Relevance. In recent years, in Russia, against the background of a stable high (no less than 95%) coverage of live measles vaccine (GI) inoculations of decreed groups of the population for almost twenty years, increases in morbidity have been registered, reaching the indicators of 3.3(2014) and 3.1 (2019) per 100 ths population and local outbreaks involving the child population. This situation has raised doubts among a number of researchers about the reliability of high vaccination coverage in children and adults. In this regard, some researchers assumed the loss of post-vaccination immunity and suggested revaccination against measles every 10 years for people up to 50 years old. Others suggested serological examination of certain cohorts of the adult population without taking into account the vaccination history for timely detection and vaccination of individuals with primary post-vaccination failures and who have lost post-vaccination immunity. The purpose of the work: to assess the state of population immunity for some manifestations of the epidemic process of measles infection and the feasibility of changing the tactics of vaccination against measles. Materials and methods. The work uses epidemiological operational and retrospective analysis. The research is based on the analysis of official statistics № 2, № 5, № 6, reports of regional centers, «maps of the surveillance of a case of suspected measles...», information and analytical bulletins of the National scientific and methodological center for the supervision of measles and rubella (NNMC). A total of 18,750 documents were analyzed. The average values, the average standard error, the correlation coefficient of the series, the reliability of the correlation coefficient, and the regression coefficient were calculated. Results and discussion. One of the indirect indicators of the state of population immunity is the ratio of vaccinated and not vaccinated against measles in the structure of patients. The analysis showed a steady trend towards the prevalence of cases not vaccinated against measles in the structure: since 2011, more than 70%, and since 2017 – more than 80%. The percentage of vaccinated people is decreasing from 12.8% to 5.4% (2017) and has stabilized in the last 2.5 years at the level of 5.4–7.2%. Over the past 2 years, there has also been some stabilization of the proportion of people twice vaccinated – 9.4–9.8%. Intensive indicators of morbidity confirmed the General trend of extensive indicators. In addition, over the past 3 years, the intensive incidence rate of those vaccinated is 14 times lower than that of those not vaccinated against measles. All this testifies to the lack of accumulation of susceptible individuals due to the loss of post-vaccination immunity and confirms the adequacy of the strategy and tactics of vaccination against measles in our country. The calculation of the regression coefficient showed that with an increase in vaccination coverage of the entire population by one percent, the incidence of measles among unvaccinated people will increase by 1.34 per one hundred thousand unvaccinated people against measles. The prevalence of foci without infection spread (more than 80%) during the analyzed period, and the restriction of secondary measles spread by the second generation of infection reproduction in foci with two or more cases of measles, multiple circulation of genotypes and subtypes of the measles virus also characterizes a fairly high population immunity. Conclusion. The steady predominance of lesions 1 case, limiting secondary spread of infection in outbreaks, the maintenance of the epidemic process of measles through an unvaccinated population indicate adequate tactics and strategy for measles immunization in our country. At the same time, the achieved 74.1% vaccination coverage of the entire population is clearly not enough to prevent sustained endemic transmission of the measles virus, since the reproductive index R<1 can be maintained with vaccination coverage of at least 95%. To increase population immunity, it is necessary to search for new forms of work of pediatricians and therapists with the population to form a commitment to immunization, as well as to legislate responsibility for the consequences of refusing vaccinations, as is done in a number of States.

Relevance. According to the scientific literature in the Russian Federation (RF), over recent years there has been a decrease in the incidence of acute bacterial intestinal infections (AII) and, conversely, an increase in the incidence of AII of viral etiology. The reasons for these trends remain unclear in many respects. Goal. To study the trends in the long-term dynamics of the incidence of AII of bacterial and viral etiology among the population of the RF. Materials and methods. The work uses the materials of state reports of the Federal Service for Supervision of Consumer Rights Protection and Human Well-Being for 2000 - 2018. The incidence rates of bacterial AII (dysentery, salmonellosis, intestinal yersiniosis, Escherichiosis and intestinal infections caused by opportunistic bacteria) and viral AII (rota-, noro-, enterovirus infections), as well as the results of microbiological control of food and drinking water were studied compliance with sanitary regulations. Results. A tendency towards an increase in the incidence of acute intestinal infections with an average annual rate of 1,7% in population of the Russian Federation was revealed. At the same time, there was a decrease in the incidence of bacterial AII with an average annual rate of 3,8% and, conversely, an increase in the incidence of viral AII with an average annual rate of 384,1%. These changes were observed on the back of a decrease of samples` percent of food and drinking water that did not meet sanitary standards for bacteriological indicators, and an expansion of the range of virological methods for diagnosing viral AII. Conclusion. During 2000–2018 revealed a decrease in the incidence of bacterial OCI in the Russian Federation against the background of improved quality of food and drinking water according to microbiological indicators and, on the contrary, a sharp increase in the incidence of viral OCI associated with the expansion of the spectrum and scope of diagnostic virological studies.

