[Monitoring of the medicodemographic situation in Moscow].

There has been recently a trend in declining mortality rates in all population groups. Higher birth rates and lower mortality have been responsible for a reduction in natural population loss in Moscow. At the same time, 14 of the 123 Moscow municipal districts show a positive natural population growth largely due to higher birth rates. Better social and economic living conditions, the effective activities of health care bodies and sanitary and epidemiological well-being services of the city have caused recent positive changes in the demographic situation.

Economic evaluation of Haemophilus influenzae type b vaccination in Moscow, Russian Federation.

OBJECTIVE: To estimate the cost-effectiveness of providing Haemophilus influenzae type b (Hib) vaccine to children in Moscow in routine immunization services. METHODS: The incidence of Hib meningitis among children aged <5 years in Moscow was obtained from a prospective surveillance study undertaken during October 1999-September 2001, with treatment cost data collected for all cases. Sequelae in surviving children were assessed in December 2002. The costs of Hib vaccination in Moscow were estimated assuming a vaccine price of US dollar 5 per dose and the same four-dose schedule and 97% coverage as for diphtheria-tetanus-pertussis vaccine. The most uncertain variables were varied in a sensitivity analysis. RESULTS: The annual incidence of Hib meningitis was 5.7 per 100,000 children <5 years. The average treatment cost for an acute Hib meningitis case was US dollar 1296. For a patient with sequelae, the average additional lifetime discounted treatment cost was US dollar 15,820. The total annual cost of Hib vaccination of infants in Moscow was estimated as US dollar 1.5 million per year. In the base case analysis, the cost-effectiveness ratios amount to US dollar 77,503 per Hib meningitis case averted and US dollar 10,842 per discounted disability adjusted life year averted. The break-even vaccine price, where the annual vaccination costs equal annual treatment costs averted, is only US dollar 0.04 per dose in the base case scenario. If discounted indirect costs are included, the break-even vaccine price is US dollar 0.5 per dose. CONCLUSION: In Moscow, the incidence of Hib meningitis is low and the costs of hospitalization and subsequent medical treatment are relatively inexpensive. Given these factors, Hib vaccine at US dollar 5 per dose would not be a cost-effective option in Moscow at the present time.

[Significance of epidemiological analysis for the development of epidemiology]. / Znachenie épidemiologicheskogo analiza dlia razvitiia épidemiologii.

The significance of epidemiological analysis for the study of the epidemic process is substantiated. The historical stages of the development of the doctrine on the epidemic process along with the role of epidemiological analysis in social and hygienic monitoring and epidemiological surveillance from the viewpoint of systemic approach are presented. The conclusion has been made on the necessity of the development of the systemic methodology of controlling the epidemic process and the sanitary and epidemiological situation.

[The scientific, organizational and methodological bases for the epidemiological surveillance of streptococcal group A infection in a large city]. / Nauchno-organizatsionnye i metodicheskie osnovy épidemiologicheskogo nadzora za streptokokkovoi infektsiei gruppy A v usloviiakh krupnogo goroda.

These investigations have made it possible to establish the extent and scale of the spread of streptococcal infection (group A) and its socioeconomic importance in Moscow, a great mega-police of the world. The deterioration of the epidemiological situation in recent years, accompanied by an increase in morbidity and mortality caused by streptococcal infection, has been demonstrated. The program and conceptual foundations of epidemiological surveillance on this infection in Moscow are presented. The aspects of epidemiological surveillance (informational and analytical, diagnostic, administrative) have been indicated and described. The order and direction of their realization have been determined.

[The development of an automated system for computing the "standard" values of the economic loss brought by one case of infectious disease]. / Razrabotka avtomatizirovannoi sistemy rascheta "standartnykh" znachenii ékonomicheskogo ushcherba, nanosimogo odnim sluchaem infektsionnoi bolezni.

An original and technically realizable system for the determination of the values of economic damage produced by a single case of an infectious disease has been developed, based on a concrete socio-economic analysis. The system has been realized with the use of an IBM PC/AT by means of the Econ program module developed in the SuperCalc-4 tabulated processor program environment. The use of the average socio-epidemiological, national economic and demographic statistical data has made it possible to calculate the "standard" values of the economic damage produced by a single case of 15 infectious diseases (total average, as well as for different groups of patients and measures). Analysis of the values thus obtained shows their, on the average, 1.25-fold growth, as well as their considerable variability reflecting the clinico-epidemiological nature of infectious diseases.

