卷 12, 编号 1 (2022)

Objective. To analyze the prevalence and structure of asymptomatic SARS-CoV-2 carriage among the students and teachers of Saint Petersburg colleges during the rise in the incidence of COVID-19 in January 2022. Subjects and methods. In January 25 to 27, 2022, nasopharyngeal and oropharyngeal samples were collected from 3,886 out of 8,350 students and teachers from 4 colleges located in different districts of Saint Petersburg. The examinees had no signs of acute respiratory viral infections and other symptoms that did not rule out COVID-19. The samples were examined by PCR assay for SARS- CoV-2 RNA. The positive samples were tested for mutations to the omicron and delta variants using the laboratory PCR procedure developed by the Pasteur Research Institute of Epidemiology and Microbiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being. Laboratory studies were conducted in the Saint Petersburg Center for Hygiene and Epidemiology. Results. There was a high detection rate of asymptomatic SARS-CoV-2 positive persons among the students and teachers of Saint Petersburg educational establishments during the rise in the incidence of COVID-19 caused by the predominant omicron variant. On average, in 14-17-year old adolescents, the frequency of both positive samples (20.6%) and the proportion of the omicron variant in the positive samples (51.7%) were significantly higher than in the persons aged 18years and older (10.1 and 33.1%, respectively). This pattern was observed in all the analyzed educational establishments. The adolescents aged 14-17 years were statistically significantly 2.3 times more frequently asymptomatic virus carriers than the adults. In addition, among them, people who were 3.3 times more identified to be infected with the omicron variant than to the cohort of the studied individuals aged 18 years and older. There was a significant direct correlation between the increased number of the subjects to be tested and the probability of detecting asymptomatic carriers, including those infected with the omicron variant. Conclusion. During the rise in the incidence of COVID-19 in January 2022, there was a high prevalence of asymptomatic SARS-CoV-2 carriage among the students and teachers of educational establishments located in different parts of the city. The findings suggest that it is inadvisable to examine and isolate contact persons from amongst the students and teachers of educational establishments, who have no clinical manifestations of the infection. The examination and isolation of people with symptoms of the disease, the transfer of risk-group people to online work or education, as well as enhanced monitoring of compliance with nonspecif ic prevention measures in all public institutions remain relevant.

The problem of healthcare-associated infections (HAIs) has assumed particular importance during the pandemic of the novel coronavirus infection COVID-19. Objective. To qualitatively assess risk factors for the occurrence and spread of HAIs by the example of multidisciplinary hospitals in Moscow. Materials and methods. ELISA was used in the screening serological testing of serum samples taken from the healthcare workers of multidisciplinary somatic hospitals in Moscow for specific antibodies (IgG) to the viruses of hepatitis B (n = 890) and measles and rubella (n = 200). The 2017 to 2020 microbiological monitoring data (6852 clinical material samples), as well as a planned sanitary and bacteriological study of 6547swabs from intrahospital environment objects were used to assess the risk of HAIs caused by opportunistic bacteria of the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae) in patients from different clinical units. Results. The medical staff of multidisciplinary hospitals has been established to be at risk for spreading hepatitis B, which increases with age and the time that has elapsed since the end of a vaccination cycle. If the measles agent is brought into the territory of these facilities, there is a risk of its spread with the participation of healthcare workers. Microbiological examination of inpatients revealed a high risk of detection in the microflora isolated from the biomaterial of various multiple antibiotic resistance loci, the strains of representatives of the family of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs), nonfermenting gram-negative bacilli (NFGNB), gram-positive (GP) coccal flora (oxacillin resistant Staphylococcous aureus (ORSA), oxacillin resistant Staphylococcous epidermidis (ORSE). There has been identif ied a risk for spreading Klebsiella strains, the producers of extended spectrum carbapenemases. Conclusion. Risk-oriented HAI monitoring in the context of the novel coronavirus infection pandemic should be based on a multidisciplinary approach to this problem, by using various studies: serological, microbiological, sanitary-bacteriological, clinical epidemiological, statistical, and others.

