Vol 9, No 3 (2019)

In 1980 to 2010, the Trans-Baikal region remained free of rabies. In 2011, the first cases of rabies in animals were recorded; outbreaks were later detected in several areas. Objective. To characterize the epidemiological features of rabies outbreaks recorded in Transbaikalia after a long period, during which no cases of th is disease were found. Material and methods. The authors conducted a descriptive epidemiological study of a series of outbreaks identified in the Republic of Buryatia and the Trans-Baikal Territory in 2011-2018. GIS technologies and phylogenetic analysis of virus isolates were used. Results. There were 262 cases of rabies in animals (35.5% of cases in wild animals, 7.2% in dogs and cats; 57.3% in agricultural animals). No human rabies cases were reported. Foxes (Vulpes vulpes) were the main natural reservoir of infection. Rabies virus isolates belonged to the steppe genetic lineage and differed from the viruses isolated in this region in the 1970s (Arctk-like lineage). Epidemiological and molecular genetic data are indicative of the transboundary introduction оf infection from Mongolia and China. Conclusion. The outbreaks of rabies in Trans-Baikal occurred due to the spreading of the steppe variant of the rabies virus in the eastern direction and its penetration into the peripheral areas of Mongol-type steppes. In 2011-2018 dogs and wolves were rarely involved in the circulation of the virus, unlike to the epizootics described in the 20th century, which is obviously associated with a change in the variant of the virus.

Healthcare-associated infections (HAIs) are customary to be analyzed from registered disease cases, which cannot always reflect real values. In accordance with the sanitary and epidemiological rules in force in the Russian Federation, each case of HAIs is to be considered and registered in the established procedure. However, this registration arrangement is not always effective against nosocomial infections, since the attending physician is not interested in publicly reporting complications, even if his actions are perfectly correct. Therefore, the incidence of all HAIs in a number of healthcare facilities does not exceed 0.1-0.5%. On the other hand, due to staff shortage, the hospital epidemiologist is unable to analyze all medical records in order to identify nosocomial infections and to provide their epidemiological characteristics. As a result, it seems to be difficult, time-consuming, and almost impossible to assess the conformity of the incidence of HAs in the registered cases to its actual values in a healthcare facility. The authors have proposed an alternative procedure to estimate the incidence of surgical site infections from the use of reserve antibacterial drugs, which will be able to assess the adequacy of registration of complications with the specification of a specific unit and without attending physicians’ participation.

Owing to immunization, significant successes have been achieved in the fight against infectious diseases. However, many issues of organizing an epidemiological surveillance over vaccination in the population still need to be improved. Objective. To determine the importance of monitoring adherence to vaccination in different population groups in the system for epidemiological surveillance of immunoprophylaxis and to elaborate recommendations for its improvement. Subjects and methods. A survey of 865 parents, 1325 health care workers, 750 students and 216 teachers of the Medical University was conducted to determine the commitment of certain groups of the population of a large industrial city to vaccination. Epidemiological, sociological, and statistical studies were used. Results. Assessment of parents’ attitude towards vaccination ascertained that 79.3% of the respondents were positive, 6.4% denied the need for vaccination, and 14.3% expressed doubts about its effectiveness and safety. The main source of information about vaccinations in parents was the opinion of health workers; however, their survey identified 187 (14.1%) employees, mainly among the trained professionals with negative attitudes towards vaccination. Among the students of the medical university, there were 66 (8.8%) persons doubting the effectiveness of vaccinations, while most of them were junior students. There were negative answers to the question about vaccinations in 8.3% of the questionnaires filled out by the teachers (n = 18), mainly by those working at the theoretical departments. It is obvious that to form a positive attitude to vaccination in the population and to increase vaccination rates, it is necessary to specify educational programs, taking into account the target audience: junior students of medical universities, teachers of theoretical departments, health care medical workers with more than 20 years of experience. Conclusion. Monitoring vaccination adherence enables important information to be obtained to determine the trajectories of education, upbringing of the population, and to enhance the competence of teachers and health care workers, who will contribute to the improvement of vaccination. This type of monitoring should be included in the information subsystem of epidemiological surveillance over vaccination as an independent component used on a regular basis.

