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Epidemiology and Vaccinal Prevention

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Vol 18, No 3 (2019)
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https://doi.org/10.31631/2073-3046-2019-18-3

PROBLEM-SOLVING ARTICLE

4-12 1926
Abstract

Relevance. Acute upper respiratory infections (AURIs) annually cause enormous economic damage due to the incidence of the working population.

Aim. Identify the features of morbidity with temporary disability (TD) due to AURIs and influenza in Russia and in Moscow.

Materials and methods. A retrospective epidemiological analysis of morbidity with TD due to AURIs and influenza was carried out for the period 2009-2016. Data processing was performed in Microsoft Excel 2013.

Results. For the period 2009-2016 in Russia, the proportion of AURIs is up to 73.6% of cases and 66.6% of days of TD from all diseases of the respiratory system, as the cause of TD. In Moscow, the proportion of AURIs for all diseases of the respiratory system accounts is up to 77.9% of cases and 69.3% of TD days. The average duration of a case of TD due to AURIs is 7.9 days (Russia) and 7.3 days (Moscow), and the average duration of a case of TD due to influenza increased in Russia from 8.5 days (2009) to 9.3 days (2016), and in Moscow from 8.4 days (2009) to 9.1 day (2016).

Conclusions. Annually, on average, 498,440 cases and 4,382,631 days of TD due to diseases of the respiratory system are not counted in Russia.

ORIGINAL ARTICLES

13-21 1644
Abstract

Relevance. Influenza viruses, having an extremely high variability of the genome and significant environmental plasticity, continue to maintain a potential threat to the biological safety of mankind. The purpose Aims of the work is to analyze the features of the epidemic season of2017-2018.

Materials and methods. The collection of data on the incidence and laboratory diagnosis of influenza and ARVI was carried out in the framework of the epidemiological surveillance of the circulation of influenza viruses in the Russian Federation. The observation period was from 40 weeks (october) 2017 to 25 weeks (june) 2018. The typing of the isolates was performed in the reaction of inhibition of hemagglutination activity (HI) according to the standard technique with diagnostic sera to reference and epidemic influenza viruses.

Results and discussion. The article presents the features of the influenza virus circulation n for the period from october 2017 to may 2018 in some territories of Russia, collaborating with D. I. Ivanovsky Institute of Virology. The epidemic season had its own peculiarities: delayed and long-term activity of three influenza viruses, the share participation of which was almost equal, with some dominance of the influenza A(H1N1)pdm09 virus by the end of the season. Morbidity rates for the total population were comparable with the last epidemic season, meantime the morbidity among schoolchildren was higher. The number of hospitalizations and lethal outcomes was lower and mostly was found in patients of 65 years and older. In patients with severe acute respiratory infection (SARI) influenza A(H1N1)pdm09 was detected more frequently (58%). The influenza A(H1N1)pdm09 and A(H3N2) viruses were antigenically similar to strains included in influenza vaccines, at the same time, 96% of the isolated strains of influenza B virus belonged to a different evolutionary line. Epidemic strains were sensitive to neuraminidase inhibitors, except for 5 strains of influenza A(H1N1)pdm09 virus, isolated from pregnant women.

Conclusions. The activity of non- influenza ARI viruses was similar to preliminary epidemic seasons. Recommendations on the influenza vaccines composition for the Northern hemisphere for 2019-2020 season are presented as well.

22-27 1494
Abstract

Relevance. It is now known that toxigenic strains of Corynebacterium diphtheriae are capable not only of adhesion, but also of invasion into epithelial cells of the upper respiratory tract. In addition, Corynebacteria have the ability to form biofilms, as a part of which they can change to some extent their properties (sizes of bacterial cells, antibiotic sensitivity), which can affect their adhesion and invasive properties.

Aims. Identification and comparative analysis of adhesive and invasive activity of typical and biofilm cultures of various toxigenic strains of C. diphtheriae.

