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Epidemiology and Vaccinal Prevention

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Vol 21, No 2 (2022)
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PROBLEM-SOLVING ARTICLE

4-­16 1400
Abstract

Relevance. The ongoing COVID-19 pandemic in the world, which is characterized by a long undulating course, requires an in-depth study of the features of the epidemic process, including the influence of natural, climatic and social factors on it. 
Aim. Compare the intensity of three waves of the COVID-19 pandemic in Russia. To identify the features of the parameters of the COVID-19 pandemic in Russia in the age groups of the population and in the federal districts. 
Materials and methods. Data from the computer database of the Influenza Research Institute and the Stop-coronavirus website were used. 
Results. The construction of the weekly dynamics of COVID-19 made it possible to clarify the start, peak and end dates of each wave in megacities, federal districts and among the population of the Russia. 
Conclusion. In the dynamics of the incidence of COVID-19 in the population of the Russian Federation from March 2020 to September 2021, three waves were detected: I spring-summer wave, II autumn-winter, III spring -summer. All three waves started in megacities, first in Moscow, and spread across federal districts. The rise of morbidity in Russia as a whole began and peaked in the autumn-winter wave later than in the spring-summer waves (immediately after the megacities). The total duration of the epidemic and the period of its development in the autumn-winter wave were longer than in the spring-summer waves. Morbidity, hospitalization and mortality depended on age, and in all three waves were higher among people over 65 years of age. The intensity of COVID-19 in the first spring-summer wave was the lowest. The II autumn-winter wave was the most intense in terms of morbidity, hospitalization rate and mortality in all age groups. The III spring-summer wave in terms of morbidity and hospitalization was less intensive, than the II autumn-winter wave, but there were no significant differences between the mortality rates in the II and III wave hospitalization and fatal outcomes were revealed.

ORIGINAL ARTICLES

17-22 493
Abstract

Relevance. The formation of humoral immunity is one of the most important manifestations of the protective mechanism against an infectious disease. The formation of antibodies with neutralizing activity is a key factor in preventing infection.

Aims. Analysis of the  esults of an ELISA study for the presence of IgM and IgG antibodies to the causative agent of a new coronavirus infection (COVID-19) in the population of the Central Orenburg region.

Materials and methods. Immunoassay of blood serum for the presence of IgM and IgG antibodies using ELISA test by Vectro-Best (Novosibirsk, Russia).

Results and discussion. The analysis revealed the presence of more than half of the cases of seroconversion among the examined individuals. The most surveyed was the group aged 21 to 65 years. The most typical humoral immune response to SARS-CoV-2 has been established, and the age-related characteristics of its formation have been determined. The dependence of the positivity coefficient on the age of the patients was revealed.

Conclusions. According to the results of the study, the formed humoral (collective) immunity to the SARS-CoV-2 virus was registered in more than half of the studied sample.

23­-28 492
Abstract

Relevance. One of the most common opportunistic infections among HIV-infected people is community-acquired pneumonia (CAP).

Aim. To determine the features of the epidemic process of CAP in HIV-infected patients and to study the incidence of infection depending on the level of immunodeficiency and viral load.

Materials and methods. The epidemiological manifestations of the incidence of CAP among HIV-positive and HIV-negative population of Perm Region in 2014–2019 were studied. The incidence of CAP in HIV-infected patients was determined in dependence on the level of immunodeficiency (230 patients) and viral load (132 patients).

Results. The incidence of CAP among HIV-infected in some years exceeds the incidence of HIV-negative residents in 3.9–9.3 times. Other manifestations of the epidemic process of CAP among HIV-positive and HIV-negative patients are similar. The risk group for CAP morbidity among HIV-positive and HIV-negative people are children in their earliest years and people over the age of 60. Urban residents and men become ill more frequently. The subannual dynamics of the epidemic process is characterized by moderate seasonality during the cold period of the year. CAP is most often recorded when CD4 + lymphocytes are less than 200 cells/μl and viral load of 10,000–100,000 copies/ml.

Conclusion. HIV-infected people are at risk group of CAP morbidity. The incidence of CAP in HIV-infected people expands with an increase in immunodeficiency and viral load.

29­-37 888
Abstract

Relevance. Hepatitis B is a global problem of global and Russian public health due to its high prevalence and the possibility of forming a chronic form of the disease with the development of cirrhosis and hepatocellular carcinoma.  

Aims. Assessment of the herd immunity to hepatitis B in the population of the Russian Federation in 2017‒2019.

