Hemorrhagic Fever with Renal Syndrome – Russia (07): Tatarstan Archive Number 20081002.3106 Published Date 02-Oct-2008 The Republic of Tatarstan in Russia has experienced an increased incidence in Hemorrhagic Fever with Renal Syndrome (HFRS) for this year. The current report states the incidence for 2008 is seven times greater than reported for 2007. Between September 19 and 25, 2008, 29 confirmed or suspected cases were reported (International Society for Infectious Diseases [ISID], 2008a). This is in addition to outbreaks reported earlier this year. According to the Russian Epidemiological Surveillance System, there were 165 cases reported as of July. Cases increased from 65 on July 4 to 165 by July 22 (ISID, 2008b). Only one fatality has been reported at this time; generally, case fatality rates for HFRS range from 1% to 15%. Approximately 11% of total cases reported so far in 2008 have occurred in the capital city of Kazan. The majority of other cases have occurred in rural, forest areas of Tatarstan. The most recent outbreak of 29 cases has occurred in the following cities: Kazan (10), Naberezhnye Chenly (8), Nizhnekamiskiy (3), Almetievskiy (3), Sabinskiy (2), Kukmorshiy (1), and Bavlinskiy (1) (ISID, 2008a). The Republic of Tatarstan is located in eastern Russia, about 800 kilometers southeast of Moscow (Department of Foreign Affairs to the President of the Republic of Tatarstan, 2008). As of 2002, the population of Tatarstan was 3,779,265, with an urban/rural population of 2,790,661 and 988,604, respectively.  HFRS is endemic to Tatarstan and surrounding republics in eastern Russia (ISID, 2008a). Other geographic areas with endemic HFRS include Scandinavia, Western Europe, and the Balkans. The Puumala virus spread by the bank vole is the likely cause of the disease in Russia, Western Europe and Scandinavia. The Dobrava virus is found in the Balkans and the Seoul virus may occur worldwide. All viruses are part of the Hantavirus classification. Hantavirus is transmitted to humans by vector rodents such as voles and field mice (Centers for Disease Control and Prevention [CDC], 2005). According to research conducted by Alla Bernshtein and colleagues of the Chunakov Institute in Moscow, natural increases and decreases of the bank vole population occur every three to four years. In years of higher vole populations, the incidence of human HFRS increases (ISID, 2008c). Experts speculate a number of factors have contributed to the rise above endemic levels of human HFRS in Tatarstan and surrounding regions. First, an increase in the bank vole population may be a result of climate changes. Less harsh winters and warmer summers allow for better access to food sources for the rodents.  Second, the new capitalistic Russia has resulted in increased construction of homes in rural forest areas. Humans have invaded the natural habitat of forest rodents. This has increased the potential for contact between the habitats of bank voles and humans ...

1. Hemorrhagic Fever with Renal Syndrome – Russia (07):
Tatarstan
Archive Number 20081002.3106
Published Date 02-Oct-2008
The Republic of Tatarstan in Russia has experienced an
increased incidence in Hemorrhagic Fever with Renal Syndrome
(HFRS) for this year. The current report states the incidence for
2008 is seven times greater than reported for 2007. Between
September 19 and 25, 2008, 29 confirmed or suspected cases
were reported (International Society for Infectious Diseases
[ISID], 2008a). This is in addition to outbreaks reported earlier
this year. According to the Russian Epidemiological
Surveillance System, there were 165 cases reported as of July.
Cases increased from 65 on July 4 to 165 by July 22 (ISID,
2008b). Only one fatality has been reported at this time;
generally, case fatality rates for HFRS range from 1% to 15%.
Approximately 11% of total cases reported so far in 2008 have
occurred in the capital city of Kazan. The majority of other
cases have occurred in rural, forest areas of Tatarstan. The most
recent outbreak of 29 cases has occurred in the following cities:
Kazan (10), Naberezhnye Chenly (8), Nizhnekamiskiy (3),
Almetievskiy (3), Sabinskiy (2), Kukmorshiy (1), and
Bavlinskiy (1) (ISID, 2008a).
The Republic of Tatarstan is located in eastern Russia, about
800 kilometers southeast of Moscow (Department of Foreign
Affairs to the President of the Republic of Tatarstan, 2008). As
of 2002, the population of Tatarstan was 3,779,265, with an
urban/rural population of 2,790,661 and 988,604, respectively.

