Methodological approaches to morbidity forecasting in military educational organizations

The article discusses aspects of the application of extrapolation and factor approaches to epidemiological forecasting, outlines the limitations and features of their application in relation to the prediction of morbidity.It is shown that when using an extrapolation approach, it becomes possible to predict the most likely numerical characteristics of morbidity in a certain time perspective. At the same time, the accuracy of the obtained forecast depends on the length of the time series and the type of long-term dynamics of morbidity. In turn, the trends formed by the results of forecasting artificially level the critical levels of morbidity that characterize individual periods of time and are fundamentally important for understanding the real picture.The factor approach is based on the prediction of morbidity levels using a certain set of factors. The difficulty of using the factor approach is noted due to the stochasticity of the epidemic process.Based on the results of a retrospective epidemiological analysis of the personalized morbidity of cadets of the Military Medical Academy, the heterogeneity of military contingents in susceptibility to acute respiratory infections of the upper respiratory tract is shown.From the standpoint of the academician V.D .Belyakov’s et al. theory of the parasitic systems self-regulation, the conclusion is made about the expediency of using a factor approach for epidemiological forecasting of morbidity in organized collectives. It is proposed to use the state of individual resistance as one of the main factors determining the epidemic well-being of organized collectives.The results of the development and testing of an electronic database that allows epidemiological surveillance of the morbidity of trainees and its linear prediction are presented.

Measles and rubella in the North-West of Russia in period of elimination

Aim: To evaluate the epidemic situation on measles and rubella and to carry out the laboratory diagnostics of these infections in the North-West of Russia in the period of elimination.Materials and Methods. In 2016-2019 a total of 534 blood serum samples from patients with measles diagnosis, 210 – from patients with rubella diagnosis and 1251 – from patients with exanthema were studied by ELISA using “VectoMeasles-IgM” and “EIA-Rubella-IgM” test-systems.Results. Measles incidence in NWR varied from 0 to 0.96 per 100,000 in 2016 and 2019, respectively. Among measles patients the proportion of children and adults changed in 2018-2019, adults constituted 65.9%. Patients not vaccinated against measles and those with the unknown vaccination status were mainly involved in epidemic process (85%). High level of patients with revaccination status was revealed in 2018 (18.4%). These patients demonstrated high levels of IgG (>3.0 IU/ml) as well as high percentage of IgG avidity (>94.3%) on 4-7th day of rash onset thus evidencing secondary immune response. Molecular studies of the samples from patients revealed the circulation of D8 and B3 genotypes of measles virus. Strains of D8 and B3 genotypes were represented by 3 and 4 variants, respectively. Rubella incidence did not exceed 0.13 per 100,000. Strains of rubella virus of genotype 1E were detected.Conclusion. The data of annual measles incidence and molecular studies of circulating wild type measles viruses prove the on-going measles elimination process in the NorthWest of Russia. For rubella, the persistent phase of elimination was demonstrated in the region.

New onset of generalized myasthenia gravis developed after a new coronavirus infection (COVID-19)

Development of various immune-mediated neurological complications after a viral infection is of particular interest to medical society during a pandemic of COVID-19. It was found that SARS-CoV-2 has the ability to cause hyperstimulation of the immune system, thereby initiating developing of autoimmune diseases. The article describes a clinical case of new onset of generalized myasthenia gravis with thymoma in a patient after previous COVID-19.

Modern understanding about the role of group A β -hemolytic streptococcus in acute tonsillitis

Objective: assess the modern value of group А β-hemolytic streptococcus in patients with acute tonsillitis and the effectiveness of the rapid streptococcal antigen detection method.Materials and methods: microbial landscape assessment of acute tonsillitis was based on retrospective analysis of 902 bacterial culture results of a throat swab of patients with syndromes of acute tonsillitis treated in the Infectious Diseases Clinic of the Military Medical Academy named after S.M. Kirov during the period of 2019-2020. The effectiveness of the rapid streptococcal antigen detection method in the oropharynx was determined by a prospective study involving 35 patients with acute tonsillitis.Results: in the study, we have found that bacterial culture results of a throat swab, the following were more common: Nesseria species (39 %), Streptococcus viridans (23 %), and Staphylococcus aureus (17 %). The frequency of detection of β-hemolytic streptococcus was 1 %. The rapid diagnostic system «Streptatest» in patients with acute tonsillitis has demonstrated efficiency, under which that sensitivity of test was 80 %, specificity – 90 %, positive predictive value – 57,14 %, negative predictive value – 96,43 %.Conclusions: the frequency of group A β-hemolytic streptococcus in patients with lesion of lymphoid tissues of the oropharynx has declined significantly nowadays. The rapid diagnostic system «Streptatest» is a highly effective medical product that can be used in both hospital and pre-hospital stage.

