

Project Renaissance demonstrated a significant effect for biological and behavioral endpoints. Findings draw attention to an HIV/HCV/STI prevention intervention strategy that can be scaled up for drug-involved couples in harm reduction programs, drug treatment, and criminal justice settings.

The effect of psychological distress on IVF outcomes: Reality or speculations?

Introduction

Infertility is a problem that affects millions of people worldwide. The aim of this study was to assess the effect of stress, depression and anxiety on the IVF outcomes in Kazakhstan.

Methods

The prospective cohort study was performed using questionnaires to assess psychological distress in 304 infertile female in three different cities in Kazakhstan.

Results

The average age of participants was 33.7 years with infertility duration of 5.9 years. Regarding stress, depression and anxiety we found that more than 80% of all respondents had CES-D score higher than 16, indicating that they are at risk of developing clinical depression. On average, FPI subscales’ scores, global stress score and anxiety scale (STAI-S and STAI-T) scores were statistically significantly higher among not pregnant women than pregnant women. Similarly, in simple logistic regression analysis all FPI subscales scores, global stress scale score and anxiety scales’ scores were negatively associated with clinical pregnancy.

Conclusion

Rates of stress, anxiety and depression among IVF patients are higher than in general population. If the level of infertility-related stress is higher, IVF success rate is lower. Findings of our study indicate the need for the specific psychological interventions for all infertility women, to improve IVF success rate.

First evidence of bluetongue virus in Kazakhstan

We report the results of the first serological survey for bluetongue virus in Kazakhstan. We analysed blood samples collected from 958 livestock and 513 wild saiga antelopes over a large area of the country, and found 23.2% seroprevalence in livestock and 0% in saigas. Seroprevalence in livestock did not vary by species, but increased significantly with age. There was no evidence for variation in seroprevalence at the regional level, but there was significant clustering at the farm level. Bluetongue has never before been reported in Kazakhstan, yet our results suggest that it may be endemic. We found seropositive animals at the furthest known northern limits of the bluetongue virus in this region of the world. Recorded vectors are not known to be present in Kazakhstan, so a novel vector is likely to be operating. The lack of evidence for bluetongue virus in saigas is unexpected and suggests a need for further investigation.

Risk factors for HIV and unprotected anal intercourse among men who have sex with men (MSM) in Almaty, Kazakhstan

Introduction

Men who have sex with men (MSM) are at high risk for HIV infection. MSM in Central Asia, however, are not adequately studied to assess their risk of HIV transmission. Methods: This study used respondent driven sampling methods to recruit 400 MSM in Almaty, the largest city in Kazakhstan, into a cross-sectional study. Participation involved a one-time interviewer-administered questionnaire and rapid HIV screening test. Prevalence data were adjusted for respondent network size and recruitment patterns. Multivariate logistic regression was used to investigate the association between HIV and selected risk factors, and unprotected anal intercourse (UAI) and selected risk factors.

Results

After respondent driven sampling (RDS) weighted analysis, 20.2% of MSM were HIV-positive, and 69.0% had unprotected sex with at least one male partner in the last 12 months. Regression analysis showed that HIV infection was associated with unprotected receptive anal sex (AOR: 2.00; 95% CI: 1.04–3.84). Having unprotected anal intercourse with male partners, a measure of HIV risk behaviors, was associated with being single (AOR: 0.38; 95% CI: 0.23–0.64); very difficult access to lubricants (AOR: 11.08; 95% CI: 4.93–24.91); STI symptoms (AOR: 3.45; 95% CI: 1.42–8.40); transactional sex (AOR: 3.21; 95% CI: 1.66–6.22); and non-injection drug use (AOR: 3.10; 95% CI: 1.51–6.36).

Conclusions

This study found a high HIV prevalence among MSM in Almaty, and a population of MSM engaging in multiple high-risk behavior in Almaty. Greater access to HIV education and prevention interventions is needed to limit the HIV epidemic among MSM in Almaty.

