MODERN EPIDEMIOLOGICAL PROBLEMS OF HEALTHCARE-ASSOCIATED INFECTIONS. NEW HORIZONS IN PREVENTION.
L.P. Zueva, A.V. Liubimova North-Western State Medical University named after I. I. Mechnikov, Russian Federation, 191015, Saint-Petersburg, Kirochnaya street, 41. Abstract Introduction. Healthcare-associated infections (HCAI) are of high importance in modern world causing tremendous medical, social and economic damage. According to EU data about 4.5 million cases of HCAI are annually registered in Europe, resulting in 16 million additional days of hospitalization, direct cause of 37,000 fatal cases and indirect cause of 110,000 fatal cases correspondingly. By US data, annually 1.7 million patients (4,5%) are diagnosed with HCAI causing 99,000 fatal cases. The prevalence of HCAI in developing countries comprises 5.7-19.1%. It was estimated that 2-2, 5 million cases of HCAI costing Russian federal budget 500 billion rubles per year. The purpose of the study was to assess characteristics of the modern organization of the HCAI infection control and its prevention measures worldwide. Materials and methods. It was performed the literature review on these issues and analyzed the personal authors database. Results.The paper presents the requirements evaluation of the necessity of HCAI prevention and control specialists as well as training systems of infection control specialists in the USA, Europe and Russia and their key competencies. Modern trends and challenges of epidemiological surveillance, development and implementation of preventive measures are discussed. Conclusion. Currently, there is a need in Russia for revision of staffing requirements for epidemiologists in health institutions, introduction of infection prevention and control specialists from among nursing staff, changing of their training system, focusing more on developing and implementing methods for active epidemiological surveillance, and developing preventive measures considering the HCAI risk factors. Key words: Healthcare association infection, Hospital epidemiologist, infection control specialist, epidemiological surveillance.
ANTIMICROBIAL RESISTANCE CHARACTERISTICS TO S.TYPHI ISOLATED IN RUSSIAN FEDERATION IN 2005-2016.
L.A. Kaftyreva 1,2, S.A. Egorova1, М.A. Makarova1, C.V.Tjulenev1, G.F.Trifonova1 ,O.V.Kalinina1 1 Pasteur St. Petersburg Scientific Research Institute of Epidemiology and Microbiology, Saint-Petersburg, 197101, Mira street, 14 2 North-Western State Medical University named after I.I.Mechnikov, Russian Federation, Saint-Petersburg, 191015, Kirochnaja street, 41 Abstract. Purpose: The aim of the study is to obtain the antimicrobial susceptibility data of S. Typhi isolated in Russian Federation. Methods. The study included 306 of S. Typhi strains isolated in 2005-2016. Antimicrobial susceptibility testing was conducted according to Russian Clinical guidelines 2015 (EUCAST), the resistance mechanisms were determined by whole-genome sequence analysis, the phylogenetic analysis – by PFGE. Results. About 83,0% of isolates had the resistance phenotypes caused by different chromosomal mutations and plasmid-mediated mechanisms. The majority of quinolone resistant isolates due to a mutation Asp87Asn in gyrA belonged to one PFGE-cluster. Conclusion. A high prevalence of antimicrobial resistance in S. Typhi complicates the choice of antimicrobial therapy of typhoid fever. The combination of phenotypic and genetic methods for S.Typhi has information value and shows the epidemiological concordance. Key words: enteric fever, S. Typhi, resistance, antibiotics, genotyping
MODERN ISSUES OF VACCINAL PREVENTION
I.V. Feldblium Perm State Medical University named after Academician E. A. Wagner, Russia, 614990, Perm, Petropavlovskaya street,26 Abstract The purpose of this research was to determine the modern issues of vaccinal prevention and its further development. Materials and Methods. The research was performed as literature review of both Russian and foreign scientific literature. Results. The vaccination is considered as the main diseases prevention measure and source of healthy lifestyle promotion. Modern issues of vaccinal prevention, ways of improvement of the National Vaccination Calendar, organizational principles of vaccination, post-vaccination reactions as well as opposition to anti-vaccination movement were determined.
