6. ЭПИД. Х-КА ИНФЕКЦИЙ ДЫХ.ru.en

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EPIDEMIOLOGICAL CHARACTERISTICS OF INFECTIONS

RESPIRATORY TRACT
respiratory tract infection in an infectious structure (parasitic) pathologies occupy first place. Among
respiratory infections dominate flu and other SARS, the weight of which exceeds 80-90%.
These infections are easy spread of the pathogen, what

It determines the number of unique features in the manifestations of the epidemic process: speed of the spread
of disease, the age structure of the patients, seasonality, fluctuations in incidence rates over the years, and
others.
respiratory tract infections include anthroponoses. The source of infection It is a sick person, the
carrier. Many respiratory tract infections characterized by infectiousness of patients in the latent period - the
end of incubation. a great danger patients as the source of infection in the prodromal period, much more
than in during the height of the disease.
It unites group respiratory tract infections easily realizable Aspiration pathogen transmission
mechanism, which includes three stages.
The first step - the allocation of the pathogen from the infected organism - carried out during
expiration, speaking, sneezing, coughing. Exciter drops saliva or mucus gets into the environment - namely
air. The second stage - presence of the pathogen in the environment - is realized through the dropping,
drip-nucleolar dust or aerosol phase.
Third stage - penetration of the pathogen into the body susceptible individuals
- It occurs at physiological act of inhalation.
When you exhale, sneezing and talking allocated mainly pathogen, localized in the upper
respiratory tract (mucous membrane of the mouth, nose and throat). When coughing is thrown pathogen
penetrates into the deeper parts of respiratory tract. Depending on the particle size and atomizing
distinguish globular aerosol phase. Atomizing - particle size less than 100 microns, globular - more than 100
microns. aerosol droplets are ejected source infection ellipsoidal projection and located at a distance of 1-2
meters, seldom propagate further. After separation into the environment drops dry out in the next 20
minutes, but at high humidity and low ambient temperature can be stored up to 2 hours. The respiratory
pathogens is generally low stability in the external environment, so during the second step of the
mechanism transmission is their mass death.
Large aerosol droplets accumulate, dry up and turn to dust in the end. The fine aerosol of the Clock
may be suspended and move with the convection currents inside and penetrate its limits through corridors
and air passages, their subsidence is slow.
With convective air currents for cleaning, the movement of people and under the influence of other
factors create a secondary dust aerosol phase. Most important factor of forming dust phase infectious
aerosols is
Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)
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phlegm (e.g., tuberculosis), as well as pathological when the contents additional localization of the
pathogen in the body (eg, brown skin lesions).
In this case, essential in the formation of contaminated dust Patients will have the linen.
The ease and speed of propagation of the pathogen is brought into conditions susceptible to high
levels of collective incidence.
High susceptibility of the population to these infections often lead to manifestation of infection after
the first meeting with the source infection that determines the appearance in organized groups (children
kindergartens, schools, military units) outbreaks, for example, an outbreak of mumps, measles, rubella,
meningococcal disease, and others.
Most Affected age groups - children. Thus in various social and living conditions, age limits may be
ill are not the same: children up to 2 years, 3-5 years Preschoolers, schoolchildren 6 years and older, boys
- technical students, schools, preferably living in dormitories recruits (18-19 years old) who are in barracks.
Seasonal fluctuations in the incidence of infections in the respiratory tract largely determined by
unequal opportunities of communication between people on During the different seasons of the year. Thus,
the formation of the new autumn groups of children and adolescents, their prolonged stay indoors
overcrowded conditions contribute to the activation of the aspiration and transfer mechanism Ascending
incidence in autumn and winter.
A role in the occurrence of diseases in organized groups It belongs to the so-called factor of mixing,
such as the completion of military units due recruits migration processes in particular administrative
territory, which leads to the destabilization of the current immunostruktury and development of epidemic
outbreaks.
A peculiar feature of respiratory tract infections - the frequency, or cyclicality, the epidemic process
when considering its long-term dynamics, resulting in an undulating movement, the alternation of ups and
downs morbidity.
In analyzing the causes of this phenomenon is a direct correlation of its increase or decrease the
number of susceptible to the particular disease among population.
The increase in the share of non-immune, Highly responsive people has consequence increased
incidence, while the accumulation of a large number of non-responders immune individuals naturally leads
to a reduction of morbidity. In conditions natural development of the epidemic process of the interval
between the two, the following friend
successive rises of morbidity determined by the duration formed
postinfection immunity birth and
migration. Internal factor of self-control epidemic Process respiratory infections is infectious and
immunological.
In summary, the process of display of epidemic infections respiratory tract are shown in Scheme
8.1.

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Scheme. 8.1. Epidemic process of respiratory tract infections
Displays of epidemic process
the incidence of type

sporadic epidemic
the outbreak
of a
pandemic
Periodicity (cyclical)
3-5 years or other periods
Seasonality
autumn and winter (winter-spring) Age
sick
Children primarily contingent Factors
influencing incidence
- infectivity of the pathogen
- the age structure of the population at a particular
administrative territory
- childbirth
- migration
- population density
- overcrowded accommodation
- the formation of organized groups
- presence (absence) means vaccination
Anti-epidemic and preventive measures
Control measures for these infections are aimed at three components of the epidemic process.
The complex measures are required and actions is paramount to identify and neutralization of
sources of infection. Early detection and diagnosis of patients - an integral part of the work of district health
staff. However, the presence of widely common carrier, the infectiousness of the patient at the end of the
incubation period, the possibility of the erased, the atypical course of the disease, after treatment patients
with medical care,
difficulties in diagnosis lead to
delay treatment and restrictive measures.

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All of the above leads to the fact that the restrictive measures, taken with regard to the source of
infection may not have a significant impact on the display of epidemic process.
Arrangements for the second link epidemic process - exigeant and not always productive work.
Thus, the use of masks medical personnel, regular airing and cleaning of the premises may somewhat
limited, but not completely interrupt the implementation of the transmission mechanism infectious agent.
With regard to the third level of the epidemic process is carried out complex preventive and
anti-epidemic measures, which include, for example, the introduction of quarantine in hospitals,
cancellation of mass children's activities in the the flu epidemic. Routine immunization through the National
Immunization Schedule and epidemiological indications It seeks to provide immunity to infectious disease
(the formation herd immunity), this means that the main measure of infection control respiratory tract is the
impact on the third link of the epidemic process.
Availability of currently effective vaccines and their rational use allowed

distinguish notion infection manageable means
immunization, e.g. diphtheria, measles, mumps, pertussis and al Infection unmanaged -. infectious
(parasitic) disease, for which there are no effective means and methods of prevention.
surveillance for respiratory tract infections System It includes a complex dynamic observation of the
manifestations of epidemic process: analysis of long-term and intra-morbidity and mortality in different
social and age groups; clinical records manifestations of the infection and the factors contributing to the
spread of infection; tracking the massive circulation of the pathogen population to study its biological
properties; sero-epidemiological studies in order to identify most at risk of the disease with the calculation
of the proportion of refractory to infection; evaluate the effectiveness of vaccination.
Influenza and other acute respiratory viral infections
Urgency problems of acute respiratory diseases (ARD) is determined their ubiquitous, highly
contagious, coming after transferred disease organism allergization recover from a violation immune
status, their influence on overall mortality.
These infections cause considerable social and economic damage. constantly dominated by the flu
in infectious diseases and other acute respiratory infections, the weight of which exceeds 80-90%. In the
Russian Federation are registered annually from 2.3 to 5 thousand. Cases these diseases in terms of 100
thousand. population. Of the total number of cases temporary disability for all illnesses for influenza and
acute respiratory diseases account for 12-14