Objective. To assess the structure and quality of communications on HIV infection treatment according to the results of a survey of HIV-infected patients. Subjects and methods. In 2019-2020, a direct written survey of 437 HIV-infected patients was conducted during continuous sampling at the planned follow-up visit. Surveys were made in 161 patients (Group 1) in the Republican Center for Prevention and Control of AIDS and Communicable Diseases, Ministry of Health of the Republic of Tatarstan, in 166 patients (Group 2) in the Leningrad Regional AIDS Center, and in 110patients (Group 3) in the Republican AIDS Center, Ministry of Health and Social Development of the Kyrgyz Republic. The respondents were asked to answer indicator questions to assess the fact and content of conversations made by healthcare workers about HIV infection treatment, and also to assess whether there is enough time at the physician’s appointment to investigate treatment issues. Results. A conversation on their treatment was confirmed by 46.9%, 91.5%, and 100% of the respondents in Groups 1, 2, and 3, respectively. The lowest rate of an affirmative answer to this indicator question was observed in Group 1 (p1-2 < 0.001; p1-3 < 0.001). The differences in the rate of this indicator between Groups 2 and 3 were also statistically significant (p2-3 = 0.011). An affirmative answer to all the asked indicator questions was obtained; counseling on HIV infection treatment was in full carried out in 22.4, 34.4, and 14.5% of cases in Groups 1, 2 and 3, respectively. Full-scale counseling was most frequently made in the Leningrad Region (p1-2 = 0.050; p1-3 = 0.049; p2-3 < 0.001). However, only a third of the surveyed participants confirmed that they had received counseling in full. In all the groups, the reasons for an impaired medication regimen were least often discussed with 36.5, 47.5, and 29.1% of respondents in Groups 1, 2 and 3, respectively. Most of the respondents noted that there was enough time to investigate treatment issues at the physician’s appointment: these were 88.4%, 88.4%, and 77.3%, respectively. Conclusion. The findings may suggest that in the regions where the questionnaire survey is conducted, the directive style of communications prevails in the specialist-patient system, and motivating counseling strategies are insufficiently used. There is a deficit in identifying the risks of non-adherence. Clarification and minimization of the risks of non-adherence, the use of incentives that motivate adherence to the antiretroviral therapy regimen, in particular, reminders of the prospect of improving the health status with regular use of drugs, contribute to enhancing the effectiveness of communications on HIV infection treatment.

Objective. To study the demographic and clinical characteristics of patients with HIV/CHC co-infection with the known hepatitis C virus (HCV) genotype. Subjects and methods. The investigators analyzed data on 700patients with HIV/CHC co-infection with available information on genotyping, who were first identified and registered in the Sverdlovsk Regional Center for AIDS Prevention and Control for HIV infection in the period from 2016 to 2019. Results. HCV genotype 1 was most common (50% of cases), genotype 3 was found in 45% of cases. The proportion of patients with F3-F4 fibrosis was 15%. In this cohort, the narcotic way of getting HIVprevailed (58%) versus 37% through heterosexual contacts. At least one comorbidity was present in 99% of patients. There were also deviations from the normal laboratory parameters (ALT, AST, creatinine, etc.). Conclusion. The clinical characteristics of patients with HIV/HCV coinfection differ from those of patients with HCV monoinfection; and these differences may influence the timing of initiation and choice of antiviral therapy for CHC. It is preferable to use direct-acting antiviral drugs in co-infectedpatients.

Objective. To analyze the incidence of measles in a children hospital in order to def ine strategic directions for the control of the nosocomial spread of this infection. Materials and methods. The investigators analyzed the 2007-2019 data available in the federal state statistical observation form No. 2 in Moscow and the Eastern Moscow Administrative District (EMAD), as well as epidemiological investigation of the Territorial Off ice of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being Directorate for the EMAD over 2017 and operational reports on case K, which had been submitted by the Moscow City Center for Hygiene and Epidemiology, Branch in the EMAD. Epidemiological and statistical studies were used. Results. During the analyzed period, the incidence of measles in Moscow had two epidemic rises: from 2011 to 2015 and from 2017 to 2019. The situation in the EMAD generally corresponded to the development of the measles epidemic process in the metropolis. The increased incidence of measles in the EMAD in 2017 was found to be caused by its several local outbreaks in one of the children hospitals due to periodic infections in the nonspecialized units.A total of 47 people out of228 contacts without information about vaccination from 5 sources of infection caught measles and fell ill. The average duration of contact from the onset of catarrhal phenomena in the source of infection was 2.8 days; the focal rate in the healthcare facility (HCF) was 50.0%; and the average number of cases in the focus was 5.7. Among the sick, the children aged 6months to 1 year were 46.0%; those aged 1-2years were 30.7%. The reasons for the spread of measles in the HCF were the low level of specific protection, late diagnosis, impairments in the anti-epidemic regime, and failure to take measures to ensure hospital environment hygiene. Conclusion. To control the measles infection situation and to prevent the infection and spread in the HCF, it is necessary to achieve high measles vaccination coverage rates, efficiency in organizing anti-epidemic measures, examination and isolation of patients with symptoms of measles, alertness of medical personnel regarding the diagnosis of the disease, as well as constant monitoring of the situation on the territory of HCF dislocation.