Enteric viral hepatitis in the Socialist Republic of Vietnam (Southern Vietnam)

Aim: To study the hepatitis A (HAV) and hepatitis Е (HEV) prevalence in the Southern region of Vietnam based on the frequency analysis of the antibodies to hepatitis A and E viruses detection in the local population and groups at increased risk of infection.Materials and methods. Serological markers of enteral viral hepatitis were determined in blood serum samples from adults aged 18 to 65 years of three groups: conditionally healthy individuals (n = 397), HIV-infected (n = 316), and patients with chronic viral hepatitis (n = 268). The ELISA method was used for the qualitative detection of anti-HAV IgG, anti-HAV IgM, anti-HEV IgG, anti-HEV IgM.Results. When analyzing the prevalence of anti-HAV IgG in samples obtained from conditionally healthy, HIV-infected, and patients with chronic viral hepatitis, no differences were found between the groups. The incidence of anti-HAV IgG in the general group (n = 981) was 80.1%, in the absence of anti-HAV IgM. There were no gender-age differences in the frequency of anti-HAV IgG in the examined groups. Antibodies anti-HEV IgG in the groups of conditionally healthy, patients with chronic viral hepatitis, and HIV-infected were present in the samples in 36,2%, 33,2%, and 39,8% of cases, respectively. The prevalence of anti-HEV IgM in these groups was 3,27%, 4,1%, and 3,79%, respectively. In the general group (n = 981), anti-HEV IgG was detected in 36,6% of cases, anti-HEV IgM in 3,66%, which corresponds to the prevalence of antibodies to HEV in endemic regions.Conclusion. A high incidence of enteral viral hepatitis markers was shown in residents of South Vietnam, including the groups of conditionally healthy, patients with chronic viral hepatitis, and HIV-infected. There is an obvious need for further studies of the spread extent of hepatitis A and hepatitis E in the Socialist Republic of Vietnam using currently available highly sensitive diagnostic methods, including sequencing of the virus›s nucleotide sequences.

Psychological care for HIV-infected patientsat the St. Petersburg AIDS Center: history and the present time

The psychological state of people living with HIV is suffering from the moment when the diagnosis of HIV infection is perceived to the onset of remission during treatment. To achieve real effectiveness of HIV treatment, it is important to use not only the potential of modern pharmacotherapy, it is equally important that all people living with HIV receive psychological support in overcoming the difficulties arising from daily regular intake of drugs throughout their lives. Psychologists who are working at the AIDS Center are ready and conduct crisis counseling, extended counseling on adherence to treatment, psychological diagnostics to identify disorders which prevent the initiation and continuation of drug therapy, psychological correction in case of treatment interruptions. The use of traditional psychological methods should be based on knowledge of the characteristics of the disease and the specific treatment of HIV-infected people, which is currently being acquired in real clinical conditions. The article summarizes the many years of experience of the team of psychologists at the St. Petersburg AIDS Center and presents a model of modern psychological care for HIV-infected people based on knowledge of the characteristics of the disease, its prevention and specific treatment.

Characteristic of herd immunity among the population of Stavropol region amid the COVID-19 epidemic

Introduction. The first pandemic in the 21st century, caused by the pathogenic representative of the coronavirus SARS-CoV-2, began in the Chinese city of Wuhan, where the first outbreak of coronavirus pneumonia was recorded in December 2019. The disease spread so quickly around the world that already on February 11, 2020, WHO was forced to declare a pandemic of the “coronavirus disease 2019” COVID-19. The first case of COVID-19 in the Stavropol Territory was registered on March 20, 2020, and three weeks later, starting from the 15th week of the year, a steady increase in the incidence began, which lasted until the 52nd week. During the study period, the incidence increased from 21.1 to 28.3 per hundred thousand of the population. Growth 1.3 times.Purpose: to determine the dynamics of population immunity among the population of the Stavropol Territory in 2020-2021. during the period of an epidemic increase in the incidence of COVID-19. Materials and methods. The SARS-CoV-2 study was carried out according to a unified methodology within the framework of the program for assessing the population immunity of the population of the Russian Federation, developed by Rospotrebnadzor with the participation of the St. Pasteur. In total, 2688 people were examined, divided into 7 age groups. In the examined individuals, the level of specific IgG to the SARS-CoV-2 nucleocapsid was determined by the enzyme immunoassay.Results. The level of seroprevalence among residents of the Stavropol Territory was 9.8%. The largest proportion of seropositive individuals was found in the age groups 1-6 and 7-13 years old (19.2% and 19.7%, respectively). Seroprevalence had no gender differences and ranged from 9.3% to 10.8%. When assessing the distribution of the proportion of seropositive persons in different geographic territories of the region, it was found that the maximum proportion was found in the Kochubeevsky district (23.1%), the minimum in Kislovodsk (7.7%). Among convalescents, the content of specific antibodies to SARS-CoV-2 was noted in 73.3%, which is 7.8 times higher than the average population level. When conducting seromonitoring in the 2nd half of 2020, a 10-fold increase in seroprevalence was recorded, accompanied by a decrease in incidence from the 5th week of 2021. Among asymptomatic volunteers in whom SARS-CoV-2 RNA was detected by the polymerase chain reaction, antibody titers to viruses were found in 78.6%, which corresponds to the seroprevalence of convalescents. The proportion of seropositive persons among those who have come into contact with COVID-19 patients was 16.4%, (1.8 times higher than the average for the population). Out of 262 seroprevalent volunteers, the asymptomatic form of SARS-CoV-2 was detected in 92% of the examined, which indicates a significant role of the number of asymptomatic forms of infection in the epidemic process of COVID-19.Conclusion. The results of assessing the population immunity of the population of the Stavropol Territory indicate that it has not yet reached the threshold level at which a decrease in the intensity of the COVID-19 epidemic process can be expected.

