Nº 4 (2013)

The paper covers adult immunization. It gives information on the morbidity and mortality associated with influenza and pneumococcal infection in Russia and worldwide. It is emphasized that the elderly people have the highest death rates from these infections. The author has deduced from international experience that vaccination against influenza and pneumococcal infection in adults is highly epidemiologically, socially, and economically effective. It is concluded that it is necessary to compile a national calendar for immunization of adults and vaccination against influenza and pneumococcal infection in elderly people in Russia.

Objective. To define the indicators of immune response to hepatitis B (HB) vaccination in different periods after immunization and to evaluate its epidemiological efficiency from the detection rates of HBV infection markers in vaccinated and unvaccinated children from different regions of Ukraine. Subjects and methods. 1586 serum samples obtainedfrom HB vaccinated and unvaccinated children in different regions of Ukraine were examined. Enzyme immunoassay was used to measure HBsAg, anti-НВс, and анти-HBs level. Results. Among the vaccinated children, there were a large number of negative anti-HBs cases (46.7%) with the highest proportion in the 10-14-year-old group (57.9%). There was evidence supporting the comparable immunological efficiency of two- and three-dose vaccination. The HB vaccination initiated in infants above 1 year of age was shown to be more immunological efficient than neonatal immunization. The epidemiological vaccination efficiency coefficient was 71.2%. There were data on equal HBV infection rates in HB vaccinated and unvaccinated children aged 10-14 years (3.7 and 2.0%, respectively). In the vaccinated children, the presence of HBV infection markers was accompanied by the absence of a protective anti-HBs level. Conclusion. The results of the multicenter study conducted in Ukraine suggest that HB vaccination has displayed a good epidemiological efficiency as a whole. They show the needfor further investigations to determine when to initiate vaccination in infants with no risk of perinatal infection and whether booster immunization is expedient in the low HB prevalence regions.

Numerous efforts by a number of research organizations to design staphylococcus vaccines have been unsuccessful to this day and there are virtually unavailable effective commercial immunopreparations to control staphylococcal infections. The review presents the results of trials of vaccines designed using the major virulence factors of Staphylococcus aureus. Foremost, these are capsular polysaccharides, alpha-toxin, leukocidin, and surface protein antigens. During the clinical trials, the vaccines based on these antigens proved to be insuff iciently effective; in this connection, a start was made to develop polyvalent vaccines by choosing protective antigens. These vaccines were designed on the basis of surface proteins, including iron-regulated ones. There are also attempts to develop vaccines based on polysaccharide-protein compositions obtained from specially selected S.aureus strains. Virtually all multivalent vaccines are passing a clinical stage or phase 1 clinical trial now. To select S. aureus strains and to choose protective antigens are an important condition for preparing an effective staphylococcal vaccine; these have been used to design the vaccine developed at the I.I. Mechnikov Research Institute for Vaccines and Sera, Russian Academy of Medical Sciences.

The discovery of hepatitis D virus (HDV) dates back to the mid-1970s and is associated with the detection of a novel nuclear antigen in patients with severe forms of hepatitis B. HDV is present in all age groups and widespread, but not in all regions of the world at equal frequency. HDV genomes of different isolates present about 40% heterogeneity. There are at least 8 HDV genotypes with varying prevalence rates. HDV is the least among the animal RNA viruses, the replication of which depends on the enzyme systems of a host hepatocyte and the virion assembly is related to the protein structures of hepatitis B virus (HBV). HDV RNA encodes the only protein -HDAg. Minor protein is a major transcription product. Since HBV is essential for the assembly and intercellular spread of HDV, the infection caused by the latter is generally related to HBV infection. Hepatitis may have a severe course and show two peaks for the enhanced activity of transaminases. The main cause of death in patients with chronic hepatitis B + D is hepatic failure in the outcome of liver cirrhosis. Together with interferons, direct-acting antiviral agents are used to treat chronic hepatitides B and C. Standard interferon-a andpegylated interferon-a are the only class of medicines that may ensure 25-30% steady-state HDV viremia elimination.

