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Epidemiology and Vaccinal Prevention

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Vol 17, No 3 (2018)
View or download the full issue PDF (Russian)
https://doi.org/10.31631/2073-3046-2018-17-3

PROBLEM-SOLVING ARTICLE

4-18 3108
Abstract

The history of polio vaccines and their use illustrates the concept of evolution of vaccines driven by changing epidemiological and socioeconomic conditions. The development of two vaccines against poliomyelitis – inactivated Salk vaccine (IPV) and live oral Sabin vaccine (OPV) – is among the most consequential achievements of prophylactic medicine of the past century. Each with their own strengths and weaknesses, they were used over the past 50 years in different settings and different regimens and combinations. This resulted in virtual elimination of the disease in almost the entire world with the exception of a few countries. Continuation of the eradication campaign coordinated by WHO may soon result in complete cessation of wild poliovirus transmission, and poliovirus may join smallpox virus in the club of extinct pathogens. However, unlike smallpox vaccination that was stopped after the interruption of virus circulation, vaccination against poliomyelitis will have to continue into the foreseeable future, due to significant differences in the nature and epidemiology of the viruses. This review provides the reasons for the need to maintain high population immunity against polioviruses, makes the case for developing a new generation of polio vaccines, and discusses their desirable properties as well as new vaccine technologies that could be used to create polio vaccines for the post-eradication environment.

ORIGINAL ARTICLES

19-26 1011
Abstract

Study results of IgG to diphtheria and tetanus in 785 residents aged from 1 to 76 years old from different regions of the Republic of Belarus (in 2017) in long-term (since 1996) immunization schedule: at 3, 4, 5 and at 18 months old – DTP vaccine, at 6 years old – DT, at 11 years old – Diphtheria toxoid, at 16 years old, 26 years old and every following 10 years –Td or Diphtheria toxoid are presented. The antibody concentration was measured by Virion/Serion kits (Germany) and evaluated in accordance with the international standard: less than 0.01 IU/ml – individual is susceptible, 0.01–0.09 IU/ml – levels of antitoxin giving some degree of protection, 0.1 – < 1 IU/ml – protective level of circulating antitoxin, ≥ 1.0 IU/ml – a level of antitoxin giving long-term protection. It was shown that the proportion of immune individuals against diphtheria and tetanus (with antibodies ≥ 0.01 IU/ml) was 96.7% (CI 95.4 ÷ 97.9) and 99.5% (CI 99.0 ÷ 100,0), respectively, and was quite high in all the population age groups – from 87.7 to 100% for diphtheria and from 96.5 to 100% for tetanus. In seropositive individuals IgG were presented mainly in protective and highly protective (≥ 0.1 IU/ml) titers: for diphtheria 93.7% – in 1–14 years old; 88.7% – in 15–19 years old; 78.4% – in 20–76 years old and for tetanus 100.0% – in 1–14 years old; 100.0% – in 15–19 years old; 99.3% – in 20–76 years old. Comparison of the current and previous studies results (in 1989–1994 – during the outbreak of diphtheria, in 1998–2001 – after the mass immunization campaign, in 2004 – in the context of continuous single cases of diphtheria registration in adults) had shown that the data of 2017 demonstrated the highest population immunity level to diphtheria and to tetanus in the last 30 years of observation.

27-31 1051
Abstract

The descriptive retrospective epidemiological study of Acinetobacter spp. cases in healthcare units was performed in Kemerovo regions (2012–2016). Total 113967 outcomes of treatment were studied and 1742 Acinetobacter spp. were identified. The incidence of Acinetobacter spp. was 15.29 per 1000 patients, the share of this pathogens was 1.32%. Frequency of Acinetobacter spp. cases in adults was 2.15 times higher than in children, χ2 = 105.609, p = 0.000. We revealed a trend to decrease the incidence of Acinetobacter spp. (the average growth rate is 53.7%, the average growth rate is 46.3%, y = -2.054x + 21.346, R² = 0.8692) during the long-term period (2012–2016). Acinetobacter spp. prevalence differed in 28.5 times from 2.55 to 72.16 per 1,000 patients, p = 0,000. Patients of neurosurgical units were under the highest infection risk. The Acinetobacter spp. incidence in the intensive care units was 34.84 per 1000 patients. Among all the isolated Acinetobacter spp. 46% of the strains were resistant to carbapenems (7.12 per 1000 patients), while for the units with a high risk of infection it reached to 19.0 per1000 patients (p = 0,000).

