The results of foreign and Russian author`s researches about  immunization of adult population are presented in article. The analysis  of the vaccinal prevention state of infectious diseases in adults in  different countries of the world (national guidance on adults  immunization, coverage of preventive vaccinations, financing  mechanisms) is given. The tasks of improving immunization in adult  population of Russia are defined.

The creation in the middle of the 20th century vaccines against  poliomyelitis (PM) – inactivated vaccine (IPV) and live oral vaccine  from Sabin strains (OPV) with various properties, advantages and  disadvantages, but highly effective, made it possible to implement  the idea of elimination of PM. Since 1988, the WHO Global Program  of PM eradication has achieved remarkable success: the incidence of  PM caused by wild poliovirus (PV) has been reduced by 10 thousand  times, the number of endemic countries has been reduced to 3, the circulation of wild PV has been discontinued in 4 regions of the  world the wild type 2 of PV has been eradicated, and wild type 3 of  PV has not been detected for almost 5 years. Under conditions of a  decrease in the incidence of PM caused by wild PV, the known  negative properties of trivalent OPV made its further use  problematic. These negative properties are: 1) the ability to cause  post-vaccination complications and 2) the genetic instability of Sabin  strains, especially PV of type 2, and their ability under certain  conditions (primarily in conditions of low collective immunity to PV)  to quickly restore neurovirulence, transforming into circulating  vaccinederived PV (VDPV), capable of causing incidents and  outbreaks of PM. In order to reduce the risk associated primarily with type 2 PV, WHO proposed a global switch to the use of bivalent OPV from types 1 and 3, completed in 2016. In 2019, WHO plans to  complete eradication of type 1 and 3 PVs, and in 2022 completely  abandon the OPV. The precondition for the safety of such tactics is  the maintenance of high collective immunity to PM. There are several  threats to the security of this strategy. PVs can “silently”  circulate in the human population for a long time without clinical  manifestations of PM, which, with inadequate epidemiological  surveillance can lead to the return of PM. The reintroduction of both  wild PV and Sabin strains can occur from institutions that preserve / work with PV. The source of VDPV can be people with primary immunodeficiencies, which continuously excrete PV. It is necessary to maintain surveillance over the PM, expand additional types of surveillance for the PV, strict containment of all  PVs. The only way to maintain collective immunity is immunization with trivalent IPV. The current global shortage of IPV poses a  significant threat to the world’s epidemiological well-being. The  solution to the problem is the development of a new generation of  safe and effective vaccines, improving the ways of introducing IPV, developing antiviral drugs.

The review presents the special aspects of bacillary excretion in  tuberculosis patients co-infected with HIV and the yield of acid-fast  smear depending on the CD4-cell count. Predictors of positive  growth of Mycobacterium tuberculosis from sputum under negative  microscopy in this category of patients are considered. The  experience of different countries of the world on the effectiveness of  various diagnostic algorithms for detecting tuberculosis in HIV/TB  co-infection and the role of molecular-genetic methods in the  diagnosis of tuberculosis are discussed. According to the data  presented in the review, the yield of acid-fast sputum smear  microscopy varies significantly, and depends on a variety of factors,  including the immune status of the patient with HIV infection, the  level of the laboratory service. The different yield of the smear  microscopy in combination with the subclinical course of tuberculosis  and atypical radiologic presentation in patients with HIV infection leads to a delay in diagnosis and to late initiation of  antituberculosis therapy. The culture and the molecular-genetic  methods of sputum examination increase the frequency of detection  of the pathogen, however, the diagnosis of tuberculosis by culture can not be considered rapid in patients with  immunodeficiency. Therefore, in the context of the continuing  increase in the number of patients with co-infection, rapid,  molecular-genetic methods for the detection of MTB DNA should be  included in the algorithm for screening for tuberculosis of HIV- infected patients during their first encounter with the healthcare system.

Review focuses on estimation of population immunity and  effectiveness of vaccination against socially significant influenza  infection. Long-term observations of the population immunity,  including post-vaccine seroprevalence to influenza are an important  component of surveillance. The possibility of use of systems of  biological banks (biobanks) in these investigations is of great  interest. The data on the principles of biobanks design in the world,  the scope of their application, the present state of the industry are  described. The information about collections of infectious diseases  agents is presented. Suggestions to build a network of biobanks in the Russian Federation and its implementation in the system of  epidemiological influenza surveillance are formed. The biobanks  filling by samples, principles of selection of donors biological  specimens, methods of laboratory research are discussed.

The aim: to assess the incidence of various forms of pulmonary aspergillosis in patients with cystic fibrosis.