Large epidemic outbreaks of enterovirus infections (EVIs) are periodically recorded among children in urban settlements. Objective. To use geoinformation technologies to test the hypothesis about the important role of contacts between children in the spread of EVIs during the years of rising incidence in an urban environment. Materials and methods. The investigators conducted a descriptive epidemiological study using geographic information systems (GIS) according to the data of recording EVI cases in Irkutsk in 2019 (n = 214). EVIs were mapped according to the geographical coordinates of the addresses of cases registration using the QGIS 2.18 program. Natural Earth and OpenStreetMap resources were used to build a map. The distribution of cases was compared with the location of preschools and schools. Results. During the period of the seasonal increase in the incidence, there was a local rise in the number of EVI cases in the quarters of high-rise and mid-rise buildings. The risk of multiple EVI cases in the areas of educational establishments was higher: the odds ratio (OR) = 16.6 (4.8-58) for areas with preschools and 2.5 (0.9-6.9) for those with schools. A statistically significant association of areas with an increased density of registration of EVI cases with the localization of preschools and schools on the city map. Conclusion. The spatial and temporal features of distribution of EVI incidence confirm the important role of contacts between children in the spread of EVI in the urban environment.

Objective. To provide the clinical characteristics of patients with Pseudomonas aeruginosa infection, by taking into account the antibiotic resistance of isolated P. aeruginosa strains. Subjects and methods. The investigators retrospectively analyzed clinical data on 79 patients, in whom P. aeruginosa was isolated from their various biological material samples, by taking into account the antibiotic resistance of the isolates. Results. Pseudomonas aeruginosa infection is equally common in males and females; it can be recorded in both children and adults. Patients with Pseudomonas aeruginosa infection caused by antibiotic-resistant strains of P. aeruginosa were found to have underlying chronic diseases, such as diabetes mellitus, chronic obstructive pulmonary disease, chronic pyelonephritis, anemia, malignant tumors, bedsores, and urinary catheters. In 11.3% of patients, antibiotic-resistant strains of P. aeruginosa were isolated from the biological material collected within 48 hours after admission to hospital, indicating that they had a healthcare-associated infection prior to hospitalization. P. aeruginosa was established to be susceptible in vitro to polymyxins (86.1%), amikacin (81.0%), tobramycin (68.2%), levofloxacin (61.5%), meropenem (60.8%), imipenem (49.4%), doripenem (53.1%), ceftazidim (55.7%), cefepime (34.2%), and cefoperazone (24.2%). Conclusion. Among the P. aeruginosa strains isolated from inpatients, antibiotic-resistant strains prevailed, amounting to 78.5%. According to the monitoring results, polymyxins remain the drug of choice for severe invasive infections caused by antibiotic-resistant P. aeruginosa strains, to which the highest frequency of susceptibility was noted.

The review substantiates the relevance of studies on the specific prevention of plague. It analyzes publications from the databases of electronic libraries PubMed, e-library, CyberLeninka, etc. It also gives information on the existing areas in the development of anti-plague vaccines, modern methods for providing specif ic protection against plague and prospects for its improvement.

Objective. To study the effect of alloferon on the number of Epstein-Barr virus (EBV) DNA copies in saliva samples, the time course of changes in the content of natural killer (NK) cells and in the cytotoxic activity of killer cells in patients with chronic EBV infection (CEBVI) at 6 weeks after the end of therapy. Subjects and methods. One hundred (69 females and 31 males) suffering from CEBVI were divided into 2 groups. Within 2 months, Group 1 patients (n = 70) received therapy with alloferon (9 subcutaneous injections of 1.0 mg every other day), Group 2 patients (n = 30) took valacyclovir (Valtrex). The EBV DNA level in the saliva samples was determined by the PCR method; the cytotoxic activity of NK cells was assessed by the spontaneous and induced expression of CD107a (LAMP, number of NK cells). Results. At 6 weeks after the end of therapy, no EBV DNA was detected in 38 (54.28%) patients from Group 1 and in 9 (30.0%) from Group 2(p = 0.001). Conclusion. Alloferon has a pronounced effect on reducing the number of EBV DNA copies in the saliva samples, induces the expansion of NK cells and their cytotoxic activity in patients with CEBVI.