[Characterization of contamination of hematology hospital environmental objects with micromycetes].

The paper presents of laboratory studies of the environmental objects in the hematology unit of a multidisciplinary hospital for micromycetes. Its air was found to be highly contaminated with mold fungi (85.4 ± 5.5%). The structure of micromycetes showed a preponderance of the fungi Aspergillus (47%), Rhizopus (36%), Penicillium, and other species (17%). The air contamination rate was 15.6 ± 3.3 CFU/m3 and did not exceed the recommended thresholds. Yeast fungi were prevalent in washouts. The contamination rate of ward louvers was 12 and 4 times higher than that of bedside tables and door handles, respectively. The degree of micromycetes contamination of environmental objects in the hematology unit did not depend on the destination of rooms and the length of stay of hematology patients in them.

[Reactogenicity, safety, immunogenicity and prophylactic effectiveness of polysaccharide pneumococcus vaccine during immunization of HIV-infected patients].

AIM: Study safety, reactogenicity, immunogenicity and prophylactic effectiveness of polysaccharide pneumococcus vaccines during immunization of adult HIV-infected patients. MATERIALS AND METHODS: 200 HIV-infected patients at stages 3 to 4A of the disease aged 20 to 50 years with the quantity of CD4+ T-lymphocytes in blood of no less than 500 microl(-1) took part in the study. 100 individuals immunized with polysaccharide 23-valent pneumococcus vaccine (Pneumo 23, Sanofi Pasteur, France) constituted the observation group. 100 individuals not immunized against pneumococcus infection constituted the comparison group. The groups were standardized by sex, age and disease stage. Vaccine reactogenicity was evaluated by detection of general and local postvaccination reactions, degree of their intensity and duration. Vaccine safety was evaluated based on comparative evaluation of results of general clinical and biochemical studies of blood, general urine analysis, determination of IgE in blood sera, CD4+ T-lymphocytes level, quantity of HIV RNA (viral load) before vaccination and 28 days after the immunization. Vaccine immunogenicity was evaluated by determination in blood sera of IgG against a mixture of Streptococcus pneumoniae polysaccharides comprising Pneumo 23. Prophylaxis effectiveness of the preparation was evaluated by juxtaposition of acute respiratory illness morbidity in observation and control groups. RESULTS: During immunization of HIV-infected patients against pneumococcus infection postvaccination complications, severe local and general postvaccination reactions were not detected, laboratory studies carried out before and after the immunization gave evidence on the lack of progression of the main disease and activization of the infectious process. After the immunization the geometric mean antibody titer against S. pneumoniae increased by 2 times and reached protective level. Index of prophylactic effectiveness of Pneumo 23 vaccines during immunization of HIV-positive patients was 5.6, and relative risk of the disease in the immunized group--0.07, in the control group--0.42. CONCLUSION: The data provided give evidence on the high prophylactic effect of vaccination of immune compromised HIV-positive patients with a lack of deterioration of the main disease course.

[Epidemiologic diagnostic of nosocomial suppurative-septic infections of Pseudomonas etiology based on intraspecies typing of causative agent].

AIM: Scientific justification of optimization of epidemiologic diagnostic of suppurative-septic infection (SSI) caused by Pseudomonas aeruginosa based on comparability of antibiotic sensitivity and beta-lactamase production. MATERIALS AND METHODS: Intraspecies typing of 37 P. aeruginosa strains isolated during microbiological monitoring of 106 patients and 131 objects of clinical environment of surgical and obstetrician hospitals by using a complex ofphenotypic and molecular-biological methods including determination of sensitivity to antibiotics by serial dilutions method and PCR-diagnostics with determination of TEM, SHV, CTX, OXA, MBL, VIM genes was performed. RESULTS: P. aeruginosa strains combined into groups by isolation location during studies turned out to be heterogeneous by sensitivity to antibiotics and beta-lactamase production that allowed to form subgroups of strains by focality attribute. Isolates recovered from different SSI foci had significant differences in minimal inhibitory concentration (MIC) reaching 1024 times. MIC parameter within subgroups did not exceed 8 - 16 consequent dilutions. CONCLUSION: Use of a complex of phenotypic and molecular-biologic methods of causative agent typing including determination of sensitivity to antibiotics by serial dilutions method and evaluation of beta-lactamase production allowed to establish a mechanism of development of SSI epidemic process caused by P. aeruginosa, detect origins and reservoirs of infection in hospital, modes and factors of transmission and reach maximum justification of epidemiologic control and prophylaxis measures of localization of foci of nosocomial infections of pseudomonas etiology.

