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Том 14, № 2 (2024)
Epidemic Situation
Results of multi-year monitoring of the safety of immunization against rotavirus infection
Аннотация
Objective. Assessment of the safety of long-term vaccination of children with a live pentavalent recombinant rotavirus vaccine as part of a pilot project in Podolsk, Moscow region.
Materials and methods. A retrospective analysis of the incidence of intussusception (ICD-10 K56.1) was carried out based on data on hospitalization of children in a city hospital before (2013–2015) and against the background (2016–2022) of vaccinations against rotavirus infection (RVI). The data of expedited reports (form No 058u) and form No 2 of federal statistical observation, as well as reports of investigations of post-vaccination complications received by Territorial Administration of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being in the Moscow region in 2013–2022 were also studied.
Results. Over the 7 years, children received 38 144 vaccinations against RVI. No post-vaccination complications were recorded. The background incidence rate of intussusception in the city has not changed since the beginning of the pilot project. Over 10 years, 21 children were diagnosed with intussusception, four of them were vaccinated against RVI: two received the full course of vaccinations, two received only two vaccinations. The duration of the disease ranged from 69 days to 5 years after receiving the last dose of the vaccine, which indicated the absence of a cause-and-effect relationship between the cases of intussusception and the introduction of the rotavirus vaccine.
Conclusion. The results confirmed the published data on the safety of the pentavalent rotavirus vaccine. When organizing vaccine prevention of RVI, it is necessary to monitor adverse events in accordance with current guidelines.
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Current trends in the development of the epidemic process of community-acquired pneumonia and their relationship with upper respiratory tract infections
Аннотация
Despite significant progress in studying the etiology of community-acquired pneumonia (CAP), up to 50% of disease cases remain undeciphered, which determines the difficulties in assessing the epidemic situation, developing and implementing a set of preventive and anti-epidemic measures.
Objective. Identification of trends in the development of the epidemic process of CAP and assessment of their connection with the incidence of influenza, ARVI, COVID-19, infectious mononucleosis in the Russian Federation in 2011–2023.
Materials and methods. Based on the data of form No 2 Information on infectious and parasitic diseases», a retrospective epidemiological analysis of the incidence of the studied infections was carried out, the etiological structure of CAP was studied, the relationship between the incidence of influenza, ARVI, COVID-19, infectious mononucleosis and CAP was assessed
Results. A feature of the epidemic process of CAP has been a change in morbidity trends and etiological structure. A direct strong correlation has been identified between the incidence of CAP and ARVI, COVID-19, and infectious mononucleosis in different age groups of the population.
Conclusion. The course of the epidemic process of CAP significantly depends on the prevailing circulation of pathogens of a viral and bacterial nature. At the same time, the morbidity of the adult population is largely determined by viruses of the respiratory group of infections. For children, the bacterial nature of the process is most characteristic, as well as the etiological association of bacteria and viruses (primarily the Epstein–Barr virus), which have a long-term suppressive effect on the immune system.
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The role of pathogens of upper respiratory tract viral infections in the formation of an epidemic rise in morbidity in the season 2022–2023 in Moscow
Аннотация
Objective. Assessment of the dynamics of morbidity and the role of pathogens of influenza, acute respiratory viral infections (ARVI) and herpes in the epidemic season 2022–2023 in Moscow.
Materials and methods. A retrospective epidemiological analysis of the dynamics of morbidity rates was carried out using the federal state statistical observation form No 2 Information on infectious and parasitic diseases» for 2010–2023, data from the weekly national bulletin on influenza and ARVI of the Smorodintsev Influenza Research Institute and N.F. Gamaleya National Research Center for Epidemiology and Microbiology for the epidemic season 2022–2023. Molecular genetic methods were used to etiologically decipher cases of diseases and serological methods (ELISA, RTGA) – to assess the level of specific antibodies (IgG) to current pathogens of acute upper respiratory tract viral infections.
Results. Influenza and ARVI incidence rates during the epidemic season2022–2023 corresponded to the characteristics of the pre-pandemic» period with peak values at the 48–49th week in Moscow and at the 50th week in the Russian Federation. The dominant circulation of influenza viruses A(H1N1)pdm09 (A/Victoria/4897/2022) among Moscow residents was noted due to the large number of non-immune individuals. On the contrary, against the background of high seroprevalence to influenza viruses B line B/Victoria-like and A(H3N2) (A/Darwin/9/2021), there were low number of cases of diseases. Among the pathogens of ARVI, rhinoviruses (35.6% of all findings), as well as metapneumo-, boca-, adenoviruses and parainfluenza viruses 1 prevailed; the circulation of rhinoviruses was most intense at the beginning and end of the epidemic season. It was established that the presence of IgG to SARS-CoV-2 in the examined individuals was a prerequisite for detecting markers of reactivation of chronic infections caused by the Epstein–Barr virus and herpes simplex virus, which indicates the trigger role of COVID-19 in maintaining the epidemic process of herpesvirus infections.
