The structure of the population morbidity with specific intestinal infections in areas with different intensities in the development of the epidemic process and an evaluation of its manifestations]

The authors analyze the morbidity structure in five enteric infections (typhoid fever, dysentery caused by Shigella flexneri and Shigella sonnei, hepatitis A, and hepatitis E (non A, non B) with the fecal/oral mechanism of the agent transmission) in three towns of Turkmenia and in the town of Novomoskovsk, Tula Province. The incidence of S. sonnei dysentery was found higher in Novomoskovsk and that of the rest enteric infections under study in Turkmenia. The incidence of typhoid fever and hepatitis E was the highest among schoolchildren and adults, whereas preschool children suffered mostly from hepatitis A and S. sonnei dysentery. The authors discuss the specific features of the epidemic process manifestation in enteric infections.     

The manifestations of the epidemic process in shigellosis and their theoretical interpretation]

This work, based on the retrospective analysis of shigellosis morbidity among organized groups of adults, as well as the whole population of the city, demonstrates the manifestations of the epidemic process. Water supply was common in the city, while water consumption was autonomous. The organized groups of adults did not use the products of the local milk-processing factory. The following facts were established. The dynamics of morbidity in Flexner's dysentery showed the change of dominating variants of the infective agent, which reflected the action of internal mechanisms of the development of the epidemic process. The role of Sonne dysentery in the total structure of shigellosis morbidity did not correlate with the consumption of milk and milk products. The theory of the self-regulation of the parasitic system and the theory of correspondence served as the basis for the theoretical interpretation of the manifestations of the epidemic process of Shigella infections. To ascertain the real correspondence of individual Shigella species to concrete transmission factors, further investigation are necessary.     

Nature of the epidemic process in Sonne and Flexner dysenteries and the causes of its induction

A comparative study of the epidemic process in Sh. sonnei and Sh. flexneri dysentery in different regions of the USSR revealed that the morbidity level of Sh. sonnei dysentery changed simultaneously in the regions under study at intervals of 2-3 years. Sh. flexneri dysentery showed morbidity rises occurring at intervals 6-8 years, and their occurrence did not coincide with the periods of elevated morbidity in Sh. sonnei dysentery. The data obtained in the cohort analysis and in the study of recurrent morbidity suggest that Sh. flexneri dysentery produces more pronounced postinfection immunity than Sh. sonnei dysentery, and the immunological factor probably affects the dynamics of the epidemic of these Shigella infections.     

An analysis of the dysentery epidemic process in Blagoveshchensk

The retrospective analysis of dysentery morbidity in Blagoveshchensk for the period of 1960-1987 was made. The regularities linking general natural and biological factors triggering the epidemic process with dysentery morbidity among the population are emphasized. The study revealed that under the conditions of Blagoveshchensk dairy products were of major epidemic importance among factors contributing to the transmission of dysentery. Such a factor as flies also had a definite influence on the epidemic process of dysentery. Another risk factor was drinking water which influenced the epidemic process both directly and indirectly through dairy products and, probably, other foodstuffs. Reliable correlation between dysentery morbidity among the population and the quality of dairy products, tap water and the number of flies was established.     

Manifestations of the cyclic nature of the epidemic process in dysentery

Different forms of dysentery, especially those caused by Sh. sonnei and Sh. flexneri, have been found to differ considerably in their cyclic recurrence. The development cycles of the epidemic processes of dysentery have an objective character, occur in the presence of any tendencies in the morbidity rate, and depend on the natural factors. Thus, the cycles of increase and decrease in morbidity are 3, 6, 9, 12 years for dysentery caused by Sh. sonnei and 6, 7, 8 years for dysentery caused by Sh. flexneri.     

Isolation and characteristics of Shigella antigens during the course of dysentery

In 2,436 fecal samples and 1,272 urinary samples taken from 633 patients with dysentery caused by S. flexneri, S. newcastle and S. sonnei, Shigella antigens were detected by means of the passive hemagglutination test with antibody diagnostic agents and the antibody neutralization test. The antigen-binding activity of shigellae in urine dynamically increased in the course of dysentery. The comparison of the parallel results of both serological tests made it possible to evaluate the dispersion of the released antigen: it dynamically increased in the course of the disease, this increase being particularly high in feces. The dispersion of Shigella antigens in urine was greater than in feces over the entire course of the disease. These regularities in the release of the antigens and especially the specific features of the serological tests determined the scheme of the serological diagnosis of dysentery by the indication of Shigella antigens.     

Immunoelectrophoresis analysis of the antigenic composition of E. coli K12 hybrids which acquired the serological specificity of S. newcastle and S. flexneri

Genetic and immunoelectrophoretic studies confirm earlier data on the presence of 2 specific antigens of acidic nature in S. newcastle; one of them is a specific thermolabile K-antigen responsible for type IV specificity of these bacteria. The data concerning the differences in the genetic determinants controlling the synthesis of O- and K-antigens in S. newcastle have been obtained. S. newcastle O- and K-antigens did not react with S. flexneri in the group serum system 3, 4, which indicates that S. newcastle are serologically isolated and form a separate taxonomic group of dysentery bacteria. The existence of cross reactions between S. flexneri and S. newcastle due to the presence of neutral R-core antigens common to these 2 species has been shown . Immunoelectrophoresis in agar is the most promising and informative method in genetic and chemical studies of the antigenic structure of bacteria.     

