Epidemiologic analysis morbidity with meningococcal infections in the USSR]

The authors present the analysis of the incidence of epidemic cerebrospinal meningitis in the USSR from 1937 to 1974, and of meningococcus infection from 1965 to 1974. A rise of the meningococcus infection incidence from 1969 to 1974 was recorded 28 years after the elevation of 1940-1942 and was 1.5 times below this latter rise. The rise in 1969-1974 was characterized by marked signs peculiar to the infection with the droplet transmission mechanism; among those who contracted the disease prevalence was seen among children aged under 14 years (63-72%). A marked affection of juveniles was noted. Three types of the dynamic of the meningococcus infection incidence in the republics located in different climatic-geographical zones of the USSR were noted: slow, gradual increase of the level, interrupted and explosive. Such character was determined in the dynamics of the seasonal elevations of morbidity. Antiepidemic measures including a complex of nonspecific measures could not be assessed as sufficiently effective. This finds reflection in the natural course of the epidemic process of the meningococcus infection which remains uncontrolled. From the patients with generalized form of the disease meningococci of group A were isolated in 80-100% of cases, from the number of those typed. The group-specific reference of the nasopharyngeal strains depended on the epidemic situation: strains of serological group A prevailed at the period of the morbidity elevation, and other serological groups (particularly of C and B) increased at its decline.     

Detection of the etiologic structure of generalized and localized forms of meningococcal infection using the passive hemagglutination test

Preparations of formalin-treated erythrocytes sensitized with meningococcus polysaccharides of serological groups A, C, X, Y, and Z were used for the purpose of examination of patients with meningococcus infection; these preparations were highly specific in the tests of precipitation, hemagglutination and hemagglutination inhibition. Indirect hemagglutination test with the sera of 99 patients suffering from generalized forms of meningococcus infection was conducted with the mentioned preparations in Moscow and Novosibirsk in 1974--1975 when a stable morbidity decline was noted in these towns after an epidemic rise. The diagnostic value of this test was confirmed: it permitted to diagnose meningococcus etiology beginning from the 5th day of the disease and to decipher it from the aspect of individual serological groups. As shown, the incidence of cases caused by serological group A, reaching 87% at the height of the epidemic rise, fell to 49.5% at the stage of decline. Cases caused by group Y which was not encountered formerly were revealed in 16.2% of the patients. Among 127 patients with miningitis of nonmeningococcus etiology meningococcus antibodies to groups A and Y were revealed with the same frequency (in titres of not over 1 : 20--1 : 80), but the leading role of serological group A in the etiology of the manifest forms permitted to draw a conclusion on the presence of a higher invasiveness in the strains of group A.     

Epidemiological and laboratory criteria in the assessment of meningococcus carrier state]

A study was made of the duration of meningococcus carrier state, immunological indices and group-specific properties of meningococci isolated from them. The periods of meningococcus discharge were studied in 738 persons. Three categories of the carrier state were revealed: a single discharge (67% of the carriers), of average duration (up to 4 weeks), and prolonged. Greater indices of group-specific antibodies (in the passive hemagglutination test) were revealed in the carriers with prolonged presence of meningococci in the nasopharynx. Dynamics of immunological indices and periods of the carrier state formation in the foci of infection permitted to characterize the prolonged carrier state as a latent form of meningococcus infection. A study of the group-specific properties in 1845 strains and comparison of the group-specific pattern of the circulating strains with the epidemic situation indicated that meningococci of group A were not only epidemic, but also more virulent.     

Basic patterns in the epidemic process of measles under conditions of massive immunization]

Observations over the measles epidemic process in Leningrad showed that the sporadic morbidity level reached in 1974--4.1 per 100 000 residents; however periodic elevation and decline of morbidity and tis seasonal variations persisted. A rise of morbidity in 1972--1973, and by preliminary data--in 1975, occurred on account of the older age groups. There was revealed no dependence of the disease incidence among the persons vaccinated on the time lapse after their vaccination. Individual batches of live measles vaccine issued in 1963--1969 were not up to the standard, this serving as one of the cases of the occurence of group incidence of the infection in some foci.     