Conclusion. The introduction of mandatory molecular genetic monitoring along with seroprevalence assessment can ensure effective prediction and identification of priority pathogens of acute respiratory tract infections for the upcoming epidemic season.
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Epidemiological monitoring of West Nile fever in the territory of the Rostov Region in 2022
Аннотация
The wide territorial distribution of West Nile fever in the Rostov Region determines the significance of this nosology for regional monitoring.
Objective. Assessment of the results of epidemiological monitoring of West Nile fever in the Rostov region in 2022.
Materials and methods. Epizootological surveys were carried out in 33 districts of the Rostov Region. 3,634 specimens of carriers and vectors were examined for the presence of West Nile virus markers using ELISA and PCR. 484 blood sera samples from donors from 7 administrative districts of the region were tested using ELISA method.
Results. During zooentomological monitoring, positive findings were obtained in Tarasovsky, Salsky, Neklinovsky, Proletarsky, Millerovsky, Kamensky, Sholokhovsky districts of the Region; in general, the summury contamination of field material was 3,1%. Specific IgG in healthy donors was detected in Veselovsky (22,2%), Neklinovsky (12,2%), Salsky (11,8%), Azov (9,7%), Zavetinsky (7,5%) districts and in Rostov-on-Don (18,0%). The overall seroprevalence was 12,4%.
Conclusion. The data obtained indicate the activity of natural foci of West Nile fever in the Rostov Region.
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Original Investigations
Clinical and laboratory characteristics of Q fever in the Novosibirsk Region
Аннотация
Objective. Characteristics of clinical symptoms of Q fever and determination of molecular genetic and serological markers of C. burnetii in patients in the Novosibirsk region hospitalized in the early stages with unspecified fever and suspected infectious diseases transmitted by ticks.
Material and methods. 830 patients hospitalized with suspected infectious diseases transmitted by ticks in the spring-summer period 2018–2022 were examined. To confirm the results of PCR analysis, positive samples containing C. burnetii DNA were amplified using fragments of the IS1111 genes and the heat shock protein B gene (htpB), followed by their sequencing. The presence of class G immunoglobulins to C.burnetii in blood serum samples of patients was detected using ELISA.
Results. All patients with Q fever had intoxication syndrome with febrile fever, 86% had hepatitis with mild-to-moderate cytolysis syndrome; 2 (14.3%) patients developed serous meningitis. Pneumonia was diagnosed in 1 (7.1%) case.
Conclusion. Diagnosis of Q fever due to the polymorphism of the clinical course is impossible without laboratory confirmation. Identification of cases of the disease in the Novosibirsk region during a comprehensive clinical and laboratory study dictates the need to include early diagnosis of Q fever in the list of mandatory tests in patients with tick bites, which is of great practical importance for timely and adequate therapy.
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Risks of COVID-19 in private nursing homes in the Eastern Administrative District of Moscow
Аннотация
Objective. Assessing the association of COVID-19 incidence among residents of long-term care facilities with different ownership types.
Materials and methods. A retrospective cross-sectional study and a retrospective analytical study of the COVID- 19 incidence among residents of closed long-term care facilities of private and state ownership in the Eastern Administrative District of Moscow during the period of the first rise in the COVID-19 incidence was conducted. 6 acts of sanitary and epidemiological investigation of focus of disease, 288 electronic medical records, issued in the «Department for Registration and Record of Infectious Disease (DRRID)» AIS system, form № 2 of the federal statistical observation «Information on infectious and parasitic diseases» for March–June 2020 were analyzed.
Results. For-profit facility status was associated with higher odds of resident infection (odds ratio 4.791; 95% CI 3.193–7.188; p < 0.05). The reasons included the architectural features of private institutions: the lack of an isolation ward with a gateway and a separate exit, lack of a medical office, the impossibility of dividing floors into «red» and «green» zones, as well as the recruitment of unqualified personnel, a small staff.
Conclusion. Private nursing homes are risk areas, the COVID-19 incidence in such facilities can significantly complicate the epidemic situation.
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Diversity of streptococcus species isolated in the departments of purulent surgery and coloproctology of a multidisciplinary hospital and their antibiotic resistance
Аннотация
Objective. Determination of the frequency of occurrence and characteristics of sensitivity to antibiotics of different Streptococcus species isolated from patients in the departments of purulent surgery and coloproctology of a multidisciplinary hospital in Moscow.
