SERIES OF COVID-19 OUTBREAKS IN SEVERAL SETTLEMENTS OF MANGISTAU REGION OF THE REPUBLIC OF KAZAKHSTAN

2017. P. 35-9. Available from: http://www.mz.gov.kz/sites/ default/fi les/pages/sbornik_2017_ 10 Forma 12. Otchet o chisle zabolevaniy, zaregistrirovannykh v rayone obsluzhivaniya meditsinskoy organizatsii i kontingentakh bol'nykh, sostoyashchikh pod dispansernym nablyudeniem 2012 god – 2016 gg. [Form 12. Report on the number of diseases registered in the service area of the medical organization and the contingents of patients who are under dispensary observation 2012 – 2016]. Moscow; MEDInform. Available from: http:// www.medinfo.kz 11 Nasonov EL, editor. Revmatologiya. Klinicheskie rekomendatsii [Rheumatology. Clinical guidelines]. Moscow: GEOTAR Media; 2017. P. 113 12 Kalunian K, Merrill JT. New directions in the treatment of systemic lupus erythematosus. Curr. Med. Res. Opin. 2009;25(6):1501-14 (In Russ.) https://doi.org/10.1185/ 13 Rahman A, Isenberg DA. Systemic lupus erythematosus. N. Engl.J. Med. 2008;28;358(9):929-39. doi: 10.1056/ NEJMra071297. 14 Balabanova RM, Erdes SF. The incidence and prevalence of rheumatic diseases in. Russia in 2012–2013. Nauchnoprakticheskaya revmatologiya = Rheumatology Science and Practice. 2015; 2(53): 120-124 (In Russ.) 14 Балабанова Р.М., Эрдес Ш.Ф. Распространенность ревматических заболеваний в России в 2012-2013 гг. // Научно-практическая ревматология. – 2015. – No2 (53). – С. 120-124


ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ
OVID-19 is a severe disease, which mainly affects respiratory system and causes lung failure [1]. The etiological agent of COVID-19 has been confirmed as a novel coronavirus, now known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is most likely originated from zoonotic coronaviruses, like SARS-CoV, which emerged in 2002 [2]. The virus belongs to the order Nidovirales, family Coronaviridae, subfamily Orthocoronavirinae, the subgenus Sarbecovirus of the genus Betacoronavirus [3]. The global incidence of COVID-19 has increased dramatically: by April 2020 it has affected 85,403 patients in 57 countries/territories and has caused 2,924 deaths in 9 countries [4]. So, national healthcare systems are facing the contagion with the need of immediate emergency response.
The first cases of COVID-19 in Kazakhstan were registered on March 13, 2020 in the cities of Almaty and Nur-Sultan. These cases were imported from Germany and Italy [5]. From March 20, confirmed cases of COVID-2019 began to be registered in other regions of the country [5]. The vast majority of symptomatic patients had mild disease, and the proportion of patients with moderate disease was about 10% [6]. Between March 13 and September 30, 2020, a total of 107,979 laboratory confirmed cases of COVID-19 were registered in Kazakhstan. Of them 8,518 (7.8%) cases occurred in healthcare workers (own data).
This study aims to describe epidemiological characteristics of the COVID-19 outbreaks in five settlements of Beyneu and Karakiya districts of Mangistau region of the Republic of Kazakhstan.

Study design C C
A descriptive cross-sectional study was carried out in Mangistau region for the period from 31 May 2020 till 06 June 2020 to investigate the epidemiological characteristics of several COVID-19 outbreaks, and to assess the effectiveness of intervention implemented.
Case definition and case-finding Case-finding and field epidemiological investigation was conducted among all households in the target area; we used diagnostic criteria and case definitions for COVID-19 from the National Clinical Protocol, 7th edition, that corresponds to the WHO case definitions of 27 February 2020.

STUDY SITE
Mangistau region (province) is located in the south-west of Kazakhstan, to the east of the Caspian Sea on the Mangyshlak plateau (Mangistau). The administrative center is the city of Aktau, an international seaport. Mangistau region is an industrial region, 25% of Kazakhstan's oil is produced here. There are seven administrative territories in the oblast: two cities, five rayons (districts). The population of Mangistau region as of 01 January 2020 is 707,329 people, including 247,446 children under 14 years old.