32-37 752
Abstract

Mutual relations of Yersinia pestis and fleas are a necessary condition to estimation the role of carriers in maintenance of the causative agent circulation. Objective – the comparative analysis of frequency of «conglomerate» and «block» formations by Y. pestis in fleas parasitizing on the main and minor carriers in the Tuva natural focus. Materials and methods. Results of experiments with representatives of eight genera of Siphonaptera order and Y. pestis subsp. pestis from the Tuva focus were analyzed. Mammals with various epizootological roles in the focus were used as flea fooders. Frequency of «block» and bacterial «conglomerate» formations and death of the infected insects was estimated. Results and discussion. The highest level of block formation was observed in Citellophilus tesquorum altaicus, Frontopsylla elatoides, Neopsylla mana, Oropsylla alaskensis, Rhadinopsylla li transbaicalica – parasites of the basic carrier (Spermophilus undulates). Formation of «conglomerates» was more often revealed in F. hetera, Paradoxopsyllus scalonae, P. scorodumovi, P. dashidorzhii, Amphipsylla primaris – ectoparasites of the minor carriers (Ochotona pallasi, Alticola strelzovi). Positive connection between frequency of Y. pestis conglomerate formations in fleas and their death rate was detected. Maximal death rate of the carrier was observed at high degree of Y. pestis aggregation. It was supposed that fleas of the basic carrier participated in a greater degree in Y. pestis distribution and ectoparasites of the secondary carriers – in its persistence.

38-50 996
Abstract

Relevance. In 2005 International Health Regulations, the plague, is on the list of dangerous infectious diseases that can cause emergency situations of interstate importance. Even single cases of human plague are considered as the basis for carrying out preventive measures. The paper presents the results of immunological monitoring conducted on the territory of the Republic of Kalmykia in order to assess the immunological efficacy and safety of the plague live vaccine The paper presents the results of immunological monitoring in the territory of the Kalmyk Republic over the individuals vaccinated against plague due to epidemiological reasons. Materials and methods. Studies of immunological efficacy of live plague vaccine were conducted alongside stepwise assessment of cellular and humoral components of innate and adaptive immunity in persons revaccinated against plague, using a complex of advanced informative tests. Results and conclusions. It is established that before the second revaccination all the surveyed persons retained expressed immune response by the mixed or cellular type, characterized by high level of spontaneous and induced production of Th1-associated cytokines. Activation of Th1 immune reaction was registered one month after the scheduled revaccination; immune response change-over from Th1 to Th2 type – after 6 months of observation, and retention of adaptive immunity by mixed type at the moderate level – in a year. Specific humoral immunity developed in 85% of the surveyed persons, but throughout the whole investigation the dynamics of antibody titers to plague microbe F1 individualized and did not coincide with cellular immunity indicators. Performed complex study has confirmed the relative safety of the live plague vaccine.

51-56 874
Abstract

The use of lyophilization as a means of preserving commercial properties of the dried live plague vaccine is closely linked to a number ofresistant microbial cells surviving in the preparation after microbial population exposure to such stress action. Lyophilized live vaccine efficiency, even without violation of storage rules at low temperatures (4 ± 2 – 6 ± 2 оС), decreases gradually due to death of live cells of microorganisms forming the base of a vaccine. Aim: The aim of this study was to enhance resistance of the reference vaccine strain Yersinia pestis EV of NIIEG lineage to freeze-drying in vacuum (lyophilization) by different techniques: the use of lyophilization process per se as a selection factor, resistant clone selection from populations of strains which underwent single, double and triple lyophiliation, strain culturing at low temperatures (4 ± 2 – 6 ± 2 °С). Summary and conclusion: It was demonstrated that after double and triple lyophilization the Y. pestis EV strain resistance to the process increased by 3–3.5 times. Clonal selection of twice and three times lyophilized variant facilitated detection of resistant clones and stabilization of this property.The clones selected were characterized by increased immunogenicity, high heat stability, as well as by increased duration of vaccine efficiency (by 2.3 times). A psychrophilic variant of Y. pestis EV strain was obtained in vitro acquiring higher resistance to lyophilization (in 2 times or more) in comparison with the reference strain. The number of psychrophilic variant cells surviving post-liophilization was higher in comparison with the commercial strain. Thus the methods used in this study for selection of strains and clones with the highest resistance to lyophilization from Y. pestis EV reference strain population showed a significant potential for quality improvement of dried live plague vaccine. So, the possibility of receiving of a vaccine of more high quality by means of the ways of selection explained in our work is experimentally confirmed. Effectiveness of these ways creates prerequisites for their use in production of a live plague vaccine.

PRACTICAL ASPECTS OF EPIDEMIOLOGY AND VACCINE PREVENTION

57-62 994
Abstract

In this multicenter double blind randomized clinical study with parallel groups conducted with 612 healthy volunteers, domestic influenza quadrivalent inactivated subunit vaccine Grippol® Quadrivalent safety, tolerability and immunogenicity was evaluated in comparison with seasonal trivalent vaccines, It was demonstrated that quadrivalent influenza vaccine Grippol® Quadrivalent possesses good tolerability, low reactogenicity, and has favorable safety profile similar to that for trivalent comparators. Besides, it was proven that quadrivalent influenza vaccine Grippol® Quadrivalent has same immunogenicity for three conventional strains and significantly exceeds trivalent comparators for missed influenza B strain.