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%, And the economic damage they cause about 90% of the total damage caused by infectious diseases.
Acute respiratory infections cause pathogens, the number of species which reaches 200. These include
adenosine, paramikso-, corona-, rhino-, rheological, enteroviruses, and as mycoplasma, chlamydia, streptococci,
staphylococci, pneumococci and others. In this the situation seems difficult to develop effective means of
specific the prevention of acute respiratory infections in the foreseeable future.
A common feature characterizing the causative agents of acute respiratory viral diseases, are their
low resistance and a rapid extinction environment.
FLU
From an epidemiological point of view of the total group of acute respiratory infections should be
allocated flu due to its ability to Pandemic proliferation.
Influenza - anthroponotic viral acute infectious disease with aspiration of transmission mechanism.
The causative agent of influenza - an RNA virus of the family Orthomyxoviridae genus
Influenzavirus. By antigenic characteristics distinguish three serological types influenza virus - A, B, C.
To include virus surface antigens hemagglutinin (H) and neuraminidase (N), on which are marked
subtypes of influenza A virus, e.g. H1N1, H3N2.
Unlike viruses of type B and C, characterized by more stable antigenic structure type A virus has
considerable variability surface antigens. It manifests itself either as antigenic "drift" (Partial update
antigenic determinant of hemagglutinin or neuraminidase within a subtype, which is accompanied by the
emergence of new strains of the virus) or as antigenic "shift" (full substitution of a genome fragment
encoding synthesis only hemagglutinin and neuraminidase or hemagglutinin) leading to the emergence of
a new subtype of influenza A viruses
Influenza viruses are unstable in the environment. They are more resistant to low, adverse
temperature and die quickly when heated and boiling. The high sensitivity of the influenza virus to
ultraviolet rays and Effects common disinfectants.
The source of infection with influenza - a sick man. its infectiousness It appears at the end of the
incubation, a few hours before the onset of illness. AT Later in the development of the disease is most
dangerous to the patient first 2-5 days with vigorous isolation of the virus from the upper respiratory tract.
AT rare cases, the period of infectivity can be prolonged until the 10th day of illness. how the source of
infection are the most dangerous patients are mild forms of flu that remain in groups of children and adults,
use public transport, visit the cinema and theater.

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The influenza virus serotype A isolated as pigs, horses, birds that It increases the likelihood of a new
subtype of the virus. Were registered (1999) isolated human cases of influenza A, caused by a virus,
isolated from pigs, but further proliferation of epidemic process not received.
The transmission mechanism influenza virus aspiration; transmission path airborne. During
coughing, sneezing and talking in the air around the patient It creates a "contaminated zone" with a high
concentration of the virus, which is dependent on frequency expiratory acts salivation intensity of the
patient, the particle size spray, air humidity, ambient temperature and in air room. In experiments it was
shown that influenza virus can remain viable in dried saliva,
mucus, sputum, dust but the role

airborne dust transfer path is insignificant pathogen.
the susceptibility of the population new serotypes (subtypes) of influenza virus high.
Postinfectious immunity tipospetsifichen at conserved influenza A 1-3 years, with influenza B - for 3-6
years.
Flu Epidemic process seen sporadic incidence, Outbreaks and epidemics lasting 3-6 weeks.
Periodically there pandemic caused by a new subtype of influenza A virus to which majority of the
population is susceptible.
Seasonal decline during the summer and epidemic rises in the autumn and winter period associated
with the common determinants of seasonal fluctuations the incidence of acute respiratory infections.
Features of the epidemiology of influenza is largely determined unique variability of its surface
antigens of the pathogen - glycoproteins hemagglutinin and neuraminidase.
The degree of antigenic differences determines the latitude and the propagation velocity pathogen,
age structure and morbidity, which is influenced by meteorological
factors hypothermia, morbidity sharp
respiratory infections and socio-economic conditions (communication between people, sanitary and
hygienic conditions in groups of children and adults). During the XX 6 century influenza pandemics
recorded: 1918-1928. - A (HSWINI); 1929-1946 gg. - A (H1N1); 1947-1956 gg. - A (H1N1); 1957- 1967's. -
A (H2N2); 1968-1977 gg. - A (H3N2); 1978 - A (H1N1). Formed the typical path pandemic spread of
influenza viruses related to international transport communications appearing in the area of South-East
Asia and Oceania, new variants of influenza A viruses were recorded first in North America, Europe or
Asia, spreading to other regions, the least striking, As a rule, South America and Africa.
In the northern hemisphere countries with temperate climates flu epidemic occur in November and
March, the southern - in April and October.
The emergence of new antigenic variants of influenza virus leads to growth non-immune disease in
all age groups with the highest defeat children during the first years of life.

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Age composition ill defined level of specific Immunity. Malovospriimchiva influenza in children aged
6 months through passive immunity obtained from the mother. At the age of 6 months to 3 years the
incidence is increasing.
Influenza viruses cause epidemic rise, which often occur after the growth of the epidemic disease
caused by influenza A the background of its recession, which leads to the emergence of two wave
epidemics. The influenza virus C causes sporadic infections in children.
Preventive and anti-epidemic measures

The main strategic direction in the fight against influenza throughout a number of years is
vaccination on epidemiological indicators. Practice Health has now a large range of vaccine preparations:
alive inactivated, chemical, subunit,

Split vaccines. For of receipt epidemiological effect from
vaccination is necessary that the vaccine contained the same types and subtypes virus, which will
determine the epidemic rise in incidence in a particular territory, and others at high risk should be
vaccinated before the season lifting flu.
Table 8.1. The list of drugs, recommended for

nonspecific prevention of influenza and SARS lasts from several hours up to 2 days, and on the testimony
of the use of specific and non-specific funds Protection (circuit 8.2, 8.3).
drug Name scheme application

"Alguire" Polymer shape "rimantadine" Sugar syrup. For children from 1
year
"Amiksin" Adults only! Appointed 1 tablet 1 times a week for 4-6 weeks.
antiviral effect
"Aflubin" Homeopathic medicine. Children from 1 year to 12 years 3-5

drops 2 times a day in a spoonful of water or milk; children
from 12 years and adults on 5-10 drops in pure form or with
water. Course treatment
- 20 days
Vitamins (in the complex) At the age dosages 2-3 times a day, also
infusion (or syrup), rose hips,
currants, raspberries.
Trippferon "(nose drops) For children from 1 year and adults. No contraindications and
side effects Assigned course in September, November and
"Dibazol" January within 10 days of each month 1 time per day. Children
6 years - 0.004; 7-14 years - 0.01; 15 years and above - 0.02
Leukocyte human interferon Children and adults for 20-25 days 0.25 ml in each nostril
"Oxolinic ointment" Children 0.25% ointment 2 times a day - 15-25 days. Adults, 2
times a day 15-25 days

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"Rimantadine" Adults 1 tablet 5 days (lobular prevention) 1 tablet 15-20 days

(Planned prevention) For
"Ribomunil" children sufferers chronic

diseases, often chronically ill ARI. The drug in a single dose
(tablet or 3 sachets of granulate 1) take one time a day from
October to March, according to the scheme: October - the
first 4 day of the week for 3 weeks; next 5 months (November
- March) - the first 4 days of each month homeopathic tablet
formulation sublingual administration. For children from 1 year to
"Sandra" 6 years of 1 tablet (0.25) 4 times per day. Course 5-6 days of
treatment
Herbal
"Eleutherococcus" Tincture of 1-2 drops per year of life 2 times a day, adults -
25-40 drops 2 times day for 14 days
"Echinacea" Tincture 10-20 drops 2 times a day within 14 days
However, the protection only on the flu vaccine and the absence of other viral ARI do not give the
desired effect in the form of a significant reduction in morbidity. At the same time accumulated strong
evidence that there are real ways of influencing the epidemic process of acute respiratory infections. It is
established that the application of chemoprevention using immunomodulators (dibasol, prodigiozan et al.)
among risk groups (schoolchildren 7-14 years, often and long ill) causes a significant reduction in the
incidence of acute respiratory disease population as a whole, resulting in a substantial reduce infections
caused by these socio-economic damage. Scroll
drugs recommended for nonspecific

prevention of influenza and acute respiratory infections are listed in Table. 8.1.
Anti-epidemic measures in the epidemic focus should start with patient isolation. Hospitalized
influenza patients by clinical and only epidemiological indications: children up to 3 years old, the elderly
with underlying diseases, pregnant women, and people living in hostels and boarding schools. AT indoors,
where the patient must be established ventilation,

UV irradiation, regular wet cleaning with disinfectants resources, frequent changes and boiling nasal sick
handkerchiefs, thorough cleaning utensils. A protective role for the surrounding patient perform regularly
exchangeable gauze masks that cover the mouth and nose. Working with contact with the patient includes
monitoring them during the incubation, which
Scheme 8.3. WORK epidemic focus of influenza and other acute respiratory direction and
content of the anti-epidemic measures