Materials & Methods. Abstract adhesive and invasive properties of standard and biop^nochnyh (120- and 720-hour) cultures of toxigenic strains of C. diphtheriae gravis tox + № 665, № 6765, C. diphtheriae mitis tox + № 269, derived from NISC L.A. Tarasevich, strain C. diphtheriae gravis tox +, isolated from patients with a diagnosis of "localized form of diphtheria" bacteriological laboratory FSI «1002 CSSE SNCMD» Ministry of defence of the Russian Federation, C. diphtheriae gravis strain with a “silent" tox-gene provided by the MBUZ “GB № 1 them. ON. Semashko Rostov-on-Don " on culture pharyngeal epithelial carcinoma cells Hep-2.

Results. The identification and comparative analysis of the adhesive and invasive activity of typical an biofilm cultures of various toxigenic strains of C. diphtheriae was carried out. The adhesive and invasive properties of typical and biofilm (120- and 720-hour) cultures of toxigenic C.

diphtheriae strains were studied on the culture of Hep-2 carcinoma cells of the pharyngeal epithelium. The ability to adhere type cultures of all toxigenic strains of corynebacteria increased by the 8th and 18th hours of cultivation, and the dynamics of their invasive properties correlated with adhesion. The most pronounced adhesive-invasive potential was found in the circulating strain of C. diphtheriae gravis tox +. Adhesion processes prevailed over invasion in the C.

diphtheriae gravis tox + strains № 6765, C. diphtheriae gravis with the “silent" tox-gene and C. diphtheriae mitis tox + № 269. When biofilm was formed, adhesion of corynebacterium increased, and invasiveness decreased dramatically. Conclusion All studied toxigenic strains of C. diphtheriae had adhesive and invasive activity. These properties were most pronounced in the circulating strain of C. diphtheriae gravis tox +.

Conclusions. Adhesion and invasion of the causative agent of diphtheria play a significant role in the early stages of the infectious process, whereas subsequently, during the formation of a biofilm, the adhesion of corynebacteria increases and the invasiveness decreases sharply.

28-39 2498
Abstract

Relevance/aims: Multivalent vaccines are crucial in the control of diseases including diphtheria (D), tetanus (T), pertussis (P), polio, hepatitis B (HB), and Haemophilus influenzae type b (Hib [PRP~T]). To evaluate the safety and immunogenicity of a fully liquid, hexavalent DTaP-IPV-HB-PRP~Tvaccine in infants in the Russian Federation.

Materials & methods. Infants (N=100) who had received a standalone HB vaccine within 24 hours after birth and at 1 month of age and a pentavalent (DTaP-IPV/PRP~T) vaccine at 3 and 4.5 months of age were enrolled and received the hexavalent DTaP-IPV-HB-PRP~T vaccine at 6 months of age. Safety was assessed from parental reports and immunogenicity using validated assays.

Results. There were no safety concerns, with 38.0% and 49.0% of participants experiencing ≥ 1 solicited injection site and ≥ 1 solicited systemic reaction within 7 days after vaccination, respectively, and 16.0% reporting an unsolicited adverse event (AE) within 30 days after vaccination. The incidence of each solicited reaction with severity Grade 3 was ≤6.0% and all unsolicited AEs were Grade 1 or 2. Most AEs started ≤ 3 days post-vaccination, were short-lived, and resolved spontaneously. There were no serious AEs. On month post-vaccination 100.0% of participants had antibodies ≥ 10 mIU/ mL for anti-HBs, ≥ 0.01 IU/mL for anti-D and anti-T, ≥8 (1/dil) for anti-polio-1,2, 3, and 97.9% of participants had anti-PRP antibodies ≥ 0.15 gg/ml. For anti-PT and anti-FHA, GMCs were in the expected range.

Conclusion. These results support vaccination with the DTaP-IPV-HB-PRP~T vaccine in the Russian Federation following the recommended national immunization schedule.

40-53 1022
Abstract

Relevance Tularemia - natural focal zoonotic infection occupies an important place in the structure of human infectious pathology. The incidence is associated with natural foci, where there are favorable conditions for the existence of the pathogen, its circulation among rodents and other mammals. Natural foci of tularemia are widespread and are characterized by high environmental plasticity of the pathogen, which has polyhostality, polyvector, a plurality of transmission mechanisms, the duration of preservation of the pathogen in the external environment, especially at low temperatures, as well as the hydrophilicity of the pathogen and the ability to experience adverse conditions in a resting (uncultivated) form. Tularemia is a particularly dangerous infection, is included in the second group of pathogenicity.