Key words: vaccinal prevention, modern issues, ways of development.
HEALTH CARE-ASSOCIATED ZOONOTIC INFECTIONS
A.D. Botvinkin State educational establishment of higher professional education «Irkutsk State Medical University» of the Public Health of the Russian Federation, 644003, Irkutsk, Krasnogo vosstania street, 1. Abstract.
The research is aimed to summarize the data on possibility of zoonotic infection among the patients and staff of medical institutions. Zoonotic diseases were classified as following: 1. Highly contagious zoonosis with potential epidemic spread in medical institutions (plaque, hemorrhagic fevers, coronavirus pneumonias). 2. Noncontagious zoonosis with sporadic infectiom cases after occasional injuries, invasive medical procedures, hemotransfusions, tissue or organs transplantation, autopsy and in the laboratories (rabies, arboviral infections, hepatitis E, prion diseases and etc). 3. Zoonotic infections with the adaptation signs to hospital conditions and human-to human transmission (salmonellosis, some opportunistic infections). Kеy words: Health care-associated infections, zoonosis CANCER INCIDENCE AND CANCER CONTROL IN MONGOLIA, 2008-2012
B. Tseveen, T. Sandagdorj, E. Sanjaajamts, T. Undarmaa National cancer of Mongolia, 13370, Ulaanbaatar, Bayanzurkh district, Nam Yan Ju street, 14th sub-district Abstract Introduction. Mongolia has a high burden of noncommunicable diseases. Cancer is the second leading cause of mortality. The purpose of this paper is to describe national and regional cancer incidence patterns for 2008-2012 based on cancer registry data, compare and contrast these with other populations in the region, and discuss the prospects for cancer control action in Mongolia. Materials and methods. Given the paucity of situation analyses from the country, this study reports cancer data based on new cases 2008-2012 from the National Cancer Registry of Mongolia covering the entire population (2.87 million). Results. 21 564 new cancer cases were diagnosed over the 5-year period, with a slight predominance of cases (52%) in men. Liver cancer was the leading cancer site in both sexes (ASRs of 114.7 and 74.6 per 100 000 males and females), and responsible for almost two-fifths of all cancer diagnoses, followed by cancers of stomach, lung and oesophagus in men, and cervix, stomach and oesophagus in women. The cumulative risk of incidence for all cancers (27.7% and 20.8% in men and women, respectively) positions Mongolia above China (20.2% and 13.3%), below the U.S. (34.1% and 28.5%) and similar to Russia (26.1% and 19.1%). Discussion.These figures shed light on the considerable magnitude of cancer in the country and the large fraction of cancers that can be prevented by lifestyle modifications and vaccine implementation. An expansion of activities of the cancer registry and the continued development of research are necessary steps in support of national cancer control planning in Mongolia. Kеywords: Mongolia; cancer control; cancer incidence; cancer registry; epidemiology NOSOCOMIAL TRANSMISSION OF CRIMEAN-CONGO HEMORRHAGIC FEVER IN PREGNANCY: DESCRIPTION OF CASES
N.Y. Pshenichnaya 1, 2, L.A. Ermakova2, G.N. Abuova3, G.V. Gopatza1, A.S. Zhuravlev4 1Federal state educational institution of higher professional education "Rostov state medical university Ministry of healthcare of the Russian Federation”. Russia, 344022, Rostov-on-Don, Nakhichevansky lane, 29 2Federal budget institution of science "Rostov research Institute of Microbiology and Parasitology of the Federal service for supervision of consumer rights protection and human well-being", Russia, 344000, Rostov-on-don, Gazetniy lane, 119 3South Kazakhstan state medical Academy, Shymkent, 160019, Al-Farabi sq.1, Kazakhstan 4Federal state educational institution of higher professional education “First Moscow state medical university named after I. M. Sechenov of Ministry of healthcare of the Russian Federation. Russia, 119991, Moscow, Trubetskaya str., 8, bilding 2 Abstract Introduction. Crimean-Congo hemorrhagic fever (CCHF) is acute viral infection and a major emerging infectious diseases threat, affecting a large geographical area. There is no proven antiviral therapy and it has a case fatality rate of 4–30%.
