Nº 6 (2013)

The paper demonstrates the socio-economic importance of pneumococcal infection in Russia and the world. It gives the characteristics of the main manifestations of pneumococcal infection. The directions of improving epidemiological surveillance are defined and determined. The importance of improving the notification of invasive infections and the introduction of active monitoring of the incidence and characteristics of circulating pneumococci are emphasized. Evidence is provided for the widespread use of molecular biological studies of the pathogen. The results of recent studies into the serotyping characteristics of the pathogen isolated from patients with various manifestations of pneumococcal infection are presented.

The paper considers the issues of formation of topical research areas in disinfectology and shows the bases and prerequisites for the designing and introducing novel disinfectants and technologies. To extend investigations into the resistance of microorganisms and their carriers to disinfectants, to use bacteriophages for disinfection, to improve the normative basis for disinfection activity, and to perform researches to assess the risk of infectious diseases if disinfectants are not used are proposed as urgent areas of the development of disinfectology.

The paper considers the problem of arthropod resistance to insectoacaricides, which is of medical and sanitary importance on a global scale. It presents the basic principles of determining the resistance of arthropods collected on objects and analyzes the data available in the literature on pesticide resistance in arthropods from different systematic groups. It also briefly characterizes the mechanisms of resistance of arthropods to insectoacaricides and describes the ways of solving the problem.

Objective. To investigate the spread of vaccine-induced escape mutant variants of hepatitis B virus (HBV), by using a developed computer-based model. Materials and methods. The authors used the data available in the scientific literature on the current clinical and epidemiological features of hepatitis B (HB), the results of long-term retrospective epidemiological analysis of HB morbidity rates, and the data on the achieved scopes of HB vaccination among the Russian Federation’s population. The HB epidemic process model was based on the Baroyan-Rvachev mathematical epidemic modeling theory. The mathematical HB epidemic process as a computer-based HBV-escapemut program was accomplished by the computer-based EpidMod for Windows modeling technology developed at the N. F. Gamaleya Research Institute of Epidemiology and Microbiology, Ministry of Health of Russia. Results. The preliminary results of computer-based experiments using the model have shown that there is presently a potential accumulation for the spread of HBsAg-mutant variants in Russia: the incidence of acute HB infection caused by mutant variants will be low and insignif icantly higher over more than 40-50years, after which the incidence of acute HB may show a pronounced rise and a peak. The spread rate and intensity of HBsAg-mutant variants are influenced by a number of parameters: the probability of their emergence in patients with chronic HB; the number of people with prior HB infection caused by wild-type virus and with a risk for infection with HBsAg-mutant variants; and the scope of wild-type HB infection vaccination in the population. Conclusion. The prediction results establish the need to design new-generation recombinant vaccines inducing protective immunity against both wild-type and HBsAg-mutant variants in order to prevent their spread. Sanitary and education work on HB prevention is of no small importance to a target group (aged 15-40 years), particularly to people at risk for infection with an HBsAg-mutant variant.

Objective. To study the outcomes of perinatal HIV contact in children born to HIV-positive mothers in the Volga Federal District in 2006-2011 and to characterize risk factors for infection in the child. Subjects and methods. The influence of risk factors on the likelihood of virus transmission was studied in a retrospective cohort of children with perinatal HIV contact, by calculating odds ratio (OR) and 95 % confidence interval (CI). Results. A high viral load (more than 1000 copies/ml) and lower CD4+ lymphocytes (less than 350 cells/μl) in maternal blood were shown to substantially increase the risk of HIV transmission by the moment of delivery. Cesarean section was ascertained to reduce the risk for infection in the child only with high and unknown viral loads. Conclusions. The virologic and immunologic criteria for the high likelihood of a poor outcome of perinatal HIV contact are substantiated. A differential approach to choosing the mode of delivery is shown to be needed in HIV-infected women in view of the level of viremia. The results of the investigation contribute to improving measures to prevent perinatal HIV infection.

The article deals with pneumococcal vaccination in young children, including those in high risk groups. It gives the summarized data on the efficacy, reactogenicity, and safety of 7/13-valent pneumococcal conjugate vaccine (PCV7/13) from eight regions of Russia. These data have led to the conclusion that PCV7/13 is effective and well tolerated (including among premature infants) from 2 months of age when administered concurrently with other vaccines in accordance with the Russian national immunization calendar.

The use of fixed-dose combinations of(FDC) of nucleoside reverse transcriptase inhibitors in an antiretrovirus therapy (ARVT) regimen has today certain benefits, by reducing the amount of drugs and the frequency of their administration. The review gives the results of some large studies (including cohort ones) of the efficiency and safety of ARVT regimens including the FDC of abacavir and lamivudine (Kivexa). The proportion of patients showing a high compliance (> 95%) ensuring the optimal virologic suppression was higher with FDC than that with monodrugs (39 and 31%). The results of the investigation demonstrated that the application of FDC increases adherence to not only treatment as a whole, but also that to dosage (from 91.9 to 97.1%), administration time (from 86.3 to 95.5%), a third medication in the ARVT regimen (from 85 to 92.3%), treatment satisfaction (from 85 to 92%), and first-line therapy duration. In addition, FDCs permit specialists to more effectively manage comorbidities requiring co-treatment (for opportunistic infections, tuberculosis, chronic viral hepatitides, etc.). Having a high virologic and immunologic efficacy and a favorable safety and tolerance profile, Kivexa is incorporated into first-line ARTV regimens by most current guidelines, including the Russian National Research Society of Infectiologists guidelines (2012).