The source of infection
The patient - clinical and hospitalization

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epidemiological indications
The transmission mechanism
ventilation
Wet cleaning with disinfectants UV irradiation
boiling utensils, handkerchiefs, towels persons to
communicate with the source of infection
Medical supervision thermometry 2 times a day

early detection and prevention of insulation
patients (indicated) specific nonspecific
Scheme 8.2. PREVENTIVE for influenza and other acute respiratory infections Time, facilities
operation and maintenance work
pre-epidemic period
Population
health education hardening Vaccination
Clinics
staff vaccination
sessions with physicians on the diagnosis and treatment of influenza, acute respiratory
disease of the supplies of disposable masks Hospitals noncommunicable
staff vaccination
sessions with physicians on the diagnosis and treatment of influenza, acute
respiratory disease of the supplies of disposable masks reserve funds to ensure specific
and
nonspecific protection
The period of epidemic rise
Population
health education

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early care-seeking Clinics
expansion of the registry, and additional phones to increase vehicle
increase in the number of doctors for care at home a separate
entrance for the febrile work of the personnel in masks Hospitals
noncommunicable
health education filter for incoming patients

insulator for influenza patients
restriction, prohibition of visits of patients (quarantine) staff work in

masks and ventilation UV irradiation chambers of the use of the
prevention of influenza and acute respiratory disease
DIPHTHERIA
Diphtheria - anthroponotic bacterial acute infectious disease with aspiration of transmission

mechanism.
Diphtheria - toxigenic Corynebacterium. Corynebacterium Diphtheriae genus Corynebacterium (
"stick Leffler ') - Gram-positive coli clavate fixed with thickenings at their ends. According to the culture,
morphological and enzymatic properties differentiate biovar 3: gravis, intermedins, mitis. There toxigenic
strains and nontoxigenic among them. The most common are mitis and gravis.
The serological variants against toxigenic divided into 11 serovars and 21 fagovar. Corynebacterium
diphtheria phage typing is used in Epidemiological practice for examination and decoding foci group
diseases.
Corynebacterium diphtheria have complicated antigenic structure. The main diphtheria feature
pathogenicity of bacteria is the ability to produce exotoxin virulence adhesion is determined, ie. e. the
ability to attach to mucous membranes (or skin), and reproduce.
Diphtheria bacteria have considerable stability in the outer environment. The dust stored up to 2
months, a diphtheria film, drops of saliva on infected household items, they can be stored for 2 Weeks, in
water and milk - 6-20 days in the carcass - about 2 weeks, resistant to freezing. Direct sunlight, high
temperatures and disinfectants solutions for them ruinous.

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The source of the pathogen infection is a person sick or carrier toxigenic Corynebacterium.
According to the massiveness of abjection leading position hold sick with diphtheria. However, most
epidemiological importance patients have atypical clinical forms of diphtheria, as last often not diagnosed
and identified in the later stages. patients recovered diphtheria pathogen throughout the disease,
as well as during
convalescence.
Duration carrier from convalescents of 2-7 weeks; rarely up to 90 days. Significant epidemiological
importance as a source of the pathogen diphtheria have bacillicarriers, which played a leading role in
disseminating
infection at conditions of sporadic morbidity.
Bacteriological observations have shown that in acute inflammatory changes in the nasopharynx and roto
found higher contamination mucosal diphtheria corynebacteria. This provision deals with the sick and
bacillicarriers.
It is found that the greatest danger pose environmental contamination bacillicarriers,

secreting Corynebacterium diphtheria of nose.
Epidemiological risk depends on the duration bacillicarriers abjection.
Distinguish carrier 4 categories: 1-7 days - transient; 7-15 days - short; 15-30 days - the average
length and more than 1 month - protracted. With increasing carrier increases the risk for bystanders. Long
carrier frequency varies in different bands and can be up to 13-29% of the total number of carriers.
The absence of recorded diphtheria bacillicarriers They are the reservoir of infection, while
maintaining the continuity of the epidemic process.
The transmission mechanism Aspiration of the pathogen. transmission path - airborne, transfer
factor - air, in which weighed bacterial aerosol.
Corynebacterium sufficiently stable outside the body. In this regard, possible airborne dust,
contact-household and food (rarely) transmission path. there are descriptions of "food and" dairy
"diphtheria outbreaks.
Susceptibility determined by the state to the antitoxic diphtheria and antimicrobial immunity.
epidemic process diphtheria develops in a planned vaccination, which has made some changes in
its display (Fig.
8.2). In the 60-70-ies of XX century. not recorded periodic upgrades morbidity, so characteristic of the
pre-vaccine period; happened smoothing autumn and winter, the basic form of the infectious process become
carriers of toxigenic bacteria in immune individuals. In Russia as a whole in by creating a high immune
layer among the population incidence It fell to the level of sporadic; manifest forms of the disease are rare,
and carriage preserved everywhere, but its level was low. Against this background,

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late 70-ies started the activation of the epidemic process, covering mainly way the adult population.
During these years, the adults were 82,2-89,1% of the total number of patients diphtheria, while in
1958, for example, their share was 19%. "Grow more mature" diphtheria in the late 70's - early '80s was
due to the low level post-vaccination antitoxic immunity in adults. The main reason this phenomenon were
serious shortcomings in the organization and conduct of vaccinations the population and the consequent
low level of immunity. The spread of diphtheria also contributed to the change of the dominant Biovariant
pathogen - instead biovar mitis began to circulate widely biovar gravis, characterized by a high virulence
and pathogenicity.
As a result, there was accumulation of large masses of non-immune adults and children, the
epidemic process of diphtheria intensified, taking character not only sporadic, but an epidemic disease, as
it is known that the incidence is inversely proportional to the level of graft population against this infection.
Taking into account the current epidemiological situation of diphtheria in the whole country,
conducted mass vaccination of the adult population epidpokazaniyam in the 90-ies of XX century., that
turned the tide of the epidemic and to the 1995 level incidence has been steadily declining (Fig. 8.3).

The main role in the prevention of diphtheria belongs to routine vaccination, conducted according to
the National Immunization Schedule.
The complex belongs to the anti-epidemic measures important early and proactively identify
patients (Scheme 8.4.).
Diphtheria patients or suspected diphtheria hospitalized immediately. Provisory admission of the
person subject to an epidemic outbreak diphtheria, patients with angina blends or croup. For early detection
diphtheria, apart from immediate bacteriological examination of patients angina must actively monitor them
for 3 days. The infectious Department of hospitalized carriers of toxigenic Corynebacterium. Doctor, To
establish the diagnosis,
immediately sent emergency notification in

territorial CSES. On the same day, an epidemiologist begins at the source epidemiological study,
whose task - identifying the source
infection, determining the boundaries of the hearth, the organization of it Epidemic work. Bacteriological
examination of the patient to communicate with people spend once, at one time. Nose swabs and tonsillar
taken dry sterile swab on an empty stomach or 2 hours after a meal, immediately sent to the laboratory.
After 24 h provisional response may be issued if necessary to detecting Corynebacterium diphtheria. After
48 hours - the answer about the presence of toxigenic Corynebacterium, 72 hours confirmation of toxigenic
may be given corynebacteria. After 96 h laboratory outputs the response of biochemical properties toxigenic
and nontoxigenic cultures. Medical surveillance continue to 7 days, at the same time - visiting an
otolaryngologist. Contents subsequent work It is determined by the results of surveys.

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Scheme 8.4. WORK diphtheria epidemic focus direction and content of the
anti-epidemic measures
The patient - hospitalization is required bacillicarriers
toxigenic Corynebacterium
- hospitalization is required
- as an exception, long-term carriers of the graft can be left
in the team
Disinfection
- Current
- final
Persons who communicate with the source of infection
- medical surveillance 7 days

- thermometry 2 times a day
- bacteriological research of mucus
oropharynx and nose
- uncoupling with a team of children and adults from the
pre-school and school facilities for the duration of
bacteriological research
- specific immunoprophylaxis
TB patients and carriers of toxigenic bacteria hospitalized. Only in some cases in boarding schools
and orphanages with a population Children less than 300 provided fully immunized team and detection
more than 10% of the carriers of toxigenic Corynebacterium permitted to leave the carrier in team under
constant medical supervision and bacteriological examination.
Media nontoxigenic Corynebacterium diphtheria is not treated with antibiotics, and not hospitalized for
their obligatory consultation of an otolaryngologist, detection and treatment of pathological processes in the
nasopharynx.
An important section of anti-epidemic work in the focus is the creation of antidiphtheria immunity in
persons exposed to patients, ie. e. vaccination on epidemiological indicators. For this Td-toxoid
administered a single dose of 0.5 ml for all children and adults who have become due revaccination
and previously untreated grafts and do not have

contraindications.

