The Doctrine for the prevention of healthсare-associated Infections (HAIs) is a declaration of the state policy in the field of epidemiological safety of medical care. This is a system of views and provisions that establishes the direction of prevention of HAIs, the ways and forms of their implementation. The presence of a deeply developed doctrine makes it possible to have a basis for decision-making. According to the conclusion of experts from the World Health Organization, no type of healthcare settings in any country can claim to be free from the risk of HAIs. Four key provisions underpin the risk-based approach: 1. The risk of HAIs in a healthcare settings always exists; 2. The risk of HAIs is determined by the degree of aggression and invasion, the epidemiological safety of the medical technologies used, the properties of pathogens and the conditions of the hospital environment; 3. The need to move from assessing and managing the epidemiological situation by morbidity to assessing the potential risk, risk management and risk-oriented prevention technologies; 4. Epidemiological safety is an integral part of ensuring the quality and safety of medical care.

Aim to study antibacterial activity of benzydamine hydrochloride, against clinic isolated of bacteria, located in hospitals in Russia and compare this data to results of similar trail of Spanish isolates.

Materials  and  method  for this study were used clinical isolates  of bacteria,  which are counted as typical agents  of infections in otorhinolaryngology and gynecology. Enterococcus spp., Escherichia coli, Klebsiella pneumoniae, Staphylococcus spp. and Streptococcus  spp.,  isolated from patients  in Russians  hospitals;  reference  strains  Escherichia coli, Staphylococcus  aureus and Streptococcus agalactiae, from ATCC collection; and also, Lactobacillus acidophilus strain, isolated from probiotic drug «Lactobacterin». Antibacterial activity of benzydamine hydrochloride was evaluated with serial dilution method in agar. For comparison of results we used data of Spanish study of benzydamine activity against clinical isolates and reference strains. The Spanish Study was completed in microbiological department of San-Pau hospital in Barcelona in 2001.

Results.  It was indicated that minimum inhibitory concentration (MIC) of benzydamine hydrochloride for clinical isolates of gram-negative and gram-positive  bacteria, isolated from Russian and Spanish hospitals is about the same level: for E. coli it was 640 – 1280  mg/l, for K. pneumoniae  – 512–1280  mg/l, for S. aureus  – 256–1280  mg/l, for S. agalactiae  – 320–1280  mg/l, for S. pyogenes – 256–640 mg/l, for E. faecalis – 512 mg/l, for E. faecium – 256 mg/l, for S. mitis – 640 mg/l, for S. epidermidis 320 – 1280 mg/l, for S. pneumoniae  –  40 mg/l, for S. viridans  –  40 mg/l. The same data was obtained by assessment of sensitivity to benzydamine hydrochloride reference-strains from ATCC collection: for E. coli MIC was 512 – 640 mg/l, for S. aureus – 512 – 640 mg/l, for S. agalactiae – 320 mg/l, for S. pneumoniae – 640 mg/l. Probiotic strain L. acidophilus was resistant to benzydamine hydrochloride activity with MIC = 20000 mg/l. Conclusion: It was indicated that antimicrobial activity of benzydamine hydrochloride against clinical strains, isolated from the patients of hospitals in Russia and Spain. Also, resistance of probiotic strain of lactobacteria was detected to this drug, which indicates the possibility of benzydamine hydrochloride application in clinical practice in otorhinolaryngology  and gynecology without risk of negative influence on normal lactobacterial flora.

Although incidence of invasive meningococcal disease (IMD) in the Russian Federation is low, children younger 15 years of age are significantly affected. Serogroups A, B, and C are frequently implicated. The quadrivalent meningococcal diphtheria toxoid conjugate vaccine (MenACWY-D) is approved in Russia for immunization of individuals 9 months to 55 years of age. Goals. We evaluated the safety of a single dose of MenACWY-D administered to individuals 2–55 years of age in routine clinical practice in the Russian Federation. Materials and Methods. Using diary cards filled by participants or their parents, this prospective multicenter observational study quantified the occurrence of solicited injection site and systemic reactions up to 7 days after vaccination as well as unsolicited non-serious adverse events (AEs), and serious adverse events (SAEs) for 28 days. Results. The systemicrate of solicited injection site and systemic reactions during the 7-day observation period was 52.0% (95% CI: 41.8; 62.2). Rates of solicited injection site reactions and systemic reactions of any severity were 49% (95% CI: 38.9; 59.2) and 20% (95% CI: 12.7; 29.2), respectively. The rate of unsolicited AEs was 9% (95% CI: 4.2; 16.4). Rates of solicited grade 3 injection site and systemic reactions ranged between 1–3% and 0–1%, respectively. There were no unsolicited adverse reactions (ARs), SAEs, or deaths. Conclusions. These findings  corroborate  those  of pre-licensure  and post-registration studies  and confirm  the safety  and good tolerability of MenACWY-D when used in routine clinical practice in individuals 2–55 years of age in the Russian Federation.