HEALTH ORGANIZATION ORIGINAL INVESTIGATIONS
The mean age of cases was 49.0 ± 19.2 SD. The main risk groups for COVID-19 were non-working people (16.9 %), workers of Tenigizchevroil Company (TCO; 10.2 %), including catering staff (2.3 %), medical workers (10.5 %) and retirees (7.3 %). All identified catering workers were employees of the Caspian Food Company and were located at the TCO Company's Kalamkas oil field at the time the COVID-19 outbreak began ( Table 1).
Analysis of a COVID-19 daily timeline in Mangistau region shown that there were two incidence increases: from April 29 to May 17, 2020 and from May 28 to June 4, 2020 (Figure 2).
The COVID-19 incidence increase in the period from April 29 to May 17, 2020 was due to residents of the village of Senek and the town of Zhanaozen had contact with a previously identified COVID-19 patient in the village of Senek, Karakiyanskiy districts, during the funeral with the Muslim ritual of Sadaqah that led to mass people contamination.
The incidence increase in the period from May 28 to June 4, 2020 was associated with the identification of COVID-19 cases at the Kalamkas and Zhetybai oil fields. In the same period there were COVID-19 outbreaks in the villages of Beyneu and Borankul.
Thus, from April to June, five outbreaks were detected in Mangistau region: in Beineuskiy rayon (villages of Beineu and Borankul), in Karakiyansky rayon (village of Senek) and in the oil fields Kalamkas and Zhetibay.
Description of the outbreaks is given below.

Outbreak 1. Senek village (April 27-29, Karakiyanskiy districts)
The first two cases of coronavirus infection were reported on April 27, 2020. As mentioned above, we established that on April 12, 2020, the village residents participated in the funeral and had contact with the confirmed case of COVID-19. During the epidemiological investigation, we identified 143 contacts, including 36 close contacts. Between April 28 and 29, 13 of the

ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ
contacts were ill with COVID-19, including two cases in the city of Zhanaozen and 11 cases in the village of Senek.

Outbreak 2. The village of Beineu (May 4-17, Beineuskiy districts)
The index case was a local nurse in the village of Beineu. She was registered as a confirmed case on May 6, 2020 and had 49 contacts. Six of them showed positive results on COVID-19. From May 8 to May 11, 2020, when examining 88 people who had contact with these six patients, another 22 cases of COV-ID-19 were revealed. Subsequently, in the village we identified a total of 40 patients. Of these, 18 (45%) were medical workers, who subsequently became a source of infection for 26 (65%) patients with COVID-19. One woman, a medical worker, had contact with the index case at home, and then, from April 6 to May 4, 2020, she took part in the duty at the checkpoint where employees of the Tengiz oil field arrived, which subsequently became ill with COVID-19.

Outbreak 3. The village of Borankul (May 6-20, Beineuskiy districts)
The index case was registered on May 6, 2020. We identified 10 contact persons, of which two were his relatives and two contacts at work. Among the contacts, four had a positive test for COVID-19. On May 7, 2020, another case was registered, which had contact with 23 persons, among whom seven COVID-19 cases were identified. The next patient was identified on May 15, 2020 among workers who arrived from the Tengiz oil field. A total of 24 cases of COVID-19 were identified in the village. It should be noted that 20 of 24 patients were identified during the examination of a provisional hospital. Of the total number of cases, clinical symptoms were present in only 10 patients.

Outbreaks 4 and 5 Kalamkas and Zhetibay oil fields (15 May -06 June, Mangistau districts)
Index case, resident of Aqtau. At the Kalamkas field, he worked in the Capital Construction Department. From May 15, 2020, she was in the rotational camp. During work in the period from May 24 to May 25, 2020, the case developed catarrhal manifestations (sore throat, mild cough). Self-medicated, she did not seek medical help. The case was identified and isolated only on May 29, 2020 after a work day during a medical examination (thermometry); the diagnosis of COVID-19 was confirmed by PCR. Were identified her contacts (171 employees); in 17 cases COVID-19 was diagnosed. Due to the free movement of workers between camps, an outbreak was subsequently recorded at the Zhetibay field.

DISCUSSION
The main reason for the spread of the disease was overcrowding and cross-contact between oilfield workers, which influenced the registration of outbreaks among workers in field camps. The active movement of workers between camps, the involvement of medical workers with no experience in using PPE to work at checkpoints and local hospitals, as well as the presence of a confirmed case of COVID-19 at funerals where participants did not use respiratory protection also influenced the spread of infection.

CONCLUSIONS
This article describes the epidemiologic features of the outbreak series in five settlements located in the oil production zone of Mangistau region of Kazakhstan during May -June of 2020. An exponential increase in numbers of COVID-19 patients in Beyneu districts appeared to be caused by exposure among the members of in canteens and dormitories for shift workers in oil-producing areas with the additional communityand hospital-transmission.