Aims. The purpose of this work is to identify the main patterns of functioning and epidemic manifestations of natural foci of tularemia in the far Eastern Federal district (far Eastern Federal district) on the basis of long-term monitoring and using various research methods.

Results, The analysis of the epizootic state and epidemic manifestation of natural foci of tularemia in the territory of the far Eastern Federal district for 2000-2017 shows that the main regularities of the epidemic process remain in the natural foci of this infection. Given the nature of the epidemic manifestations of tularemia, due to different ways of infection, seasonality, vaccination, etc., it is necessary to improve the system of epidemiological surveillance of the state of natural foci of infection and develop a differentiated approach to the prevention of tularemia. The analysis revealed the dynamics of epizootic activity of natural foci of tularemia, confirmed by the release of cultures of the pathogen and positive serological findings of antibodies and antigen, and in recent years, DNA Francisella tularensis in biological objects. For the first time, a retrospective diagnosis of 249 serum tularemia of people living in the regions of the Kamchatka region and the Koryak Autonomous district was made, which made it possible to identify among the local population those who had been ill with tularemia at different times, which indicates the presence of natural foci of this infection. In the Khabarovsk territory and the Amur region, mixed infection of patients with two natural focal infections was revealed: tularemia - hemorrhagic fever with renal syndrome, tularemia - tick rickettsiosis. Thus, there is a possibility of simultaneous or consecutive infection of people with two, and possibly more natural focal infections in combined foci. Eleven years of observation of natural foci of tundra tularemia not subjected to anthropogenic and man-made impact on the island of Wrangel allowed to establish their epizootic activity, which is an epidemic danger for contingents traveling to temporary work in the areas of the island.

Conclusions Analysis of the epidemic manifestations of natural foci of tularemia on the territory of the far Eastern Federal district in recent years has shown that immunization of the population living in enzootic areas for this infection is not carried out in full, and in some subjects is completely absent. Reducing the incidence of tularemia as a result of vaccination does not mean the recovery of natural foci, the potential danger of which continues to persist.

54-59 1221
Abstract

Introduction. The Sverdlovsk region is on the second place among all subjects of the Russian Federation on the level of infestation of the population is HIV. The prevalence of HIV-infected residents of the Sverdlovsk region is 1.6%. This corresponds to a generalized stage of infection. Annually in medical institutions of the Sverdlovsk region up to 4 million patients with HIV infection receive various types of medical care. In these conditions increase the risk of infection employees related to their professional activities.

Aims of this study was to assess the completeness and timeliness of post-exposure antiretroviral therapy to employees in case of accidents with exposure to blood and to determine their professional the risks of infection.

Materials and methods. The study was conducted on the basis of the Sverdlovsk Regional Center for Prevention and Control of AIDS and the Department of epidemiology of the Ural State Medical University. The authors analyzed 1678 strategic messages in an emergency for 2013-2016.

Results. In medical organizations of Sverdlovsk region in 2013 was introduced registration of all emergencies, regardless of the HIV status of the patient. The number of registered accidents was 6.7 ± 0.3 cases per 10 thousand employees. The frequency of emergency situations doctors have1.7 times higher than the average staff and nurses. Among nurses there was a trend to increasing frequency of emergencies, with an annual growth rate of 3.0%. Changes in the frequency of emergency situations, the doctors and nurses are not installed. The authors found considerable variation in the number of accidents according to the official registration and results of the employee survey. The frequency of emergency situations is determined by the profile of the Department, business process, profession, work experience of the employee, day of week and time of day. The number of persons who received chemoprophylaxis during emergency situations, reduced annually. Reasons for the decline were later appeal for help, the failure of prevention and the absence of indications to antiretroviral therapy in low risk of infection. The proportion of doctors who are not receiving antiretroviral treatment was higher than the proportion of paramedical staff and nurses.

