Ministry of Health of the Republic of Kazakhstan

Background: Antimicrobial resistance (AMR) is a growing global threat that complicates the treatment of infectious diseases, including plague. Yersinia pestis, the causative agent of plague, remains a serious public health concern in natural foci, such as those in Kazakhstan, where approximately 40% of the territory is plague-endemic. Despite the last reported human case in 2003, data on antibiotic resistance among Y. pestis isolates from these foci, especially historical ones, remain limited. Materials and Methods: A total of 75 Y. pestis strains were examined, including 61 isolates obtained from patients and deceased individuals during epidemic outbreaks (1926-2003) and 14 isolates from carriers and vectors in natural plague foci. Taxonomic identification was conducted using the Vitek 2 Compact 30 system. Antibiotic susceptibility was assessed by Kirby-Bauer disk diffusion and E-test methods. Extended-spectrum β-lactam (ESBL) activity was evaluated phenotypically, and resistance genes to glycopeptides and β-lactams were screened by real-time polymerase chain reaction (RT-PCR) using the BacResista GLA Detection Kit. Results: All isolates showed complete susceptibility (100%) to β-lactams, tetracyclines, aminoglycosides, amphenicols, glycopeptides, lincosamides, and quinolones. The overall susceptibility rate across antibiotic classes was 97.5%. Macrolides exhibited low activity (0.0-58.0%), consistent with known limitations against Gram-negative bacteria. No ESBL production was detected phenotypically, and RT-PCR screening found no resistance genes (vanA/B, mecA, tem, ctx-M-1, shv, oxa, imp, kpc, ndm, etc.). Conclusions: These findings confirm a lack of resistance to key antibiotic classes in historical Y. pestis isolates from Kazakhstan. Despite the absence of recent human cases, ongoing epizootics among wild animals highlight a persistent risk of transmission. This study, conducted for the first time in Kazakhstan, has important implications for public health preparedness and clinical management during plague outbreaks.