Materials and methods. In 2014-2017 yy. in prospective study in  different regions of Russia were included 190 patients with cystic  fibrosis aged 1 to 37 years. Children – 130, adults – 60. All patients  underwent allergy (skin tests with fungal allergens, total IgE level,  specific IgE to fungal allergens) and mycology (microscopy and  cultural investigations of respiratory biomaterials) testing. Chest  computed tomography was performed according to the indications.

Results. The incidence of fungal sensitization in patients with cystic  fibrosis was 57%, to Aspergillus spp. – 27%. The incidence of  allergic bronchopulmonary aspergillosis was 5,7%, chronic lung  aspergillosis – 4,2%, invasive aspergillosis developed in one patient  (0,5%) during immunosuppressive therapy after liver transplantation.

Conclusion. The incidence of pulmonary aspergillosis in patients  with cystic fibrosis in the Russian Federation was first determined  (10.5%). Mycology testing is indicated for patients with cystic  fibrosis for early treatment of different variants of pulmonary aspergillosis.

The aim of the research. Evaluation of the structure of viral  hepatitis in patients with oncohaematological diseases and activity of ALT and AST during various methods of treatment of the main disease.

Materials and methods. Retrospective analysis of data from 2000  patients treated during 2001–2014 in Raisa Gorbacheva Memorial  Research Institute for Pediatric Oncology, Hematology and  Transplantation Pavlov of the First Saint Petersburg State Medical  University was carried out. The dynamics of cytolytic enzymes during therapy (polychemotherapy, transplantation of hematopoietic stem  cells, symptomatic) of oncohematological diseases was evaluated between the patients with concomitant chronic viral  hepatitis (N=175) and without liver pathology (N=203). Analysis was performed with SAS software. 

Results. Over a 10-year follow-up period, 9% of the oncohematological patients of the specialized center identified markers of hemocontact viral hepatitis. The results of the study  showed that in patients with concomitant viral hepatitis, in contrast  to a group without hepatitis the activity of ALT and AST significantly  increased compared to baseline values after the treatment of  hematological malignancy. It was twofold increase of the activity of  enzymes after transplantation of hematopoietic stem cells and 3–4- fold incease after courses of polychemotherapy. In patients without  viral hepatitis, changes in enzyme activity after such therapy were  not observed.

Summary. Thus, the associated effect of concomitant viral hepatitis  and toxic effects of treatment methods with the use of  polychemotherapy and transplantation of hematopoietic stem cells  was proven on the development of cytolytic syndrome in oncohematological patients.

The aim of the study was to examine the incidence of influenza in  epidemic seasons from 2000 to 2017 in Khanty-Mansi Autonomous  Okrug — Yugra, analysis of selected pathogens flu, clinical course,  outcomes, risk and contingent. Used by the Russian Agency  management database Khanty-Mansijsky autonomous region-Yugra  weekly influenza morbidity, hospitalization, deaths, results of  antigenic analysis of selected influenza viruses (1203 biosample)  various age groups of the population from 22-x administrative  territories district. Clinical-Laboratory conducted a survey of 133  hospitalized patients, of whom 70 patients over 18 years and 63  child aged 7 months to 9 years. Results: when analyzing the highest  rates of flu were reported in the period 2000-2007, with a significant reduction in the beyond. The incidence of flu is caused by  a prior distribution of influenza A (H1N1-pdm), seasonal influenza A  (H1N1) and influenza A (H3N2). Epidemic season 2016/17, due to  the simultaneous circulation of influenza A virus (N3N2) (52.1%),  influenza A (H1N1) (39.6%) and influenza virus B (8.3%), was the  longest. High proportion of flu registered among children under 6  years (79%), as well as in non-immunized population (95%).  Compared with adults, children with influenza A (H1N1-pdm) is  characteristic fever lasting more than 3 febrile-x days (100%), a  combination of intoxic index with qatar syndrome of the upper  respiratory tract, 2 times more likely to develop viral and bacterial  pneumonia (23.8%). See influenza antiviral therapy high efficiency drug oseltamivir (Tamiflu) in children and adults.

The aim of the study was to establish the clinical and laboratory  features of Lyme borreliosis (LB) and borreliosis caused by Borrelia miyamotoi in adults from Novosibirsk region.

Materials and methods. The study included 724 patients, residents of the Novosibirsk region, hospitalized with a  fever that arose after a tick bite in the epidemic seasons 2015–2017. In all patients, clinical manifestations of the disease, hemogram  parameters and biochemical parameters of blood serum were  studied. DNA of B. miyamotoi was detected in blood and  cerebrospinal fluid (CSF) of patients using nested PCR; the results  were confirmed by direct sequencing of PCR fragments. LB was  diagnosed by the presence of erythema migrans as well as by the  detection of Borrelia burgdorferi sensu lato DNA by PCR and/or  specific IgM by ELISA. 