Epidemiological evaluation of the serological grouping of meningococci]

Use of the precipitation and hemagglutination inhibition tests to determine the serological group of 114 meningococcus strains which cannot be grouped by agglutination slide permitted to establish the serological group of 56% of the strains, this pointing to the greater diagnostic value of these tests. Nevertheless, 70% of 307 strains isolated from carriers could not be referred to any of the determinable groups (A, C, X, Y, and Z). Strains (417) isolated from the cerebrospinal fluid of patients with meningitis were grouped depending on the epidemic curve: only half of the cultures could be classified in sporadic cases, but from 80 to 100% of the strains were classified at the "peak" of the meningitis incidence rise. This rise was connected with increase of the incidence of cases caused by meningococcus, group A; at the decline these strains were eliminated, and cases due to the rarely encountered serological groups and nongrouping strains occurred. Marking meningococc by serological groups proved to be of no use for detection of epidemiological relations between the infected persons.     

Characterization of the foci of meningococcal infection in closed groups of males

A total of 257 foci of meningococcal infection in groups of servicemen were selectively examined in 1982-2002. From these groups 353 patients with generalized forms of the disease underwent hospitalization. Most of the foci had a single infection, the proportion of foci with 10-40 patients was 82.6%. The meningococcal infection rate among humans in the foci was 25-37%, group A meningococci playing the leading role. In the structure of meningococcal infection generalized forms of infection constituted 16%, localized forms constituted 25% and inapparent forms (carriers)--59%. The formation of the morbidity structure was influenced by the type of the focus (with a single or multiple infection) and the character of morbidity for many years (during epidemic or at the period between epidemics). No absolute dependence of the level of meningococcal carrier state in the groups of servicemen on the appearance of the generalized forms of meningococcal infection was noted. Thus, both during epidemic and at the period between epidemics the population of meningococci, heterogeneous in its serological structure and differing in its clinical and epidemiological importance, constantly circulated with the leading role played by group A meningococci.     

Epidemiological research in amyotrophic leukospongiosis

The epidemiological aspects of amyotrophic leukospongiosis (AL), a slow viral infection of the central nervous system leading to the fatal outcome in 2-4 years, have been studied. As a rule, this disease is observed in the inhabitants of rural areas or in town dwellers born in rural areas and having spent there a considerable part of their life. AL occurs in persons of middle and older age; young people under 19 years and old people over 68 years of age are not affected by this infection. In contrast to amyotrophic lateral sclerosis and the Jakob-Creutzfeldt disease, AL is characteristic for persons in the phase of hormonal activity. The disease starts mostly in autumn and winter; this regularity is especially pronounced in women. The morbidity level (according to the average annual data) is at present 0.3 per million of population. An increased morbidity rate is characteristic of the family and group type of the epidemic process. This higher morbidity rate, by one order higher than that observed in the sporadic type of morbidity, is caused by the gradual formation of "genetic isolates".     

Serologic pattern of meningococci in a focus of infection]

The authors present the results of typing of meningococci (isolated from the patients and carriers) by the sera of serological groups A, B, C, D, X, Y, and Z made at the Leningrad Institute of Vaccine and Sera. The causative agents of serological group A were most frequently isolated from the patients with the generalized forms of meningococcus infection. The percentage of detection of meningococci of serological group A was the greatest in the patients and much less in the carriers in and outside the foci of this infection. Many dissociated cultures were revealed among the strains isolated from the carriers. Sera of the Leningrad Institute of Vaccine and Sera have permitted typing of meningococci cultures belonging to various serological groups in accordance with the international classification.     

Manifestations of angina morbidity as a reflection of the self-regulation of the epidemic process in streptococcal infection

The data on the application of the principles of the self regulation of the epidemic process for understanding the annual dynamics of angina morbidity in organized groups of adults are presented. In this case the reservation of group A streptococci occurs in chronic (resident) carriers, whose proportion was found to be 15.8 +/- 2.6%. The epidemic manifestations of morbidity are regulated mainly by the concentration of newly arrived members in the groups, i. e. by the size of the stratum providing the optimum conditions for the parasitization of the streptococcal population. The annual morbidity levels depend essentially not only on the heterogeneity of the group members with respect to their susceptibility to streptococcal infection, but also on the conditions of their accommodation, affecting the transmission of droplet infection. The role of individual risk factors in the variation of the quantitative characteristics of the angina morbidity manifestations under study is calculated.     

Conquering the meningococcus

Since the first outbreaks of meningococcal meningitis were first described in Geneva in 1804 and in New England in 1806, and since the discovery of the causative agent by Weichselbaum in 1887 and the beginning of epidemics of meningococcal meningitis in the sub-Saharan Africa approximately 100 years ago, Neisseria meningitidis has been recognized as the cause worldwide of epidemic meningitis and meningococcemia. The massive epidemic outbreaks in sub-Saharan Africa in the 1990's, the emergence since 1995 of serogroups Y, W-135 and X and the prolonged outbreak of serogroup B meningococcal disease in New Zealand over the last decade serve to remind us of the continued potential of the meningococcus to cause global morbidity and mortality. This report reviews new discoveries impacting prevention and future prospects for conquering the meningococcus as a human pathogen.     