[Terminologic aspects of infections associated with administration of medical aid].

Evolution of key terms used in epidemiology of nosocomial infections is discussed. A modern point of view on terminology and comparison of Russian terms with foreign analogues are presented.

[Analysis of pyogenic microflora structure of a cardiac surgery hospital].

AIM: Long-term analysis of structure and resistance level ofpyogenic microflora in cardiac surgery hospital. MATERIALS AND METHODS: Data from microbiological studies carried out in Perm Regional Hospital No. 2 Institute of Heart from 2002 to 2010 was used. Isolation and identification of cultures was carried out by traditional methods, determination of antibiotic resistance--by disk diffusion method, sensitivity to disinfectants--by serial dilution method. RESULTS: Gram-positive bacteria predominate in the structure of clinical flora--enterococci and staphylococci (aureus--during the first years of observation, coagulase negative staphylococci--later). In 2010 an increase of relative rate of gram-negative bacteria, especially pseudomonas and acinetobacters, as well as Serratia marcescens was noted. Among all microorganism species a constant increase of antibiotic resistance level was noted. Clinical microflora is highly sensitive to the preparation for final disinfection, but at the same time is characterized by the generation of resistance to the current disinfectant. CONCLUSION: Monitoring of structure and properties of clinical microflora allows to introduce correction into antibacterial therapy schemes and epidemic control measures, as well as register the emergence of hospital strains. High level of drug resistance of the flora indicates the practicability of antibiotic rotation.

[Rubella in Russia: variability of the infectious agent during the period of vaccine prophylaxis].

AIM: To assess influence of vaccination against rubella on the genetic diversity of rubella virus. MATERIALS AND METHODS: Vaccine strains of rubella virus Wistar 27/3 and Orlov-B as well as sera from patients with rubella obtained in Perm region during 1999 - 2005 period and standard serologic, molecular, epidemiologic and statistical methods were used. The study was performed according to the WHO recommendations on the genotyping of wild rubellavirus strains. RESULTS: Strains of rubella virus isolated in Perm region, vaccine strain Orlov-B (Saint Petersburg), and 4 Russian strains isolated in 1967-1997 before vaccine introduction belong to the same genetic group with high degree of homology - genetic divergence do not exceed 0 - 1%. This group was identified as genotype 2c which, according to WHO's data, circulates only in Russia. Periods of epidemic peaks of rubella incidence and its falls as well as selective immunization of girls and women of childbearing age did not influence on the genetic stability of the virus (divergence did not exceed 0.6 - 2.0%). On the contrary, mass immunization of children aged 1 - 2 years during 4 years resulted in statistically significant changes of rubella virus subtype inside the genotype 2c. CONCLUSION: Ten-year experience of rubella vaccination in Perm region demonstrates necessity of inclusion of monitoring for rubella virus variability in the system of epidemiological surveillance and control for rubella infection during period of its prevention by vaccine.

[The molecular epidemiological aspects of hiv-infection spreading in Perm region].

Retrospective analysis of HIV-infection spreading in Perm region in conjunction with the genetic characterization of viral subtypes circulated on this territory from 1988 (when 1st case of infection was detected) until 2005 was performed. Analysis of epidemic process allowed to determine three periods of its development basing on both epidemic intensity and nature of circulating HIV-1 subtypes. During 1988 - 1996 (first period), when viral population was heterogenous (simultaneous circulation of three HIV-1 subtypes) with multiple routes of transmission, the epidemic process was characterized by low intensity. High incidence of HIV-infection among injection drug users and high homogeneity of circulated HIV-1 variants (98% of isolated variants belonged to HIV-1 subtype A with low level of genetic variability) were characteristics of the second period lasted from 1997 to 2001. Decrease in HIV-infection incidence in 2002-2005 was accompanied by the increase of HIV-1 transmission through heterosexual contacts and continuation of subtype A predominance between isolates. However increase in heterogeneity of viral population during this period, which manifested as increase of env and pol genes polymorphism, was detected.

[Risk factors of development of nosocomial pyogenic and septic infections in maternity hospitals].

During prospective epidemiological surveillance cases of pyogenic and septic infections (PSI) in mothers and newborns in two maternity hospitals were studied using standard case definition and leading risk factors of their development were revealed. These factors differed in two hospitals and were connected mainly with high level of patients colonization, contamination of the environment by nosocomial strains of microorganisms, and degree of participation of mother's relatives in delivery. It was shown that permission to relatives for presence on delivery did not influence on the rate of PSI. Specificity of risk factors of PSI in mothers and newborns dictates necessity to determine them in each maternity hospital.