To assess the relationship between the incidence of influenza and RS, Corona, Metapneumo, Adeno, Paragripp, Rhino and Boca-viral infections, a correlation analysis of cases of influenza and each infection in the age groups of 24 cities of the Russian Federation was carried out. The age structure of infections had significant differences. Among the adult population, influenza was more often detected, more than A(H1N1)pdm09 (61.4%), and ARVI of no influenza etiology – among children 0–2 years, especially Boca-viral and RS-viral (72.5% and 62.8%) infections. The proportion of adults was higher than children aged 3–6 years, with Corona, Rhino and Paragripp infections. The pronounced winter-spring season of influenza was confirmed. RS, Corona and Metapneumo viral infection had a shift at the spring, and Adeno, Paragripp, Boca and Rhino-viral infections – in the autumn. A direct positive correlation between the incidence of influenza in the population as a whole and RS, Corona, Metapneumo, Adeno and Paragripp was shown, but there was no significant correlation with Rhino and Bocaviral infections. The correlation between the adult population and influenza was higher (strong – in RS) and was detected earlier than in children. The duration of correlation with influenza depended on the etiology of ARVI, influenza etiology and age.

This review analyzes the methodological reasons for the heterogeneity of the results of the evaluation of the epidemiological effectiveness of vaccine prophylaxis of tick-borne encephalitis (TBE) using indicators such as the efficiency coefficient (COEF) and the efficiency index (IEF), and their discrepancy  with similar indicators of the immunological effectiveness  of vaccines. It is shown that the calculation of COEF and IEF according to official statistical reporting is illegal in connection with the emergence of systematic errors of selection due to the impossibility of retrospective formation of compared groups of vaccinated and unvaccinated, comparable in risk of infection and disease. In addition, COEF and IEF do not allow to compare the efficiency of vaccination in different areas in physical and monetary units. Based on the analysis of the literature data on immunogenicity of modern vaccines against TBE, protective titer of antibodies and results of field tests of vaccine efficacy in the conditions of total coverage of the population with vaccinations, the authors conclude that the third generation vaccines against TBE protect against disease 95-98% of persons attacked by ticks. Algorithm for calculating the number of preventable cases of TBE diseases is proposed for a comparative evaluation of the effectiveness of vaccination as an anti-epidemic measure in different areas.

Background. More than 4,000 cases of acute disease in humans were reported during the mass Q fever outbreak in the Netherlands in 2007–2010. The Coxiella burnetii NL3262 strain was isolated during this outbreak from an aborted placenta of a goat and was studied using means of molecular biology and bioinformation techniques. Goals. Approbation of a new bioinformatics approach – formal order analysis – to study the origin of the strains that caused a massive outbreak of Q fever in the Netherlands using the C. burnetii NL3262 strain. Methodology. New tools of the formal order analysis (FOA) «Map of Genes» and «Matrix of Similarity» (available at http://foarlab. org) were used in this work to study the degree of similarity of the genome (chromosome, plasmid) of this strain with the genomes of other strains of C. burnetii. The nucleotide sequences of the chromosomes of 10 C. burnetii strains and 8 plasmids were loaded from GenBank: www.ncbi.nlm.nih.gov/genome. Results. The map of genes data showed that the chromosome of NL3262 strain significantly distanced from the chromosome of other strains by the characteristic of the average remoteness of nucleotides in the chromosome (g) that ranged from 1.448295 (for Dugway 5J108-111) to 1.448865 1.449640 (for CbRSA331). This may be due to the presence of 106 copies of the «transposase family IS110» gene associated with the growth of virulence, while in the chromosomes of other strains their number ranged only from 1 to 48. The similarity matrix showed that 84.9% of C. burnetii NL3262  chromosome components had complete (100%) homology with chromosome components of strain Z3055. The percentage of similar components ranged from 12.06 to 47.14 for chromosomes of other strains. Plasmids of the pQpH1 type of strains NL3262 and RSA 331 contained 50.0% of components with complete homology. For the same type of plasmids of strain RSA 493 and its clones, the index varied from 28.89 to 29.89%, and for plasmids of other types it was from 5.56 to 6.74%. It is shown that the chromosomes of strains NL3262  and Z3055 have the highest percentage of components with complete homology. However, by the g index, chromosomes of these strains are significantly distanced from each other, due to the large number of copies of IS110 in the chromosome of strain NL3262, which caused the formation of 21 collinear blocks. This led to a change in the properties of the Q fever outbreak strains in the Netherlands and the increase in their epidemiological significance, which caused the largest outbreak in the history of the study of this infection. Conclusions. The results of the study, obtained on the basis of the application of formal order analysis, made it possible to make an assumption about the origin of the strains of Q fever in the Netherlands in 2007–2010.  It is shown that the leading reason in the reorganization of the C. burnetii genome is the adaptation of the microorganism to a new ecological niche.