Model of meningococcal sepsis in mice]

The authors studied a possibility of obtaining experimental meningococcus sepsis model on mice. The use of cyclophosphane, iron compounds, yolk medium produced no significant organism. When 4--5% mucine was injected intraperitoneally together with meningococcus culture mice died with sepsis phenomena. Differences were revealed in the sensitivity of linear and mongrel mice to meningococcus infection--AKR mice proved to be more sensitive. At the same time it was found that mongrel mice weighing from 10 to 12 g could be used to induce meningococcus sepsis.     

Intensity of the epidemic process of whooping cough under conditions of mass immunization over a period of many years

On the basis of analysis of whooping cough incidence in 1959 to 1975 in Moscow the authors present characteristics of the epidemic process under conditions of planned many-year immunization of children against this infection. Whooping cough morbidity proved to undergo significant changes-from sharp falls the first 8 years of immunization to a relative stabilization with a gradual reduction the last 5 years. Marked seasonal and periodic elevations persist against the background of reduction of morbidity. Preschool- and schoolchildren are equally involved in the epidemic process; the most frequently involved are nonvaccinated children aged 1 year and 4 to 10 years, which lost postvaccinal immunity. Further reduction of the severity of whooping cough and increase in the number of unimanifested forms of the infection was noted. This was apparently connected not only with immunization, but also with the reduction of the virulence of H. pertusis detected in studying the cultures isolated in Moscow from 1967 to 1974. The intensity indices of the epidemic process in whooping cough pointed to the necessity of using a more effective vaccine for the protection of children from whooping cough, despite the noted reduction of morbidity, and diminished severity of the course of the disease, and of the causative agent virulence.     

Phase changes in the population of group A streptococci and their influence on the course of the epidemic process of tonsillitis

This work presents the data on the complex evaluation of the population of group A streptococci, studied at each of four phases (reservation, epidemic transformation, epidemic spread, reservational transformation) of the course of the epidemic process of streptococcal infection of the respiratory tracts (tonsillitis) in an organized group of adults. The characterization of the phases of the infective agent in accordance with the level of the carrier state, the size of streptococcal foci and the virulence of streptococci is given. Thus, the study shows that the heterogeneity of group A streptococci with respect to their virulence reaches its maximum level at the phases of reservation and epidemic spread and its minimum level at the phases of epidemic and reservational transformation. The size of streptococcal foci in carriers and the virulence of streptococci isolated from them are the inter-related unidirectional signs of the population of the infective agent and, at the same time, the main factors responsible for the phase character of the epidemic process and the morbidity level in tonsillitis.     

B群脑膜炎球菌疫苗的研制策略

脑膜炎奈瑟菌主要引起儿童细菌性脑脊髓膜炎和败血症,有较高的发病率和病死率。现用疫苗能够控制A、C、W135和Y群脑膜炎球菌引起的感染,而由于B群荚膜多糖免疫原性弱,外膜蛋白变异性高等原因,仍无安全和具有广泛保护性的疫苗用于控制B群脑膜炎球菌的感染。目前,B群脑膜炎球菌大多已成为引起发达国家侵袭性脑膜炎疾病的主要病原体。随着研究的不断深入,B群脑膜炎球菌疫苗的研究已经取得了很大的进展,外膜囊(Out membrane vesicles,OMV)疫苗已经在控制特异性菌株爆发流行中取得了成功。然而,人们对具有广泛保护性的B群脑膜炎球菌疫苗的探索仍在继续。本文对近年来B群脑膜炎球菌基于不同型抗原疫苗的各种研制策略及其存在的问题进行了综述。     

Prognosis of the dynamics and intensity of the epidemic process in viral hepatitis A

The article deals with approaches to the calculation of the annual morbidity rate in virus hepatitis A at the period preceding the season of maximum morbidity, necessary for planning the relevant prophylactic and antiepidemic measures in due time. The method for calculating the monthly levels of sporadic morbidity in virus hepatitis A is proposed. This method permits the detection of complications on the epidemic situation, which is necessary for the timely organization of antiepidemic measures. The proposed method for predicting annual and monthly morbidity levels can be used in the practical work of specialists at sanitary and epidemic stations.     