Abstract: The Semipalatinsk Nuclear Test Site (SNTS) in Kazakhstan was the site of extensive nuclear testing during the Soviet era, leading to long-term environmental contamination and potential health effects for exposed populations. Aim: Analysis of existing studies on radiation dosimetry and health effects of radiation exposure in the affected regions. Search strategy: Relevant literature was identified through searches in PubMed, Scopus, and Web of Science databases. The search covered studies published up to January 2025 using the following key terms: “Semipalatinsk nuclear test site”, “radiation exposure”, “biodosimetry”, “transgenerational effects”, and “radiation-induced mutations”. No date or language restrictions were applied at the search stage. A total of 74 records were initially retrieved. After duplicate removal, 70 articles were screened based on title and abstract. The full text of 45 articles was reviewed for eligibility, and 39 publications were selected based on their relevance to the objectives of this review. Results: The article discusses key biodosimetric methods, including electron paramagnetic resonance (EPR), fluorescence in situ hybridization (FISH), and glycophorin A (GPA) assays, which have been used to estimate radiation exposure. Studies indicate increased mutation rates, potential transgenerational effects, and a heightened risk of oncological diseases among exposed populations. Despite decades of research, uncertainties remain regarding radiation exposure's long-term genetic and epigenetic consequences. Conclusions: This review highlights the necessity for further investigations using advanced molecular techniques to clarify the impact of radiation on future generations and improve radioprotection strategies. Введение:Семипалатинский ядерный полигон (СЯП) в Казахстане был местом обширных ядерных испытаний в советский период, что привело к длительному загрязнению окружающей среды и потенциальным последствиям для здоровья подвергшихся облучению групп населения. Цель.Анализ существующих исследований по радиационной дозиметрии и последствиям облучения для здоровья в затронутых регионах. Стратегия поиска:Актуальная литература была найдена посредством поиска в базах данных PubMed, Scopus и WebofScience. Поиск охватывал публикации до января 2025 года с использованием ключевых слов: «Семипалатинский ядерный полигон», «воздействие радиации», «биодозиметрия», «трансгенерационные эффекты», «мутации, вызванные радиацией». На этапе поиска ограничения по дате и языку не применялись. Всего было отобрано 74 публикации. После удаления дубликатов было проанализировано 70 статей по названию и аннотации. Полный текст 45 публикаций был рассмотрен на предмет соответствия критериям включения, и в итоге 39 статей были включены в обзор. Результаты:В статье рассматриваются ключевые методы биодозиметрии, такие как электронный парамагнитный резонанс (ЭПР), флуоресцентная гибридизация insitu (FISH) и анализ по гликофорину А (GPA), применяемые для оценки уровня радиационного воздействия. Исследования указывают на повышенный уровень мутаций, возможные трансгенерационные эффекты и увеличенный риск онкологических заболеваний у подвергшихся облучению групп населения. Несмотря на десятилетия исследований, остаются нерешённые вопросы о долгосрочных генетических и эпигенетических последствиях радиационного воздействия. Выводы: Настоящий обзор подчеркивает необходимость дальнейших исследований с применением современных молекулярных методов для уточнения влияния радиации на будущие поколения и усовершенствования стратегий радиационной защиты. Кіріспе:Семей ядролық сынақполигоны (СЯСП) —КеңесдәуіріндеҚазақстанаумағындаорналасқанядролықсынақтардыңауқымдыаймағыболып, қоршағанортаныңұзақмерзімділастануынажәнехалықтыңденсаулығынаәсеретуқаупінеалыпкелді. Зерттеудіңмақсаты:зардапшеккенаймақтардағырадиациялықдозиметрияжәнеденсаулыққаәсеріжөніндегіғылымизерттеулердіталдайды. Іздеу стратегиясы:Қатыстыәдебиеттер PubMed, Scopus және Web of Science дерекқорларындаізделді. Іздеу 2025 жылдыңқаңтарынадейінжарияланғанеңбектердіқамтыды. Қолданылғаннегізгісөздер: «Семейядролықсынақполигоны», «радиацияәсері», «биодозиметрия», «ұрпаққаберілетінәсерлер», «радиацияменшақырылғанмутациялар». Іздеубарысындажарияланғануақытыментілібойыншашектеуқолданылғанжоқ. Барлығы 74 мақалатабылып, қайталанатындарыалыныптасталғансоң 70 мақалатақырыбыменаңдатпасыбойыншасарапталды. Толықмәтіндішолунәтижесінде 45 мақалақаралып, 39 мақалаосышолуғаенгізілді. Нәтижелер:Мақаладарадиациялықәсердібағалауғаарналғаннегізгібиодозиметриялықәдістер—электрондықпарамагниттікрезонанс (ЭПР), флуоресцентті in situ гибридизациясы (FISH), жәнегликофорин A (GPA) сынақтарыталданады. Зерттеулермутацияжиілігініңжоғарылауы, ықтималұрпақаралықәсерлержәнеонкологиялықауруларқаупініңартқанынкөрсетеді. Ондағанжылдарғасозылғанзерттеулергеқарамастан, радиацияныңұзақмерзімдігенетикалықжәнеэпигенетикалықәсерлерітуралысұрақтарашықкүйіндеқалыпотыр. Қорытынды:Бұлшолурадиацияныңболашақұрпаққаәсеріннақтылаужәнерадиациялыққауіпсіздікстратегияларынжетілдіруүшінзаманауимолекулалықәдістерменқосымшазерттеулержүргізудіңөзектілігінкөрсетеді.

