Health Action − in the North Caucasus NEWSLETTER ON EMERGENCY PREPAREDNESS AND RESPONSE JANUARY-MARCH 2006 Epizootic of Avian Flu in the Southern Federal okrug of the Russian Federation Nine subjects of the Southern Federal okrug of production; control over borders; sanitation- the Russian Federation have been hit by epizo- quarantine checks; control over water supply otic of Avian Flu, caused by A (H5N1) virus, in and food markets; securing an appropriate February-March 2006. According to the data of stock of drugs and medical consumables; alloca- the Federal Surveillance Service of Consumer's tion of additional hospital beds; organization of Rights and Human Well-Being (www.gsen.ru), practical training/field exercises among state 30 districts, 7 cities, 78 residential areas and six health facilities, and awareness activities. bird farms have been affected in Stavropol Krai, Dagestan Republic, Krasnodarsky krai, Republic All over this period WHO has been closely moni- of Kalmykia, Republic of Adygea, Kabardino- toring the Avian Flu situation, providing constant Balkaria, Chechen Republic, North Ossetia and updates on recent developments and activities, Astrakhan oblast. By the end of March, the epi- undertaken by the authorities. WHO examined zootic and preventive measures (culling) has the national response plan to Avian Flu and es- killed over 1,3 million birds. tablished contacts with relevant and responsible state authorities, including the Ministries of In order to minimize and eliminate the conse- Health and Agriculture, the Federal Surveillance quences of the Avian Flu epizootic, and following Agency, Emercom in the Republics of Chechnya, the recommendations, issued by the Federal Ingushetia, North Ossetia and Kabardino- Surveillance Service of Consumer's Rights and Balkaria, as well as held negotiations with the Human Well-Being, the Ministries of Health of chief specialists on infections, epidemiology and respective republics, in cooperation with territo- surveillance of the Southern Federal okrug about rial agencies of surveillance control (SES) and WHO potential assistance in strengthening epi- other responsible actors, have introduced and demiological service in the North Caucasus implemented on their territories a detailed action through the use of national experts, planning of plan, including, inter alia, creation of a special training courses, implementation of public Emergency Commission comprised of relevant awareness campaigns and distribution of infor- state structures in each republic; organisation of mation materials. mobile disinfecting teams; registration, monitor- ing and surveillance of all poultry and cattle; On March 20-24 WHO funded participation of vaccine procurement and poultry vaccination; four experts from Chechnya, Ingushetia, North coordination with the veterinary service to iden- Ossetia and Kabardino-Balkaria in the All- tify risk groups of people in contact with con- Russian certified training course on epidemiol- firmed Avian Flue; provision of additional per- ogy, organised by the Federal Institute of Epi- sonnel to make door-to-door inquiries (especially demiology in Moscow, as part of its prepared- in the areas of suspected Avian Flue cases); ness plan on Avian Flu and strengthening na- control over health status of workers in poultry tional surveillance capacity. 1 Children hit by unknown disease in Schelkovskoy district of Chechnya At the end of 2005, 89 cases of an unknown dis- Stavropol clinics and sanatoriums and rehabili- ease with symptoms of asphyxia, fainting fits tation centre in Argun, a large number of chil- and hysteria were registered in Schelkovskoy dren was still reported to continue experiencing district of Chechnya. The disease hit mainly chil- serious health problems, linked mainly to con- dren and teenagers, coming from Staro- vulsions, aggression and hallucinations. Children gladovskaya, Shelkozavodskaya and Shelk- do not attend schools. Chechen officials are ovskaya settlements. Chief psychiatrists from deeply concerned over the children’ health the Serbsky state research centre of social and status and call for their thorough medical ex- forensic psychiatry in Moscow diagnosed it as a amination and subsequent follow up and psycho- conversion-spasmodic syndrome spread by social rehabilitation. means of psychological contagion. According to In April, WHO will undertake a special monitor- the specialists of the centre, hysteria-caused ing mission to Schelkovskoy district of Chechnya spasms and hysteric reactions are the most an- in order to receive first-hand information. WHO cient mechanism of reaction to stress. The gov- will visit the central district hospital in Shelk- ernment of the Chechen republic has allocated 5 ovskoi, district hospital in