Materials and methods. The research was carried out at the Central Institute of Epidemiology within the framework of a large-scale program to assess herd immunity to hepatitis B in the population of the Russian Federation. The results of studies for the presence of anti-HBs in various subjects of the Russian Federation in 2017 to 2019, which were performed in accordance with MU 3.1.2943-11, were analyzed. Additionally, as a reference study in 2020, a survey of donors in Moscow (n = 427) was conducted for the presence of anti-HBs. Standard methods of descriptive statistics Microsoft Excel and STATISTICA 12.0 (StatSoft, USA) were used for statistical processing. The mean values were estimated taking into account the 95% confidence interval [95% CI] (according to the Klopper-Pearson method (exact method).

Results. The average annual values of the proportion of persons with protective immunity against hepatitis B for 2017, 2018 and 2019 were 70.03%, 67.95% and 66.36%, respectively. Significant differences were revealed in the average values of the proportion of persons with a protective level of anti-HBs in the Federal Districts (FD): higher than the average Russian indicators were found in the Northwestern (74.2%), Southern (71.0%) and Far Eastern FD (70.7%). In 44 subjects of the Russian Federation during the observation period, the proportion of persons with protective immunity against hepatitis B was less than 60%.

Conclusion. The necessity of optimizing the system of serological monitoring of post-vaccination immunity against hepatitis B is substantiated, which will increase the effectiveness of preventive measures nationwide

38-45 774
Abstract

Relevance. Currently, the study of the combination of natural foci of zoonotic infections has become one of the urgent problems in the field of human infectious pathology, since there is a real possibility of simultaneous or not simultaneous infection of people with two or more natural focal pathogens of different etiologies and the formation of mixed infections in them. Combined lesions are characterized by territorial and morphological structure of the landscape, the presence of common reservoir hosts and types of circulating pathogens (bakterialno-bacterial, bacterial-viral, bacterial, viral, parasitic, etc.). 
Aims. Conduct an analysis of epizootic and epidemic activity of natural foci of tularemia, leptospirosis and hemorrhagic fever with renal syndrome (HFRS) and identify the reasons for the occurrence of mixed infections in humans. 
Materials and methods. To assess the activity of natural foci and to identify epizootics in populations of mouse-like rodents, the materials of long-term epizootological studies in Russia were used. A comprehensive study of rodents captured in the natural foci of the Central Federal District and the Northwestern Federal District for tularemia by serological, molecular genetic and biological methods was carried out. Statistical data on the incidence of tularemia, leptospirosis and HFRS in the territory of the Russian Federation for 2015-2020 are presented. 
Results. The analysis of our own research and literature data allowed us to characterize the combined foci of tularemia, leptospirosis and HFRS as bacterial-viral, according to the degree of combination in the parasitic system of common reservoir hosts, such as common, red, water voles, forest, field and house mice, insectivores. According to the level of combination of the morphological structure of the landscape, the foci belong to steppe, meadow-field, forest and floodplain-swamp, and by type these foci are characterized as infectious geographically combined. The assessment of the epizootic manifestation of foci is determined by the number of natural carriers of infections, isolation of cultures of pathogens, detection of antigen, antibodies or DNA from environmental objects, as well as the recorded incidence of people. The intensity of the circulation of infectious agents in natural foci varies in time and space depending on biotic (number of carriers, abundance of vectors, etc.) and abiotic (temperature, humidity, etc.) environmental factors. Adverse weather conditions (frosts, thaws, etc.), lack of food supply force wild rodents to migrate to populated areas, creating additional risks of human infection. To assess the epizootic manifestation of foci, the volumes of epizootic studies are of great importance, which have been reduced to a minimum and according to their results it is impossible to predict the epidemic manifestation of a particular focal area. The incidence of tularemia, leptospirosis and HFRS in humans depends on the characteristics of human-animal contacts. The epizootological situation and nosological profile in different regions have significant differences, which determines the difference in the risk of human diseases. In recent years, the number of officially registered patients with tularemia and leptospirosis in the Russian Federation is relatively small and ranges from several tens to hundreds of cases. However, the figures of officially registered patients do not reflect the real picture of the incidence of these infections, and to a greater extent indicates not the wellbeing of these nosoforms, but rather the problems of identifying (diagnosing) sick people of a particular infection. The analysis of the incidence of each case of tularemia over the past ten years has allowed to identify mixed-infected patients with pathogens of zoonotic natural focal infections. These are mainly patients with moderate-severe and severe manifestations of the disease with a primary diagnosis (acute respiratory infections, acute respiratory viral infections, purulent lymphadenitis of various localization, angina, chronic pyelonephritis, pneumonia, hepatitis, etc.). Diagnostics is aimed at determining the nosology, clinical form, severity of the condition, detection of complications and indications for treatment. For natural focal infections, information on epizootic and epidemiological examination of the focus of an infectious disease is necessary. The diagnosis is established on the basis of clinical and epidemiological data: a combination of fever and intoxication, determine the relationship of the development of the disease with work and the circumstances in which the patient was. Currently, as a result of the examination of sick people, mixed infections with natural focal infections are increasingly being registered: HFRS + tularemia; tularemia+ leptospirosis; leptospirosis + HFRS; tularemia+ borrelliosis; rickettsiosis +tularemia, etc., the presence of two pathogens of zoonotic infections was detected in the patient during successive studies. It was found that the infection of people occurred in areas enzootic for these infections. It should be remembered that a high-quality comprehensive epizootological examination of focal areas allows you to make a forecast and determine the factors of real epidemiological risk. 
Conclusions. In the epidemiology of any natural focal disease, it is necessary to take into account the presence of combined foci in a particular territory. Lack of experience in the diagnosis of natural focal infections of tularemia, leptospirosis and HFRS often leads to diagnostic errors, and the lack of alertness to their appearance makes it difficult to identify sporadic cases of diseases. Most nosoforms of hemorrhagic fevers lack specific prevention (HFRS among them), therefore it is necessary to strengthen measures aimed at improving the focal areas, i.e. to carry out deratization work in the most active foci near settlements and mass recreation areas of the population. Mixed infection can lead to both activation and suppression of the protective mechanisms of the human body. The exchange of information between medical and veterinary services will make it possible to better organize and carry out comprehensive measures for epizootic and epidemiological surveillance on the territory of natural foci of zoonotic infections. The formation of modern tactics of differential laboratory diagnostics will ensure the identification of mixed-infected patients with natural focal infections.

