Structure and modules of computer informational-analytical system "Electronic atlas of Russia" is presented, the object of mapping in this system is epidemiology of socially significant infectious diseases. Systemic information on processes of emergence and spread of socially significant infectious diseases (anthroponoses, zoonoses and sapronoses) in the population of Russian Federation is presented in the atlas. Detailed electronic maps of country territory filled with prognosis-analytical information created by using technological achievements of mathematic and computer modeling of epidemics and outbreaks of viral and bacterial infections are of particular interest. Atlas allows to objectively evaluate the pattern of infection spread, prepare prognoses of epidemic and outbreak developments taking into account the implementation of control measures (vaccination, prophylaxis, diagnostics and therapy) and evaluate their economic effectiveness.
Due to increasing resistance to chemical therapeutants, the use of 'cleaner fish' (primarily wrasse, Labridae, species) has become popular in European salmon farming for biocontrol of the salmon louse, Lepeophtheirus salmonis (Krøyer). While being efficient de-licers, cleaner fish mortality levels in salmon cages are commonly high, and systemic bacterial infections constitute a major problem. Atypical furunculosis, caused by Aeromonas salmonicida A-layer types V and VI, is among the most common diagnoses reached in clinical investigations. A previously described real-time PCR (qPCR), targeting the A. salmonicida A-layer gene (vapA), was modified and validated for specific and sensitive detection of all presently recognized A-layer types of this bacterium. Before stocking and during episodes of increased mortality in salmon cages, cleaner fish (primarily wild-caught wrasse) were sampled and screened for A. salmonicida by qPCR and culture. Culture indicated that systemic bacterial infections are mainly contracted after salmon farm stocking, and qPCR revealed A. salmonicida prevalences of approximately 4% and 68% in pre- and post-stocked cleaner fish, respectively. This underpins A. salmonicida's relevance as a contributing factor to cleaner fish mortality and emphasizes the need for implementation of preventive measures (e.g. vaccination) if current levels of cleaner fish use are to be continued or expanded.
We describe the impact of enhanced infection control interventions on controlling the spread of vancomycin-resistant enterococci (VRE) in our hematology-oncology unit. Between April and September 1998, 13 patients on this unit were identified as having VRE. In addition to contact precautions, other measures that were needed to control the outbreak included closure of the unit to new admissions, creation of a cohort of VRE-positive patients and staff, and thorough cleaning of patients' rooms with 0.5% sodium hypochlorite.
The system of scientific and reasonable measures for hygienic and anti-epidemic providing of rail ridership is elaborated. The legal and methodical base for precautionary and current sanitary inspection in the field of hygiene and epidemiology of ridership has been created, standard and methodical documents have been introduced in practice of medical sanitary health services of the railroads and accepted to realization by the design, car-building and car-repair organizations. Sanitary and hygienic monitoring for rail ridership, including control for sanitary, hygienic and microbiological indices of the air environment of passenger and service premises of stations and passenger trains, and also control for indices of health of the workers providing ridership, with use of pre-nosological symptoms of pathology is organized. Features of a bacterial aero-plankton of passenger objects are revealed. The increase of indices of bacterial pollution of air in passenger objects during the summer-autumn periods of year in comparison with winter period is established. Direct relationship between levels of bacterial air pollution of passenger rooms of stations and integrated indices of anti-infectious stability of an organism of workers of the railway stations serving ridership, and also number of persons with the changed indices of the immune status is revealed.
The authors briefly review the incidence of some of the more important communicable diseases in Norway today. Thanks to extensive use of vaccines, effective preventive measures and useful antibiotics, many of these diseases are no longer a threat to public health, as was the rule up to the latter half of this century. However, constant vigilance is needed to sustain this positive situation.
To describe the investigation and control of transmission of vancomycin-resistant enterococci (VRE) in a residential long-term-care (LTC) setting. OUTBREAK INVESTIGATION: A strain of vancomycin-resistant Enterococcus faecium not previously isolated in Ontario colonized five residents of a 254-bed LTC facility in Toronto. The index case was identified when VRE was isolated from a urine culture taken after admission to a local hospital. Screening of rectal swabs from all 235 residents identified four others who were colonized with the same strain of E faecium.
Colonized residents were cohorted. VRE precautions were established as follows: gown and gloves for resident contact, restriction of contact between colonized and noncolonized residents, no sharing of personal equipment, and daily double-cleaning of residents' rooms and wheelchairs.
