Cholera in Ukraine. 7^th Pandemic.

In the contemporary history Cholera appeared in the Ukraine in 1970 in Odessa and Kerch and for the last 30 years has been present in the country causing either only some cases, outbreaks or isolations of Vibrio from the environment objects.

According to the doctor L.Y.Mogilevsky, Ph.D (1970-2000) who has bee studying the problems of Cholera for all these years since 1970 up to 1999 in Ukraine there were 4058 Cholera patient or vibrio carriers registered. Infected with Vibrio Cholera were found in all territories except for Chmelnitskaya and Ternopilskaya regions. 3849 infected (94,8%) were found in 29 epidemic complications. During 14 outbreaks the number of infected were 10-50; in 5 outbreaks 51-100; in 4 outbreaks 101 - 200; in 5 outbreaks - 200 and more.

During the 30 years period infected with the Vibrio Cholera were found in 24 separate years.

The analysis of the Cholera presence in the country in the mentioned period gives the opportunity to mark some stages of the different intensivety of the epidemic process:

1. 1970 - 1974. 1255 Cholera patients and Vibrio cariers were registered (average No per year - 251,0), 16 administrative areas were involved in the process including Crimea and Kiev. The real epidemic dissemination of infection was marked in the separate years in Zaparizhie (1974), Donetsk (1073,1974), Odessa (1970), Kherson (1972) areas and Crimea (1970,1972,1974). In this territories 1188 (94,7%) of all registered Cholera patients and Vibrio carriers were found. At the same time in the other territories only 67 (5,3%) of infected were found, majority of who came from the territories of the epidemic transmission of the disease.

2. 1975 - 1991. Only few sporadic or group cases of the disease or the cariers status were registered. Total - 85 cases of Cholera or cariers (average No per year - 5,3).

78 from the territories where in 1970-1974 the epidemic form of infection was registered.

3. 1991 - 1995. The period of the epidemic increase. 2679 Vibrio Cholera infected were registered (average No per year - 535,8).

Two new areas Dnepropetrovskaya and Donetskaya regions joined the group where the epidemic form of infection was registered in 1970-1974. (Zaporozhie, Donetskaya, Odessakaya, Khersonskaya, AR Crime). 67,2% of infected in this period and 44,4% of all the carriers in the Ukraine during the 7^th pandemic were registered in Nikolaev Area.

66 cases were found in 10 other regions as the transmission from the epidemic registered territories.

After the 1994-1995 outbreak there were only a few cases of the disease and carier status registered. Only 39 infected were found in 1996-1999. All of them were from the territories with the epidemic development in the past, except for one case.

All this shows the decrease of the Cholera Epidemic process in Ukraine and the start of the new stage.

The correlative analysis of the 7^th Pandemic of Cholera epidemic process in Ukraine and the world indicates the clear synchronization of the increase and decrease stages.

This synchronization shows the same tendencies in the Cholera 7^th pandemic development in the world and Ukraine and the presence of the Epidemic situations in the Ukraine in the years and the cases of the first registration in the border countries (Russia, Romania, Moldova) or distant (Turkey) which shows the transmisive model of the outbreaks of the infection in the country.

The long term investigation (1970-2000) of the 7^th Cholera Pandemic specifics in Ukraine demonstrated the epidemic model development in the cities, towns or villages located in the Southern Part of the Ukraine in 6 areas (Donetsk, Dnepropetrovsk, Zaporigie, Myikolaev, Odessa, Kherson) regions and AR Crimea. The majority of the Cities were located on the banks of the open waters, which were the end points for the non-treated wastewater. At the same time these waters are used for the recreation and other needs of the population.

It is clear that the starting mechanism for the epidemic process in the involved areas is the contact of the population with the Vibrio Cholera polluted waste waters.

All mentioned above shows the same problems in the 7^th Cholera Pandemic for the Ukraine as for the whole world. It is extremely important to study the factors of the transmission and the of the epidemic and outbreaks mechanisms. For the practice we need to create the guaranteed system of water use, canalization, wastewater treatment and the protection of the environment from the infection pollution.

For the specific medical diagnostic development we need to use the modern laboratory technologies to be able to recognize the disease materials from environment and patients. These adequate technologies are important to obtain the comparable results to share and evaluate the data from the different countries including the Ukraine.

HIV/AIDS epidemic in Ukraine.

The statistical data shows the HIV Epidemic development in Ukraine. In the official UNAIDS announcement it was marked "…. Ukraine is the center of infection in the Eastern Europe…. and the registered figures are only the top of the iceberg".

Even in 1995 WHO carried Ukraine to the countries with the low HIV/AIDS rates. But this year the prompt growth of HIV especially in drug users (75%-80% of the total registered cases) began. Now according to the results of the Ukraine HIV/AIDS. Prevention Center (Ukrainian Ministry of Health) examination up to the October 1999 - 29317 there were HIV positive cases were registered.

Today HIV/AIDS cases are reported in all administrative areas of Ukraine with 100 times difference between the first and the last.