63-67 1234
Abstract

Relevance. Foreign and domestic authors notice that over the past thirty years there has been a significant reduction in the incidence of meningococcal infection, in contrast to bacterial meningitis not meningococcal etiology. S. pneumoniae occupies one of the leading places in the etiological structure of bacterial meningitis in the Russian Federation The purpose is of substantiation of the complex approach to the diagnosis of pneumococcal meningitis in adults, taking into account the clinical and epidemiological features of the disease and highly sensitive laboratory tests Materials and methods. Was conducted a retrospective analysis of 38 case histories of patients who were hospitalized at the Krasnoyarsk Interdistrict Clinical Emergency Hospital named after NS Karpovich with bacterial meningitis during 2015 to 2017. Results. Among those hospitalized with the diagnosis of «bacterial meningitis» the leading role in the etiology of the disease belonged to Streptococcus pneumoniae (55.2%), in other cases: Staphylococcus aureus, Streptococcus spp, fungi of the genus Candida spp., E. coli, Neisseria meningitidis, Cryptococcus spp., Some bacteria were detected in associations with other bacterial species or viruses, in 7.8% cases the pathogen was not detected. Conclusion. Microbiological diagnosis of bacterial meningitis requires the use of a set of methods that include not only microscopic, bacteriological and serological (latex agglutination) studies, but also PCR detection of pathogenic microorganisms in the cerebrospinal fluid, who diagnostic value is 46.4%.

 

68-73 1006
Abstract

Relevance. Rotavirus infection (RVI) is a widespread disease with a high intensity of the epidemic process and variability of its manifestations from sporadic cases of diseases to large outbreaks. At the present stage, RVI remains one of the urgent problems for practical health care, and vaccination is still the only and most effective method of monitoring RVI. To date, the practice has accumulated a great experience of vaccination against RVI, confirmed its high clinical and immunological efficacy. However, in the Sverdlovsk region, no studies have been conducted to assess the epidemiological effectiveness of vaccination against RVI. Goal. To assess the effectiveness and safety of vaccine prophylaxis for rotavirus infection and its impact on the epidemic process of acute intestinal infections in the framework of the regional program of vaccine prevention of RVI in the Sverdlovsk region. Materials and methods. The study was conducted in 2015. Vaccination first year of life children of the against RVI was carried out with live oral pentavalent vaccine (PEPV) in 4 municipalities of the Sverdlovsk region, in which the incidence of RVI exceeded the average regional indices. A special questionnaire was developed to assess the data on vaccination against RVI, which included information on the gender characteristics of the vaccinated, their age, the presence of episodes of acute intestinal infections before, during and after vaccination, combinations of the vaccine against RVI with the introduction of other immunobiological drugs, reactions to Inoculations. A total of 785 questionnaires from medical organizations of 4 cities of the Sverdlovsk region were analyzed. Results. In the «risk territories» 27.3 to 47.0% children from the first year of life were 3 times vaccinated. After the immunization in all territories was a decrease incidences of rotavirus infection, as well as a decrease in the cumulative percentage of infection with RVI in the age group of children under the 1 age. Children vaccinated against RVI had no cases of rotavirus infection, as well as hospitalizations for acute intestinal infections of other etiology, during the entire follow-up period. Conclusions. The data obtained indicate that vaccination against RVI is an effective tool for controlling morbidity. The optimal age for the initiation of immunization against RVI is 2 months of the child's life (8 weeks), which allows to take into account the minimum and maximum terms of vaccine introduction, actively combine vaccinations against RVI with the introduction of other immunobiological drugs of the National schedule of preventive vaccinations and timely complete the vaccination against RVI to 32 weeks of a child's life.

 

74-79 1128
Abstract

The adherence of population and health workers to vaccination is currently one of the most important aspects to achieve high effectiveness of immunization programs. Goal. Study of the attitude of doctors to the need for vaccination. Materials and methods. A survey was conducted on the questions of the attitude to immunization of 512 doctors of different specialties. Results. Analysis of questionnaires has shown that 80% of respondents positive attitude to vaccination. More than 84% of respondents believe that vaccination reduces the incidence, but only 54% noted that they have enough information about it. Even with a positive attitude towards immunization in general, there are different opinions about vaccinations against some infections. More than 90% of the respondents vaccinated their children against diphtheria and tetanus, poliomyelitis. Against measles 88%, tuberculosis 87%, pertussis 85%, hepatitis B 80%, epidemic mumps 77%. The inadequate adherence of doctors to vaccination against influenza (57%), pneumococcal infection (43%), Heamopfilus Influenzae infection (31%) and varicella (29%). Conclusion. The adherence of doctors to immunization is deficient. The reasons for this are a low level of knowledge and a lack of reliable information on vaccination. It is necessary to use all possible variants of informing health workers.

OVERVIEW

80-84 1306
Abstract

Despite the clinical epidemiological, social and economic significance, the problems of sepsis terminology and classification till now are discussed in many respects. Data on sepsisology development as clinical discipline are represented, problems of sepsis terminology evolution, its classification, the matter of septic states are discussed. The importance of formulation of the "sepsis" concept for development of diagnostic criteria, treatment principles and prevention is shown. Special attention is directed to epidemiological manifestations of this pathological syndrome.

 

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ISSN 2073-3046 (Print)
ISSN 2619-0494 (Online)