Relevance. The spread of the epidemic and resistant Mycobacterium tuberculosis genotypes presents a serious threat to the implementation of the national tuberculosis control program in Russia. The study aimed to assess the trends in the development of the epidemic process of tuberculosis and the prevalence of strains of different sublineages and clusters of the M. tuberculosis Beijing genotype in the Omsk region. Materials & Methods. Following the generally accepted algorithm of descriptive and evaluation epidemiological research, the incidence, prevalence, and mortality from tuberculosis in the Omsk region for the period 2009-2019 were studied. The structure of the M. tuberculosis population in the Omsk region was studied (n = 483). M. tuberculosis culture, drug susceptibility testing, DNA extraction were carried out by standard methods. The M. tuberculosis Beijing genotype and its sublineages and clusters B0/W148 and 94-32 were detected based on the PCR analysis of specific markers. Results. The incidence of tuberculosis decreased by 1.9 times and was 67.3 per100 ths in 2019. The dynamics of tuberculosis prevalence and mortality were also characterized by a pronounced decreasing trend. 65.6% (n = 317) of the isolates belonged to the Beijing genotype, which was represented by strains of ancient (n = 44, 13.9%) and modern (n = 273, 86.1%) sublineages. The latter one included two main clusters: B0/W148 (n = 94, 29.6%) and 94-32 (n = 178, 56.2%). Almost all ancient Beijing strains were MDR (97.7%), and were characterized by extensive drug resistance (XDR) and pre-XDR (52.2% versus 19.4% in modern sublineage (PR = 0.59; [95% CI 0.35÷0, 99]). The high level of clustering of strains of ancient sublineage (CR = 0.84) allows us to consider them as potential epidemics for the Omsk region. Conclusions. Despite the general improvement of the epidemiological situation with tuberculosis in the Omsk region, the circulation of MDR strains of the Beijing B0/W148 cluster and pre-XDR/XDR strains of an ancient sublineage of the Beijing genotype points to the epidemic potential of these M. tuberculosis genovariants and emphasizes the need for their careful monitoring in the epidemiological surveillance system.

Relevance. The development of the HIV epidemic in different parts of the word is accompanied by the dynamics of its manifestations, including a change in the role in epidemics of various routes of transmission, “risky groups” and shifts in the gender structure of morbidity. The study of the epidemic process in dynamics, including the gender indicators of the epidemic, is important for forecasting the epidemic and modernizing prevention strategies. The aim of the study is to assess the gender characteristics of the manifestations of the epidemic process of HIV infection in the Republic of Tatarstan. Materials and methods. A retrospective analysis of the incidence of HIV-infection among women and men in the Republic of Tatarstan (Russia) for the period of 1996–2018 was carried out. We used information from database of AIDS-centre of Tatarstan Republic. Incidence of HIV in association with age, ways of transmission, social status was calculated for men and women separately. We analyzed the role of main transmission routes in different age groups over the entire period of the epidemic (1987–2018). The data is processed in Microsoft Office Excel 2010. Results. Incidence rate of HIV per year in men is higher then in women from 1999 (p < 0,05). In the structure of the adult population's incidence of HIV infection, the proportion of women increased by 2.4 times: from 14.8 ± 0.7% in 2001 to 35.6 ± 1.3% in 2018 (p < 0.001). During the entire follow - up period of 1996-2018, the most common route of getting infection for men was intravenous (68%); most of women (73,3%) got HIV via sexual rout including women, living in areas with the highest prevalence of drug addiction. The proportion of sexual route of HIV-transmission increased from 5.6 ± 0.5% in 2001 to 52.3 ± 1.7% in 2018 for men, and from 23.7 ± 2.2% in 2001 to 84.6 ± 1.7% in 2018 for women (p < 0.001). Dynamic of HIV-epidemic is presented by involvement of older age groups. With age, the proportion of people who were infected via sexual rout increases in both women and men groups. Conclusion. The dynamics of the epidemiological manifestations of HIV infection in the Republic of Tatarstan for the period 1996–2018 has many similarities among women and men: they have unidirectional changes, and the incidence rates decreases for people under 30 years. The incidence rates for men are higher than those for women, however, the development of the epidemic is accompanied by an increase in the proportion of women, for whom, unlike men, regardless of the age and prevalence of drug addiction in the territory the live, the sexual route of infection is predominant.