PRACTICAL ASPECTS OF EPIDEMIOLOGY AND VACCINE PREVENTION

46-58 556
Abstract

Relevance. Employees of a TB facility are a high-risk group for the incidence of COVID-19 due to their involvement in the detection and treatment of a new coronavirus infection, so vaccination of staff should play a significant role in their protection against a new coronavirus infection. 
Aim. Analyze the incidence of COVID-19 in employees of a large TB medical organization in a big city before and after mass immunization with anti-coronavirus vaccines. 
Materials & Methods. An analysis was made of the incidence of a new coronavirus infection COVID-19 among employees of the Moscow Research and Clinical Center for Tuberculosis Control during April 1, 2020–September 30, 2021, considering two periods of nine months in 2020 (2771 employees) and 2021 (2845 employees) and taking into account the data on the implementation of the first and second vaccinations carried out during the study period. Calculation of the average weekly and annual incidence per 1000 employees was carried out taking into account the different time spent by employees "at risk of getting sick". The incidence rate was calculated both for the entire study period as a whole and for weeks of high risk of COVID-19 incidence in the population of Moscow with an indicator of 500 or more per 100,000 population. 
Results. A comparative analysis of the incidence of COVID-19, registered from April 1, 2020 to October 1, 2021, was carried out among the average number of 2808 employees of the leading anti-TB institution in Moscow, taking into account vaccination. During the period under review, a total of 35.5% of employees in the institution fell ill and the annual incidence of staff was 177.4 per 1000 employees. 5.7% [95% CI 4.4–7.4%] of previously ill employees had a recurrence of the disease. Being unvaccinated until September 2020 and limitedly vaccinated until July 2021, the staff of the Center was massively immunized from July to August 2021 – up to 86.0% of the institution's staff by the end of the observation period. Based on the calculation of the weekly number of disease cases and of not yet ill persons among fully vaccinated, vaccinated with one drug, not vaccinated and previously ill, the incidence in these groups was compared, taking into account the time at risk of disease before a new case of COVID-19 was registered. For periods of high monthly incidence of the city's population (above 500 per 100 thousand), the annual notification rate of the unvaccinated was 2.8 times higher than that of the fully vaccinated (408.2 and 144.0 per 1000 people, RR = 2.8 [95% CI: 2.0–4.0]). The notification rate among those vaccinated with only one component of the two-component vaccine was 1.5 times higher than among those who were not vaccinated (271.5 and 409.2 per 1000 people. RR = 1.5 [95% CI: 1.04–2.2]). The probability of getting sick in fully vaccinated people was significantly higher than in those who previous infected with SARS-CoV-2 (144.0 and 78.0 per 1000 people, RR = 1.9 [95% CI: 1.1–3.1]). 
Conclusions. The obvious effectiveness of vaccination has been confirmed, including among the personnel of medical organizations directly involved in the fight against a new coronavirus infection.