Cost-effectiveness of meningococcal vaccination of infants in the Russian Federation

Generalized forms of invasive meningococcal desease (IMD) are very dangerous because they have a high mortality rate.The aim of the work was to assess the cost-effectiveness of meningococcal vaccination of infants with the 4-valent MenACWY-D conjugate vaccine in the Russian Federation.Material and methods. Cost-effectiveness analysis based on epidemiological data for the Russian Federation was carried out by a modeling method with a horizon of 80 years from the position of the healthcare system and taking into account the social perspective. Vaccination costs were calculated on the basis of the registered price of the vaccine, including VAT, the costs of GFMI therapy and patient rehabilitation – based on the compulsory medical insurance tariffs in St. Petersburg for 2021. Indirect costs due to temporary disability of patients’ parents, disability of patients and premature death were estimated by the lost GDP. In the base case, costs were discounted by 3,5% per year, life expectancy – by 1,5% per year.Results. Given the assumptions made, the average lifetime burden of a child’s illness is 17,556 million rubles. (no discounting). In the base case, the incremental cost per LYG from the payer perspective – 7,821 million rubles, and from the social perspective – 3,328 million rubles. Incremental cost per QALY – 5,350 million rubles and 2,277 million rubles, respectively. The most important factors that have a significant impact on the cost-effectiveness of vaccination are the incidence of IMD, the price of the vaccine, and the value of the discounting of costs and life expectancy.Conclusions. Given the assumptions made, meningococcal vaccination of infants with 4-valent meningococcal vaccine can be considered as a viable option.

Influence of the ways of spreading influenza epidemics across the territory Russia on the peculiarities of the epidemic process in various Federal districts

Aims. Show the ways of spreading influenza epidemics across the territory of Russia over a long period (1968–2019) and their influence on the incidence of influenza and ARVI in total and separately influenza A (H1N1), A (H3N2) and B in the Federal Districts in the period from 2009 to 2019.Materials and methods. The analysis of influenza epidemics was carried out according to the computer database of the National center for influenza.Results. A retrospective analysis of influenza epidemics shows the absence of inter-epidemic seasons after 1986, the increase in epidemics of mixed etiology and different routes of entry and spread of influenza viruses in Russia. During the circulation of the influenza A (H1N1)pdm09 virus, influenza epidemics were mainly of mixed etiology. The main causative agents of epidemics entered the territory of Russia more often from the west and in both ways, and from the west and from the east. In the next season, the main pathogen changed, and the path of the virus circulating in the previous season also changed. Influenza viruses of different types A and B usually diverged in time. Influenza viruses of the same type A, but of different subtypes, usually spread in different directions, with one of them having a limited distribution in the districts. The tendency of greater intensity of the epidemic process in the districts involved in the epidemic first is shown.Conclusions. 2009 to 2019 the incidence was higher in the Northwestern and Ural districts of the European part of Russia. One of the reasons for the high morbidity in these districts is the predominance of the western route of influenza viruses entering the territory of Russia and the high intensity of the epidemic process in the districts that were the first to be involved in the epidemic.

Respiratory viral infections in the lower respiratory tract failure (Literature review)

The sharp increase in viral pneumonia against the background of the pandemic of the new coronavirus infection SARS-CoV-2 requires more attention to the study of the role of viruses in damage to the lower respiratory tract, including their etiological significance in the development of community-acquired pneumonia. Modern possibilities of laboratory diagnostics make it possible not only to identify and study respiratory viruses, but also to help differentiate active viral infections as a cause of lower respiratory tract disease from virus carriers. The review describes the epidemiological and clinical features of the most relevant or less studied pneumotropic viral infections in children (respiratory syncytial, adenovirus, bocavirus, metapneumovirus), including their role in the etiology of pneumonia in children. Understanding the viral etiology of pneumonia in children will reduce the antibacterial load, which will help to reduce the side effects of chemotherapy and slow the emergence of antimicrobialresistant bacterial strains.