Relevance. Acinetobacter baumannii is a significant nosocomial pathogen that can cause severe infections, especially in immunocompromised patients. Aims. This study aimed to investigate clonal diversity of A. baumannii isolated from blood culture in hematological patients by random amplified polymorphic DNA assay (RAPD). Materials & Methods. Genotyping of A.baumannii isolated from blood culture in hematological patients in 7 Russian hospitals (2003–2017) was assessed by RAPD-PCR with primer OPA-2 (5’-TGCCGAGCTG-3’). The computer-assisted analysis was performed by using GelJ software by UPGMA method and Dice similarity coefficient for banding patterns comparison. Using a similarity coefficient (SC) of ≥ 65%, the strains were grouped. Based on the similarity coefficient, the strains were determined as genetically related (≥ 80%). Strains had identical RAPD-patterns if the similarity coefficient was 100%. Results. A total of 96 A. baumannii strains were examined, of those 77 (80.2%) were nonsusceptible to carbapenems. Acquired OXA-carbapenemase genes were detected among 79.2% carbapenem non-susceptible strains. RAPD-PCR genotyping revealed 84 RAPD patterns. The four groups (A-D) including 98% strains were defined by similarity coefficient ≥65%. The predominant group A included 58 (60.4%) strains, the C and B groups – had 15 strains (15.6%) each, and the group D – 6 strains (6.3%). A total of 82 (85.4%) genetically related A. baumannii with a similarity coefficient ≥ of 80% were allocated into 20 clusters. Identical RAPD-patterns were defined for 22 strains that belonged to 6 clusters within the group A and 1 cluster within the group B. Strains with identical RAPD-patterns were detected in a single hospital as well as in several hospitals located in different cities. Conclusions. The current study has demonstrated genetic diversity and clonal dissemination of A. baumannii in hematological departments.

Relevance. The Arctic Zone is a territory with very specific characteristics among the following: extreme climatic conditions, low population density, remoteness from industrial centers, and dependence even on insignificant anthropogenic impact. The concentration of natural resources and the focal development of territories leads to an increase of migratory flows. All of these factors influence the morbidity of the population. Aims. The aim of this study was to reveal the difference in the intensity of morbidity in the Arctic zone in comparison with other territories. Materials & Methods. We conducted a comparative retrospective analysis of the incidence of influenza, ARVI, community-acquired pneumonia, pertussis, and meningococcal infection in adults in the Arctic zone of Russia for the period of 2007–2018. Also, we conducted a correlation analysis using the Pearson method. We performed data processing in Microsoft Excel 2019. Results: In the retrospective analysis, the incidence rates ARVI and influenza are significantly higher in the Arctic zone in comparison with other territories. The incidence rate of influenza in the Arctic is comparable with other regions but complications arise more frequently. As much as influenza, ARVI may be more severe. The incidence rates of pertussis and meningococcal infection do not show any significant deviations from the rates in other regions. Conclusion: Thus, higher incidence rates ARVI and influenza were registered in the Arctic. Influenza and ARVI may be more severe.

Relevance. Measles is one of the most contagious infectious viral diseases affecting all age groups and leading to severe complications. There is no specific therapy for measles, but highly effective vaccines are available for specific prevention, both in monoform and in combination. The world is currently experiencing a significant rise in the incidence of measles, which dictates the need to increase coverage with preventive vaccinations. Aims. Show the necessity of using combined drugs for the prevention of measles, rubella, and mumps in non-standard clinical situations and in pregravid preparation. Conclusions. All currently used vaccines, regardless of strain composition, are capable of providing effective protection against wild variants of the measles virus. Combined drugs against measles, rubella, and mumps, have proven their safety and effectiveness for many years of use in the world, including in Russia, and can be used without restrictions. Combined vaccination against measles, rubella, and mumps should be considered as a mandatory measure for additional immunization of citizens who do not have information about revaccination or acceptable confirmation of the immune status, especially as a mandatory element of pre-conceptional preparation of women of childbearing age.

