[Epidemiology and prophylaxis of community-acquired pneumonia in servicemen].

Community-acquired pneumonia is one of the most pressing issues for military medicine in connection with a high incidence among conscripts. After the vaccination beginning in 2002, the uninterrupted increase of the pneumonia incidence that had been observed in 90-th years was changed to the tendency of decrease. But in 2009 and 2010 the incidence of pneumonia increased significantly in all military districts because of crowded conditions of accommodation and activation of "mixing" of personnel in connection with reduction of military service period from 2 and 1.5 years to 1 year. The improvement of accommodation conditions and prevention of excessive cooling are the bases of prevention of pneumonia. It is recommended to use bactericidal air recycling apparatus in barracks. Medicament prophylaxis consists of vaccination with polysaccharide pneumococcal vaccine (Pneumo 23) together with influenza vaccine. It is necessary to approve in the troops conjugate pneumococcal vaccine (Prevenar 13), which was registered in Russia 2 years ago. Vaccination should be combined with the use of immunotropical and antivirus medication, vitamins.

[Epidemiologic analysis of non-hospital pneumonia incidence in the troops]. / Epidemiologicheskii analiz zabolevaemosti vnebol'nichnoi pnevmoniei v voiskakh.

The analysis of dynamics of pneumonia incidence in servicemen for 50 years and 1 year was conducted. The risk factors of pneumonia development in the troops were studied. Some of them decrease the body immunoresistance (supercooling, acute respiratory disease, adaptation to the service and new climatic-and-geographic conditions, stress, body mass deficiency, etc.). The others activate the mechanism of pneumonia agent transmission ("mixing" factor during the fresh forces admission, overcrowding, many people in the sleeping rooms, etc.). To prevent the pneumonia incidence in military collectives the prophylactic and anti-epidemic measures should reduce the influence of these factors.

[The prophylaxis of nonhospital pneumonia using 23-valent pneumococcus vaccine in the military collectives]. / Profilaktika vnebol'nichnoi pnevmonii v voinskikh kollektivakh 23-valentnoi pnevmokokkovoi vaktsinoi.

Basing on the results obtained during the study of risk factor effect and extra-hospital pneumonia (EHP) etiology in servicemen in order to prevent this nosologic form the complex of prophylactic and antiepidemic measures was developed. The effective measure of EHP pneumonia prophylaxis in military collectives proved to be the polysaccharide 23-valent pneumococcus vaccine "Pneumo-23". After immunization of about 14 000 servicemen on the average EHP incidence has 3 times decreased with vaccine efficiency coefficient up to 74.23%. The more considerable decrease in EHP incidence was observed during the combined use of pneumococcus and influenzal vaccines: the efficiency was 78.5%.

[Efficacy of pneumococcal vaccine in military units]. / Effektivnost' primeneniia pnevmokokkovoi vaktsiny v voinskikh kollektivakh.

Pneumococcal vaccine Pneumo-23, used for specific prophylaxis of pneumonia and other pneumococcal infections, was tested in military training units of the North Western, Central and Far Eastern Military Districts. The vaccine used for immunization of servicemen, was shown to have high immunogenicity with no adverse reactions. In the training group of the North Western Military District the epidemiological effectiveness of the vaccine was particularly high a month after immunization and amounted to 83.7%. During the period between month 2 and month 5 after immunization pneumonia morbidity among the immunized servicemen was 6.12 times lower than among the non-immunized ones. In the training units of the Central and Far Eastern Military Districts, where the period of the formation of postvaccinal immunity coincided with the peak of the outbreak of pneumonia, the protective properties of the used batches of the vaccine could be observed as early as during the first month after immunization, which made it possible to recommend this vaccine for urgent prophylaxis in the foci of pneumococcal infection. During the period of 5 months the effectiveness of the vaccine with respect to pneumonia was 62.1-66.2% for all three districts. The effectiveness of the combined immunization of conscripts with vaccines Pneumo-23 and Vaxigrip with respect to pneumonia was higher (78.54%) and the index of effectiveness (4.66) was 1.58 fold greater than in monoimmunization (2.95). The epidemiological effectiveness of the pneumococcal vaccine was high also with respect to other pneumococcal infections: acute bronchitis, acute respiratory diseases of pneumococcal etiology, cases of acute sinusitis and acute otitis. The use of the vaccine for the immunization of servicemen yielded the economic effect equal to 92 US dollars per person.

[Pneumonia epidemiology and prophylaxis in servicemen in local wars and military conflicts]. / Osobennosti épidemiologii i profilaktiki pneumonii u voennosluzhashchikh v usloviiakh lokal'nykh voin i vooruzhennykh konfliktov.

The high military-and-epidemiological significance of pneumonia in servicemen during the war in Afghanistan (1979-1989) and the armed conflict in Chechnia (1995-1996) is shown and the measures for increasing the pneumonia incidence in the regions of operations are substantiated. It is established that more than 70% of pneumonia are conditioned by pneumococci that rather frequently show the pathogenic features against the background of viral (usually influenzal) respiratory infection or in association with Hemophilic bacillus, Chlamydia or Mycoplasma. The main factor leading to development of pneumonia during the period of local wars is the decreased organism resistance caused by supercooling, stresses and overwork as well as untreated acute respiratory diseases.

[Pneumococcal and chlamydial infections in a closed community]. / Pnevmokokkovaia i khlamidiinaia infektsiia v zakrytom kollektive.

An epidemic outbreak of acute respiratory infection (295 patients) in an organized group of young people was observed in December-May 1997-1998. Pneumococcal etiology was established by means of indirect immunofluorescence reaction in cases of outpatient pneumonia (81.9%), acute bronchitis (80%) and acute respiratory diseases (92.5%). Respiratory chlamydiosis caused by Chlamydia pneumoniae was detected in enzyme immunoassay with the use of immunoComb Chlamydia Bivalent IgG in patients with pneumonia (66.7%), acute bronchitis (60%) and acute respiratory diseases (50%). Synergic relationship between pneumococcal and chlamydial infections was noted.

[Exogenous and endogenous risk factors in the development of nonspecific lung diseases in young people]. / Ekzogennye i éndogennye faktory riska v razvitii nespetsificheskikh zabolevanii legkikh u lits molodogo vozrasta.

An organized community numbering 900 normal subjects aged 18 to 19 years were examined. Acute pneumonia was encountered in 15% of persons of the group under study per year. To identify persons with premorbid condition of nonspecific pulmonary diseases, anamnestic screening and outpatient examinations (microbiological and immunologic studies) were performed. As a result, the group constituted by subjects at risk for disease accounted for 18.6%, whereas S. pneumoniae was found in 44.9%. The immunologic findings were compared to the data obtained in the anamnestic screening. It was inferred that certain anamnestic signs correlated with the immune status. The leading factor in the formation of the premorbid condition lies in integral shifts in the immunologic system during adaptation. It follows from the data obtained that persons with risk factors need immune correction.