Chervlennoe and FAPs million roubles from its reserve fund for medical in Staroshedrinskaya and Kobi, as well as pay treatment of affected children. However, three visits to the families of affected children. months later, after treatment, received in INGUSHETIA AND CHECHNYA Demography WHO continues delivering (with WFP support) food commodities to the Republican TB hospital in Nazran, Ingushetia. In January - March, As of 31 March 2006, a total of 25,080 internally around 330 TB patients (with over 40 children) displaced persons (IDPs) from Chechnya (5,710 received some 8600 kg of flour, over 900 kg of families) were registered for assistance in In- oil, 120 kg of sugar and 30 kg of salt every gushetia in the database of UNHCR's implement- month. ing partner, the Danish Refugee Council (DRC). Of this total, 9,051 persons (2,001 families) were in temporary settlements, and 16,029 per- Epidemiology and immunization sons (3,709 families) in private accommodation. Despite high standards and timely vaccination of TB children against poliomyelitis in the Russian Federation, re-vaccinating of children at the age On 24 March, the Republican conference com- of twelve and twenty-four months falls short of memorating 2006 World TB Day took place in the required norm in a number of regions, in- Nazran, Ingushetia. 150 representatives from cluding Chechnya. With this in view and in ac- the government bodies, health professionals, cordance with the special resolution, signed by educational institutions, clergy, NGO and UN the Chief Sanitary Doctor of the Russian Federa- community attended the event, coupled with the tion, Chechnya will conduct an additional vacci- children’ drawing contest and performance and nation campaign in spring 2006. The campaign distribution of awareness booklets. will involve no less than 95% of children under five years old and will be held on 24-29 April and 22-27 May. Control over implementation of the additional vaccination campaign is entrusted to 2 the heads of regional health service bodies and ground waters. Many of the functioning refiner- head sanitary doctors of the respective territo- ies do not comply with the state required tech- ries. nological process of oil processing. A large num- Within its EPI programme, aiming at increasing ber of existing boreholes are not properly the coverage and quality of the immunization sealed, with oil spreading around them and pol- services for children in Chechnya and In- luting hundreds of hectares of land. Only 30- gushetia, UNICEF has recently procured: 35% of water springs are fit for purification, with over 150 000 disposable syringes for distribution practically all surface water sources dangerously to paediatric and mother and child health facili- polluted, either by human or industrial waste. ties, medical equipment (electronic scales and In a number of industrial enterprises in Grozny auxanometers) for 43 primary health care facili- radioactive material is stored right on their terri- ties in Chechnya and 20 in Ingushetia, tori es, with local authorities lacking resources for IT equipment (computers and printers) to the its removal and transportation to a specialised epidemiological departments of the local Minis- facility. Consequently, poor health of population, tries of Health, as well as to the vaccination cen- and particularly, the growing need for oncologi- tres in five districts in Ingushetia and 16 rural cal services in the republic, can be attributed to districts (plus Grozny city) in Chechnya. the poor environmental situation and pollution, as well as to stressful leaving conditions. As reported by the MoH of Chechnya, the number Within the framework of the same project, and of oncological patients in the republic is increas- in cooperation with the MoH of Ingushetia, ing – while there were 1,614 oncological patients UNICEF conducted a one-day conference for registered in the republic in 2004, in 2005 this paediatricians and epidemiologists to discuss figure grew up 2,437. More children and younger future immunization strategies and other rele- people are diagnosed with cancer annually. vant issues, as well as the poor environmental Many of the registered oncology forms have not situation, pollution and stressful living condi- been recorded before. A considerable proportion tions. Some 19 participants, including two spe- (up to 50 %) of detected patients have grave cialists from the Statistical Department of the oncological conditions The highest oncology Chechen Ministry of Health, the ICRC and vari- rates (lung and skin cancer) are in the areas of ous NGO representatives attended the confer- traditional oil refinery industry (Kurchaloi, Shali, ence. Grozny, Grozny-Selsky) and military activities (Achkhoi-Martan, Shali and Vedeno).