Relevance. The Russian Federation is one of the largest states in the world, includes 85 subjects of the Federation located in two hemispheres of the Earth (Western and Eastern). The geographical location of the country, as well as the differences in territories according to the epidemiological situation, allow each subject, in accordance with the law, to develop regional schedules of vaccination. Aim. To analyze the trends in improving the regional schedule of routine vaccination, as well as to outline the directions of its development. Materials and methods. The analysis of regional schedules of vaccination in different years, including a descriptive stage based on the study of regulatory documents for the period from 2001 to 2019, was carried out. Results. The regional vaccination schedule was first introduced in Moscow in 2001. Infectious diseases against which vaccination was carried out, basically repeated the National calendar. Over time, the Regional Schedule has changed depending on the epidemic and economic situation in the capital. For the period from 2001 to 2019, the calendar had 4 editions - the number of infections against which residents of Moscow are vaccinated increased from 10 infectious diseases to 17. Vaccination schemes also undergo changes: the age of measles and mumps booster vaccination, the tactics of vaccination against viral hepatitis B, the introduction of combined vaccines, as well as changes in composition persons at risk to be vaccinated. The stages of introducing vaccination against rotavirus infection, meningitidis, pertussis, human papillomavirus infection, varicella, viral hepatitis A, pneumococcal infection into the Regional Schedule are described. A brief overview got of the regional schemes of vaccinations in some regions of the Russian Federation. Conclusion. The article describes an almost 20-year history of improving the Regional Schedule of Routine Vaccination in Moscow in the context of the development of the National Schedule of Routine Vaccination of the Russian Federation, as well as in comparison with immunization calendars from other countries of the world and constituent entities of the Russian Federation. Achievements and directions for further improvement of the Regional schedule of preventive vaccinations in the city of Moscow are indicated.

Relevance. The lethal outcomes of HIV infection are determined by secondary diseases, among which tuberculosis and pneumonia take the leading place. Vaccination is an important way to reduce and prevent the development of infectious diseases in both adults and children. Particular attention is paid to children with HIV infection, the incidence of which is much higher in comparison with children without HIV positive status. The purpose of the study was to study the effectiveness of the prevention of lower respiratory tract infections with pneumococcal and influenza vaccines in HIV-infected children. Materials & Methods. The material was data from medical records about HIV-infected children. The research method is visual using retrospective analysis. Results. Immunological indicators and the general health status of HIV-infected children were assessed during their registration with the regional AIDS center. Changes in the immunological status of patients under dynamic observation were described. The timing of vaccination was analyzed and a comparison was made with the development of bacterial diseases in HIV-infected children. Conclusions. A low incidence of bacterial infections and the absence of pneumococcal pneumonia in HIV-infected children were revealed. Vaccination against pneumococcal infection and influenza must be given to all HIV-infected children from the moment they are registered with a regional specialized medical institution.

Relevance. Sexually transmitted infections (STIs) remain an urgent problem in modern society due to the high incidence of morbidity, the development of complications, including cancer, affecting the reproductive health of the population. The purpose of the study is to assess the incidence of sexually transmitted infections in the Republic of Tatarstan, including the incidence of certain nosoforms (syphilis, gonorrhea, trichomoniasis, chlamydial infection anogenital warts and urogenital herpes) in the period 2013–2017. Material and methods. A descriptive epidemiological study was conducted-a retrospective analysis of the incidence of STIs in the Republic of Tatarstan. We analyzed the long-term dynamics of the overall incidence of STIs, as well as for the nosoforms of STIs for the period from 2013 to 2017. The data was processed using Microsoft Excel 2010 and OpenEpi online calculators. Results. There is a statistically significant downward trend in the overall incidence of STIs in Russia, RT, and Kazan in 2013–2017 (p < 0.05). The incidence of STIs is higher in Kazan and the Republic of Tatarstan in comparison with the incidence of the population of the Russian Federation. A statistically significant decrease in the incidence of syphilis, gonorrhea, trichomoniasis, chlamydia, and anogenital warts was detected in 2013–2017 (p < 0.05). Among the nosologies of STIs, anogenital warts have the highest incidence rates (84.8 cases per 100 ths) and occupy the 1st place in the structure of STIs in the Republic of Tatarstan (53.3% in 2017). Conclusion. The long-term dynamics of morbidity is characterized by a statistically significant downward trend in the overall incidence of STIs in the Republic of Tatarstan in 2013–2017. Anogenital warts dominate the structure of STI in the Republic of Tatarstan.