Stable chromosome aberrations in the lymphocytes of a population living in the vicinity of the Semipalatinsk nuclear test site

SalomaTranslocation analysis using FISH (fluorescence in situ hybridization) chromosome painting was performed to evaluate the magnitude of exposure to ionizing radiation among the human population living close to the Semipalatinsk nuclear test site in Kazakhstan. We studied two generations of people living in villages that were in the path of the radioactive cloud from the first Soviet surface nuclear test performed in August 1949 and from later tests. The older generation (P(0)) lived in the area at the time of testing, and the younger generation (F(1)) was exposed to smaller doses from the residual fallout and later tests. In both P(0) and F(1) generations, similar translocation frequencies were observed in persons living in either the Semipalatinsk area or a noncontaminated area. Assuming translocation stability in peripheral blood lymphocytes over several decades, these findings suggest that on average, the magnitude of exposure of this cohort in the Semipalatinsk area has been considerably smaller than that reported in the literature. Previously reported doses of the order of 1-4.5 Gy (mean 2.9 Gy in the P(0) generation) cannot be confirmed by the present data.

A serological survey of ruminant livestock in Kazakhstan during post-Soviet transitions in farming and disease control

The results of a serological survey of livestock in Kazakhstan, carried out in 1997–1998, are reported. Serum samples from 958 animals (cattle, sheep and goats) were tested for antibodies to foot and mouth disease (FMD), bluetongue (BT), epizootic haemorrhagic disease (EHD), rinderpest (RP) and peste des petits ruminants (PPR) viruses, and to Brucella spp. We also investigated the vaccination status of livestock and related this to changes in veterinary provision since independence in 1991. For the 2 diseases under official surveillance (FMD and brucellosis) our results were similar to official data, although we found significantly higher brucellosis levels in 2 districts and widespread ignorance about FMD vaccination status. The seroprevalence for BT virus was 23%, and seropositive animals were widespread suggesting endemicity, despite the disease not having being previously reported. We found a few seropositives for EHDV and PPRV, which may suggest that these diseases are also present in Kazakhstan. An hierarchical model showed that seroprevalence to FMD and BT viruses were clustered at the farm/village level, rather than at a larger spatial scale. This was unexpected for FMD, which is subject to vaccination policies which vary at the raion (county) level.

Width and center-axis location of the radioactive plume that passed over Dolon and nearby villages on the occasion of the first USSR A-bomb test in 1949

In relation to the efforts to reconstruct the radiation dose in Dolon village, which was affected by the first USSR atomic bomb test in 1949 at the Semipalatinsk nuclear test site, the width and the center-axis location of the radioactive plume were investigated based on the soil contamination data around Dolon and the nearby villages. Assuming that the radioactive plume passed over along a straight line from the ground zero point to this area, the spatial distributions of soil contamination were plotted as a function of the perpendicular distance from the supposed center-axis of the plume. In total 83 and 52 soil contamination data were available for 137Cs and 239,240Pu, respectively. The plotted distribution formed a peak-like shape both for 137Cs and 239,240Pu. A Gaussian function drawn so as to envelop the points plotted for 239,240Pu indicated that the central part of the radioactive plume passed over the residential area of Dolon with a sigma value of 1.5 km. Additional soil contamination data around Dolon and other villages are necessary for more detailed discussion.

Diabetes prevalence, awareness and treatment and their correlates in older persons in urban and rural population in the Astana region, Kazakhstan

AIMS

The evidence on the prevalence and distribution of diabetes and its determinants in Central Asia is sparse. The aim of the present study was to investigate the prevalence, awareness, treatment, and control of diabetes and factors associated with these characteristics in the population of Astana (capital) city and adjacent rural area in Kazakhstan.

METHODS

Participants aged 50-75 years old, residing in Astana city (the capital) and Akmol village were invited to participate in a cross-sectional study. The subjects were randomly selected from polyclinic registers. A total of 953 adults were interviewed (response rate 59%), and their fasting plasma glucose, blood pressure, height and weight were measured. Diabetes was defined as fasting plasma glucose (FPG) ≥ 7.0 mmol/l (126 mg/dl) and/or being on diabetes medication.

RESULTS

The overall prevalence of diabetes was 12.5%, and it was almost twice higher in the urban residents (16.3%) than in the rural population (8.6%). Diabetes prevalence was associated with age, men sex, hypertension, obesity, and Russian ethnicity. Among subjects with diabetes, 72.3% were aware of their condition; 65.6% were on treatment and 27.7% had controlled fasting plasma glucose. The awareness, treatment and control of diabetes were substantially higher in the urban population and among women.

CONCLUSIONS

The large differences in all diabetes indices between urban and rural regions, if confirmed in larger studies, may suggest an impact of westernised and urbanised lifestyle as well as access to health care.