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There are 3 groups of indications for bacteriological examination on carriage of diphtheria:

diagnostic, epidemiological and prophylactic (Scheme 8.5). According to the WHO statement uses the
following quantitative criteria which characterize the degree of susceptibility to diphtheria Depending on the
level of antitoxin antibodies (Table. 8.2).
Epidemiological welfare of the territory against diphtheria characterized by the following criteria:
● coverage of immunization against diphtheria children and adults decreed to age at least
95%;
● registration of individual cases of diphtheria, with no risk death;
● the absence of clinically diagnosable forms hypertoxic diphtheria;
● no deaths of diphtheria during the last 5 years;

● no diphtheria epidemic foci with secondary cases disease.
Table 8.2. Level antitoxic antibodies and susceptibility to diphtheria
Contents antitoxic antibodies interpretation of results

<0.01 IU / ml The subject is susceptible to diphtheria
0.01 IU / ml The minimum level of circulating antibodies, providing
some degree of protection
0,01-0,09 IU / ml Level of circulating antitoxin antibodies, providing some

degree of protection
0.1 IU / ml Protective level of circulating antibodies

> 1.0 IU / ml Level antitoxin, providing
stable long-term immunity diphtheria
Driving 8.5. INDICATIONS FOR bacteriological examination

AT carriage diphtheria bacteriological examination
testimony
diagnostic
Sick
- rhinitis
- laryngitis
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- laryngotracheitis
- croup
- angina with pathological plaque on the tonsils
- with suspected paratonzillit, paratonsillar
abscess
- infectious mononucleosis
- stenosing laryngotracheitis Epidemiological
face contact with patients in the epidemic focus Prevention
Children entering the first

- baby at home
- orphanages
- TB sanatorium for children adults coming to work in
the
- baby at home
- orphanages
- TB sanatorium for children
MEASLES
Measles - anthroponotic viral acute infectious disease with aspiration of transmission mechanism.
The epidemiological characteristics of measles, as well as other diseases, "Managed immunization

means" isolated pre-vaccine period and period of planned vaccination.
Live measles vaccine introduced in the calendar of immunization children in Russia in 1968, is the
principal means of preventing disease. AT the ensuing years, the incidence of measles and age
composition bolevshih We were directly dependent on the proportion of immune individuals at the expense
of post-vaccination immunity.

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Measles - an RNA virus of the family Paramyxoviridae kind Morbilivirus, is unstable in the
environment, is highly sensitive to drying and disinfectants.
The source of infection is the only patient with measles, fairly accurately outlined contagious
period: the last day of incubation, prodromal period, during precipitation until the 5th day. When
complications, which may be accompanied by disease, possibly lengthening the infectious period to the 10th
day of the onset of the rash. Knowledge of the date of commencement and the end of this period, the patient
has the exclusive value for identifying infected persons belonging to communicate with patients and determine
the boundaries of an epidemic outbreak. In this regard, the identification of the patient and sending
emergency notification about it to the territorial CGSEN doctor must specify the date of the onset of rash.
Measles incubation period lasts 9-17 days, when administered immunoglobulin, this period may be
extended to 21 days. then comes prodromal period (3-4 days) is characterized by catarrhal symptoms in
upper respiratory tract, conjunctivitis, temperature reaction.
The uncertainty of these symptoms difficult to diagnose - and only defeat oral mucosa -
Filatov-Koplik spots - are essential diagnostic value.
The possibility of infection from the patient continues during precipitation to 5th days until the face,
trunk and limbs covered with a rash. In typical cases, measles diagnosis is based on clinical and
epidemiological data and It causes great difficulties. In the context of mass vaccination Measles is difficult
due to the high frequency of the light and atypical course disease in previously vaccinated, so it is
necessary to confirm the diagnosis use immunological methods (HAI, TPHA, ELISA, PCR). diagnostic
consider a four-fold increase in titer measles antibodies in paired sera taken with an interval of 2 weeks.
The transmission mechanism exciter aspiration; way transfer

airborne.
Measles virus, while in the mucosa of the upper airway and nasopharyngeal mucus excreted from
the body by coughing, sneezing, talking, and even breathing. The virus is very unstable in the environment,
so spread it It occurs only by droplets at a distance of about 2 m or several more within indoors. high
sensitivity people susceptible to measles in mild airborne transmission path It leads to infection even in
short-term communication with the patient.
Susceptibility measles is extremely high. Usually sick all non-immune persons who communicate
with the patient.
Post-infectious immunity is usually lifelong.
Epidemic process. Measles is widespread. Many years dynamics of measles and completeness of
coverage given to children Fig. 8.4, 8.5.
The characteristic measles alternating periodic rise and fall disease persists. However, if prior to the
planned vaccination

17
periodic rises incidence recorded at intervals throughout 2-3 years, against the background of vaccination,
this interval was extended to 8-10 years. There was also a shift of seasonal rise of the incidence in the
spring and summer months.
From the 80-ies of XX century. steel record instances of measles among adolescents and adults
(students, soldiers). This increase in incidence associated with defects in the organization of routine
immunization services and a violation of the principle of "Cold chain".
Organization of anti-epidemic work in the outbreak of measles is given in Scheme 8.6. Isolation of
patients in the infectious period is required. AT depending on the
severity, sanitary conditions availability
susceptible individual patient can be left at home (with detailed recommendations about care, measures to
protect others, and so on. d.) or hospitalized hospital.
Instability of the virus makes it unnecessary to disinfect, so the focus is enough ventilation and
general cleaning.
Epidemiologist conducting an epidemiological survey of the hearth at identify the first patient with
measles utmost care must determine focus border and to identify susceptible persons who are in need of
protection.
Incubation of measles is long enough, so there may be situations When you communicate with a
patient susceptible person can be in any hospital over another disease.
In this case, only the timely information can epidemiologist prevent drift of measles in a hospital and
its nosocomial spread.
Most likely to measles previously or were ill vaccinated. In the absence of contraindications to these
persons vaccinate ZHKV. It is to be performed urgently in the first three days after the detection of patient.
If there are contraindications to vaccination to all that were not previously vaccinated, including children
under 1 year are administered immunoglobulin.
In outbreaks of measles in the presence of susceptible observation set at 17 (Or 21) days; During
this period, children's groups will only accept previously convalescents and vaccinees ZHKV.
Children who recover from measles, take the team after a full clinical recovery, but not earlier than
the 10th day of the onset of the disease.
Planned vaccinal live measles vaccine (ZHKV) is performed once at the age of 12 months followed
by a booster. Given the high thermolability ZHKV, recommended immediate introduction of the diluted
vaccine since live measles vaccine, located at room temperature, inactivated after 2 hours.
Scheme 8.6. OPERATION In epidemic focus MEASLES

18
Direction and content of anti-epidemic measures

Sick
hospitalization for clinical and epidemiological indications transmission mechanism
airing wet cleaning
Children vaccinated live measles vaccine

- medical surveillance for 17 days
- nerazobschenie with collective Children
not vaccinated live measles vaccine

Vaccination of persons who have no contraindications
- uncoupling with the team from the 8th to 17th day of administration of
immunoglobulin contact persons with contraindications
to vaccination
- uncoupling with the team from the 8 th to 21 th day of contact had been ill
with measles: control measures are not carried out measles control in most regions of the country to
sporadic cases, widespread and steadily increasing vaccination coverage and revaccination within the
national calendar terms, the presence in the country high-performance live measles vaccine allowed to
develop project National measles elimination program and join the European program WHO Regional
Office for the elimination of the infection.
The activities envisaged by the National Program, scheduled to implemented in three phases: (.
2002-2004) on the first stage of widespread stabilization the incidence of sporadic level; the second
(2005-2007 gg.) creation conditions for the prevention of measles and its total eradication in country; the
third (2008-2010 gg.) - certification territories free from measles.
WHOOPING COUGH
Whooping cough - anthroponotic bacterial acute infectious disease with aspiration of transmission
mechanism.
The causative agent of whooping cough - Bordetella pertussis genus Bordetella (stick Bordet-Zhang). This
bacteria, are unstable in the environment. circulating pathogens distinguished by a set of model antigens 1, 2, 3; 1,
2, 0; 1, 0, 3.