Materials and methods. An epidemiological observational descriptive continuous retrospective study using data from patients of departments of purulent surgery (n = 2094) and coloproctology (n = 1933) aged 18 years and older for 2017–2022 was conducted. The sensitivity to antibiotics of 1208 streptococcal cultures isolated in the department of purulent surgery and 827 cultures obtained in the department of coloproctology was analyzed. Antibiotic susceptibility was determined using microbiological analyzers BD Phoenix M50 and VITEK 2XL in accordance with EUCAST and CLSI recommendations.
Results. In the department of purulent surgery, Streptococcus pyogenes (28,53%), Streptococcus agalactiae (22,0%), Streptococcus anginosus (16,49%) were isolated statistically significantly more often; in the department of coloproctology – S. anginosus (41,66%), Streptococcus constellatus (15,99%), S. agalactiae (14,54%). A significant proportion of S. agalactiae cultures showed resistance to tetracycline (80,32%) and clindamycin (41,13%). In the department of purulent surgery, S. agalactiae resistance to erythromycin increased from 15,4 to 38,3% from 2019 to 2021, in the department of coloproctology – from 16,67 to 38,46%.
Conclusion. The results obtained revealed significant differences in the antimicrobial resistance of streptococci and showed the inappropriateness of using tetracycline and erythromycin to treat patients in the department of purulent surgery.
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Evaluation of contamination by salmonella of food raw materials and food products of animal origin
Аннотация
Objective. Assessment of the frequency of Salmonella isolation from food products of animal origin and determination of the sensitivity of detected strains to antimicrobial agents (AMAs).
Materials and methods. In 2021–2022, sanitary and bacteriological studies of 71,856 samples of food products and food raw materials of animal origin produced or consumed in the territory of the Republic of Tatarstan for contamination by Salmonella spp. were carried out. The sensitivity of the isolated strains to AMAs was determined.
Results. It was found that Salmonella spp., mainly S. Infantis (48,0%), S. Enteritidis (17,0%), S. Virchow (7,0%) were found in 0,14% of samples of food raw materials and food products. 13,5% of Salmonella spp. showed resistance to AMAs. Serovar-specific differences in the resistance of strains to chloramphenicol and co-trimoxazole, tetracycline drugs (tetracycline and doxycycline), to certain representatives of aminoglycosides (gentamicin) and fluoroquinolones were revealed. It was established that Salmonella serovar Bareilly, which had not previously been detected in the region, was the etiological agent of a large outbreak of group incidence of salmonellosis (254 cases) with food transmission.
Conclusion. Evaluation of the characteristics of circulating Salmonella spp. strains allows to identify epidemically dangerous variants of salmonella and confirm the role of food in the occurrence of infection.
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Development of a Dot-assay for detecting antibodies to tick-borne encephalitis virus using recombinant EDIII-TBEV antigen and IgY antibodies
Аннотация
Objective. Evaluation of the effectiveness of the use of recombinant protein EDIII-TBEV and chicken IgY antibodies in the development of a diagnostic kit for detecting IgG to the tick-borne encephalitis virus by dot analysis.
Materials and methods. Probes based on colloidal gold and secondary immunoreagents (Au-SpA, Au-SpG, Au-IgG-a/Hum and Au-IgY-a/Hum) were manufactured and studied in a dot analysis of human immunoglobulins of A, M and G classes. Experimental kits for dot-immunoassay of IgG to TBEV were created based on the probes and EDIII-TBEV.
Results. Experimental assessment of the characteristics of the kits using panels of blood serum samples containing and not containing IgG to TBEV, as well as panels of samples containing antibodies to pathogens of other flavivirus infections (dengue fever and yellow fever) showed 100% sensitivity and specificity of the dot analysis, which indicates the high selectivity of the recombinant EDIII-TBEV antigen. Probes based on polyclonal IgY-a/Hum are not inferior in sensitivity and provide a 10-20% more intense optical signal compared to probes based on mouse monoclonal IgG-a/Hum.
Conclusion. Probes based on IgY-a/Hum and recombinant EDIII-TBEV antigen can be considered as promising reagents for antibody analysis, in particular, for dot analysis on flat substrates. Kits created on their basis can be used to diagnose tick-borne encephalitis in remote areas with poorly developed laboratory infrastructure.
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Prevalence of latent tuberculosis infection among contact persons in social homes
Аннотация
Objective. Assessment of the prevalence of latent tuberculosis infection (LTBI) and the effectiveness of preventive measures among contact persons living in social homes.
Materials and methods. An epidemiological investigation was carried out into 6 cases of tuberculosis without bacterial excretion registered in three social homes in Moscow. All contact persons, including staff, were examined at the Branch for the Eastern Administrative District and the North-East Administrative District of the Moscow City Scientific and Practical Center for the Fight against Tuberculosis of the Moscow Healthcare Department. Based on the examination results, contact persons were prescribed chemoprophylaxis with two combination drugs for 3 months.