Objective. To analyze the laboratory criteria and clinical and epidemiological features of parvovirus-induced nonimmune hydrops fetalis (NIHF) in the Republic of Belarus. Materials and methods. In the period 2012-2018, a total of51 cases of NIHF were investigated to establish the role of primate erythroparvovirus 1 (B19P), formerly known as parvovirus B19, in the occurrence of the disease; and laboratory-verified cases of parvovirus-induced infection underwent epidemiological analysis. Results. Parvovirus infection was confirmed in 12 (23.5%) cases of NIHF; the average long-term incidence rate was 1.5per 100,000 newborn infants. The main diagnostic method was the detection of B19P DNA in the serum of pregnant women and in different types of fetal biological material. Specific IgM was detected in 5 (41.6%) women and in none of the neonates. None of the women had episodes of acute exanthema during pregnancy. Hydrops fetalis was detected by ultrasound screening in 8 out of 12 cases and by ultrasonography in the remaining 4 cases due to the worse health of a pregnant woman or to the appearance of fetal arrhythmia. The main manifestations of hydrops were subcutaneous edema (83.3%), ascites (75.0%), hydrothorax (58.3%), and hydropericardium (58.3%). Parvovirus infection caused death in 7 (58.3%) cases: in 5 fetuses and 2 neonates. Conclusion. Parvovirus infection is a significant cause of NIHF and requires that molecular assays should be used to verify the diagnosis. In most cases, parvovirus-induced hydrops fetalis has an unfavorable outcome.

Objective. To analyze the reasons for the discrepancy between the preliminary and final clinical diagnoses at a tuberculosis (TB) hospital and to determ ine the ways of improving the accuracy of diagnosis. Materials and methods. Sixty-nine medical records were studied in the patients treated at the Republican Clinical Tuberculosis Hospital in Donetsk in 2014-2018, in whom the diagnosis of tuberculosis was removed after examination in the TB department. The patients were divided into groups: 1) HIV-positive (n = 31) and 2) HIV-negative (n = 38). There was a male preponderance in both groups: 17 and 21, respectively; the mean age was 42.3 ± 1.8 and 57.8 ± 2.4 years and the median bed/days were 10 and 11. Bacteriological assays, chest and head spiral computed tomography (SCT), and diagnostic fibrobronchoscopy (FBS) were used. Results. Exclusion of tuberculosis and clarification of its diagnosis were made in 44 (63.8%) patients within 2 weeks; tuberculosis test therapy was required in 7 (10.1%) patients. The HIV- infected patients were most frequently diagnosed with HIV/AIDS-associated nervous system lesions and pneumonia (including atypical ones); the HIV-negative patients had lung oncopathology (cancer, carcinomatosis). Acid-resistant bacteria detected prior to hospital, unconfirmed in a specialized dispensary, were present in 15 (39.5%) HIV-negative patients. Conclusion. To improve the accuracy of tuberculosis diagnosis in the facilities of the general medical network, it is necessary to improve the quality of microscopic examination and to prevent the contamination of biological samples. If there are clinical and radiological signs of pneumonia in HIV-infected persons with a negative sputum microscopy, their treatment should be performed in the specialized departments of AIDS centers with repeated consultation of a TB specialist if necessary.

The literature review provides data on promising drugs being at different stages of testing for the treatment of patients with chronic hepatitis B.

Objective. To assess the microbial landscape structure in the units of the V.A. Baranov Republican Hospital and to specify the susceptibility of pathogens to antimicrobial agents. Materials and methods. The investigators assessed the results of microbiological assays of biomaterials (blood, sputum, urine, and wound discharge), which had been performed for 7 months (from April to November 2015) and the spectrum of pathogens and their antibiotic susceptibility in all hospital units. The studies were conducted for 4 months in the Bacteriology Laboratory of the Republican Infectious Diseases Hospital, where microflora was obtained from 298 patients (no data on the number of negative results) and in the Citylab laboratory (Saint Petersburg) for 3 months. During 3 months, there were 552 studies, 367(66.48%) of them identified the microflora. The disk-diffusion test was used. Results. The microflora is more often examined in the surgery units; more resistant pathogens are noted in the anesthesiology and intensive care units; the gram-negative pathogens are susceptible to carbapenems in 100% of cases in the urology and surgery units; Staphylococcus aureus prevails in the trauma unit; methicillin-sensitive strains were obtained in the majority of patients with community-acquired infection. Conclusion. Consideration of the local landscape, timely microbiological diagnosis, and adequate antimicrobial therapy are needed to decline the number of multidrug-resistant strains of pathogens, to reduce the costs of treating nosocomial infections, and to improve the prognosis for patients.