HIV- positive officially registered in the Ukraine

Regions	1987-1999(9 m)
Donetsk obl.	6489
Dnepropetrovsk obl.	6006
Odessa obl.	4796
Nikolaev obl.	2050
AR Crimea	1820
Kyiv city	1021
Zaporizie obl.	863
Kharkiv obl.	858
Poltava obl.	705
Cherkasy obl.	700
Lugansk obl.	681
Khmelnitsky obl.	385
Sevasyopol obl.	385
Kherson obl.	382
Volin obl.	260
Gitomir obl.	243
Kyiv city	239
Chernovitsy obl.	237
Vinnitsa obl.	215
Lviv obl.	214
Chernigiv obl.	210
Summi obl.	133
Kirovograd obl.	104
Ternopil obl.	104
Zakarpatskaya obl.	77
Iv-Frankovskaya obl.	75
Rivne obl.	65
Total	29317

HIV – infected in the Ukraine by age and sex. (Inf. Bul. No11. Kyiv, 1998)

Age	1993		1994		1995		1996		1997
	m	f	m	f	m	f	m	f	m	f
0-1	1	-	-	-	8	1	54	38	91	105
2-5	-	-	-	-	-	-	-	-	-	-
6-10	-	-	-	-	-	-	-	-	-	-
11-14	-	-	-	-	1	1	1	1	4	5
15-19	1	-	1	-	165	102	282	140	317	147
20-29	9	6	13	6	441	353	1991	685	2953	1251
30-39	11	3	3	2	269	69	1091	267	2945	804
40-49	7	-	5	-	47	26	633	101	228	32
50-59	2	-	1	-	4	2	75	38	26	5
60-69	-	-	-	-	1	-	3	-	5	-
Всего	31	9	23	8	936	554	4130	1270	6569	2344

For the different areas there were no specific signes before 1995. As for example among the most significant groups for Odessa area they were the sexual contacts especially with the HIV positive foreigners (Uganda, Ethiopia, Congo, Burundi, Tanzania).

Since 1987 every year from 1 to 3 new groups appear among tested influencing the epidemic process.

But the principle change was connected with the outbreak of HIV infection among the drug users started in the Southern region and then involving all Ukraine.

Drug users registered in Ukraine (Inf.Bul.No 16, Kyiv)

Regions	1998 (9m.)	%	1999 (9m.)	%	1994-99 (9)^*	%
AR Crimea	168	50.45	142	57.48	1221	68.01
Vinitsa obl.	l42	85.70	31	72.10	161	77.00
Volin obl.	36	94.70	10	50.00	232	89.20
Dnepropetrovsk obl.	1423	85.40	684	71.10	5187	86.42
Donetsk obl.	996	67.70	667	63.95	4810	74.50
Gitomir obl.	36	87.80	28	65.11	205	85.01
Zakarpatskaya obl.	14	73.60	5	38.46	48	62.30
Zaporigie obl.	168	67.74	73	70.87	729	85.01
Iv.-Frankovsk obl.	12	92.30	8	44.44	54	72.96
Kyiv obl.	38	74.50	40	83.33	183	62.45
Kirovograd obl.	18	51.40	11	45.83	56	54.90
Lugansk obl.	140	82.80	55	67.00	555	81.60
Lviv obl.	49	89.00	47	92.15	176	84.60
Nikolaev obl	365	82.00	201	73.35	1590	77.60
Odessa obl.	308	56.10	355	47.65	2972	62.60
Poltava obl.	202	89.30	122	82.99	607	87.70
Rivne obl.	10	58.80	4	100	47	72.30
Summy obl.	39	79.60	32	80.00	100	75.76
Ternopil obl.	34	87.20	10	90.90	88	84.60
Kharkiv obl.	225	74.00	58	60.41	585	71.20
Kherson obl.	58	75.30	25	51.02	302	79.30
Khmelnitsky obl.	124	74.25	72	65.45	282	73.20
Cherkassy obl.	86	86.80	76	80.00	584	84.00
Chernigiv obl.	45	90.00	14	77.77	189	90.00
Chernovitskaya obl.	25	65.80	19	63.33	187	80.25
Kyiv city	180	92.70	82	89.13	806	86.00
Sevastopil city	115	92.00	51	78.46	319	83.00
Total	4956	77.80	2922	65.32	22275	76.70

* – up to1994 г. HIV-positive drug users were not registered.

Every year the rates have been rising up to 20% and more not only in big cities but also in towns and even villages.

According to the prognosis of the Ukrainian specialists which was formed on the basis of the present situation by the end of 2000 we will have 100 000 HIV positive citizens of Ukraine. According the opinion of the WHO experts we should multiply this figure at least 5 times (500 000).

The group of the international experts developed the short and long-term of HIV/AIDS epidemic development in Ukraine.

According to the executed estimation two options are possible:

"Slow HIV/AIDS" - the variation of development similar to the situation in Western Europe where distribution occurs in very closed and separate group of drug users without significant involving of the heterosexual ordinary population.

"Fast HIV/AIDS" - the variant of development similar to the South East Asia and Brazil, where development of epidemic occurs among the most heterosexual population. In the case of the "Fast HIV/AIDS epidemic development" we will have the loses as follows:

By 2010 the total number of HIV-infected can come up to 1,4 million with the number of new cases per year:

2001 - (20 000 - 24 000)

2006 - (61 000 - 111 000)

2011 - (65 000 - 175 000)

2016 - (40 000 - 155 000).

The number of death cases caused by HIV/AIDS epidemic will make:

2001 - (12 000 - 13 000)

2006 - (55 000 - 92 000)

2011 - (67 000 - 169 000)

2016 - (45 000 - 163 000).

The total number of deaths caused by HIV/Aids will make 0,8 - 1,9 million in 2016.

For all medical, economical, ethical, demographical reasons we need to do everything to stop the "Fast HIV/AIDS model" epidemic development. In order to accomplish that it's necessary to collaborate at different national levels involving State and NGOs, ordinary population, professionals and Mass media as well as to use the best international examples and experiences.