[Evaluation of the reactogenicity and immunogenic potency of combined vaccine "Bubo-Kok" in the immunization of children against diphtheria, tetanus, pertussis and viral hepatitis B]. / Otsenka reaktogennosti i immunogennosti kombinirovannoi vaktsiny "Bubo-Kok" pri immunizatsii detei protiv difterii, stolbniaka, kokliusha i virusnogo gepatita B.

Combined vaccine "Bubo-Kok" is characterized by safety and high immunological activity. The number of postvaccinal reactions in children aged 1 and 2 years, immunized with vaccine "Bubo-Kok", was not statistically different from those in groups of children immunized with adsorbed DPT vaccine, as well with such vaccine in combination with vaccine against hepatitis B. After the completion of the primary course of immunization 100% of children had protective antibody titers against diphtheria, tetanus and hepatitis B. Antibody titers against pertussis, equal to or exceeding protective titers, were found in more than 70% of immunized children. The immunogenic potency of vaccine "Bubo-Kok" with respect to all its components was not inferior to that of adsorbed DPT vaccine and vaccine against hepatitis B, when introduced simultaneously in different areas of the body. Vaccine "Bubo-Kok" successfully passed state trials and was recommended for registration.

["Epidemic" vs "epidemiological": linguistic aspects of epidemiological terminology]. / "Epidemicheskii" vs "épidemiologicheskii": lingvisticheskie aspekty épidemiologicheskoi terminologii.

The meaning of the terms "epidemic" and "epidemiological" used in a medical discourse have been analyzed; differential signs have been found by the method of linguistic analysis, making it possible to avoid unjustified interchanges of these terms.

[Vaccination of medical personnel against hepatitis B: epidemiological and socio-economic aspects]. / Vaktsiantsiia meditsinskikh rabotnikov protiv gepatita B: épidemiologicheskie i sotsial'no-ékonomicheskie aspekty.

Epidemiological and social aspects of the vaccinal prophylaxis of medical personnel against hepatitis B are discussed on the basis of the morbidity analysis in viral hepatitis, the results of dynamic screening for the presence of hepatitis B markers and the state of postvaccination immunity. The reactogenicity and immunogenicity of the vaccine "Euvax B", as well as the socio-economic effect of vaccinal prophylaxis, are evaluated.

[Evaluation of reactogenicity and immunogenicity of Bubo-M, the Russian combined vaccine for immunization of adults against diphtheria, tetanus and viral hepatitis B]. / Otsenka reaktogennosti i immunogennosti otechestvennoi kombinirovannoi vaktsiny Bubo-M pri immunizatsii vzroslykh protiv difterii, stolbniaka i virusnogo gepatita B.

Bubo-M, the first Russian associated vaccine, was found to have low reactogenicity and high immunogenic potency. The frequency of postvaccinal reactions in the group of persons immunized with Bubo-M (20%) appeared to be considerably lower than among persons who received the combined injection of adsorbed DT toxoid with reduced antigen content and vaccine against hepatitis B (47.7%). Following the course of vaccination the level of anti-HBs considerably exceeded the protective level. Immune response to the diphtheria and tetanus components of Bubo-M exceeded that observed after immunization with absorbed DT toxoid with reduced antigen content (p < 0.05).

[Reactions to and immunogenic properties of the combined vaccine Bubo-M for immunization of children against diphtheria, tetanus and viral hepatitis B]. / Reaktogennost' i immunogennost' kombinirovannoi vaktsiny Bubo-M pri immunizatsii detei protiv difterii, stolbniaka i virusnogo gepatita B.

Bubo-M, the first Russian combined vaccine, was found to have low reactogenicity. The difference between the number of postvaccinal reactions in the group of children immunized with Bubo-M (25.9%) and those in the group of children who had been simultaneously injected into different sites of the body with ADS-M toxoid (adsorbed DT toxoid with reduced antigen content) and hepatitis B vaccine (26.7%) was not statistically significant. Following immunization a considerable increase in the level of diphtheria and tetanus antibodies (p < 0.005) was observed in all children (100%), the level of HBs antibodies in the group of children immunized with Bubo-M (the geometric mean titer: 13,721 IU/l) essentially exceeding that observed in the control group injected with ADS-M toxoid and hepatitis B vaccine (the geometric mean of the titer: 2,441 IU/l). Bubo-M was duly registered and allowed for industrial production and medical use.