The epidemic process of diphtheria infection in the RSFSR during the introduction of epidemiological surveillance

In this work the characterization of the epidemic process of diphtheria infection on the territory of the RSFSR under the conditions of epidemiological surveillance (1983-1986) is presented. In comparison with the period of 1979-1982, an increase in morbidity rate occurred, which accounts for more complete detection of patients with mild forms of diphtheria, including persons found to be carriers of toxigenic Corynebacterium diphtheriae. Beginning from 1983, the leveling out of seasonal morbidity rises is observed. In the total number of persons affected by this infection the prevalence of adults is noted. Among them, a decrease in the morbidity rate was registered in 1986 (the maximum decrease was observed in age and professional groups of risk), which confirms the effectiveness of measures carried out for the protection of the adult population from diphtheria. Among children, a tendency towards a decrease in morbidity rate was noted in all age groups. The existing system of epidemiological surveillance on the territory of the RSFSR is capable of stabilizing diphtheria morbidity on a sporadic level and minimizing the number of fatal outcomes. The intensification of the epidemic process in some areas of the RSFSR is due to shortcomings in the realization of different measures of epidemiological surveillance.     

Incidence of epidemic parotitis in different countries]

The authors analyzed the incidence of epidemic parotitis in various countries in 1960--1969 on the basis of the data published by the WHO. It can be supposed that there was no significant difference in the morbidity in various countries and that discrepancy in the official data of individual countries was apparently caused by the errors in recording. In the majority of the countries morbidity curve was fluctuating in character with a 4--5-year periodicity. In the countries of the northern hemisphere the greatest number of cases occurred in spring, and in the southern--in autumn. Monthly distribution of cases during the years with a high and low morbidity level displayed no significant changes.     

Analysis of the trends in typhoid-paratyphoid morbidity in the USSR]

Mathematico-statistical analysis of typhoid-paratyphoid infection morbidity in the USSR during 1900--1940 revealed a regular many-year cyclic recurrence of the changes in the morbidity level. The intensity of the morbidity level reduction at the periods of decline--in 1900--1917, 1920--1928, and in 1932--1939--was similar. A successive reduction of morbidity of this group of infections, by 6.45% on the average, annually, occurred in 1930--1976. The character of reduction of typhoid-paratyphoid infections morbidity level in the USSR during that period is well described by the exponential function.     

Results of virological and serological studies of three influenza A Hong-Kong epidemics in Leningrad.

An analysis of morbidity of the population in the course of 3 influenza A/Hong-Kong epidemics showed a pronounced decrease in influenza affection of adult population in the last epidemic in 1971--1972. Comparative studies of the diagnostic value of CFR and HIT demonstrated identical sensitivity of CFR as a method of influenza diagnostics in both the epidemic and interepidemic periods. HIT was suitable for the detection of influenza only in the epidemic period. In the interepidemic period, the percentage of influenza infection diagnosed by means of HIT ammounted to only 23--24 of all serologically confirmed cases of influenza. The highest percentage of virus isolation was observed when material from patients with serologically confirmed influenza was used. All strains of influenza A virus isolated in 1969 and 1970 were similar in their sensitivity to inhibitors of animal sera. During the last influenza epidemic, 2 of the 136 isolated strains were found to be resistant to gamma inhibitors and highly sensitive to the inhibitors showed their close relationship to gamma inhibitors. Antigenic analysis of the influenza A strains isolated during the 3 influenza epidemics revealed changes in the antigenic structure of the agents of the influenza epidemic in Leningrad in comparison with the standard strain A/Hong-Kong/I/68 (H3N2).     

The plasmid composition and pathogenetic characteristics of Yersinia pseudotuberculosis strains isolated from human subjects against a background of epidemic and sporadic morbidity

112 newly isolated clinical cultures of Y. pseudotuberculosis have been studied. The strains have been characterized by the presence of plasmids and pathogenicity signs associated with plasmids. The results of the study have confirmed the decisive role of the plasmid with a molecular weight of 44-48 MD in the virulence of Y. pseudotuberculosis. The plasmid with a molecular weight of 82 MD, previously attributed the role of an epidemic marker, has also been found to be widely spread. Our study has revealed no specific features in the plasmid composition of the strains isolated under the conditions of sporadic and epidemic pseudotuberculosis morbidity. The results of the study of the pathogenicity of isogenic derivatives differing by the presence of pXV indicate that the role of plasmids with molecular weights of 3.8 and 82 MD in this process is not essential in the model systems, traditional for enteroinvasive Yersinia.