Cases of CCHF in pregnancy are rare, but associated with high rates of maternal and fetal mortality, and nosocomial transmission. Aim of the study: to describe CCHF cases with nosocomial transmission among pregnant women and discuss the gaps for improvement diagnostic, clinical management of CCHF during pregnancy and infection control of CCHF cases in hospitals. Materials and Methods. We describe epidemiology and clinical course of 4 CCHF cases in pregnant women in Russia and Kazakhstan. Results. 3 CCHF cases among pregnant women of them are connected with 14 nosocomial cases among health care workers (HCWs) with different way of transmission and 1 of them demonstrate severe secondary CCHF case in pregnant HCW. All cases have severe course of disease, 3 of them were fatal . All cases were associated with difficulties in diagnostic. Conclusion. Due to non-specific clinical presentation CCHF in pregnancy can be difficult to distinguish from other causes of undifferentiated febrile illness at the pre-hemorrhagic stage of disease. It is necessary to rise awareness of HCWs in regard to CCHF, especially on endemic areas. Keywords :Crimean-Congo hemorrhagic fever; pregnancy; healthcare associated infection; clinical features CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF RISK FACTORS OF ENDOMETRITIS IN POSTPARTUM WOMEN AND MODERN TECHNOLOGY DELIVERY
A.A. Golubkova¹, S.S. Smirnova², A.N. Bolshakova³ ¹ Ural State Medical University, 620028, Ekaterinburg, Repin street, 3 ² Sverdlovsk Regional for Prevention and Control of AIDS and Infectious Diseases 620102, Ekaterinburg, Yasnaya street, 46. ³ Regional Children's Clinical Hospital № 1, Russia, 620149, Ekaterinburg, Serafima Deryabina street, 32 Abstract Introduction. Women's health maintenance is an important aim of modern healthcare system. The labour is a complicated process associated with particular health risks such as postpartum inflammatory complications developed in 3% to 20% of postpartum women with the prevalence of endometritis (90%).
Purpose of the study is to determine clinical and epidemiological risk factors for endometritis in postpartum women within modern perinatal . Materials and research methods. The study is based on official infections register (form № 060/у), labor medical records (form № 096/y) of perinatal Regional Children's Clinical Hospital № 1. 208 delivery medical records including 100 women with normal postpartum period (control group) and 108 women with purulent-septic complications (main group) were analyzed to determine the risk factors for the endometritis development. The summarized data present information on postpartum woman, way of delivery, non-infectious and infectious pathologies before and after pregnancy, labour and postpartum period. The effectiveness of uterine cavity debridement using therapeutic ultrasound was evaluated in 96 postpartum women by symptoms of endometritis. The control group comprises 91 postpartum women weren’t undergone ultrasound uterine cavity debridement. Results. It has been discovered that a significant part of pregnant women had associated non-infectious and infectious pathologies but without observed impact on incidence of postpartum endometritis. The risk factors for postpartum endometritis: absence of amniotic fluid more than 6 hours (RR – 1,66), increased number of vaginal examination during labour up to 2-4 times (RR – 1,67), manual examination of the uterus (RR–1,85), previous respiratory infections (RR – 1,43) during pregnancy and labour. The ultrasound uterine cavity debridement increased the risk of endometritis development, especially in postpartum women after C-section. Key words: postpartum women, postpartum endometritis, risk factors. PROMED-MAIL: INTERNET-BASED SURVEILLANCE SYSTEM FOR EMERGING INFECTIOUS DISEASES