Characteristics and trends in the development of an epidemic process of Sonne and Flexner dysentery among preschool children

The results of studies indicate that the morbidity rates of dysentery among children attending preschool institutions and children brought up at home converged in recent years. This phenomenon was most pronounced among children of the kindergarten age group. At the same time dysentery caused by Sh. sonnei and Sh. flexnery produced a higher morbidity rate among children attending nursery in comparison with that among children of the same age group brought up at home. Group infections in preschool institutions were caused by Sh. sonnei in 89.1% of cases and by Sh. flexneri in 10.9% of cases. Outbreaks due to the transfer of infection through everyday contacts were observed only in dysentery caused by Sh. sonnei, constituting 71.4% of the total number of dysentery outbreaks.     

Detection of Shigella antigens in the feces of patients with acute intestinal diseases using a coagglutination reaction

A total of 113 patients with acute intestinal diseases have been examined with the use of the coagglutination test. 84.95% of the patients showed the presence of different Shigella antigens. In patients with bacteriologically confirmed dysentery the corresponding Shigella antigens were detected in 96.97% of cases in S. sonnei dysentery, in 90% of cases in S. flexneri dysentery, in 75% of cases in S. newcastle dysentery and in 100% of bases in S. boydii dysentery. In 81.6% of patients with acute intestinal diseases of unknown etiology the coagglutination test revealed the presence of various Shigella antigens.     

Changes in the etiologic structure of Sonne shigellosis in its multiyear dynamics

The dynamics of Sonne dysentery morbidity in connection with changes in the structure of S. sonnei circulating among the population of Leningrad for the period of 1959-1984 was studied. Considering such sign as the leading fermentovar, three smaller periods were established in this stretch of time. Changes in the structure of circulating shigellae were accompanied by changes in the intensity and direction of tendencies or decrease in the manifest and asymptomatic forms of infection, as well as in annual morbidity levels and seasonal rises. A slow decrease in morbidity, which started in 1974, occurs in the presence of the predominant circulation of S. sonnei, fermentovar II, among the population; this fermentovar showed greater virulence and immunogenicity than other biovars. One of the decisive moments characterizing the dynamics of the epidemic process of Sonne dysentery is the intensity of the circulation of shigellae in the S-form, and the intensity of the population immunity of the host, linked with this fact, is subject to phasic fluctuations during each annual epidemic cycle.     

Spread of salmonellosis in Moscow and the ways of its prophylaxis

The article deals with the results of the epidemiological analysis of the spread of salmonellosis in Moscow. During the last 15 years the proportion of Salmonella enteritidis was about 80% and more. After salmonellosis morbidity decreased to 19.9 per 100,000 of the population (the minimum level) in 1985 its sharp rise was noted. Morbidity rate increased from 31.7 in 1987 to 55.1 per 100,000 in 1988, then to 93.9 per 100,000 of the population in 1989 (the maximum level). In the subsequent years up to 1996 a decrease in morbidity rate was observed, but in 1997-2002 morbidity rate stabilized within 29.8-35.7 per 100,000 of the population without a perceptible tendency towards decrease. The sharp increase of the etiological role of S. enteritidis which led to a wide spread of Salmonella infections was caused by the "chicken-egg" factor of their transmission. High morbidity rate among children and adults, registered all the year round, is the consequence of the constant epidemic activity of this factor.     

Use of data on Shigella contamination and immunity indices for studying the activity of the epidemic process in dysentery

The comparative study of the monthly distribution of characteristics indicating the levels of contamination with Sh. sonnei and Sh. flexneri separately, as well as the seasonal dynamics of the corresponding antibodies, in the years with high and low morbidity levels has been made with the use the indirect hemagglutination test. The possibility of using these characteristics for the evaluation of the activity of the epidemic process in dysentery caused by Sh. sonnei is shown.     

The formulation of epidemiological hypotheses by using the methods of multivariate statistical analysis

The work demonstrates the main approaches to the use of the methods of multidimensional analysis for the creation of a hypothesis on the mechanism of the epidemiological process of dysentery in organized groups. The main risk factors have been established, and their role in the formation of annual, all-the-year-round and seasonal dysentery morbidity has been quantitatively evaluated. The results of analysis show the existence of diverse variants of the alimentary route of the transmission of infection, maintaining the epidemic process of dysentery, and the necessity of differentiating measures for the prophylaxis of all-the-year-round and seasonal morbidity.     