2. HFRS is endemic to Tatarstan and surrounding republics in
eastern Russia (ISID, 2008a). Other geographic areas with
endemic HFRS include Scandinavia, Western Europe, and the
Balkans. The Puumala virus spread by the bank vole is the
likely cause of the disease in Russia, Western Europe and
Scandinavia. The Dobrava virus is found in the Balkans and the
Seoul virus may occur worldwide. All viruses are part of the
Hantavirus classification. Hantavirus is transmitted to humans
by vector rodents such as voles and field mice (Centers for
Disease Control and Prevention [CDC], 2005).
According to research conducted by Alla Bernshtein and
colleagues of the Chunakov Institute in Moscow, natural
increases and decreases of the bank vole population occur every
three to four years. In years of higher vole populations, the
incidence of human HFRS increases (ISID, 2008c).
Experts speculate a number of factors have contributed to the
rise above endemic levels of human HFRS in Tatarstan and
surrounding regions. First, an increase in the bank vole
population may be a result of climate changes. Less harsh
winters and warmer summers allow for better access to food
sources for the rodents. Second, the new capitalistic Russia has
resulted in increased construction of homes in rural forest areas.
Humans have invaded the natural habitat of forest rodents. This
has increased the potential for contact between the habitats of
bank voles and humans. City dwellers tend to visit their
countryside homes during the summer months of June through
August. The majority of HFRS cases are reported during these
summer vacation months (ISID, 2008b).
As mentioned previously, Hantavirus is spread to humans by
rodents. As reported by the CDC (2005), infection occurs when
humans encounter “aerosolized urine, droppings, saliva of
infected rodents or after exposure to dust from their
nests.” Infection may also occur through open wounds, mucous

3. membranes, rodent bites, and in rare cases through person-to-
person contact. Most cases occur in individuals older than 15
years old, as children under the age of 15 often only show
subclinical symptoms of HFRS.
The incubation period of HFRS is one to two weeks. The CDC
(2005) lists the following symptoms: severe headaches, back
and abdominal pain, fever, chills, nausea and blurred vision.
Fever, hemorrhage, and renal insufficiency are hallmarks of
advanced disease. The disease generally progresses through five
stages: 1) fever lasting four to six days, 2) low blood pressure
lasting a few hours to 2 days, 3) decreased production of urine
for three to six days, 4) diuretic stage lasting two to three
weeks, and 5) recovery that may take three to six months. HFRS
infection is confirmed by clinical symptoms, serological testing,
microscopic inspection for Hantavirus antigen, or presence of
Hantavirus RNA in blood and tissue samples. Depending on the
patient’s fluid and electrolyte status, renal dialysis may be
warranted. Patients may be required to follow sodium and fluid
restricted diet during the oliguric stage followed by a liberal
fluid intake during the diuretic stage. In addition, the
administration of the intravenous antiviral drug, Ribavirin,
lessens the disease severity and improves survival (Bhimma,
Sairam, & Travis, 2008).
The Puumula virus carried by the bank vole is implicated in the
current outbreak of HFRS described above. Bhimma et al.
(2008) contend that prevention of HFRS starts with
environmental control of rodent populations near human
housing communities and structures. Recommendatio ns for
prevention include taking precautions such as wearing rubber
gloves while cleaning areas contaminated with rodent droppings
or urine, avoid stirring up dust in rodent areas, and using a
bleach solution with disposable cleaning towels. Storing food
and disposing of trash properly may also prevent rodents from
interacting with human habitats. Humans should take

4. precautions if sleeping outdoors, working on farm areas or
handling hay where rodents may have built nests (Bhimma et
al., 2008).
In summary, the Puumula virus is a vector carried virus that
falls within the Hantavirus family. It is endemic to eastern
Russia where rodent populations thrive in rural forest areas.
Infection leads to HFRS in humans. Symptoms take one to two
weeks to appear, with initial symptoms of headaches and back
pain that may progress to acute renal failure. The survival rate
is high for infected populations although recovery may take
several months. The Puumula virus is recognized as one of the
less severe forms in the Hantavirus family. Controlling rodent
populations and public education of risks are keys to the
prevention of HFRS.
References
Bhimma, R., Sairam, V. K., & Travis, L. (2008). Hemorrhagic
fever with renal failure
syndrome. Retrieved from
http://www.emedicine.com/ped/TOPIC968.HTM
Centers for Disease Control and Prevention. (2005).
Hemorrhagic fever with renal syndrome.
Retrieved from
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/hfrs.htm
Department of Foreign Affairs to the President of the Republic
of Tatarstan. (2008). Official
web-site republic of Tatarstan: Geographical location. Retrieved
from
http://www.tatar.ru/index.php?DNSID=7285d20214ab4a8019cb
26275358e482&node_id
=797
International Society for Infectious Diseases. (2008a).
Hemorrhagic fever with renal syndrome