Conclusion. The prevention of occupational infections require legal regulation. Preventive actions should be focused on the set in the process of research risks.

PRACTICAL ASPECTS OF EPIDEMIOLOGY AND VACCINE PREVENTION

60-64 1413
Abstract

Relevance. In the structure of the incidence of controlled infections in the Russian Federation, whooping cough takes one of the leading places, and in 2018 there is a two-fold increase in the incidence compared with 2017.

The aim. Determination of the level of postvaccination immunity to pertussis infection in children of Lipetsk aged 3 to 10 years and assessment of the safety of booster vaccination with a combination vaccine against diphtheria and tetanus with acellular pertussis.

Materials and methods. Analysis of the incidence of pertussis and the quality of vaccine prevention according to planned seromonitoring in Lipetsk (2017). 100 patients were vaccinated with a booster dose of Adaсel. The study tested reactogenicity and safety of the vaccine.

Results. There is a relationship between the epidemic process of whooping cough and the short duration of post-vaccination immunity. Epidemiology of whooping cough dictates the need to change the tactics of vaccination, the introduction of repeated revaccination of children and adults using cell-free vaccines.

Conclusions The data obtained confirm the safety and good tolerability of the Adacel vaccine in clinical practice.

 

65-70 1169
Abstract

An integrated approach to maintaining reproductive health includes, among other things, primary prevention of cervical cancer and other diseases associated with the human papillomavirus. Girls 11-14 years old vaccination against human papillomavirus is a priority in the fight against HPV-associated diseases. The purpose of the work is to show the methodology of legal support for the formation and implementation of the HPV vaccine prevention program, which is not included in the National Vaccination Calendar, using the example of the system, institutions and services aimed at protecting the reproductive health of children and adolescents in St. Petersburg.

Materials and methods. Primary specific prophylaxis of HPV-associated diseases was carried out by certified vaccines: bivalent -for protection against HPV types 16 and 18, and tetravalent - for types 6, 11, 16, 18. Information on vaccination was included in the certificate of preventive vaccinations, form No. 156/у- 93 A6. Determining the size of contingents to be vaccinated, taking into account the prevalence of infectious diseases was carried out according to the statistical forms: No. 30 «Information about the medical organization», No. 2 «Information about infectious and parasitic diseases», No. 5 «Information about preventive vaccinations».

Results. From 2012 to 2014, 22,548 girls between the ages of 12 and 14 years of age (13% of the subject) were covered by vaccination; from 2015 to 2018, 13,062 girls (7.5% of the subject) were covered. First of all, girls who are on full state support and are at risk (from families with an oncologic history) were vaccinated. From 2015, young woman under 17 years old began to be vaccinated. The planned coverage in 2019 will be 9.2% of the population to be immunized. All vaccinated were patients of children's city polyclinics.

Conclusion. The world practice of using vaccination against oncogenic viruses has proven its effectiveness against human papillomavirus infection. Before deciding on the inclusion of vaccines against HPV infection in the National Schedule of Vaccines, the health authorities of the constituent entities of the Russian Federation should actively look for opportunities to form and implement regional vaccination programs. We have shown one of the possible ways. The current favorable conditions for the development of maternal and child health services contribute to the inclusion of vaccination against HPV infection in the immunization schedules of the constituent entities of the Russian Federation.

71-81 1201
Abstract

Background. The epidemiological situation in the Astrakhan region indicates the activation of the natural foci of the Crimean-Congo hemorrhagic fever (CCHF), due to a sharp increase in carriers and guardians of the CCHF pathogen, Hyalomma marginatum, on both farm animals and in open biotopes. Natural conditions in combination with human activities (animal husbandry, crop production) and the lack of anti-tick measures create a favorable environment for the population of vectors and, therefore, for the circulation of the CCHF virus.

Aim - identification of features of ecological and epidemiological manifestations of the CCHF in the Astrakhan region in 2000-2016.