Seeding efficiency of the causative agent of dysentery as an index of the intensity of the epidemiologic process]

A study was made of the character and extent of interrelationship between the indices of dysentery morbidity and the indices of the seeding efficiency of dysentery bacilli persons who did not apply for medical aid. Establishment of such interrelationship permitted the authors to suggest the use of a more objective index of the seeding efficiency of dysentery bacilli, along with morbidity indices, for the assessment of the intensity of the epidemic process in this infection. On the basis of investigations carried out the authors came to the conclusion that a tendency to the increase of dysentery incidence the last few years chiefly bore a "statistical" character and was due to the improved detection of patients and carriers.     

Immunoglobulins and antibodies of various classes in children immunized with live oral Shigella sonnei vaccine from the spontaneous mutant]

The authors determined the immunoglobulin and specific antibodies level in the blood serum of 17 children aged from 7 to 10 years during the immunization with live dysentery Some vaccine. Mancini's test demonstrated the absence of any differences in the amount of IgA and IgG in children of the given age group and in adults before the immunization; in comparison with adults, IgM was increased in children. 14 to 20 days after the immunization in children there was a significant elevation of the IgG only, whereas in adults the immunoglobulin level of all the 3 classes increased significantly. The titres of specific antibodies of the IgA-, IgG-classes and of hemagglutinins before the immunization detected by Coombs' test failed to differ in children from the titres of antibodies of these classes in adults; the level of IgM antibodies was much greater in children than in adults. The changes and accumulation of antibodies of various classes in children and adults during the enteral immunization with live dysentery vaccine differed significantly: in children the vaccine stimulated the IgA- and the IgM-antibody synthesis, whereas adults responded to the immunization by increased production of all the 3 antibody classes. On the basis of the noted immunological shifts a conclusions was drawn on a marked local immunization activity of the live enteral Sonne dysentery vaccine from the spontaneous mutant in children.     

Comparative diagnostic value of methods for detecting dysentery antigens in substrates of the patient's body

The comparative evaluation of different immunological methods, such as the enzyme immunoassay, the aggregate hemagglutination test and the complement fixation test, used for the detection of specific Shigella antigens in biological body substrates obtained from 287 patients with acute dysentery caused by S. sonnei, S. flexneri and S. newcastle has been carried out. The enzyme immunoassay and the aggregate hemagglutination test most effective (97.5 +/- 0.5 and 92.4 +/- 0.9, respectively), the object of study being the patients' blood taken at the early stages of the disease. The diagnostic specificity of these methods has proved to be 98.7 +/- 6.7 and 95.2 +/- 1.4, respectively.     

The definition of the forms of the epidemic process in intestinal infections]

A method for the identification of the forms of the epidemic process in dysentery (annual, seasonal and outbreak forms) has been worked out. The method is based on the calculation of the upper limits of annual and seasonal morbidity from the data on the period of several years with the use of the formulae of binomial distribution, serving as the mathematical model of alternative random values, such as morbidity. The comparison of actual morbidity for each year of the analyzed period with the upper limits of annual and seasonal morbidity helps identify the form of the epidemic process.     

Specific prophylaxis of shigellosis

A high level of shigellosis morbidity requires new approaches to the control of bacterial dysentery. According to modern concepts, the outbreaks of Shigella infections are linked both with less intensive epidemic control measures and the objective cyclic character of the epidemic process. In this connection great importance is attached to the development of vaccines for the immunization of high risk groups in territories with unfavorable epidemic conditions and in zones of military conflicts, as well as children of school and pre-school age, who mostly determine seasonal rises of shigellosis morbidity. In this article the data describing new approaches to the creation of new live enteric vaccines on the basis of the knowledge of the genetic control of microbial pathogenicity and the regulation of its expression are presented. Attenuated Shigella mutants, created by different authors and having good prospects to be used for the development of vaccines, are characterized.     

Incidence of meningococcal infection in the RSFSR]

The authors present characteristics of meningococcus infection epidemic process in case of sporadic cases and under epidemic conditions (1965--1976). A scheme of epidemiological analysis suggested by the authors permitted to differentiate and to record the incidence of various clinical forms of meningococcus infection, to present data on the age, seasonal characteristics, focality, etc. Comparison of intensive morbidity indices for 10 years, both at the individual administration territories and in the Republic as a whole demonstrated morbidity level of 1.5--2.0 to be one of prognostic signs of the beginning epidemic. The main features differentiating the sporadic and epidemic morbidity periods were revealed. The presence of group diseases, a greater percentage of children among those who fell ill, and marked signs of seasonality and territorial difference characterized the period of rise caused by meningococcus of serological group A.     

Epidemiology of diphtheria in the RSFSR during mass immunization over many years

The work defines the characteristic epidemiological features of diphtheria in the RSFSR at the present moment when a high level of antitoxic immunity is generally determined in children. With the diphtheria morbidity level having, on the whole, a sporadic character in the RSFSR, the intensification of the epidemic process has been found to occur in some regions. Changes in the ratio of morbidity rates among the urban and rural population are observed, the morbidity rate among the latter have the tendency towards increase. At present the characteristic feature of diphtheria is the prevalence of adults in the general morbidity structure. An important fact is a permanently high level of toxigenicity in Corynebacterium diphtheriae. As before, autumn is the season of the highest morbidity level.