19
The ratio of these types of pertussis bacteria at different times and on different territories differently. The
most virulent variant is 1, 2, 0. pertussis bacteria in the development of infection in a patient and retaining them in nutrient
media undergo phase changes in virulence. In the course of the disease gradually changing morphological
characteristics of the pathogen,
reducing its
virulence, which probably explains the decrease in the patient as a source of danger infections by the end of the
disease.
Similar to whooping cough - parakoklyush - causes Bordetella parapertussis. Both have common ancestral
pathogen antigens, leading to post-infection the formation of a partial cross-protection, not the giver, however, the
full protection from whooping cough.
The source of the pathogen Pertussis is a patient. He is the most dangerous in the early diseases in
catarrhal coughing when the pathogen multiplies vigorously at mucosa of the upper respiratory tract and easily
dissipated by coughing. AT most of the infectious period ends before the seizure stops cough. The patient is
isolated for 25 days. Light and erased forms of pertussis is not timely recognized, they represent the greatest
danger epidemiological. carrier state pertussis bacteria is possible, but it is short-lived and did not play a significant
role in the spread of the pathogen.
Mechanism transfer exciter aspiration; way transfer

airborne. The causative agent is released when coughing and mucus droplets It extends to a distance of 1.5-2 m
from the source of infection. pertussis germs unstable in the environment, die quickly when dry, so toys, utensils, handkerc
are not dangerous as the transmission factors. For the same reason, Epidemic outbreak of whooping cough do not
disinfect. Infection with whooping cough susceptible individual occurs through direct communication with the
long-term patients, and only at a distance of not more than 2 m.
Susceptibility pertussis is high and does not depend on age. At the age of 1 year pertussis runs hard, often
with complications. In children older than 1 year of severity Clinical manifestations of the disease is largely
determined by the completeness and quality pertussis vaccination (DTP vaccine) held them. Immunization against domina
not heavy and erased forms of pertussis. Adults can also get sick whooping cough. Based on carefully performed
bacteriological, and serological clinical observations in the centers determined that 20-30% of adults who
communicate with sick in the family, become ill with pertussis. Diagnosis in adults is usually incomplete, difficult and
delayed. Often diagnosed "bronchitis", so when prolonged cough in an adult patient need to find out
epidemiological history, ask about cough children in the family.
Occasionally can repeat pertussis. But in every such case, you must use the bacteriological and serological
tests to exclude parakoklyush.
epidemic process Pertussis is characterized by periodic rises and downs morbidity. The normal frequency
of pertussis infection is 3-4 of the year. A characteristic feature of the epidemic process of pertussis is not clearly seasonal
Some increase in the incidence in the autumn and winter is associated with increased risk of infection due to
greater closeness and duration of the communication with a source infection in enclosed spaces.

20
Whooping cough is recorded mainly among children, which accounted annually accounting for up to 96-97%
of the total number of patients. The incidence rates of pertussis the urban population in the 3-3.5 times higher in
rural areas. This is due to the relatively low contagious pertussis infection and the lack of appropriate conditions for
implementing airborne drip path of transmission, but also low diagnosis in rural areas.

Pertussis vaccine prophylaxis was high in the early years application - in 1960-1965. Later it became a
limited impact on its epidemic process: preserved periodic rises of morbidity and seasonal uneven. However,
decreased morbidity, reduction of the number ill during outbreaks in kindergartens, and the prevalence of lung deleted
forms of the disease. Currently, the main challenge in prevention work Pediatricians are the organization and
control of vaccine-validity taps DPT immunization; early identification of patients. The volume of anti measures in
the outbreak of pertussis is represented in the scheme 8.7.
Scheme 8.7. WORK epidemic focus WHOOPING COUGH direction and content
of the anti-epidemic measures
Sick
airing wet cleaning

Children up to 7 years
Without a history of whooping cough
medical surveillance for 14 days at hospitalization and 25 - while

leaving the patient at home bacteriological examination cough *
uncoupling with the team at the time of observation via
immunoglobulin for children under 1 year old had been ill with
pertussis
control measures are not carried out Children older than 7

years
Without a history of whooping cough
Medical supervision 14 (25) days of bacteriological examination

cough * nerazobschenie with the team at the time of observation
had been ill with pertussis
control measures are not carried out

Adults
once bacteriological examination coughing
* In child care centers, maternity wards, pediatric hospitals, where patients with pertussis were
identified bacteriologically examined all the children and adults.
RUBELLA
21
Rubella - anthroponotic viral acute infectious disease with aspiration of transmission mechanism.
The causative agent of rubella - RNA virus Tagaviridae kind of family Rubivirus. The virus is
unstable in the environment, thermolabile, is inactivated at temperature of 56 ° C for 1 hour, at room
temperature for several survives hours. It dies quickly when exposed to ultraviolet rays and conventional
disinfectants.
The source of infection - patients with symptomatic or inapparent flowing infection and infants with
congenital rubella.
As a source of infection the patient begins to pose a risk of rubella for the incubation period,
prodromal others in the last 4-5 days during the whole period of rash and 7-10 days after the eruption. For
others sick most often dangerous for the 5 days before the rash and 5-7 days after the rash, that is. e.
about 10-14 days.
In mild and inapparent forms, there is a risk of infection for 3-4 days. In children with congenital
rubella virus may be released within 8-12 months or more (Up to 2 years) after the birth.
The transmission mechanism pathogen suction and vertical. Way transmitting airborne and
transplacental. Isolated finds virus Rubella in the urine and the faeces of patients are not sufficient to justify
the fecal-oral transmission mechanism, especially as a virus in maloustoychiv the external environment.
The causative agent is particularly dangerous for pregnant women, patients rubella, as the virus
infects the fetus during the first 8-12 weeks of pregnancy, teratogenicity further declines rapidly. When
intrauterine infection may stillbirth, development of congenital rubella syndrome (CRS: cataracts, defects
heart
deafness; registered mental disability, physical malformations). Contagiousness of measles is
low for infection needs closer contact than varicella and measles.
Susceptibility Rubella is high. After this illness developing a strong immunity.
epidemic process rubella characterized cyclicality.

Periodic rises of morbidity occur at intervals of 3-4 years, more expressed - in 7-10 years.
Seasonal winter-spring, especially pronounced during the epidemic recovery. Children under 1 year
are ill rarely, as protected by maternal antibodies. The highest incidence rates among children 3-6 years
old.
Children attending kindergartens, get sick more often than children, brought up at home. In
preschools epidemic process It manifested in the form of outbreaks resulting from introduction of rubella
pathogen.
There were no significant differences in the incidence of the floor is not among the children. AT age group
15-20 years is more common in men and from 25 to 45 years old - woman.

22
Hospitalization of patients is performed for clinical indications with insulation up to the 5th day after
the rash appears. Disinfection in the outbreak is not carried out.
For a person to communicate with patients, no restrictive actions not envisaged quarantine for a
group of children's institutions is not superimposed. In the case of communication with pregnant patients
need to rubella serosurvey ELISA to detect IgM-antibodies to rubella. Upon detection of IgM-antibodies a
woman presumed to be infected virus rubella. Women with a pregnancy up to 12 weeks in such cases to
terminate a pregnancy. In the presence of IgG antibodies woman is immune.
For emergency prevention of measles persons in contact with patients in the outbreak (children and pregnant
women), recommends the introduction of immunoglobulin.
Important and paramount importance in the prevention of rubella has specific preventive - routine
immunization of infants carried out within the time limits provided by the National calendar of preventive
vaccinations. Considering extreme urgency congenital rubella prevention 48th session Regional Office for
Europe in September 1998, included in the number of rubella infections, control of which will be determined
by the objectives of the program "Health for all in the XXI century "The main objective of the program in the
first phase of its implementation It is to reduce by 2010 or sooner frequency CRS to below 0.01 per 1000
live birth child.
Rubella of transmission gap in young children - the next task. Achieving this task is only possible if
routine immunization, as well as selective vaccination against rubella teenage girls, which will quickly
reduce the number of susceptible young women to rubella, to reduce the risk of CRS.
meningococcal disease
Meningococcal infection - acute bacterial anthroponotic infectious disease with aspiration of

transmission mechanism.
The causative agent of meningococcal disease - meningococcal Neisseria meningitidis of
family Neisseriaceae genus Neisseria, diplococcus gram.
Meningococcus extremely demanding on the growing conditions on artificial media to the medium
composition and temperature conditions (36-37 FROM). According to the structure of the capsular
polysaccharide distinguish 12 serogroups (A, B, C, X, Y, Z, 29E, 135W, H, I, K, L).
Within individual serogroups (particularly B and C) is detected antigenic inhomogeneity of the outer
membrane proteins, which define the subtype exciter.
Meningococcus is unstable in the environment, he quickly It dies in the light, at low temperature,
insufficient moisture sensitive disinfectants.
The source of infection people are infected. The degree and duration different sources of danger
depends on the finding of fact in the meningococcus oropharynx and duration of the condition. There are
three groups of sources