B.I. Aslanov1, N.Y. Pshenichnaya2, V.A. Melnik3, N. Rakhmanova4 1Federal State Budget Institution of higher education «North-Western State Medical University named after I.I. Mechnikov» of the Ministry of Health of the Russian Federation, Russia, 191015, Saint-Petersburg, Kirochnaya str., 41 2Federal State Budget Institution of higher education «Rostov State Medical University » of the Ministry of Health of the Russian Federation, Russia, 344022, Rostov-on-Don, Nakhichevansky lane, 29 3Donetsk National Medical University named after M. Gorkiy, Ukraine, 83003, Donetsk, Ilicha pr., 16 4Nonprofit Human Development Organization FHI 360, USA, 20009, Washington, DC, 1825 Connecticut Avenue NW Abstract Introduction.Internet-based epidemiological surveillance systems offer new and progressive means of the emerging infectious disease’ monitoring. Purpose:To review the capabilities of Internet-based monitoring systems, including ProMED-mail, for enhancing the epidemiological surveillance of infectious diseases. Methods.We conducted s search and description of existing web systems for tracking infectious diseases and their comparison with traditional epidemiological surveillance systems. ProMED-mail, a surveillance system for emerging infectious diseases is described in detail. Results and discussion.It is shown that Internet-based surveillance systems have number of advantages in comparison with traditional systems of epidemiological surveillance. The most important of these is the ability to rapidly identify and enable timely response to outbreaks of infectious diseases. Conclusion.The rise in the incidence of the known infectious diseases and the emergence of new ones led to the development of new of information web technologies and approaches to their detection, tracking, reporting and response. Their utilization enables timely response and reduces the scale of the consequences of outbreaks of infectious diseases. Key words: epidemiological surveillance, Internet, ProMED-mail, infectious diseases. OPTIMIZATION OF EPIDEMIOLOGICAL APPROACH FOR THE EXAMINATION OF PERSONS BELONGING TO A TUBERCULOSIS INFECTION RISK ZONE.
N. A. Skrynnik1, S. V. Fedorov1, E.B. Mjasnikova2, E. V. Shevyreva1, A.A. Dolgiy2 1St. Petersburg State Budget Healthcare Establishment "Tuberculosis dispensary № 12", Russia, 190103, St. Petersburg, nab. reki Fontanki, 152-A. 2North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, St. Petersburg. Kirochnaya street, 41. Abstract Introduction.The early detection of tuberculosis is one of the main measures preventing tuberculosis spread among the population and increasing the number of positive outcomes. The timely detection of only the one patient in a big city allows one to prevent at least 60 cases of tuberculosis infection per day. Purpose. The aim of the study was todevelop measuresto optimize patient’s assessment with risk of contracting tuberculosis. Materials and methods.The study was carried out within the photofluorography department in the Tuberculosis dispensary № 12 of the Admiralteysky District of St. Petersburg, the photofluorography departments of all outpatient clinics in the Admiralteysky District of St. Petersburg, the on-site photofluorography station of the City Municipal Tuberculosis dispensary during 2010-2016. Report forms of these organizations were used. Results and discussion.During photofluorography examination in the photofluorography department of the Tuberculosis dispensary №12 of the Admiralteysky District of St. Petersburg it was stated 10-12% of persons from a total number of risk groups , during 2010-2016 the tuberculosis detection was 1,59% (95% CI=1,3-1,9) per 1000 patients. At the same time, in the outpatient clinics of the Admiralteysky District (population at large), the tuberculosis detection was 0,25 (95% CI=0,2-0,3) per 1000 patients, that is 5 times less than in the Tuberculosis dispensary № 12.