The design of second-generation non-nucleotide reverse transcriptase inhibitors (NNRTIs) has made a great contribution to the treatment of HIV infection. The first representative of this group of antiretroviral drugs is etravirine (ETR) characterized simultaneously by high efficacy and favorable safety profile. Objective. Xo evaluate the efficiency and safety of using ETR as part of combined antiretroviral therapy (ARVT) for HIV infection in patients with the inefficiency or intolerance of the regimens involving first-generation NNRTIs or protease inhibitors. Subjects and methods. Ten patients were followed up. They all had the clinical manifestations of varying degrees of adverse events (AEs), which might be associated with the use of antiretroviral drugs (ARVDs). Efavirenz (EFV)-induced psychoneurologic disorders were most common (in 7 of the 10patients). Furthermore, there were gastrointestinal AEs in 2 patients, whose treatment regimen included lopinavir/ritonavir (LPV/r); polyneuropathy; lipoatrophy in 1 patient taking stavudine (d4T); hematological changes, elevated levels of liver transaminases and bilirubin. All the above side effects were absolutely associated with ARTVand required that the treatment regimens be modified. Results. Seven men and 3 women at the age of 27 to 53 years (mean age 37.2 years) were followed up. The duration of HIV infection was 2 to 11 years (mean 7.6 + 0.9 years). The clinical manifestations of secondary diseases were recorded in all the patients. Before the first treatment regimen was initiated, the CD4 lymphocyte counts varied from 106 to 305 cells/pl and averaged 203+24.2 cells/pl. At the start of ARVT, HIV RNA averaged 383 797 ± 166 721 copies/ml. A treatment regimen was given to all the patients in accordance with the standard treatment for HIV infection; it included zidovudine/lamivudine (ZDV/3TC) + EFV in 6patients. All the patients had the clinical manifestations of varying degrees of AEs that might be associated with ARVT. Psychoneurological disorders were observed mostfrequently (in 7patients). Among the laboratory indicators, the higher levels of liver enzymes were more common (in 4 patients). In all the patients, ARVT regimens were changed because of AEs. The goal of incorporating ETR into the therapy regimen was to improve tolerance and to enhance therapeutic effectiveness. The duration of ETR administration was 1 to 22 months. All the patients reported that AEs ceased with the use of ETR versus EFV. At a further follow-up, all the patients achieved an undetectable viral load and an increase in CD4 lymphocyte counts (an average of 361 ± 53.6 cells/pl). After therapy correction, both clinical and laboratory AEs regressed. Conclusion. The experience with ETR used in a daily dose of400 mg confirmed the high therapeutic effect in patients with a different history of ARVD use. ARVT in combination with ETR was well tolerated with a low incidence of AEs.

Objective. To evaluate the efficiency and hepatotoxicity of antiretroviral therapy (ARVT) regimens containing fosamprenavir and ritonavir (FPV/r) in a dose of 1400/100 mg once daily for 48 weeks. Subjects and methods. The data of 87 HIV-infected patients were analyzed. The proportion of patients with undetectable viral load, the levels of CD4 lymphocytes at 12, 24, 36, and 48 weeks, those of liver enzymes and aspartate aminotransferase to platelet ratio index (APRI) were estimated. Results. A viral load reduction was achieved in the vast majority (95.4%) of the patients at 48 weeks of therapy. The median increase in CD4 lymphocytes was 156 [43-257] cells/pl at that moment. No significant rise was found in the level of liver enzymes; there was even some reduction in the levels of ASAT and total and conjugated bilirubin. ARVT was not discontinued because of grade 3-4 hepatotoxicity. The parameters of the blood lipid spectrum were stable. In the average, there was no increase in APRI > 1.5, which indirectly confirms that FPV has no significant effect on the development of hepatic fibrosis. Conclusion. Once-daily FPV/r in the ARVT regimens showed high immunological and virological efficiencies, no negative impact on the liver, as well as good tolerability in co-infected patients.

The paper deals with improving a sanitary-and-epidemiological surgical site infection surveillance system. The author outlines methodological approaches to evaluating a surgical hospital in the light of the national concept of prevention of healthcare-related infections (HAI) and in terms of the current trends for the increased proportion of panresistant microorganisms causing postoperative pyoseptic complications. The paper presents an algorithm for a sequence of actions during epidemiological evaluation of the surgical hospital. It stresses the importance of the activity of a nosocomial infection control commission and its organizational and methodological significance in coordinating all subdivisions to make a sanitary-and epidemiological HAI surveillance at the institutional level. The author calls attention to a comprehensive approach that should be applied to elaborate preventive and anti-epidemic measures, by taking into account microbiological monitoring data, as well as nonspecific sanitary measures against surgical site infection.