[The monitoring of the spread of drug abuse as an element in the epidemiological surveillance of socially significant infections]. / Monitoring rasprostranennosti narkomanii kak élement épidemiologicheskogo nadzora za sotsial'no-znachimymi infektsiiami.

The necessity of monitoring the spread of drug addiction in the system of epidemiological surveillance on HIV infection and parenteral virus hepatitides is shown. The results of the epidemiological diagnostics of registered drug addiction are presented. The criteria for the assessment of the epidemiological effectiveness of epidemiological surveillance on drug addiction are determined. As revealed in this study, during the period of 1991-1998 morbidity in drug addiction rose 57-fold in Perm Province, while the number of HIV-infected persons increased 75-fold. Pronounced direct relationship between the number of drug addicts, as well as persons belonging to groups of high risk of developing drug addiction, and the dynamics of morbidity in HIV infection and parenteral virus hepatitides B and C was established.

[Experience with the development of vaccinal prophylaxis in Perm Province]. / Opyt razvitiia vaktsinoprofilaktiki v Permskoi oblasti.

The results of the introduction of the system of epidemiological surveillance on vaccinal prophylaxis on the territory of Perm Province are presented. This system has permitted the realization of the principles of the regional tactics of immunization, while following the unified strategy acting on the territory of the Russian Federation. The optimization of the organizational foundations of vaccinal prophylaxis has made it possible to maintain the morbidity rates if infections, controlled by means of specific prophylaxis, on the levels below the average figures for the Federation and to preserve more stable tendencies to their decrease.

[The effectiveness of using the Vaxigrip vaccine from the firm of Pasteur Mérieux Connaught for influenza prevention in organized groups of adults]. / Effektivnost' ispol'zovaniia vaktsiny Vaksigrip firmy "Paster Mer'e Konnot" dlia profilaktiki grippa v organizovannykh kollektivakh vzroslykh.

The results of the study of the effectiveness of using vaccine Vaxigrip for the prophylaxis of influenza in organized groups of adults are presented. The vaccine was found to have high epidemiological effectiveness (the epidemiological index was 2.6), moderate reactogenicity and pronounced immunological activity (the protection level was 89.0-100.0%). The vaccine may be recommended for the prophylaxis of influenza among adults.

[An evaluation of the epidemiological and economic efficacy of immunizing adults with the Vaxigrippe vaccine]. / Otsenka épidemiologicheskoi i ékonomicheskoi éffektivnosti immunizatsii vzroslykh vaktsinoi Vaksigrip.

The results of the evaluation of the epidemiological and economic efficiency of the immunization of the adult population with the vaccine Vaxigrip (Pasteur Mérieux Connaught, France) are presented. In accordance with the results obtained in this investigation, this vaccine was found to have pronounced epidemiological (prophylactic) efficiency and to be well tolerated. To achieve a perceptible epidemiological effect, it was sufficient to cover 43% of the group with vaccination. The economic effect of the use of Vaxigrip exceeded the costs connected with carrying out vaccination sixfold.

[Integral factorial assessment of preventive measure system in tuberculosis]. / Integral'naia faktornaia otsenka sistemy profilakticheskikh meropriiatií pri tuberkuleze.

The antituberculosis measures made have achieved their peak efficiency and, if specific measures to increase the detection rates of patients in the general population and the level of vaccination cannot be found now, tuberculosis morbidity rates cannot be expected to become lower in the near future. This is evidenced by the 1996 prognosis that the morbidity will rise from 84.6 to 96.1 per 10,000 persons. It is expedient to implement preventive antituberculosis measures, by taking into account the regional features of a specific area.

[Immunological control in the system of epidemiological surveillance over infections with different mechanisms of causative agent transmission]. / Immunologicheskii kontrol' v sisteme épidemiologicheskogo nadzora za infektsiiami s raznymi mekhanizmami peredachi vozbuditelia.

The results of immunological control of infections with different mechanisms of the transmission of their causative agents (diphtheria, measles, viral hepatitis, salmonellosis) for many years are summarized. About 25,000 serum samples taken from humans and more than 10,000 probes from agricultural animals have been studied in the passive hemagglutination test and more than 3,600 serum samples have been studied in the enzyme immunoassay for the presence viral hepatitis markers. Planned immunological control has ensured greater possibilities of the epidemiological diagnosis and prognostication of complications in the epidemic and epizootic situations. Urgent immunological control has made it possible to establish the proportion of non-manifest forms of diseases, to differentiate the foci of infection by transmission routes, to determine the degree of protection from infection and to substantiate the tactics of individual immunization.