23
infection: patients generalized forms (GFMI) (about 1% of infected); patients with acute meningococcal
nasopharyngitis (10-20% of the total number of infected persons); "Healthy" carriers. The patient most
GFMI as a dangerous source of infection in the prodromal period t. e. within 4-6 days. In Patients with
meningococcal nasopharyngitis infectious period lasts about 2 week. "Healthy" media are dangerous within
2-3 weeks, and only 2-3% of people carriage continues to 6 weeks or more.
The epidemiological importance of different sources of infection varies. Thus, in the prodromal
patients GFMI having catarrhal changes in nasopharynx, remains active and dangerous to others. Because
of the rarity convalescent carrier convalescents discharged from hospital after clinical cure without
bacteriological control.
Sick
nasopharyngitis and "healthy" carriers of meningococcus, t. e. the most difficult detectable forms of
infectious process, is more conducive to infection bystanders by maintaining the continuity of the epidemic proces
Thus nasopharyngitis patients whose disease is accompanied by coughing and sneezing, secrete
significantly greater number of agent. At the same the number of carriers in the hundreds of times the
number of patients GFMI, and the level carriage is subject to significant fluctuations. Per patient in GFMI
Depending on the epidemiological situation may fall from 100 to 10 thousand. carriers. Carriage prevalence
is higher in epidemic foci than outside foci.
The highest level recorded carriage among adults, the lowest - in children under 2 years. In this
regard, the main, and perhaps leading role as a source of infection of the pathogen belongs to patients
with meningococcal nasopharyngitis and "healthy" carriers.

airborne. Standing out in the environment when coughing, sneezing and conversation, meningococcus fall
on the mucous membrane of the nose and throat of others susceptible individuals. Compared to other
infections, where pathogens also transmitted by airborne droplets, in relation to meningococcal Infection
noted "sluggish" mechanism of transfer of the pathogen.
This peculiarity is associated with not very powerful release of bacterial aerosol source of infection,
rapid subsidence phase coarse spray and rapid death of the parasite. Along with physical decay aerosol
important important biological dying pathogen since found that in meningococcus external environment is
unstable. In this regard, human infection is possible Only at the time of allocation of the pathogen when it is
suspended At present, however to implement (0.5 m) required transmission mechanism "affinity" and
determine the exposure, ie. e. the duration of communication with the source of infection.
The epidemiological surveillance of infections were observed during the fleeting communication
susceptible people with a source of infection, but the influence of the duration and proximity communication in
the frequency of infection is clearly revealed in the appearance "Alopecia" diseases in the bedrooms and
dining rooms, convenience Group

24
pre-school institutions, student groups and the military in barracks.
Violation of sanitary-hygienic regime, compaction, increased humidity in the room invariably lead to
the spread of the pathogen group and occurrence of diseases meningococcal infection.
Susceptibility to meningococcal infection is high, and with a very polymorphic body's response to
the introduction of the pathogen from the "healthy" carriage, nasopharyngitis to the development of
generalized forms, ie. e. the ability to infection realized in various clinical manifestation forms. Severe
clinical picture of the disease develops in a few infected, that, possibly due to inadequate immunological
response of the organism to the introduction of pathogens.
epidemic process Meningococcal infection is a kind of signs, somewhat different from the typical
manifestations of it in other infections respiratory tract.
Periodic (cyclic) morbidity rise recorded less frequently, the range is from 10-15 to 30 years.
Register sporadic disease outbreaks, epidemics that cause primarily meningococcus serogroup A,
B and C.
The causes of periodic upgrades to explain the change of the dominant serogroup
meningococcus the advent of strains from changed
molecular genetic parameters, t. e. note selection epidemiologically Hazardous clones with unique
antigenic structure, such as proteins outer membrane; increase of the number of strains resistant to
sulfonamides and antibiotics; an increase in the number of people susceptible to infection due to natural
population growth (expressed or migration) and how a consequence of this change (destabilization)
immunological structure to meningococcus. It can not be excluded and the importance of genetic factors
determining susceptibility to meningococcal infection at both the individual level and, perhaps,
whole races. Harbingers of boom and bust morbidity

meningococcal infection are shown in Scheme 8.8.
Disease recorded in people of all ages, but mainly defeat the younger age groups to explain their
lack of specific Immunity. Intensive townsmen in cities leads to the formation of immunity after the first
infection, which occurs in children's groups. People living in rural areas often remain uninfected long term
and ill when infected, being in large collectives (incidence recruits). Thus, social and domestic factors have
largely the impact of the age structure of morbidity. For meningococcal infection characterized by low foci,
up to 95% - it's pockets of one case of the disease.
Seasonal rises of morbidity and carrier registered in winter-spring period t. e. later than other
respiratory tract infections. This phenomenon is explained as "sluggish" transmission mechanism and
social factors, ie. e. changes in the conditions of human communication in the cold season and reduced
resistance of the organism in the late winter and spring.

25

Anti-epidemic work begins with the filing of the notice of emergency in territorial CGSEN of all cases
of generalized forms of meningococcal infection and nasopharyngitis bacteriological confirmation. The
volume held anti-epidemic measures in the hearth shown in diagram 8.9. hospitalized All patients GFMI and
nasopharyngitis patients in some cases allowed to heal and watch the house. The reasons for this - easy
course of the disease, lack of home pre-school children and those working in kindergartens.
Scheme 8.8. BACKGROUND AND PRECURSORS ups and downs DISEASE Meningococcal
infection
Displays of epidemic process
rise in the incidence

- increase in cases among adolescents and adults
- the emergence of foci with multiple diseases GFMI in organized groups:
youth, convenience groups of pre-school institutions
- growing meningococcus carriers are responsible for the epidemic

rise
- preferential selection from blood, cerebrospinal fluid leading
meningococcus serogroup
- overall increase in morbidity compared with previous
years, the incidence of Recession
- reduction in the incidence of adults, adolescents, children

- increase the proportion of patients GFMI to 2 years
- no foci with multiple diseases GFMI
meningococcal disease
- reduction of the etiological role of meningococcus,
responsible for the epidemic rise
- an increase in the other, including rare,
meningococcal serogroups
- decrease of circulation meningococci caused
rise in the incidence
Epidemiologist determines the boundaries of the hearth, reveals all to communicate with patients.
Medical surveillance and bacteriological examination of persons exposed to infected, it is necessary for the
early detection of patients nasopharyngitis and carriers. Communicate with patients spend in thermometry within
10 days. Particular attention is paid to people who have found chronic inflammation in the nasopharynx
and having a vague "allergic" rashes on the skin. Patients with pathological changes in the nasopharynx
isolate, and if skin eruptions hospitalized for exclusion

26
meningococcemia. In day care centers, children's homes,

Boarding schools, children's sanatoria within 10 days after the last isolation patient prohibit transfers of
children and staff in other groups or classes, reception and there has been no new entrants children.
bacteriological Survey communicate with the sick children and all staff in kindergartens carried out at least
2 times in the remaining collectives once.
Final disinfection is carried out not in the focus, as meningococcus They die quickly in the
environment. In the centers where the observation is carried out for communicate with patients,
the need for frequent airing, irradiation
bactericidal lamps, daily wet cleaning, the maximum decompression in bedrooms and study rooms.
Scheme 8.9. OPERATION In epidemic focus MENINGOCOCCAL INFECTION

Sick
- generalized form: Hospitalization is required
- nasopharyngitis: hospitalization for clinical and
epidemiological indications bacillicarriers
- in preschool, school teams - insulation,

treatment
- in adult teams - treatment
- carriers of at long (more than 1 month) and the absence of
inflammatory changes - the return of the team
- ventilation
- wet cleaning
- seal failure
- medical surveillance 10 days
- examination otolaryngologist
- once bacteriological examination
- emergency specific prevention
- meningococcal polysaccharide vaccine groups A and A + C
- immunoglobulin
During the period of seasonal rise of the incidence of prohibited cluster of children on various
entertainment events, lengthened intervals between sessions in theaters. Necessary explanatory work
among the population on early to see a doctor at the first sign of illness.