5. – Russia (07): (Tatarstan).Retrieved from
http://www.promedmail.org/pls/otn/f?p=2400:1001:6253137856
52199::NO::F2400_P10
01_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,74203
International Society for Infectious Diseases. (2008b).
Hemorrhagic fever with renal syndrome –
Russia (04): (Tatarstan). Retrieved from
http://www.promedmail.org/pls/otn/f?p=2400:1001:6253137856
52199::::F2400_P1001_
BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P100
1_USE_ARCHIVE:10
01,20080722.2226,Y
International Society for Infectious Diseases. (2008c).
Hemorrhagic fever with renal syndrome –
Russia (05): (Tatarstan, Udmurtia). Retrieved from
http://www.promedmail.org/pls/otn/f?p=2400:1001:6253137856
52199::::F2400_P1001_
BACK_PAGE,F2400_P1001_ARCHIVE_NUMBER,F2400_P100
1_USE_ARCHIVE:10
01,20080730.2337,Y
MyRubricResearch Report : Pro-MED SummaryStudent Name:
________________________________________CATEGORY10
8 to 96 to 70 to 5Quality of Information Summary of Pro-
MEDInformation clearly relates to the main topic. Thoroughly
describes 4+ supporting details and/or examples from
ProMED.Information clearly relates to the main topic.
Thoroughly describes 2-3 supporting details and/or examples

6. from ProMED.Information somewhat relates to the main topic,
but only one detail and/or example is given from
ProMED.Information has little or nothing to do with the main
topic and no examples given from ProMEDMechanics Syntax,
spelling, grammar, APANo grammatical, spelling or APA
errors.Almost no grammatical, spelling or APA errorsA few
grammatical spelling, or APA errors.Many grammatical,
spelling, or APA errors.CATEGORY108 to 96 to 70Internet Use
Inlcuded information about the environmental aspect of the
outbreak from additional web siteSuccessfully uses website to
describe environmental aspect; includes 4+ details and
examples; includes exact URL in reference list.Successfully
uses website to describe environmental aspect; includes 2-3
examples in discussion; includes exact URL.Information
somewhat relates to environmental aspect, but only 1 detail
given (or) does not include exact URL.Does not offer additional
information (from another source) on the environment.Important
Note: Just giving data on the geographic land mass and
population of the country is not enough. You must relate
something about the environment and/or living conditions that
affected transmission. If in doubt about your information, ask
me ahead of due date.Internet Use Inlcuded information about
the disease from additional web siteSuccessfully uses website to
further describe the disease; includes 4+ details and examples;
includes exact URL in reference list.Successfully uses website
to further describe the disease; includes 2-3 examples in
discussion; includes exact URL.Information somewhat relates to
the disease, but only 1 detail given (or) does not include exact
URL.Does not offer additional information (from another
source) on the disease.
Ross River Virus - Australia (02): (Victoria)
Archive Number: 20210211.8183575
Published Date: February 11, 2021
Health authorities in Victoria, Australia are concerned
about the rising cases of Ross River virus disease, a viral

7. infection spread through the bites of mosquitoes. In just over
one month, 10 people have been infected with the virus in the
Victoria municipality of Wellington Shire. Authorities are
urging the residents of Gippsland, a region in Victoria that
includes Wellington Shire, to be mindful of mosquitoes and take
precautions when outside (International Society for Infectious
Diseases, 2021). A resident of Sale, a city in Gippsland, who
was diagnosed with Ross River virus disease in December 2020
believes health authorities should be doing more to spread
awareness of the virus. The resident was quite healthy and
active prior to contracting the disease. She is co-owner of a
local restaurant and has had to take it easy while working ever
since she fell sick. She describes her signs and symptoms as
having excruciating pain, especially in her joints, fatigue, and a
rash. At the time the article was written, she said she continued
having pain, although not as bad, and some numbness in her
fingers (International Society for Infectious Diseases, 2021).
Ross River virus disease is also known as Ross River
fever. The Ross River virus is part of a group of viruses called
arboviruses or arthropod-borne viruses. These viruses are
spread through the bite of an infected insect and in the case of
Ross River virus it is a mosquito (New South Wales
Government, 2016). If a mosquito bites another animal who is
infected with Ross River Virus, it may become infected. The
mosquito can then infect other animals or humans with the virus
when it feeds off their blood. The virus cannot be spread from
human to human. According to the CDC, “about 55%-75% of
people who are infected do not feel sick” (Centers for Disease
Control and Prevention, n.d.). The disease can be asymptomatic.
Not all who are infected will develop symptoms. Those that do
may have flu-like symptoms including fatigue, fever, chills, and
muscle and joint pain. Joints can become stiff and swollen. A
rash may develop on the body, arms, or legs. The incubation
period for the virus is usually 7-10 days. Most people will have
a full recovery within a few weeks but some have symptoms for
many months (New South Wales Government, 2016). Some even