[Infectious morbidity in the USSR: its structure, levels, dynamics and economic significance]. / Infektsionnaia zabolevaemost' v SSSR: struktura, urovni, dinamika i ékonomicheskaia zanchimost'.

Taking well-grounded strategic decisions on the control of infectious diseases requires the knowledge of modern epidemiological situation with respect to the total infectious pathology. The structure, levels and dynamics of morbidity in infectious diseases, registered according to Form No. 85 (Infection), on the territory of the USSR are considered. Besides, the evaluation of the economic damage inflicted to the national economy of the USSR by infectious morbidity is presented.

[Infectious disease mortality in the USSR]. / Smertnost' ot infektsionnykh boleznei v SSSR.

In recent decades infectious and parasitic diseases (class 1 according to the International Classification of Diseases-9) constitute 2-3% of causes in the total morbidity structures in the USSR. The main causes of death among diseases of class 1 are tuberculosis (37%), acute enteric infections (30%), septicemia (11%), viral hepatitides (11%), meningococcal infection (4%), measles (2%). The main groups are children aged up to 2 years (48% of fatal cases of diseases belonging to class 1). The territorial irregularity of mortality indices has been revealed.

[The use of different statistical methods in epidemiological analysis to assess the seasonality and territorial spread of infectious diseases]. / Primenenie razlichnykh statisticheskikh metodov épidemiologicheskogo analiza pri otsenke sezonnosti i territorial'nogo rasprostraneniia infektsionnykh boleznei.

To solve the problems connected with the evaluation of the seasonal and territorial distribution of infectious diseases, indications and limitations for the use of the following statistical methods have been worked out: the calculation of the monthly morbidity level, the proportion of cases of infectious diseases falling on the months of seasonal morbidity rises, the proportion of such cases appearing due to the influence of seasonal factors, the total and partial indices, the average monthly rate of increase in seasonal morbidity, the complex evaluation of seasonal morbidity, the evaluation of the nonparallelism of two curves, the determination of the mean quadratic deviations and Shannon's entropy. The algorithms based on these methods lie in the foundation of 11 computer programs, forming the software complex "Epidanalysis" and provided with the service menu permitting an epidemiologist to proceed from the task via indications and limitations to the corresponding program. The programs are intended for different types of computers (IBM PC XT, EC-1640, Robotron 1715).

[The indications for the use of different statistical methods of epidemiological analysis and delimitation in the assessment of a dynamic epidemic process]. / Pokazaniia k primeneniiu razlichnykh statisticheskikh metodov épidemiologicheskogo analiza i ogranicheniia pri otsenke dinamiki épidemicheskogo protsessa.

To solve various problems connected with epidemiological analysis concerning evaluation of the level, direction and intensity of the time course of the epidemic process and character of the cyclic component, the indications and limitations to the use of the following statistical methods have been worked out: equalizing by the method of the least squares on a straight line, a parabola, an exponential or power curve; calculation of the average annual rate of increase; leveling of dynamic series by the methods of internal prolongation, sliding and suspended sliding mean values; calculation of deviations from the theoretical tendency line; autocorrection. 11 computer programs have been compiled on the basis of the algorithms of the above methods, complete with the service menu, for the program complex "Epidanalysis" which permits an epidemiologist to proceed from the problem via indications and limitations to the adequate statistical method and the corresponding software. The programs are intended for different types of computers (EC-1840, Robotron 1715, IBM PC XT).

[Socioeconomic importance of diphtheria and whooping cough immunoprophylaxis]. / Sotsial'no-ékonomicheskoe znachenie immunoprofilaktiki difterii i kokliusha.

The evaluation of the immunoprophylaxis of diphtheria and pertussis in the USSR in respect to its social and economic significance has shown that in 20 years (1957-1976) the damage caused by these diseases to the health of the population decreased 833 and 28-fold, and to the economy 333 and 17-fold, respectively. The economic effectiveness achieved by the realization of vaccinal prophylaxis was 1 : 87 for diphtheria and 1 : 119 for pertussis.