27
Specific prevention of meningococcal vaccine is carried out, comprising capsular polysaccharide of

meningococcal serogroups A, C and divaktsinoy (A + C). Vaccine areaktogenna and harmless, causes
buildup of antibodies and protection against disease with 5-th day after a single administration, and after 2
weeks the content of antibodies It reaches a maximum level.
Booster if indicated spend 1 time in 3 years. After immunization with prophylactic vaccine is
administered no sooner than 1 month after administration of other vaccines, and for emergency
prevention in epidemic outbreak - regardless of the length perform other vaccination (Scheme
8.10). scheme
8.10. Prevention of meningococcal disease
CHEMICAL polysaccharide vaccine
Indications and grafting contingents

prophylactic indications
The incidence of more than 2 100 thousand. Population
- Children 1 year - 7 years
- Students first university students, vocational school, technical
- visitors, temporary workers living in the dormitory
- children are taken to orphanages
- First grade students of boarding schools incidence of more
than 20 per 100 thousand. population
- the entire population under the age of 20 years
Extra reading: at the source in 1-5 days after the first detection of
In patients with generalized form of the city
- face contact with patients in the family apartment, child care

center, classroom, dorm bedroom
- children for a week before entering the collective, where cases of
meningococcal infections have been reported
- all students of the first courses
- Students of senior courses in contact in the group, the hostel in the village
- children preschool
- pupils
- vocational school students
- all in contact with the patient in the absence of disease in the village within 3
years
PAROTITIS
Mumps - an acute infectious viral anthroponotic disease with aspiration of transmission mechanism.
The causative agent of mumps - an RNA virus of the family Paramyxoviridae genus Paramyxovirus,
are unstable in the environment.

28
Source of agent infection - a sick person or a typical atypical and subclinical forms of the disease.
The virus enters the body through the mucous membranes of the mouth, nose and throat. After
viremia virus accumulates in the parotid gland, where saliva is released in environment. The most
dangerous as a source of infection patients and atypical milder forms of the disease, which remains
undiagnosed or diagnosis "lymphadenitis", can be taken in kindergartens or be in a group of adolescents in
the dorms or in the military in barracks and on ships. patient a danger to others is already apparent in After
incubation and continued to the 9th day of clinical manifestations, which determines patient isolation
period.

airborne. The virus is unstable, it dies quickly in the environment at the action of ultraviolet rays, drying,
and other physical and chemical factors, so the disinfection in the centers do not conduct. To eliminate the
transmission paths sufficient ventilation, and conventional wet cleaning. However, contaminated the wet
saliva patient's toys, kitchen utensils and other household items can be the cause of mumps infection.
Susceptibility to mumps is high, post-infectious durable and long lasting immunity.
epidemic process epidemic mumps characterized

symptoms typical of the respiratory tract infections: periodic rises disease usually occur at intervals of 5-7
years, due to the accumulation non-immune populations. Seasonal rises occur in autumn and winter, t. e.
between crowding of children and adolescents in closed rooms. outbreaks cover persons who are within
the apartment, a class, a group of children offices, dormitories, barracks. Outbreaks of mumps because of
the large length of incubation and the presence of atypical pulmonary subclinical disease are long. Mumps
children get sick more often 1 year of age - 15 years, boys 1.5 times more likely to girls. In adults too
possible diseases, non-immune and in teams may even be flash mumps. This is especially true of military
bands.

The volume held anti-epidemic measures outlined in Scheme
8.11. Anti-epidemic work at the source starts with isolation of the patient. Hospitalized patients with clinical
and epidemiological indications. Final disinfection in areas where the patient is not carried out. It is
sufficient to maintain the usual sanitary-hygienic regime with regular airing and wet cleaning. When
monitoring communicated with sick pay special attention to children under 1 year, and among the rest -
unvaccinated Children up to 10 years. Given the long duration of incubation and contagiousness Only in the
last days of this period have been in contact in the hearth can attend children's groups during the first 10
days of the communication with the patient.

29
When conducting medical supervision of persons in contact with ill in an epidemic outbreak, for
early detection of cases among them it should be noted that, apart from the typical for this disease
increase in the parotid salivary gland, can be defeated submandibular and sublingual glands in Adults -
orchitis, oophoritis, mastitis, in rare cases - pancreatitis, meningitis.
In the absence of contraindications to vaccination of previously unvaccinated children for protection from
disease should enter the live mumps vaccine.
Routine immunization leads to a decrease in the incidence of epidemic mumps, primarily in children
ages grafting.
Scheme 8.11. OPERATION In epidemic focus Epidemic mumps

- The source of infection
Sick
- hospitalization for clinical and epidemiological
indications
- The transmission mechanism
- ventilation
- wet cleaning
- Persons who communicate with the source of infection
* Children up to 10 years
● Without a history of mumps
- Graft live mumps vaccine

- with the team not alienate
- Not vaccinated live mumps vaccine

- Vaccination of persons who do not have contraindications
- uncoupling with the group 11 th to 21 th day
contact
● Recover from mumps
- control measures are not carried out
* Children older than 10 years and adults
SCARLET FEVER

thirty
Scarlet fever - anthroponotic bacterial acute infectious disease with aspiration of transmission
mechanism.
Pathogen scarlet fever - p-hemolytic Streptococcus group A family Streptococcaceae kind of
Streptococcus, gram-positive cocci, obligate pathogenic human parasite, which is etiologically associated
with different clinical forms streptococcal infections: tonsillitis, chronic tonsillitis, scarlet fever, rheumatic
fever, acute glomerulonephritis, streptococcal impetigo, erysipelas, and others. Streptococcus sufficiently
stable in the environment, may be stored permanently in the organism is the objects that surround the
patient, remains viable when drying sputum and pus on toys, bedding.
At a temperature of 56-60 ° C streptococci are killed within 30 min. They sensitive to

dezinfektangam.
Source of agent infection - the patient with angina, scarlet fever,
respiratory streptococcal infection of other clinical forms, as well as carrier streptococcus group A.
Among those infected with group A streptococcus, the most dangerous the source of infection is
sick with scarlet fever.
Its infectivity is already apparent with the emergence of signs of the disease and most clearly
expressed in the first days of the disease, when the pathogen allocated with a secret mucous membranes
of the nose, throat, with purulent discharge hearths
at otitis, sinusitis, purulent lymphadenitis. greatest
epidemiological risk patients are light and atypical forms of the disease. Diagnosis of these forms is hard,
that leads to late insulation patients in epidemic outbreaks. The duration of the infectious period in patients scarlet
fever and convalescent determined at 10 days. Infectious period, convalescents in the absence of these
complications is stored for 12 days. danger convalescents reinfection increases with other types of
streptococcus.
The transmission mechanism pathogen aspiration, mainly sold way by droplets in the allocation of
agent droplets with mucus. Wherein Streptococcus distribution occurs at a relatively small distance in within
the same room. Airborne dust and contamination through the path of the objects domestic use (dishes,
towels, toys) are possible, as streptococci are stored in the dried state, and getting them on the mucous mouth
shell leads to the disease. Food route of transmission is relatively rare, it is realized during infection
carriers milk, ice cream, creams and manifests disease outbreak.
Susceptibility for scarlet fever is high, but varies in junior and senior age groups. Very rarely
manifest the disease in children under 3 months of life; the largest number of cases observed up to 6-7
years of age; in older age and in adults their number is low. Susceptibility to Streptococcus is not always
realized in the form of the disease, a number of susceptible individuals suffer infection as a carrier. A
feature of scarlet fever are repeated disease in children and adults, which is associated with the formation
of inadequate intense immunity.