8. have lingering symptoms for several years. There is no
treatment for Ross River virus disease, but you can take
medications to alleviate the symptoms. About 10 years ago, an
effective vaccine was developed for Ross River virus, but it was
not financially viable (International Society for Infectious
Diseases, 2021).
Ross River virus can be found across all of Australia. In
fact, cases of Red River virus can be found in most parts of
Victoria (International Society for Infectio us Diseases, 2021).
Victoria is a state in southeast Australia. It is the 2nd most
populous Australian state and the most densely populated. This
area of Australia is a mountainous, coastal region and the
wettest with nearly 80 inches of precipitation a year (Waterson
& Prescott, 2019). Gippsland is the southeast region of Victoria.
The dairy industry along with lumbering and tourism are very
important in Gippsland. The coastal resorts and many lakes are
a major source of income (Editors of Encyclopedia Bri tannica,
2012). Because the soil is fertile and gets lots of rainfall each
year, residents of cities like Sale take part in intensive farming
and livestock raising (Editors of Encyclopedia Britannica,
2020).
The climate of southeast Australia, especially between the
months of February through May, is favorable for mosquitoes.
The warm temperatures and frequent rainfall of the coastal
region are perfect for mosquitoes to live and breed causing an
increase in the mosquito population that are possibly carryi ng
and spreading the virus. Australian weather forecasters believe
the 2020-21 La Niña event is creating even more favorable
conditions for mosquitoes (International Society for Infectious
Diseases, 2021). La Niña brings more rainfall and warmer
nighttime temperatures. The impacts of La Niña can last for
several months (Bureau of Meteorology, 2016). Cases of Ross
River virus disease tend to increase when there is heavy rain. La
Niña and the increase of rainfall and warm temperatures could
possibly be the reason for an increase in cases since there are
likely more mosquitoes. Another reason could be the high

9. amount of outdoor activity in the region.
The coming months will have a greater potential for more
cases. Residents of Gippsland should take more precaution
when outdoors and take measures to prevent mosquito bites.
Tourists should also be made aware of the risk of infection and
what they can do to lower their risks.
References
Bureau of Meteorology. (2016, August). What is La Niña and
how does it impact Australia. Retrieved February 24, 2021,
from
http://www.bom.gov.au/climate/updates/articles/a020.shtml
Centers for Disease Control and Prevention. (n.d.). Ross River
virus disease. Travelers' Health. Retrieved February 23, 2021,
from https://wwwnc.cdc.gov/travel/diseases/ross-river-virus-
disease
Editors of Encyclopedia Britannica. (2012, January 16).
Gippsland. Encyclopedia Britannica. Retrieved February 24,
2021, from https://www.britannica.com/place/Gippsland
Editors of Encyclopedia Britannica. (2020, July 15). Sale.
Encyclopedia Britannica. Retrieved February 24, 2021, from
https://www.britannica.com/place/Sale-Queensland
International Society for Infectious Diseases. (2021, February
11). Ross River Virus - Australia (02): (Victoria). Retrieved
February 22, 2021, from https://promedmail.org/promed-
post/?id=8183575
New South Wales Government. (2016, May 1). Red River fever
fact sheet. Retrieved February 23, 2021, from
https://www.health.nsw.gov.au/Infectious/factsheets/Pages/ross -
river-fever.aspx
Waterson, D. B., & Prescott, J. R.V. (2019, March 7). Victoria.
Encyclopedia Britannica. Retrieved February 24, 2021, from
https://www.britannica.com/place/Victoria-state-Australia