A National Immunization Technical Advisory Group (NITAG) provides independent guidance to Ministries of Health (MoH) and policymakers, enabling them to make informed decisions on national immunization policies and practices. As of 2022, 50 of the 53 countries in the World Health Organization (WHO) European Region (the Region) had established a NITAG, with 58% of all NITAGs and 66% of those in middle-income countries (MICs) in the Region meeting all six WHO process indicators of NITAG functionality. However, many newly established NITAGs in MICs in the Region experience challenges in terms of their functioning, structure, and outputs. To address these challenges and achieve the goal of evidence-informed decision making on immunizations, the WHO Regional Office for Europe and the Robert Koch Institute (RKI) implemented a project to strengthen the functioning of MIC NITAGs of the Region through comprehensive evaluations of nine NITAGs and development and implementation of improvement plans. All evaluated NITAGs are formally established and complete the most important aspects of NITAG functioning. The main challenge for all NITAGs is the lack of a well-staffed Secretariat to establish annual workplans and develop NITAG recommendations following a standardized process. The evaluation identified NITAGs' strengths and challenges. Some challenges have been addressed through improvement plan implementation. WHO and RKI will continue to evaluate NITAGs and support development and implementation of improvement plans. WHO and NITAG partners will continue to provide training on the standardized recommendation-making process and advocate increased MoH support to NITAGs, including dedicated Secretariat staff.

BackgroundThe recent announcement of the next WHO State of the World’s Nursing and Midwifery Reports calls for a review of the state of nursing and midwifery worldwide. In the WHO European region, a broad set of health system reforms have been introduced in Central Asian countries (CACs), namely, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Tajikistan, Turkmenistan and the Republic of Uzbekistan. These reforms have become the focus of a series of sub-regional policy dialogs between CACs, led by government chief nursing and midwifery officers, to accelerate the implementation of a package of policies to strengthen the capacity of nurses and midwives and build health system resilience. This study reviews the current state of nursing and midwifery capacity and documents future actions that can be taken in CACs.Case presentationA systematic approach was used to describe trends, capacity and gaps in CACs’ education, practice, regulation, leadership, and working conditions of nurses and midwives. Currently, CACs face challenges in increasing the level, quality and evidence-base of nursing and midwifery education, require efforts to expand the role of nurses, with emphasis on PHC and particular attention is required to decent working conditions, including fair income and security in the workplace. The GCNMOs have demonstrated experience in the oversight of both workforces and require support for effective work in making policies. To build health systems resilience in CACs through nursing and midwifery, a strategic package of evidence-informed actions that addresses education, practice, regulation, leadership, and working conditions of nurses and midwives is suggested for the period up to 2030.ConclusionsCurrent educational reforms and curricular development, combined with innovations in clinical practice and working environment can be pursued to foster better access to quality of care, enhance workplace satisfaction and improve recruitment and retention of nurses and midwives. However, to fully achieve this, CACs will require increased institutional capacity; strengthened data for nursing and midwifery planning in the context of health workforce policy and health priorities, and financial and non-financial investment in the nursing and midwifery workforce.

The paper presents the results of determining the optimal immunising dose of inactivated vaccine against camelpox from the strain "KM - 40", obtained from the Republican Depository of especially dangerous pathogens of the Research Institute of Biological Safety Problems. The results of studies showed that intramuscular administration of inactivated vaccine against camelpox on camel rats formed antibodies to camelpox virus, the titre of which depended on the dose of the preparation. At 14 days after vaccination no antibodies were detected in the blood serum of camels immunised with the vaccine in the volumes of 2.0 and 3.0 ml, whereas in animals immunised in the volume of 5.0 ml the antibody titre was 1:2 and 1:4 in the neutralisation reaction and diffusion precipitation reaction, respectively. For use in the field, we recommend the use of 5.0 ml vaccine. If all the requirements specified in the regulations on vaccine production and control are met, this dose of the vaccine preparation ensures the formation of intense immunity against camelpox.

We measured the levels of bacterial endotoxins in the bulk vaccine product (BVP) and finished vaccine QazCovid-in® and evaluated the effect of aluminum hydroxide (adjuvant) on the results of LAL test and pyrogenicity of samples in vivo (in rabbits receiving intravenous injection into the marginal ear vein). Administration of BVP with LPS resulted in a dose-dependent increase in body temperature in rabbits similar to that caused by LPS alone, which suggests that aluminum hydroxide in the vaccine did not affect the pyrogenic response in rabbits. Moreover, the LAL test showed that the aluminum hydroxide did not hinder LPS activity after serial dilution of samples.