Results and discussion. B. miyamotoi DNA of the Asian type was  identified in samples from 10,2% of 724 examined patients, LB with  erythema migrans was diagnosed in 16,0% of patients, and LB  without erythema migrans was revealed in 4,6% of patients. All  patients with B. miyamotoi infection had high or moderate fever and  symptoms of intoxication in the absence of erythema migrans;  13,5% of patients with B. miyamotoi had meningeal symptoms  without any changes in the CSF. Notably, the changes in leukocyte  formula were recorded more often in patients with B. miyamotoi  compared to those with LB (p <0,05).In patients with B. miyamotoi  infection, the increase in the activity of serum transaminases was poorly expressed, however their average values were higher than in patients with LB with erythema migrans (p <0,05).

The conclusion. Nonspecific symptoms of the disease caused by B.  miyamotoi have been established. These studies are the basis for  inclusion the detection of B. miyamotoi DNA in blood samples using  PCR into the complex of examination for patients with a fever after the tick bite.

A randomized multicenter 96-week study of an elsulfavirine (ESV),  non-nucleoside reverse transcriptase inhibitor (NNRTI) of novel  generation, in combination with 2 nucleoside/ nucleotide reverse  transcriptase inhibitors (NRTIs) was conducted in naive HIV adult  patients, divided by 2 parts: 1) partially blind comparative to  efavirenz (EFV) 48-week study, 2) open-label observational study  during additional 48 weeks. High virological and immunological  effectiveness maintained during the study: proportion of patients  with HIV RNA <50 copies/ml in 48 weeks achieved 81,6%, in 96  weeks – 83,9% (MITT-analysis) and 91% (if patients withdrawn from the study due to other reasons not related to treatment were excluded). No resistance mutations were found in patients with viral  replication blips (HIV RNA 50-1300 copies/ml). CD4+-lymphocytes  count was increased by 187,5 at week 48 and 251,0 cells/mcl at  week 96. Good tolerability and safety were confirmed during second year of treatment: no additional safety data which could influence  benefit/risk ratio were recorded as well as withdrawal from the  treatment due to adverse events. Serious adverse events, connected with treatment, allergic reactions were not registered during the whole 96-week study.

Conclusion. Results of the 96-week study confirm earlier data from  48-week study on high efficacy and safety of ESV. Based on these  data ESV was included into “National recommendations on  dispensary follow-up and treatment of patients with HIV-infection” as the first-line ART regime in combination with 2 NRTIs.

The purpose of the study: the study of expert opinions of specialists from different regions of the Russian Federation on the  organization of rehabilitation of children with diseases of the central  and/or peripheral nervous system, including pediatric patients after the neuroinfections.

Materials and methods: The scientific method of expert evaluation  of the state and prospects of the development of children’s rehabilitation in the regions of the Russian Federation:  the North-Western, Southern and Central Federal Districts was used.

Results: physicians in different regions of the Russian Federation as  a whole have professional work experience related to issues of  providing rehabilitation assistance to children. However, only a little  more than a third of medical workers working in the field of  rehabilitation care for children received special training in the  medical rehabilitation of children with diseases of the central and  peripheral nervous system. Existing system of organizing children’s  rehabilitation in the North-West Federal District turned out to be more effective. Nevertheless, the problem of high technology development and the difficult situation with trained  medical personnel in the rehabilitation system turned out to be  relevant for the latter region. Among the proposals to improve the effectiveness of rehabilitation of children with diseases of the central and / or peripheral nervous system, specialists noted the  need to introduce new (for certain institution) types and methods of  rehabilitation, increase funding and logistics for medical  organizations, resolve the issue with the training of rehabilitation  specialists for work with this contingent of sick children, expand the  network of medical rehabilitation centers and improve the  accessibility of sanatoriums and resorts where treatment is performed on a budgetary basis.

Conclusion: the study revealed the presence of organizational problems in providing rehabilitation care for children with diseases of the central and / or peripheral nervous  system in different regions of Russia.

Aim. The objective of the study was to substantiate the rationality of using monochromatic polarized incoherent optical radiation  (photochromotherapy) on the abdomen as a supplement to the  standard program for the treatment of acute intestinal infections in  children.