During the examinations of the working population and students conducted in the on-site photofluorography station of the City Municipal Tuberculosis dispensary (socially adapted persons of working age), the tuberculosis detection in 2010-2016 was 0,15 (95% CI=0,1-0,21) per 1000 patient, that is 9 times less, than in the Tuberculosis dispensary № 12 with the decrease from 0,19 to 0,1 (by 2 times) in 2010 to 2016. Conclusion.The economic efficiency of the examinations is significantly higher in the photofluorography department of the Tuberculosis dispensary rather than in outpatient clinics. It is necessary to separate acquaintances of the patient with a contagious form of tuberculosis into a risk group because of having a direct contact with the patient. The first group of patients has to be examined in accordance with the Ministry of Health orders №109 and №951. For the persons from the risk groups it is enough to undergo a photofluorography of chest and by it results determined the extent of the examination. Economic and epidemiological efficiency of this approach is quite justified. Key words: tuberculosis, photofluorography, risk of infection, preventive measures
STRUCTURAL-FUNCTIONAL CONTENT OF THE EPIDEMIOLOGICAL COMPONENT IN THE ELECTRONIC MEDICAL RECORD OF SURGICAL PATIENTS
M.G. Daryina 1, 2, K.N. Movchan 1, 2, L.P. Zueva 2, E.R. Tsoy 3, A.S. Zakhvatova1, Y.S. Svetlichnaya 1, 2, I.G. Techova 1, 2 1St. Petersburg State Institution of Public Health "Medical Information and Analytical ", Russia, 198095, St. Petersburg, Shkapina street, 30 2North-Western State Medical University named after I.I. Mechnikov Russia, 191015, St. Petersburg, Kirochnaya streer, 41. 3State budget health care institution "City Mariinsky hospital", Russia, 194104, St. Petersburg, Litejnyj pr., 56
Abstract Relevance.Currently, there is an absence ofunified software process of the epidemiological surveillance for patients with development risk factors of surgical site infection. Purpose. Justification of the epidemiological component structure of the electronic medical record of the surgical patients. Materials and methods. A retrospective analysis of the morbidity associated with surgical site infections in hospitals of St. Petersburg. Results. Themorbidity level associated with surgical site infections in medical institutions was determined as well as permanent monitoring tool for the diseases epidemic process using epidemiological component of the electronic medical records. Conclusion. Implementation of epidemiological component in the electronic medical records allows conducting targeted preventive measures and ensuring appropriate quality medical care to surgical patients. Key words: epidemiological surveillance, epidemiological component, electronic medical records.
THE ATTITUDE OF MEDICAL STUDENTS TO HIV INFECTION S.T. Agliullina1, G.R. Khasanova1, L.M. Mukharyamova1, R.N. Khasanova2 1Federal State Budget Institution of higher education «Kazan State Medical University» under the Ministry of Public Health of the Russian Federation, Russia, 420012, Republic of Tatarstan, Kazan, Butlerov street, 49. 2Federal State Autonomous educational institution of higher education "Kazan (Volga region) Federal University", Russia, 420008, Republic of Tatarstan, Kazan, Kremlyovskaya street, 18. Abstract Purpose. The present study is aimed to determine the awareness of medical students on HIV infection. Methods. It was conducted a survey of 138 first- and second-year students of medical and dentistry faculties in Kazan Federal University. Results. 41 students (29, 7 ±3, 9%)) were sure that the HIV-infection is mainly transmitted among drug addicts and prostitutes, but not in society as a whole. Only 23 respondents (16,7±3,2%) consider HIV infection in the Republic of Tatarstan to be transmitted among all social groups. Mostly, the respondents were aware of the main ways of HIV spread with a third of students regarding condoms as a proper HIV preventive measure.107 respondents (77,5±3,6%) assessed their own risk of HIV infection as very low. Among them were 44 students having sexual activity (41,1±4,8%) where only 23 respondents (52,3±7,5%) regularly use condoms. Conclusion. It was found underestimation by respondents of the problem relevance, the undervaluation of their own risk of HIV infection, lack of awareness in prevention and low commitment to based safety behavior. Prevention measures adapted to particular social groups and needs of modern epidemiological situation are quite promising. Key words: HIV infection, prevention, awareness, risk assessment.
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