Relevance Тhe Priorities in the field of the state demographic policy of our country are to improve the reproductive health of the population, improve the system of obstetric care and the quality of medical care. An urgent problem is the quality of life of women in the postpartum period after injuries of the soft tissues of the birth canal and the use of obstetric in natural delivery (episiotomy, vacuum extraction of the fetus, the imposition of obstetric forceps, manual placental separation and manual examination of the uterine cavity). High rates of non-communicable complications confirm the need for further study of long-term effects and ways to improve the quality of care for women in the postpartum period. There is insufficient information on the dynamics of health indicators in the postpartum period, on the relationship of violations with various socio-hygienic, behavioral, medical and organizational factors acting in relation to the woman in this period. Obstetric operations and soft tissue injuries of the birth canal are also a risk factor for the development of purulent-septic infections in the postpartum period. For a comprehensive analysis of the factors determining reproductive behavior in women during rehabilitation, it is necessary to assess the effectiveness of measures in the postpartum period, the risks of long-term consequences for women after small obstetric operations. Aims. Summarize the available literary data and present modern views on the problem of the quality of life of women in the postpartum period after obstetric operations with natural delivery. Materials and methods. Analysis of publications on the quality of life in the postpartum period in the databases PUBMED, E-Library, Google Scholar, etc. from 2013 to 2019. The study includes sources in Russian and English, containing information on the frequency of various obstetric benefits for natural delivery, infectious and non-infectious complications after their implementation. Results. Birth canal Injuries (ruptures of the cervix, vaginal walls, perineum and vulva) account for up to 40% of cases [1,2]. Noted that in nulliparous they occur in 73%, while the performance of obstetric benefits (episiotomy, forceps, vacuum extraction) reach 90%. The frequency of perineal ruptures of the III degree ranges from 0.4 to 5% [3]. The frequency of ruptures of the perineum I-II degree does not have an official form of accounting and registration, also refers to injuries of the birth canal. According to official statistics, the frequency of application of vacuum extraction of the fetus in the European countries ranges from 2.8% to 16.7% of the total number of births, and in our country according to the Department of monitoring, analysis and strategic development of health, Ministry of health of the Russian Federation, the frequency of execution of vacumm extraction of the fetus and the imposition of obstetric forceps is the 11.04 and 0.56 per 1000 births. The number of women who have had these situations in childbirth is very high. At this stage, epidemiological monitoring of the postpartum period of women is reduced to monitoring infections in the field of surgery and predictors of the development of the infectious process. However, given the multifactorial nature of the problem, monitoring the quality of life in the postpartum period after these operations remains without due attention. First of all, they note negative changes after obstetric operations, such as a feeling of pain when walking, sitting, lifting weights. Unpleasant sensations in the sutures remain in the postpartum period for 2–3 weeks after discharge. After 3–4 weeks, the feeling of pain is replaced by itching and burning, which also gives discomfort to the woman. The situation is complicated by the lack of women's psychological support in this matter from the doctor. Many patients are afraid to address and ask questions about personal feelings and sexual life at the reception. Sexual dysfunction may be formed after performing obstetric benefits or injuries to the soft tissues of the birth canal, actually should be regarded as maternal morbidity. The introduction of epidemiological surveillance of the psychophysiological state of women after small obstetric operations will allow timely work with patients about the features of the postpartum period, to increase the percentage of satisfaction with the quality of services provided in obstetric institutions. The study of risk factors for the development of non-infectious diseases in women after childbirth allows us to calculate the degree of effectiveness of the planned medical and social measures for the prevention of negative consequences. Conclusions: The Development and implementation of epidemiological surveillance of women who have received obstetric benefits or had soft tissue injuries of the birth canal will allow to form an understanding of the rules and tactics of postpartum management, as well as to improve the quality of life of women during rehabilitation.

Relevance. Q-fever – a natural focal zoonotic disease The area of zoonosis covers all continents of the globe. The reservoirs and vectors of Coxiella burnetii are ixodid ticks and their hosts. This disease is characterized by a variety of mechanisms and ways of transmission of the pathogen to humans and animals (transmissible, alimentary, air-dust). The disease often proceeds as a fever, but the mortality rate can reach 2.8%. Aims of the review is to review the problems of Q fever from its discovery to the present. Conclusions. Despite the long history of the study of Q fever, the clinical diagnosis of cases of the disease causes great difficulties due to the pronounced polymorphism of symptoms. Systematic monitoring to identify the causative agent of Q fever in natural foci will allow timely anti-epidemic measures to ensure biological safety and prevent cases of the disease in humans.

Relevance. Lung transplantation is recognized as a method of treating terminal stages of lung disease when the drug therapy resource has been exhausted. In addition to the lack of material for transplantation, a serious problem of lung transplantation is the low graft survival rate. The main reasons are infections and primary allograft failure. Aims. To consider the current state of the use of vaccine prophylaxis in the integrated management of patients before and after lung transplantation. Conclusions The prevention of respiratory infections in adult candidates for organ transplantation and recipients is recommended and included in many clinical protocols and recommendations, however, they are based mainly on studies performed on healthy individuals, and are poorly supported by the results obtained in the study of individuals who underwent complete internal organ transplantation. Also, the effectiveness of vaccination remains unexplored, taking into account the individual characteristics of the immune system and the state of population immunity in relation to vaccine-preventable infections.