Material and methods. Twenty-six children with acute intestinal  infections from 6 months to 12 years old were observed during  inpatient treatment. In the comparison group (n = 11), children  received standard therapy, including diet therapy, rehydration,  sorbents, probiotics or prebiotics, as well as indications for etiotropic  drugs. In the main group, patients (n = 15) in addition to standard  therapy received photochromotherapy as an effect on the abdomen  with monochromatic polarized incoherent optical radiation from the  Bioptron apparatus with a blue filter at a distance of 5 cm labile along the bowel. The duration of photochromotherapy was 5 minutes, the course of treatment included 4-5 sessions 1 time per  day. The effectiveness of the therapy regimens used in the groups  was assessed by the duration of the disease, the length of inpatient  treatment, the dynamics of changes in the clinical blood test at the  time of discharge. 

Results. The advantage of the technique with the addition of  standard treatment of acute intestinal infections by photochromotherapy was established. In the main group of  patients, the duration of the disease was significantly shorter  (9,1±0,8 days) compared to the comparison group (10,2±1,5 days,  p=0,02) against the background of a significant decrease in the severity of inflammatory manifestations in the hemogram in form of  a decrease in thrombocytosis. 

Conclusion. The obtained data make it  possible to recommend the method of photochromotherapy in the  complex therapy of intestinal infections of various etiologies in  children older than 6 months.

The purpose of the research is to determine the value of adiponectin levels in patients chronic hepatitis C with metabolic syndrome depending on the severity of fibrosis and  histological activity in the liver.

Materials and methods. The research included 72 patients chronic  hepatitis C with metabolic syndrome. All patients underwent  calculation of body mass index, determination of adiponectin level in  serum. The stage of liver fibrosis and degree of histological activity  was determined according to METAVIR scale based on histological  research of biopsy specimens obtained at liver biopsy. The average  age in the research group amounted to 40,73±6,3 years. Prevailed patients with a body mass index of 26–30 kg/m² – 61,1%. All  patients had abdominal obesity, the gender differences in the  prevalence of abdominal obesity was not found. In 73.6% of cases, it  was patients with moderate or severe liver fibrosis; 44,4% –  moderate-severe and severe degree of histological activity. The  mean value of adiponectin is made up 9,36±3,28 microgram /ml.  Was an inverse relationship between body weight and adiponectin  level. The patients chronic hepatitis C with metabolic syndrome  found a significant reduction in levels of adiponectin, compared with healthy people. In women were observed significantly lower adiponectin levels compared to men (p<0,05). Feedback was installed between the body weight and level of adiponectin. Level of serum adiponectin in patients with chronic  hepatitis c with metabolic syndrome decreased with the progression of fibrosis and severity of pathological process activity in the liver.

The one of leading HIV infection manifestations is trophological  insufficiency developing due to violation of digestion processes and  leading to disease progress, development of multiple organ failure and lethal outcomes.

The objective of research was to reveal the clinical and laboratory  characteristics of patients with advanced stages of HIV infection and  malnutrition, as well as the efficiency of nutritional support for this category of patients.

Materials and methods. The study included 42 patients on the  stage 4A-B HIV infection and underweight. All patients were on  inpatient treatment in the department of palliative medicine of the  St. Petersburg AIDS Center. Clinical-laboratory and instrumental  measures were analyzed, the trophic status was estimated before  the beginning of antiretroviral therapy (ART). The patients were  divided in two groups. The first group received medical enteral  nutrition (liquid mixture “Impact oral”). The second group received a  regular balanced diet. At the same time, patients in both groups  were prescribed ART in accordance with clinical guidelines.

Results. A month after the start of treatment it was possible to  analyze the results in the 1st group in 23 people and in 11 in the  2nd group. Comparative analysis showed that in the 1st group the  distribution of the patients significantly changed according to the  level of CD4 lymphocytes, BMI and nutritional status, with a  markedly positive dynamics of these indicators. Also, patients of this  group coped better with ART. Despite the fact that the analysis was  conducted at the initial stages of the work, the obtained data  demonstrate a high perspective of nutritional-metabolic therapy in  the context of optimizing the HIV treatment in patients with a  marked failure of the trophic status. 

In the Russian Federation, the number of new cases of influenza
and SARS each year reaches 30 million people, and the annual total  economic damage is estimated at 40 billion rubles, accounting for  about 80% of the damage from all infectious diseases. Today, one of  the main priorities of confronting the consequences of the annual  epidemics of influenza is the development and introduction into  clinical practice of new drugs with proven effectiveness and safety, the use of which is economically feasible.

Objective. Conduct a clinical and economic analysis of two  alternative regimens for treating influenza patients using the modern drug Triasavirin® and the known Tamiflu® neuraminidase inhibitor.