Relevance.The urgency of the problem of non-polio enterovirus infection is determined by the wide spread of pathogens, the occurrence of outbreak of morbidity, polymorphism of clinical manifestations and the lack of specific prophylaxis. Most often non-polio enterovirus infection is asymptomatic. Clinically expressed  forms can be serous meningitis, herpetic sore throat, eczematous fever, vesicular pharyngitis, gastroenteritis,  epidemic myalgia (pleurodynia), tonsillitis, myocarditis, pericarditis, hemorrhagic conjunctivitis, uveitis, etc. The aim of the work is a comparative evaluation of the epidemic process  manifestations and the leading factors of serous meningitis (SM)  pathogens,  enterovirus  etiology herpetic angina  (HA) transmission  and enterovirus  etiology gastroenteritis  (GE). Materials  and  methods. Manifestations of the epidemic process of SM and HA were studied according to the official registration of the incidence of the population of Perm for the 2010–2017.  In conditions of analytical «case-control»  method the epidemiological survey of 350 epidemiological focuses of SM and 142 focuses of HA and 61 focuses of GE were conducted.  Results. According to official registration data, the incidence rates of NEVI in the population of Perm during the last 7 years (2010–2017) ranged from 0.3 to 21.5, averaging 5.4 per 100 thousand population. There were mainly three clinical forms registered - serous meningitis, herpetic sore throat, gastroenteritis, the proportion of which was 45.3; 36.6 and 12.4%, respectively. The findings clearly demonstrate that it is similarity between epidemic process manifestations of SM, HA and enterovirus etiology gastroenteritis. Conclusion. In both clinical variants of enterovirus infection the priority role is the water way of transmission of the pathogen by drinking water from centralized and decentralized sources of water system, as well as swimming in surface water.

Approaches  to the prevention of surgical site infections (SSI) in pediatric surgery is an extrapolation of data obtained mainly from studies in the adult surgical patients. In Russia, data on the actual incidence of SSI in pediatric surgery are almost nonexistent. It is known that one of the reasons for the low effectiveness of SSI prevention is a weak system of epidemiological surveillance, which leads to an underestimation of risk factors and the urgency of the problem. A number of preventive measures aimed at preventing of SSI have shown efficacy in adult surgical patients. One of the leading position belongs to antimicrobial prophylaxis. The study was conducted in St. Petersburg State Children's city hospital № 19 named after K. A. Rauhfus. The data were obtained during a retrospective and prospective epidemiological surveillance among patients of surgical units.

It has been shown that SSIs in children have high morbidity. The effectiveness of detecting the real incidence of SSI depends on the methods of epidemiological surveillance: 3.8 per 100 surgeries using standard approaches of surveillance and 11.6 using specially developed forms of active epidemiological surveillance. The incidence of SSI varied depending on the type of surgical unit: 3.8 per 100 surgeries in the traumatology unit, 7.1 in the neurosurgical unit and 15.3 in the general surgery unit. In the etiologic structure, S. aureus predominates (46.5%), E. coli (22.2%) and S. epidermidis (16.7%) were respectively in the second and third positions. It has been shown that antimicrobial prophylaxis is an effective measure for prevention of SSI in pediatric surgery (the odds ratio OR in the case-control study was 0.52 (95% CI = 0.3–0.8)).

