The paper provides the data of analysis of antituberculous care to teenagers in Moscow and characterizes its problems. Emphasis is placed on the tense and unstable situation associated with the detection of the disease in this age group. In the bulk of adolescents, the disease is identifies when they come to see a doctor, including at somatic hospitals. Active tuberculosis detection techniques (tuberculin diagnosis and fluorography) fail to produce adequate effect mainly due to organizational problems (the bulk of teenagers are outside the organized collective bodies or the latter are frequently changed; the detection of tuberculosis in Moscow nonresidents or in whose who enter secondary specialized colleges claims attention). Age-related sociomedical risk factors, such as hormonal rearrangement, comorbidity, a negative attitude towards preventive medical measures, deviant behavior, social family, and dysadaption, are of importance for the development of tuberculosis. A sociomedical portrait of an adolescent with tuberculosis is given. Attention is drawn to the fact that on implementing antituberculous measures, it is a need for an interaction of a tuberculosis-controlling service with general care health network facilities, including those that deal with the problems of social diseases and educational establishments.
Because of deterioration of epidemiological situation by tuberculosis, individuals from tuberculous infection foci and social risk group require special care. It is important to integrate efforts of phthisiatric and general therapeutic and prophylactic services in detection of tuberculosis in children and adolescents, to create controlled conditions for conduction of antituberculous measures.
Tuberculosis morbidity was comparatively analyzed in the children and adolescents of Moscow and the Penza Region. The epidemiology of tuberculosis in the children and adolescents was established to be universal in the compared regions in the study period. This manifested itself as a stable tendency for higher morbidity rates (MR), increased incidence of destructive tuberculosis, inadequate use of the existing methods for active detection of tuberculosis in these age groups, and, among those who had fallen ill with this disease, an increase in the number of persons from the foci of tuberculous infection and persons with established contact with patients with tuberculosis. Along with a steady MR growth for tuberculosis among the children and adolescents, there has been a quantitative modification to the proportion of all epidemiologically hazardous forms of tuberculosis, such as the bacillary and destructive forms of pulmonary tuberculosis complicated by extrapulmonary tuberculosis. Hypodiagnosis of tuberculous pleurisy and extrapulmonary tuberculosis has been recently noted in the general health care network. The analysis also leads to the conclusion that the quality of mass tuberculin diagnosis remains poor. In both regions, general pediatricians are not adequately alert to tuberculosis, extrapulmonary tuberculosis in particular. With a rise in tuberculosis endemic, the incidence of tuberculosis in 18-21-year-old persons is 2-3 times greater than that in adolescents, which is associated with the greater activity of this population group and with the underdetection of the asymptomatic forms of tuberculosis in adolescents.
Retrospective analysis of the data available in the reporting form 0-89/y-[cyrillic letter: see text] and information analytical tables for Moscow tuberculosis monitoring) over 7 years on all notified new cases of tuberculosis among 15-17-year-old children has indicated that it is necessary to change the procedure for detecting tuberculosis for this age group of children in order to improve the early diagnosis of the disease. The Mantoux test is likely to be rather effective in examining adolescent schoolchildren and students from secondary specialized establishments and ineffective among unorganized young people and in migrants' families. Planned fluorography is of rather informative value in all the groups under study if there is a timely referral for examination. The authors consider whether it is worth making a tuberculosis 2 TE PPD-L in organized collective bodies (schools, colleges, etc.). Other groups of children may undergo only digital small-dose fluorography. Unorganized children above 10 years of age who lack annual Mantoux test results must be referred for digital small-dose fluorography. Refusal to undergo fluorography is justifiable only if there is no tuberculin sensitivity or evident symptoms of intoxication. In the megapolis, due to uncontrolled migration, a lawmaker must consolidate the statute on that mandatory control should be exercised over 15-17-year-old adolescents who must undergo fluorography during their each visit to a health care facility, on entering an educational establishment, or on employment. On consulting a physician, the adolescent who has undergone fluorography 6 months before must have it again.
The paper analyzes the efficiency of vaccination and tuberculin diagnosis in the megapolis on the basis of official reporting forms Nos. 8 and 33 approved by the 11 November, 2005 Resolution of the Russian Statistics Agency and the Moscow tuberculosis monitoring system. It is concluded that refusals to undergo vaccination and tuberculin diagnosis may result in the system crisis of antituberculous care to the pediatric population. For the optimum solution of reducing the rate of refusals to take the drugs prescribed by a physician, the authors propose to use in pediatric antituberculous care the marketing methods that level off the responsibility of the parties in taking a decision whether a medical service is expedient. Under the marketing conditions of medical services, combating the foci of tuberculous infection should be a main line to reduce the prevalence of tuberculosis. Prevention of tuberculosis is most effective with the active interaction of medical services (pediatric phthisiological and primary pediatric care services) and society and with the needs being molded in it (as a market medical service) in the population.