Two colonized residents died of causes unrelated to VRE. Although bacitracin therapy (75,000 units four times a day x 14 days) failed to eradicate carriage in two of three surviving residents, both cleared their carriage within 7 weeks. Repeat rectal swabs from 224 residents (91%) 2 months after isolation precautions were discontinued and from 125 residents (51%) 9 months later identified no new cases. Total cost of investigation and control was $12,061 (Canadian).
VRE may be transmitted in LTC facilities, and colonized LTC residents could become important VRE reservoirs. Control of VRE transmission in LTC facilities can be achieved even with limited resources.
Progress in immunology greatly contributed to the understanding of mechanisms of infectious immunity and vaccine action. Moreover, it facilitated the development of new vaccines and vaccination not only of healthy children but also of subjects with health problems and chronic diseases including the use of several vaccines. The number of contraindications could be decreased without a rise in the frequency of post-vaccination complications. Immunoprophylaxis allowed the incidence of controllable infections to be reduced; the level of epidemiologic well-being achieved in the course of this work provided a basis for eradication of some diseases. At the same time, successes of vaccination made mankind dependent on the use of vaccines. As a result, discontinuation of mass vaccination and even temporal decrease of its scale in the absence of certain infections or in the situation of their sporadic occurrence (i.e. the lack of natural immunization) lead to their reappearance. Specific features of modern immunoprophylaxis of infectious and non-infectious pathology and its timetable are described.
To report on a 30-year prospective study of deep infection in 1993 consecutive total hip arthroplasties performed by a single surgeon.
The relations of numerous variables to the incidence of deep infection were studied.
The cumulative infection rate after the index total hip arthroplasties rose from 0.8% at 2 years to 1.4% at 20 years; 9.6% of the index operations required further surgery. When infections attributed to these secondary procedures were included, the infection rate rose from 0.9% at 2 years to 2% at 20 years. Although the usual variables increased the incidence of infection, the significant and most precise predictors of infection were radiologic diagnoses of upper pole grade III and protrusio acetabuli, an elevated erythrocyte sedimentation rate, alcoholism and units of blood transfused.
From 2-20 years, the incidence of deep infection doubled. Preoperative recognition of the first 4 risk factors permits the use of additional prophylactic measures. Spinal or epidural anesthesia reduced the units of blood transfused (the fifth risk factor) and, hence, the risk of infection. Although most deep infections are seeded while the wound is open, there are many possible postoperative causes. In this study, fewer than one-third of the infections that presented after 2 years were related to hematogenous spread. The efficacy of clean air technology was supported, and it is recommended that all measures that may reduce the incidence of deep infection be employed.
Cites: J Bone Joint Surg Br. 1982;64(5):568-97142263
Resistance of 2134 clinical isolates of etiologically significant species of gramnegative bacteria to 5 beta-lactam antibiotics, i. e. cefepime, piperacillin/tazobactam, cefoperazone/sulbactam, imipenem and ceftazidime (the 3rd generation cephalosporin) as the reference drug was investigated for the period of 5 years (2004-2008). In total, 554 strains of E. coli, 578 strains of P. aeruginosa, 255 strains of Acinetobacter spp., 161 strains of Proteus mirabilis, 359 strains of Klebsiella pneumoniae and 227 strains of Enterobacter cloacae were assayed in dynamics. The comparative analysis of the frequency of the antibiotic resistant isolates from the patients treated within 2004-2008 with often and long-term use of cefoperazom-sulbactam, meropenem and imipenem revealed an increase in development of resistance to all beta-lactams, including the inhibitor-protected ones. It least of all concerned imipenem, still isolation of 39.5% of the imipenem resistant strains of P. aeruginosa was in favour of the tendency. A dramatic 3-5-fold rise of resistance in 2007 and 2008 in the isolates of K. pneumoniae, E. cloacae and Acinetobacter spp. to both the inhibitor-protected beta-lactams, that averaged 56 and 45%, 45 and 35% and 26 and 30% respectively, deserved attention. It was assumed that the main mechanism of resistance in the isolates to the inhibitor-protected beta-lactams was hyperproduction of beta-lactamase of type CTX-M. The large part of the cefepime resistant isolates of K. pneumoniae and Acinetobacter spp. (76.8 and 62.2% respectively) was in favour of the assumption. It was concluded that periodical reversion of the policy of preventive antibiotic prophylaxis was necessary, since such a prophylaxis is a reliable barrier to development of postoperative complications and at the same time it promotes selection of nosocomial strains with some other mechanisms of antibiotic resistance under hospital conditions.