59-65 570
Abstract

Relevance. The Irkutsk region belongs to the territories of Russia unfavorable for tuberculosis. The situation in the region is exacerbated by the existence of active tourism and trade and transport contacts with Mongolia, which is a country with a higher burden of TB.
Aims. To assess the applicability of using subtype-specific PCR tests on clinical samples of TB patients to crossborder transmission analysis of the M. tuberculosis. 
Materials and methods. we investigated the cohort of 161 sputum and surgical specimens from newly diagnosed TB patients with a positive molecular genetic test (GeneXpert). The epidemic subtypes of the Beijing genotype (subtypes B0/W148, Central Asian, Asian-African 2) were identified by the method PCR with real-time detection (RT-PCR) with primers and probes of our own design. 
Results. The use of respiratory and surgical specimens with positive results of a molecular genetic test and microscopy makes it possible to differentiate epidemic subtypes of the Beijing genotype in 92.9% of cases. The frequency of detection of the Russian epidemic subtypes Central Asian (45.1%) and B0/W148 (20.3%) in clinical samples does not differ from data strains from the Irkutsk region. The «Mongolian» subtype Asian-African 2 of the Beijing genotype was not identified in the clinical samples in any case. 
Conclusions. The results indicate the applicability of the used tests for rapid monitoring as a stage in the complex of transboundary surveillance of tuberculosis.

66­-73 553
Abstract

Relevance. The environment, represented by many components, can have an unfavorable influence on human health. One of the components of air pollution, a solid-phase aerosol, that interacting with a droplet aerosol released from the mucous membrane of the upper airway of a sick person, forms dispersed structures containing various species of microorganisms. Dust fractions, being a source of microorganisms with a diverse phenotype, can become a useful object of environmental monitoring carried out for preventive purposes. 
Aims. Determination of the possibility of use of the physical phenomenon of light absorption for detection of the pollutions and their quantification on surfaces made from various materials and on environmental objects with unequal conditions of use.
Materials and methods. The surfaces of various materials with natural and artificial contamination in the closed rooms of an educational institution were studied in order to classify the level of their biotic and abiotic contamination based on the analysis of the spectrum of absorbed and reflected radiation registered by the photodiodes of the prototype device. Internal control of the levels of biotic contamination of the examined surfaces was carried out with use of ATP-luminometer and a cultural method. 
Results. The third level classification of the contaminations on the surfaces in public areas: clean, uncertain and dirty was developed on the results of experimental studies with use of «PROBER» test system, expressed in units. Statistically significant differences in the indicators of the test system were confirmed in the study of surfaces with different levels of contamination (p < 0.01) and the correlation of the test system indicators with control measurements of the levels of surface contamination by ATPluminometer (φ * emp = 1.281) and a cultural method.
Conclusions. Physical parameters such as the spectra of absorbed and reflected light and their differences can be used to determine the levels of dust contamination of surfaces in order to assess the safety of the environment for human health.

74­-82 725
Abstract

Relevance. The conceptual task of epidemiological surveillance as part of the sanitary protection of the territory of the Russian Federation (RF) from the importation and spread of diseases that pose a danger to the population at the present stage is to identify potential risks of a sanitary and еpidemic emergency and prompt response if they occur. Epidemic manifestations of diseases caused by new respiratory viruses, in most cases, cause a crisis in public health, which indicates the need for a comprehensive study of the features of their course, determination of criteria for the potential risk of an emergency of an еpidemic nature, which will make it possible to timely organize a complex of anti-epidemic (preventive) measures. 
Aim. Study, systematize and stratify the features of the atypical course of the epidemic process of acute respiratory viral infections caused by new variants of the pathogen in a city with a population of more than one million people. 
Materials and methods. The study used retrospective data on infectious morbidity in different age groups from government reports for the period 2015–2020, data from annual forms No. 2 of the federal state statistical observation for the period 2009–2020. Rospotrebnadzor Administration for the Rostov Region, Center for Hygiene and Epidemiology in the Rostov Region. Statistical data processing was carried out by a generally accepted method. 
Results. The analysis showed that the periods 2009–2010, 2015–2016, 2020–2021 had significant changes in the epidemic process in relation to its typical long-term course with a predominance in the structure of the incidence of ARVI, including influenza and new coronavirus infection, of various age groups for each period, an atypically severe infectious process and an increase in the number of community-acquired pneumonia. Moreover, in the periods 2009–2010, 2015–2016. Influenza A (H1N1) pdm09 virus was dominant in the etiological structure, in 2020–2021 – the causative agent of the new coronavirus infection SARS-CoV-2. Thus, the features of the epidemic (against the backdrop of a pandemic) spread of ARVI in Rostov-on-Don, established as a result of a retrospective analysis, made it possible to differentiate the main-external and internal-risks of the formation of emergencies of an еpidemic nature associated with new respiratory viruses in a city with a population of more than one million people.

