Vol 9, No 1 (2019)

Healthcare-associated infections (HAIs) represent a multidisciplinary problem due to the widespread occerence, negative consequences for the patients’ health, staff health and the state economy, and relevance of this problem has not diminished for decades. As early as in the late 70s of the last century, academician V.I. Pokrovsky noted the need for a systematic scientific approach to the evaluation of this problem, the development of the scientific foundations of the epidemiological surveillance of the HAIs, and the creation of a regulatory and methodological framework. The article is devoted to the issues of diagnostics, treatment and prophylaxis of HAIs in the Russian Federation, various areas of scientific work on the improvement of measures for the controlling and preventing HAIs, including analysis of the epidemiological risks associated with the spread of HAI pathogens; introduction of new methods and means for their laboratory diagnostics; professional advancement of specialists in the framework of educational activities; active international cooperation, as well as the improvement of the regulatory and methodological framework. The contribution of Central Research Institute of Epidemiology of the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being to the solution of the problem of HAIs is noted.

Objective. To assess the effectiveness of varicella vaccination in the Russian Federation in general and in Moscow in particular, a retrospective epidemiological analysis of the incidence of this infection during the pre-vaccination period (from 2006 to 2012) and after the start of vaccination (2013-2017) was carried out. Materials and methods. The data ofForm ofFederal Statistical Monitoring № 2 «Information about infectious and parasitic diseases» and Form of Federal Statistical Monitoring № 5 «Information about preventive vaccinations» were examined. Results. Planned varicella vaccination of children before enrolling in preschool educational organizations, which is held in Moscow in accordance with the regional immunization schedule, helps to reduce morbidity and more effectively affects the epidemic process of varicella than vaccination of risk groups carried out within the national immunization schedule for epidemic indications. It was found that vaccination with incomplete coverage of children aged 3-6 years in Moscow led to a decrease in the varicella incidence among children 3-14 years old, did not affect the incidence rates in adolescents and led to an increase in the incidence in adults with a tendency to increase the incidence of children under 1 year of age. Conclusion. In order to assess the effectiveness of vaccine prophylaxis of varicella in the Russian Federation, it was proposed to organize monitoring and provide vaccination coverage of different age groups in population.

Objective. The evaluation of the views of health workers on the content of the concept of «adherence», as well as the risks of violation of patient adherence to follow-up care and treatment of HIV infection. Materials and methods. In 2017-2018, questionnaire-based survey of 105 specialists was conducted in the framework of certification training courses. The survey participants composed 4 groups; 3 groups were surveyed in 2017: group 1 (n = 34) - in Nizhny Novgorod; group 2 (n = 25) - in Chelyabinsk; group 3 (n = 22) - in Moscow. The group 4 (n = 24) included specialists interviewed in Moscow in November 2018. They indicator questions about the determination of adherence and the risks of its violation were used. Results. It was revealed that the propoirtion of respondents who chose the traditional definition of adherence ranged from 31.3 to 52.2%. Understanding of adherence as a specific human behavior in relation to drug intake was relevant for 35.8% of specialists. The respondents’ choice of the option of risk of violation of adherence, «associated with therapy» (number of drugs, dosage frequency, side effects of drugs) ranged from 38.1% in the group 3 to 60.9% in the group 4. Among the risks of violation of adherence to follow-up care in all groups, the descriptions of problems associated with the emotional state of patients- «fear», «shame» - were leading (from 29.1 to 22.2%). Conclusion. The multimodality of the risks of violation of adherence to follow-up care and treatment of HIV infection requires a comprehensive approach to minimize them, and it can be implemented in the framework of a multiprofessional model of care for HIV infection.

Modern information about the etiology, epidemiology, clinical picture, principles of diagnosis and treatment of typhoid fever is presented. Clinical examples of the mild form of typhoid fever and severe course with a complication are given.

The problem of viral hepatitis is close to its solution. In 2016 WHO Global Health Sector Strategy for Viral Hepatitis for 2016-2021 has set the task for hepatitis control and elimination, and identified how to address it. The development of such a program has become possible due to the obtained fundamental knowledge about the nature of viral hepatitis, which allows to achieve this ambitious goal. Undoubtedly, the implementation of a program to control viral hepatitis in Russia, based on modern scientific knowledge and the realities of the epidemic process, will make it possible to solve the problem of controlling these diseases. However, new problems arise on this path. This publication addresses some of the current issues, in conjunction with own data. These problems may include: the possibility of the wide spread of hepatitis A virus among certain populations (hepatitis A outbreak in the USA in 2017-2018); the interspecies transmission of HEV from animals to humans; problems encountered in the implementation of the program for mass vaccination against HBV («Vaccine audit»); the history and characteristics of the circulation of the hepatitis D virus in various territories; distribution of circulating forms of the hepatitis C virus with drug resistance to direct-acting drugs (interferon-free therapy). New knowledge on the above mentioned issues are crucial for the successful implementation of the program for the control of viral hepatitis.

Generalized forms of meningococcal infection (GFMI) are serious infectious diseases caused by bacteria of the Neisseria meningitidis species. Cyclic increase in the GFMI incidence, different incidence rates in certain territories and in different periods of time can be explained by antigenic and genetic features of circulating pathogens in some cases. Currently, in Russia and abroad, molecular-biological approaches are actively used to monitor GFMI pathogens, aimed at identifying sequencing types and clone complexes within representatives of known serogroups in order to determine their role in the epidemic process. The review presents the main results obtained by domestic researchers, and updated previously outlined directions for further molecular and biological monitoring of GFMI pathogens.

An analysis of the medical literature on the role of the skin and intestinal microbiota in the pathogenesis of some inflammatory skin diseases is presented. The effect of intestinal flora metabolites on the pathogenesis of certain dermatoses is described. Clinical and experimental data on the effect of specific bacterial communities on the pathogenesis of inflammation are presented; the role of interspecific interactions in the microbiota in the development of inflammatory dermatoses is discussed. The distinctive features of microbiotas in HIV-positive and HIV-negative patients suffering from seborrheic dermatitis, psoriasis and atopic dermatitis are presented.