Results. A total of 563 contact persons were identified in three social homes. LTBI was detected in 46 people, which amounted to 8.17% (95% CI 6.05–10.57). During the control test with the recombinant tuberculosis allergen in the 2nd year of follow-up, a decrease in the papule by 5 mm was noted in 7 (15.22%; 95% CI 6.42– 26.9) patients; results of tuberculin tests remained unchanged in 39 (84.78%; 95% CI 73.1–93.58) contact persons.
Conclusion. A patient with pulmonary tuberculosis without official confirmation of bacterial excretion is contagious. The detection rate of infected individuals in years by skin testing depends on the proximity of the contact to patient zero. Preventive therapy made it possible to prevent an outbreak of tuberculosis in social homes.
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Clinical Notes
Clinical case of complicated visceral leischmaniasis in the Republic of Bashkortostan
Аннотация
According to WHO estimates, from 700 thousand to 1.3 million new cases of cutaneous leishmaniasis and 200–400 thousand cases of visceral leishmaniasis are registered annually in the world. Visceral leishmaniasis kills up to 30 thousand people in the world, and in terms of mortality, visceral leishmaniasis is second only to malaria. The article describes a clinical case of non-imported visceral leishmaniasis in a 40-year-old man. The presented clinical observation indicates the difficulties of diagnosing the disease in non-endemic regions and the difficulties of carrying out differential diagnosis for somatic doctors.
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Exchange of Experience
Choice of treatment tactics in patients with acute bacterial intestinal infections who have a high risk of developing irritable bowel syndrome
Аннотация
Objective. A comprehensive assessment of the effect of calcium butyrate (CB) and inulin (I) on reducing the risk of developing post-infectious irritable bowel syndrome (IBS) in patients with acute bacterial intestinal infections (ABIIs) with a high risk of its development in the period of convalescence.
Materials and methods. The study included 60 patients with ABIIs aged 18 to 60 years who had a high risk of developing IBS, established using a discriminant equation that included triglyceride, cholesterol and urea levels at the height of the disease. Patients were randomized into 2 groups of 30 individuals each: in the comparison group, standard therapy was prescribed; in the main group, patients additionally received the biologically active dietary supplement zakofalk (250 mg CB and 250 mg I). The effectiveness of therapy was assessed by the triglyceride levels at the height of the disease and at discharge from hospital, fecal calprotectin and I-FABP levels at the height of the disease and 1 month after after discharge.
Results. There were no statistically significant intergroup differences in the duration of the main clinical symptoms and laboratory parameters. However, the fecal calprotectin and I-FABP levels decreased statistically after 1 month after hospital treatment in the main group. Triglyceride levels were also lower during the recovery period in patients of the main group. Incidence of IBS development over the next 6 months was 38.5 times lower in the group receiving BC + I compared with patients receiving standard therapy.
Conclusion. The use of BC + I in addition to standard therapy accelerates the normalization of inflammatory markers and reduces the risk of developing IBS after ABIIs. A biologically active dietary supplement containing BC + I can be considered as an effective mean of preventing the development of IBS in patients with ABII.
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«Masks» of Crimean hemorrhagic fever in medical practice
Аннотация
The severity and outcomes of Crimean hemorrhagic fever (CHF) depend on the timeliness of diagnosis and hospitalization in an infectious diseases hospital. Delay in diagnosis and initiation of specific treatment is an important risk factor for poor outcome.
Objective. Analysis of defects in the diagnosis of CHF and development on this basis of a differential diagnostic algorithm with an assessment of its effectiveness.
Materials and methods. A retrospective longitudinal study analyzed 94 laboratory-confirmed cases of CHF in patients who were admitted in infectious diseases hospitals in the Turkestan region and the city of Shymkent for 2011–2023.
Results. Difficulties in making a diagnosis of CHF were associated with the nonspecificity of symptoms at the initial stage of the disease, incomplete collection of anamnesis and epidemiological data, limited knowledge of medical personnel about the disease and the criteria for its diagnosis, and underestimation of the severity of the patient’s condition. Infectious, surgical, therapeutic and gynecological «masks» of CHF were established, and relevant clinical observations were presented. Analysis of cases of delayed diagnosis of CHF became the basis for the development of a differential diagnostic algorithm for this disease.
Conclusion. In natural foci of CHF, it is important for doctors of different professions to be vigilant, have up-to-date knowledge and apply modern diagnostic methods to reduce the likelihood of diagnostic errors when identifying CHF. Algorithms for the differential diagnosis of CHF created and applied in the training of medical workers led to a significant reduction in the proportion of cases of underestimation of CHF by 3.6 times and allowed to avoid delays in starting etiotropic and pathogenetic therapy.
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Anniversary
Pokrovsky V.V. To the 95th anniversary of Valentin I. Pokrovsky
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