Materials and methods. The study included 127 patients with a  laboratory confirmed diagnosis of «influenza». All patients were  divided into two groups. The main group consisted of 82 patients  who received Triazavirin® 1 capsule (250 mg) 3 times a day for 5  days. The comparison group consisted of 45 patients who received  Tamiflu® 1 capsule (75 mg) 2 times a day for 5 days. To conduct a  clinical and economic evaluation of two alternative treatment  regimens, cost-effectiveness factors were calculated, such as the  ratio of the cost of therapy to the indicator of its effectiveness. The analyzed events were: (1) recovery by the 5th day from the start of treatment; (2) temperature normalization by the 5th day from the start of treatment; (3) no symptoms of intoxication (headache, myalgia, pain / rei in the eyeballs) by the 5th day from the start of treatment; (4) absence of catarrhal  manifestations (pain / sore throat, cough) to the 10th day from the beginning of treatment.

Results. The use of the drug Triazavirin® for treatment of influenza  patients in comparison with the inhibitor of neuraminidase with  Tamiflu® is economically viable, both with respect to the timing of  recovery (cost-effectiveness ratio: 935,57 rubles / unit vs 1859,39  rubles / unit) and normalization of temperature body (cost- effectiveness ratio: 869,53 rubles / unit vs. 2014,33 rubles / unit),  and with respect to the duration of intoxication (cost-effectiveness  ratio: 859,42 rubles / unit vs. 1473,90 rub ./unit) and catarrhal  (coefficient of expenditure e ciency: 869,53 rubles / unit against  1611,47 rubles / unit) syndromes.

Conclusion. Triazavirin® is a new effective antiviral agent for the  treatment of influenza. The use of Triazavirin® in the treatment of  patients with influenza is economically viable, due to significant  budget savings both in terms of the cost of treatment, and the  reduction in concomitant therapy and the reduction in the period of  temporary disability of working patients.

Infectious diarrhea takes a leading position in all infectious diseases  worldwide. As a result of the pathogens diversity, patient-specific  diagnosis and treatments are needed. Additional laboratory tests are crucial for differentiation among pathogens, as routine  bacteriological and virological methods are time-consuming. One of them is fecal calprotectin.

Aim: examination of the potential role of fecal calprotectin in infectious diarrhea.

Materials and methods: the national and international medical literature sources were analyzed.

Results: the data regarding fecal calprotectins’ structure, functional activity and diagnostic value are presented.

Conclusions: the study of fecal calprotectin, as a correlative biomarker of bacterial gastroenteritis, can be helpful for clinicians with diagnostic approach to the patient.

Documented case of the clinical observations of the complicated
course of beef tapeworm infection (Taenia saginata) have a child 17  years of age. Three years ago, the patient first noticed the active  isolation of the cuttings from the anus. Other clinical symptoms were absent and the disease was latent. At the end of may 2017,  symptoms of an acute abdomen developed and an appendectomy  was performed on 03.06.2017. Diagnosis after surgery: acute  gangrenous perforative appendicitis, periappendicular abscess,  diffuse purulent peritonitis. 07.06.2017 was a single vomiting. In the vomit seen the segments of the flat worm. 09.06.2017,  segments of worms found in the feces. They were identified as  arthropods of Taenia saginata. From 14.06.2017 the patient’s  condition worsened, the temperature increased, there were pains in  the left half of the chest. In the following days the condition remained grave. According to CT (from 19.06.2017) helminth was determined in the  lumen of the left lower salt bronchus. Bronchoscopy was performed  (21.06.2017), which reduced the presence of signs of inflammation  of the left lower salt bronchus. Worms are not detected. Sputum  sowing was performed, but sputum microscopy was not carried out.  Ultrasound (23.06.2017) showed the presence of fluid in the left  pleural cavity. Puncture was performed and 70 ml of serous fluid was obtained. In the future, double-prosodical puncture which was obtained 600 and 500 ml of a yellow viscous exudate. On  29.06.2017, teniid eggs were found in sputum. Praziquantelum is  prescribed 25 mg / kg once. On 04.07.2017, the fourth puncture of  the pleural cavity was performed, 200 ml of light yellow effusion was obtained. In the days following the symptoms of pleurisy had disappeared and 10.07.2018, came recovery. Lung damage, which  developed as a result of aspiration of the arthroplasty Taenia  saginata was accompanied by a  rare dry cough and moderate  severe intoxication syndrome. The severity of the patient’s condition  was determined by severe respiratory failure and pain. Auscultation  of the wheezing was not. Over the lesion was sharply pronounced  weakened breathing. In the peripheral blood was determined by high ESR, moderate leukocytosis and no eosinophilia.