31
epidemic process scarlet fever is characterized by a clearly expressed frequency of disease rises
at intervals of 2-4 years, increasing the number of patients in the autumn-winter period, the presence of
outbreaks in groups of children and teens.
Scheme 8.12. WORK scarlet fever epidemic focus direction and content of the
anti-epidemic measures
sources of infection
Sick hospitalization for clinical and
epidemiological indications
convalescents
uncoupling with the team for 12 days
- children of pre-school institutions
- children of the 1st and 2nd classes of schools
- staff of preschool institutions,
- 1st and 2nd classes of schools, surgical, maternity wards,
dairy production
The carrier hemolytic streptococcus
- isolation at home until a negative result of bacteriological
research
- current disinfection is conducted population
- final disinfection is not carried out
Without a history of scarlet fever
Children under 8 years old who do not attend pre-school and school
- medical observation for 7 days at hospitalization and 17 days when
leaving the patient's home, a thermometer, inspection of the skin, mucous
membranes Children up to 8 years attending preschool institutions and
schools,
- Medical supervision 7 (17) days, a thermometer, inspection of the
skin, mucous membranes
- Message in a day care center, school
- isolation from the team at the time of observation
Fly over 8 years
- Message to school
- from the staff not to isolate
Adults who work in kindergartens, 1st and 2nd classes of schools, surgical,
maternity) offices, dairies
- Medical supervision 7 (17) days, thermometry,

examination of the skin, mucous membranes
- message in the workplace

32

I have been ill with scarlet fever
Preventive and anti-epidemic work

scarlet fever are no specific means of prevention, so They are focusing on non-specific prevention
in the form of measures such as children tempering, observance of sanitary-hygienic regimen in children
institutions, early detection and isolation of patients with angina and other diseases with suspected scarlet
fever.
List of anti-epidemic measures in the outbreak in identifying patient scarlet fever is shown in
diagram 8.12.
Dates patient isolation and separation from convalescent children team determined by the nature
and severity of clinical manifestations. They can lengthen the presence of otitis, tonsillitis, lymphadenitis,
and other complications.
Current disinfection in the patient's apartment is performed by members of his family. She is
comprises treating the tableware, handkerchiefs, towels (boiling), bed linen (boiling, wash), toys
(immersion in solutions of disinfectants, eg 0.5% chloramine solution). Regular execution of the current
disinfection It makes it unnecessary to final processing. The number of exposed persons They include the
previously ill with scarlet fever. Medical supervision of recognized necessary because of the danger of
recurrent diseases. In this case, refers to two observation period - during hospitalization (the maximum
incubation scarlet fever period - 7 days), and the appearance of cases in repeated epidemic outbreak
surveillance is extended to 12 days. The second period (at leaving the patient at home) - 17 days, which
consists of a 10-day infectious period of the patient, and 7 days of incubation.
Among previously were ill with scarlet fever greatest attention should be paid to children the age of 8
years. In some cases, the clinical indications for protection susceptible children they are administered
immunoglobulin. As unspecific a prophylactic topical tomitsid can be used in organized groups in contact
with the source of infection is carried out bitsillinoprofilaktiku.
CHICKENPOX
Chickenpox - anthroponotic viral acute infectious disease with suction transfer mechanism.
The causative agent of chicken pox - DNA virus Varicella-zocter-virus from The family
Herpesviridae, which may persist for a long time in human cells in a latent form, primarily in neuronal
ganglia. In a sick person the virus is found in the nasopharynx, the contents of the vesicles and blood.
Outside the body of the virus unstable and quickly dies at low and ambient temperature.

33
The source of infection It is ill with chicken pox and shingles ringworm. Epidemiological
observations indicate that the period of infectiousness chickenpox - the last hours of incubation (commonly
referred to as the last day) the entire period of the rash and 5 days after the last eruption.
The transmission mechanism exciter aspiration, way transfer

airborne. available transplacental broadcast virus.
Airborne transmission path leading to the rapid spread of the virus in the room where the patient is. It is
believed that viruses can cover distance of 20 m.
Susceptibility to varicella high; highest incidence registered between the ages of 6 months to 3
years. After 7 years of age the incidence of reduced, and children older than 14 years suffer from
chickenpox is rare. postinfectious immunity stressful life saved. Adults not previously bolevshie varicella,
when dealing with a patient with chickenpox usually transferred shingles, and the children - chicken pox.
epidemic process varicella is characterized by signs, typical of infections with airborne

transmission of pathogen that attributed to infections,
unguided immunization:
autumn-winter season, and a primary lesion of the younger age groups. A distinctive feature of the
epidemic process of varicella is the absence of pronounced periodic ups and downs of disease that due to
the fact that perebolevayut almost all susceptible to this infection children and so there is no possibility of
accumulation of a significant number of non-immune individuals. Long-term dynamics of morbidity shown in
Fig. 8.13.
anti-epidemic work It is the main task of warning importations into the children's groups, which are
important for active detection and early isolation of patients. Hospitalization is conducted mainly on clinical
indications.
Scheme 8.13. WORK epidemic focus varicella direction and content of the anti-epidemic
measures
Sick
airing wet cleaning
Person to communicate with the source of infection

Children up to 7 years
Without a history of chickenpox
-medical surveillance for 21 days
- isolation from the collective from 11 th to 21 th day of contact
-specific prevention had been ill with
chicken pox

34

Children older than 7 years
Without a history of chickenpox
-medical surveillance for 21 days
- not isolated from the collective had
been ill with chicken pox
According to epidemiological indications it is not always feasible, as ease of propagation of the
pathogen can lead to infection and as a skid consequence - nosocomial outbreaks. During the construction
of the children's hospitals it shall be separate ventilation for each floor, each box. Disinfection in the centers
of the chicken pox is not carried out. Children under 7 years previously without a history, uncoupling and
subject to observation.
In clarifying the epidemiological history important to clarify the 1st day contact with the patient, since,
according to epidemiological data, in the first 10 days incubation, they are not dangerous to others and can
attend child care centers and are subject to separation from the 10 th to the 21 th day of contact.
Immunoglobulin indicated for the protection of children with complicated history. There is evidence of
the protective effect of interferon to persons in contact with patients in an epidemic outbreak in the first 3
days of contact can be introduced live varicella vaccine. However, the vaccine is not licensed in the Russian
Federation.
The volume held anti-epidemic measures outlined in Scheme
8.13.

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1

EPIDEMIOLOGICAL CHARACTERISTICS OF INFECTIONS

These infections are easy spread of the pathogen, what

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

Scheme. 8.1. Epidemic process of respiratory tract infections

Displays of epidemic process

the incidence of type

Anti-epidemic and preventive measures

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

Availability of currently effective vaccines and their rational use allowed

Influenza and other acute respiratory viral infections

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

mucus, sputum, dust but the role

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

Preventive and anti-epidemic measures

alive inactivated, chemical, subunit,

Table 8.1. The list of drugs, recommended for

drug Name scheme application

"Aflubin" Homeopathic medicine. Children from 1 year to 12 years 3-5

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

"Rimantadine" Adults 1 tablet 5 days (lobular prevention) 1 tablet 15-20 days

"Ribomunil" children sufferers chronic

"Echinacea" Tincture 10-20 drops 2 times a day within 14 days

drugs recommended for nonspecific

where the patient must be established ventilation,

content of the anti-epidemic measures

The patient - clinical and hospitalization

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

The transmission mechanism

boiling utensils, handkerchiefs, towels persons to

communicate with the source of infection

Medical supervision thermometry 2 times a day

operation and maintenance work

disease of the supplies of disposable masks Hospitals noncommunicable

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

early care-seeking Clinics

expansion of the registry, and additional phones to increase vehicle

increase in the number of doctors for care at home a separate

entrance for the febrile work of the personnel in masks Hospitals

health education filter for incoming patients

restriction, prohibition of visits of patients (quarantine) staff work in

Diphtheria - anthroponotic bacterial acute infectious disease with aspiration of transmission

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

It is found that the greatest danger pose environmental contamination bacillicarriers,

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

Preventive and anti-epidemic measures

immediately sent emergency notification in

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

The transmission mechanism

Persons who communicate with the source of infection

- medical surveillance 7 days

and previously untreated grafts and do not have

Epidemiological. The characteristic of a respiratory tract infection (Aliev AA)

There are 3 groups of indications for bacteriological examination on carriage of diphtheria:

● the absence of clinically diagnosable forms hypertoxic diphtheria;

● no deaths of diphtheria during the last 5 years;

Table 8.2. Level antitoxic antibodies and susceptibility to diphtheria

Contents antitoxic antibodies interpretation of results

0,01-0,09 IU / ml Level of circulating antitoxin antibodies, providing some

0.1 IU / ml Protective level of circulating antibodies

Driving 8.5. INDICATIONS FOR bacteriological examination

face contact with patients in the epidemic focus Prevention

Children entering the first