83-­90 845
Abstract

Relevance. Sharp instrument injuries among medical workers are a serious health problem in all countries of the world. There is no official registration of needle sticks injuries among medical workers in Russia and this is a problem.

Aim. To assess the knowledge and commitment of nurses about safety procedures (infusion therapy, venipuncture and injections), to identify the frequency of unintentional injections associated with these procedures, their causes, staff awareness of the existence of safe devices.

Materials and methods. A total of 1,189 nurses from 169 Russian cities participated in the study. Among the surveyed nurses, 1109 (93.27%) work only in state institutions and 80 (6.73%) combine work in state and private institutions. The majority (56.52%) had more than 15 years of experience in their specialty, 24.81% had 6-15 years of experience, and 18.67% had 0-5 years of experience. Of those surveyed, 67.03% performed infusions, 75.19% performed venipunctures, and 96.89% performed injections.

Results. In our study the most dangerous procedure was infusion therapy (21.58% of nurses reported needle sticks during the procedure). More than 40% of injuries were caused by the patient movement during the procedure. Health care workers often reported unintentional injections during the disposal phase of infusions and injections (40.70% and 43.31%, respectively), and the most dangerous step being manual disassembly of the stabbing instrument (25.98% and 21.51%, respectively). In 50.63% of nurses, unintentional injections were reported during venipuncture, after removal of the needle from the vein and before disposal. According to the survey results, only two thirds of nurses are informed about the existence of peripheral venous catheters with a needle protection mechanism, safe devices / needles for blood sampling from a vein, and 53.94% are informed about the existence of injection needles with a protection mechanism. Every nurse should know the correct procedure for the procedure and a set of measures in cases of unintentional needle sticks. However, more than 30% of respondents reported that they didn’t receive procedure safety training.

Conclusion. The use of safe devices during infusion therapy, venipuncture and injection would eliminate cases of unintentional injections at the most dangerous stages of these procedures, because of the presence of device protection mechanism, which closes the needle immediately after the procedure and protects the medical worker from further injury.

OVERVIEW

­91­-97 540
Abstract

Relevance. Currently, the development of vaccines against COVID-19, their clinical trials are actively continuing, and the effectiveness of the vaccines used is being analyzed. A very important issue will be how and when to vaccinate patients with various chronic diseases, what are the relative and absolute contraindications for vaccination, how various diseases can affect the effectiveness of vaccination.

Aims. To present an overview of the most significant published materials on the issue of vaccination against COVID19 patients with allergic diseases, as well as the likelihood of developing adverse events of an allergic nature in response to the introduction of the vaccine.

Conclusions. An active study of vaccines, their effectiveness and safety, demonstrates to us the high reliability of these drugs and the absence of high risks of adverse events in comparison with other vaccines. Anaphylactic reactions to the introduction of COVID-19 vaccines are not more common than for any other vaccines used in international medical practice.

98­-107 747
Abstract

Relevance. Currently, there is a significant increase in the combination of infectious and non-infectious pathology. as well as increasing the attention of researchers to this problem. 
The purpose. of this article is to review scientific data on the combination of the new coronavirus infection COVID-19 with infectious and non-infectious pathology and to assess the phenomenon of complex comorbidity in relation to this new infection. Results. It was found that patients 60 years and older - all have complex comorbidity, which increases the risk of death by more than 7 times, and the presence of two or more comorbid diseases in patients compared with patients who had no more than one disease, the risk of death increased by 9 times. 
Conclusion. A high potential of combination with COVID-19 is shown, primarily with tuberculosis, HIV infection, hepatitis B and C, as well as with a large group of opportunistic infections.

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