HIV incidence and mortality are increasing in Eastern Europe and Central Asia and are concentrated in people who inject drugs. Maintenance with opioid agonist therapies (OAT) like methadone or buprenorphine is the best treatment for opioid use disorder and a key HIV-prevention strategy in the region. In Kazakhstan, the scale-up of methadone has been minimal since methadone’s introduction in 2008 and has been supported through international charitable organizations. As the Republic of Kazakhstan is designated to assume financial and administrative oversight of OAT, legislative gains can ensure treatment continuity and scale-up. Here, we review legislative barriers to OAT scale-up in Kazakhstan using an implementation science lens. We review legislative, political, and cultural barriers that undermine the efficient distribution and allocation of medications and impose burdensome clinical and administrative demands on patients and clinicians. Legislative reform is required to support further OAT expansion. We therefore provide policy recommendations to overcome these barriers to increase access to this life-saving, life-prolonging, evidence-based medical treatment. Minimally, these include increased numbers of clinical sites and patients at these sites; re-engineering OAT delivery across the country and directly to patients; introducing newer formulations of OAT; and creating an open bidding process to procure treatment medications.

IntroductionThe COVID-19 pandemic negatively influenced the availability of tuberculosis (TB) services, such as detection, diagnosis and treatment, around the world, including Kazakhstan. We set out to estimate the COVID-19 pandemic influence on TB treatment outcomes by comparing outcomes among people starting treatment before the pandemic (2018–2019) and during the pandemic (2020–2021) and to determine risk factors associated with unfavorable outcomes.MethodsWe conducted a retrospective cohort study among all people newly diagnosed with drug-sensitive pulmonary or extrapulmonary TB at least 18 years old who initiated treatment from 2018 to 2021 in Almaty. We abstracted data from the national electronic TB register. Unfavorable treatment outcomes were ineffective treatment, death, loss to follow-up, results not evaluated, and transferred. We used multivariable Poisson regression to calculate adjusted relative risk (aRR) and 95% confidence intervals (95%CI).ResultsAmong 1548 people newly diagnosed with TB during the study period, average age was 43 years (range 18–93) and 52% were male. The number of people initiating treatment was higher before than the pandemic (935 vs. 613, respectively). There was significantly different proportions before compared to during the pandemic for people diagnosed through routine screening (39% vs. 31%, p < 0.001), 60 years and older (16% vs. 22%, p = 0.005), and with diabetes (5% vs. 8%, p = 0.017). There was no difference in the proportion of HIV (8% in both periods). Unfavorable outcomes increased from 11 to 20% during the pandemic (aRR = 1.83; 95% CI: 1.44–2.31). Case fatality rose from 6 to 9% (p = 0.038). Risk factors for unfavorable TB treatment outcomes among all participants were being male (aRR = 1.44, 95%CI = 1.12–1.85), having HIV (aRR = 2.72, 95%CI = 1.99–3.72), having alcohol use disorder (aRR = 2.58, 95%CI = 1.83–3.62) and experiencing homelessness (aRR = 2.94, 95%CI = 1.80–4.80). Protective factors were being 18–39 years old (aRR = 0.33, 95%CI = 0.24–0.44) and 40–59 years old (aRR = 0.56, 95%CI = 0.41–0.75) compared to 60 years old and up.ConclusionCOVID-19 pandemic was associated with unfavorable treatment outcomes for people newly diagnosed with drug-sensitive TB in Almaty, Kazakhstan. People with fewer comorbidities were at increased risk. Results point to the need to maintain continuity of care for persons on TB treatment, especially those at higher risk for poor outcomes during periods of healthcare service disruption.

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