High  incidence  of  endocrine  and  uroandrologic  disorders  among  children  and  adolescents  results  in  negative  reproductive potential in the future. These disorders include obesity, diabetes, thyroid disease (autoimmune thyroiditis, hypothyroidism), delayed puberty, cryptorchidism and varicocele. Despite a wide variety of studies on the problem of infertility, information about risk factors of reproductively significant pathology is currently of limited. Purpose. The aim of the present study was to evaluate the risk factors for reproductively  significant endocrine  and uroandrologic  diseases  in children and adolescents  in St. Petersburg.  Materials and methods. A questionnaire survey of 1 456 parents of children and adolescents was conducted during the period from 2015 to 2017. Results and discussion. It was found that a history of rubella was associated with diabetes mellitus in girls (OR 2.7, CI 1.3–5.5). Risk factors related to the parents’ health were thyroid pathology (2.7; 1.3-5.5), obesity (8.4; 2.5–27.7), varicose veins of mother (5.0; 1.8–14.0), cardiovascular diseases of father (28.7; 3.4–237.6). Insulin-independent diabetes mellitus of close relatives (grandparents) was associated with obesity (3.5; 1.8–6.8) and type 1 diabetes mellitus (6.8; 3.8–12.7) in boys. Toxicosis (2.5; 1.4–4.6), risk of pregnancy termination (2.8; 1.4–5.8), bleeding (5.1; 3.2–1.9), miscarriages (3.3; 1.2–8.9), birth of children less than 2 years apart (2.7; 1.1–6.9), birth weight less than 2 kg (5.7; 1.2–26.5)  or more than 4 kg (5.1; 2.1–12.4)  were found to be risk factors for reproductive significant diseases. There was a relationship between artificial nutrition and obesity in the group of boys (6.5; 2.2–19.0).  The study also revealed that smoking (3.4; 1.6–7.3) and alcohol (2.1; 1.2-3.8)  were risk factors. The use of diapers older than 1 year was a risk factor for cryptorchidism and varicocele (2.8; 1.4–5.6).

Background. Plague is a dangerous natural-focal bacterial disease that can cause emergencies of interstate significance. In 2014–2016, three bubonic plague cases were registered among local residents in the Republic Altai. This circumstance was the reason for implementation of complex preventive measures. Comprehensive studies of the immune status of humans vaccinated (revaccinated) with live plague vaccine are presented in this paper. These people constantly reside and work at the territory of Gorno-Altai  high-mountain natural plague focus. Methodology. The study of the clinical material (blood) from 60 volunteers included the determination of the functional activity of phagocytic cells, the production of IFN-γ, IL-4 and TNF-α  cytokines, the titre of specific IgG anti-bodies to the capsular antigen of the plague microbe and the concentrations of the main classes of immunoglobulins in blood serum by enzyme immunoassay,  as well as immunophenotyping  of blood lymphocytes through flow cytometry and the de-termination  of the alleles of HLA class II genes by a polymerase chain reaction. Results. The materials of these studies made it possible to determine a number of important parameters indicative of the cellular and humoral immunity activation in humans immunized against plague. Frequently occurring alleles of the HLA-DRB1, HLA-DQB1 and HLA-DQA1 genes were defined. Possible associations of these alleles with the levels of TNF-α  and IL-4 production, as well as with the relative content of T-helpers  and CD3-CD16+ cells were revealed. Conclusions. The obtained results indicate the immune reconstruction of the humans immunized against the plague. The immunological efficiency and safety of live plague vaccine were confirmed during the exacerbation of the epidemiological situation in active natural plague focus. Nevertheless, further immunological monitoring is necessary to fully characterize the immunological reactivity of the humans vaccinated (revaccinated) with live plague vaccine, and to improve the strategy for specific plague prevention in natural foci.

Against the backdrop of mass parenteral immunization by present pertussis vaccines the incidence rate of pertussis is recorded in many countries, as well as among adolescents and adults, according to the World Health Organisation data. The number of cases of pertussis complicated to detect is increased, meaning atypical forms and inapparent bacteria carrying. In the presence of appearance of Bordetella pertussis strains of «new» genotype the efficacy of current pertussis vaccines is decreased. Existing epidemiologic situation cries out for development of new, more efficient pertussis vaccines and  improvement of immunization methods and schedules. The most promising for this problem solution are live pertussis vaccines, constructed with genetic engineering methods.

The goal  of  present  research  is studying  of  toxicity  and  safety  of  innovative  recombinant  live pertussis  vaccine  for  intranasal administration in animals.

Obtained results demonstrate the absence of specific toxicity of candidate vaccine and its use safety in intranasal applying.