Results. The state of the natural foci of CCHF was monitored, which is endemic and the most severely occurring natural focal disease of arbovirus etiology in the Astrakhan region, preserving the tendency to expand the range. For the analyzed period from 2000 to 2016.151 cases of CCHF were registered in the Astrakhan region, the average long-term incidence rate of the population was 0.88 ± 0.2 per 100 ths of the population. The disease is registered in all districts of the region and the city of Astrakhan, but the largest number is noted in the floodplain-delta regions, where there are favorable conditions for grazing cattle. There is a clear connection between the infection and certain landscapes, where the necessary set of conditions for the circulation of the pathogen is provided.

NASCI INFORMATION

84-88 1541
Abstract

Relevance Epidemiological safety in maternity houses is an essential component of ensuring the quality of medical care. Epidemiological monitoring is a modern technology to identify the potential risk of healthcare-associated infections.

Aims The effectiveness of epidemiological monitoring in the system of healthcare-associated infections (HAIs) prevention was performed.

Materials & Methods, 1188 newborns in maternity house were under epidemiological observation. The effectiveness of epidemiological monitoring was assessed according to the criteria: 1) identification of the risk of developing HAIs at the time of its occurrence; 2) identification and removal of the source of risk before the development of cases HAIs; 3) the absence HAIs associated with the identified risk; 4) the absence of the pathogen in the hospital environment. A total of 25 suspected factors of transmission were studied. A total of 1234 swab from hospital environment objects, 267 sterility samples of materials, and 27 samples infant formula feeding were studied.

Results, During the period of prospective epidemiological observation, colonization Pseudomonas aeruginosa of intestine without any clinical signs of infection was detected in 14 newborns for 14 days, the colonization rate was 22.73 per 1000 infants [95% CI 14.26-31.20]. As a factor, liquid soap for hand hygiene was found contaminated during the manufacturing process. The elimination of the transmission factor prevented infection and the development of cases of HAIs.

Conclusions. Epidemiological monitoring allowed identification of the risk of HAIs, removal of the source of the risk, to prevent of formation and distribution of a hospital clone of bacteria.

89-97 1189
Abstract

Relevance Acute respiratory infections (ARI) are a serious health problem. Pregnant women are patients with risk factors for the development of severe/complicated course of ARI and influenza.

Aims To review the literature on epidemiological features and problems of diagnosis of ARI and influenza in modern obstetrics.

Conclusions. The review showed indicators of the incidence of acute respiratory diseases (ARI) among infectious diseases, described the specificity of ARI in pregnant women, risk factors for severe influenza and secondary complications among pregnant women, a comparative analysis of modern approaches used for the diagnosis of ARI. There is an urgent need to create a comprehensive diagnostic test panel adapted for use in obstetrics.

98-104 1689
Abstract

Background. The problem of preterm labor is currently the most relevant in modern obstetrics, and therefore requires a comprehensive study and application of an integrated approach to its solution. The identification of risk factors for the development of preterm labor, as well as their complex in a pregnant woman, makes it possible to attribute them to a high risk group for the development of preterm labor, which further makes t possible to carry out a number of preventive measures.

Aims. The purpose of the study was to identify and test the hypothesis of the relationship between various risk factors and the development of preterm labor.

Materials and methods. A retrospective descriptive-estimated selective scientific epidemiological study was conducted according tostatistical reporting forms for the period from 2012 to 2016. The study of the causal relationship of risk factors with the occurrence of preterm labor was carried out using a casecontrol analytical study and calculating the odds ratio (OR) with 95% confidence intervals (CI) using the «Epi InfoTM» program.

Results and conclusions. The study period was characterized by minor changes in the rate of preterm labor in the Nizhny Novgorod region. The average long-term figure was 5.0%. The level of preterm birth in the Nizhny Novgorod region was 1.3 times higher than in the Russian Federation. The role of the following risk factors in the occurrence of preterm labor was revealed: a history of 2 or more medical abortions (OR 5.09), inflammatory diseases of the pelvic organs (OR 3.15), menstrual disorders (OR 3.38), and arterial hypertension (OR 2,4), MARS (OR 2,07), varicose veins disease (OR 3,08), cervico-vaginal infection (OR 5,33), other infectious and inflammatory diseases (OR 9,2).

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