Ultrasound-detected thyroid nodule prevalence and radiation dose from fallout

Settlements near the Semipalatinsk Test Site (SNTS) in northeastern Kazakhstan were exposed to radioactive fallout during 1949-1962. Thyroid disease prevalence among 2994 residents of eight villages was ascertained by ultrasound screening. Malignancy was determined by cytopathology. Individual thyroid doses from external and internal radiation sources were reconstructed from fallout deposition patterns, residential histories and diet, including childhood milk consumption. Point estimates of individual external and internal dose averaged 0.04 Gy (range 0-0.65) and 0.31 Gy (0-9.6), respectively, with a Pearson correlation coefficient of 0.46. Ultrasound-detected thyroid nodule prevalence was 18% and 39% among males and females, respectively. It was significantly and independently associated with both external and internal dose, the main study finding. The estimated relative biological effectiveness of internal compared to external radiation dose was 0.33, with 95% confidence bounds of 0.09-3.11. Prevalence of papillary cancer was 0.9% and was not significantly associated with radiation dose. In terms of excess relative risk per unit dose, our dose-response findings for nodule prevalence are comparable to those from populations exposed to medical X rays and to acute radiation from the Hiroshima and Nagasaki atomic bombings.

HELMINTHS OF SAIGA ANTELOPE IN KAZAKHSTAN: IMPLICATIONS FOR CONSERVATION AND LIVESTOCK PRODUCTION

Saiga antelope (Saiga tatarica) graze extensively on livestock pasture, potentially enabling transmission of a wide range of parasitic helminths between saigas and domestic ruminants. Thirty-six of the 38 species of helminth that have been found in saigas in Kazakhstan in the past have been found also in domestic livestock. We examined 133 saigas culled for meat in autumn 1997, and found three species of cestode and 12 nematodes (nine in the abomasum), but no trematodes or lungworms. The most abundant species were Marshallagia marshalli, Marshallagia mongolica, and Nematodirus gazellae in the abomasum, Nematodirus gazellae in the small intestine, and Skrjabinema ovis in the large intestine. There was no clear relationship between intensities of abomasal nematodes and body condition. Age-intensity patterns differed between species: N. gazellae intensities were highest in saigas around 2-3 yr old, and declined in older animals, whereas the intensity of Marshallagia spp. rose asymptotically with age. Fecal egg density was directly proportional to adult worm intensity across ages for Marshallagia spp., but only in young animals for N. gazellae. There was no evidence that helminths, at the intensities observed, adversely affect saiga populations. The host range of many of the parasites found is broad, and transmission between saigas and livestock in both directions might become important to agriculture and conservation as livestock numbers recover. Simplified sampling techniques used in this study, and statistical analysis based on bootstrapping, could prove useful in other parasitologic surveys of wildlife in remote areas.

Epizootiologic parameters for plague in Kazakhstan

Infection reduces survival of otherwise asymptomatic maintenance hosts in a natural reservoir population.

Reliable estimates are lacking of key epizootiologic parameters for plague caused by Yersinia pestis infection in its natural reservoirs. We report results of a 3-year longitudinal study of plague dynamics in populations of a maintenance host, the great gerbil (Rhombomys opimus), in 2 populations in Kazakhstan. Serologic results suggest a mid-summer peak in the abundance of infectious hosts and possible transmission from the reservoir to humans. Decrease in antibody titer to an undetectable level showed no seasonal pattern. Our findings did not support the use of the nitroblue-tetrazolium test characterization of plague-infected hosts. Y. pestis infection reduced survival of otherwise asymptomatic hosts.

An HIV type 1 subtype A outbreak among injecting drug users in Kazakhstan

Kazakhstan experienced the start of the HIV-1 outbreak among intravenous drug users (IDUs) in 1997. To characterize genetically HIV-1 strains circulating in this country, peripheral blood mononuclear cells (PBMCs) DNA samples (1999-2002) derived from HIV-infected IDUs and their sexual partners in Pavlodar (n = 19), Shymkent (n = 6), and Qaraghandy (n = 18) regions were analyzed by the gag/env heteroduplex mobility assay (HMA). The 366-bp proviral env gene fragments encoding the gp120 C2-V3 region obtained from 16 individuals were sequenced. The results of HMA revealed that all 43 HIV-1 strains studied belonged to gag/env subtype A. The nucleotide sequence analysis showed a marked genetic homogeneity with the mean genetic distance being 3.63 +/- 2.39 (range 0.00-12.13). The mean genetic distance between each sequence within the Kazakhstan set and the East-European IDU subtype A consensus was 2.94 +/- 1.92 (range 0.79-8.48). The data presented thus confirm the spreading of the same IDU subtype A virus in the former Soviet Union.