The attitude towards vaccination of medical workers has been studied repeatedly. After active campaigning for vaccination during the pandemic, there was a decrease in confidence in vaccinations in general.

The aim of the work was analysis of the attitudes of medical workers towards vaccination, the effectiveness and safety of vaccines against various conditions in 2024 y

Materials and methods. In the online survey site www. meta.gcgie.ru in the period from 1.04.2024 to 1.06.2024 (2 calendar months).1,508 people took part, 91.6% women. By profession, out of 1033 respondents there were: 525 nurses (50.8%),156 therapists (15.1%), pediatricians – 115 (11.1%), surgeons 96 (9.3%), epidemiologists 41 (4.0%),. The questionnaire included 50 questions with 5­13 possible answers. Statistical processing of the survey results was carried out using a BI­system:

Results. Out of 1045 respondents, 832 treat vaccinations positively (79,6%), 142 (13,6%) – neutrally, cautiously – 60 (5.7%) and negatively – 12 (1.1%), 25.1% of respondents (264 out of 1051) believe that it is better to get over some infections than to be vaccinated. There is a significant difference between confirming the answer about the need for vaccination and vaccinating yourself, as well as evaluating the effectiveness of the vaccine (even for measles vaccines, 90.7% say they need to be vaccinated, only 83.5% are vaccinated and only 76.7% are confident in the effectiveness of the vaccine. Only 49.9% (525 out of 1,053 responses) believed that vaccines against infections not included in the national vaccination calendar were necessary. The lack of confidence in the safety of vaccines is manifested in the fact that doctors associate vaccinations with the development of cerebral palsy, oncology (10.7% each), autoimmune diseases (38.3%), epilepsy (12.0%). Doctors named unsafe vaccines (83.7% – 881 out of 1052 responses), inefficiency (24.3% ­256 out of 1052), no need for vaccinations at all (14.5% ­157 out of 1052), religious reasons (38.4% 404 out of 1052 responses) as the reasons for patients’ refusal of vaccination. To improve the work on vaccination, 44.5% indicated the need for information on the official websites of the Ministry of Health of the Russian Federation, FMBA, Rospotrebnadzor and Roszdravnadzor

Conclusion The results of the survey indicate the need to modernize the system of training in vaccination of medical workers of various specialties, the development of new forms of information presentation, the use of official websites, the development of algorithms for communicating with the population on adherence to vaccination,

Clinical manifestations of parvovirus B19 infection are varied and depend on the age, hematological and immune status of the infected person. Classic manifestations of the disease include infectious erythema in children, arthritis/ arthralgia in adults, severe anemia in patients with impaired erythropoiesis and non­immune hydrops fetalis in case of intrauterine infection. In addition, various types of exanthema associated with parvovirus B19 have been described. These include “papular­purpuric gloves and socks syndrome, PPGSS”, “purpuro­petechial rash associated with parvovirus B19, PAPPE”, “acropethechial syndrome”, “asymmetric periflexural exanthema of children”, etc. In all cases, skin manifestations are characterized by a hemorrhagic rash. A certain difficulty is the differential diagnosis of such variants of parvovirus B19 infection with vasculitis of non­infectious origin, primarily with the most common IgA vasculitis (Henoch­Schonlein purpura) and cutaneous small vessel vasculitis (CSVV). The connection of vasculitis with infection in some cases is obvious and is confirmed by epidemiological observations. Infections can act as a trigger for the development of vasculitis or be its direct cause (vasculitis in this case can be classified as “vasculitis associated with a probable etiology” in the nomenclature system of the Chapel Hill Consensus Conference 2012). Considering that the nature of vasculitis is not completely clear, the question of a possible connection between their occurrence and infection with PVB19 requires further study. From a clinical point of view, the differential diagnosis of hemorrhagic exanthema associated with PVB19 and vasculitis is extremely important primarily because of the need for immediate treatment of the latter. From an epidemiological point of view, this is important, since patients with PPGSS or PAPPE are infectious throughout the period of the rash.

Apparently, additional studies, primarily histological, of a sufficient number of samples from patients with purpuric­petechial rash and serologically proven acute parvovirus B19 infection will help solve this problem.

The emergence of new strains of respiratory viruses, especially pandemic ones, resistant to antiviral drugs, dictates the need for further search for new molecules, or reformatting of existing drugs, expanding their indications for use. The use of broad­spectrum antivirals or immunomodulators is now well justified. The goal is to systematize published data on the effectiveness and safety of the drug inosine pranobex for acute respiratory viral infections, including influenza and the new coronavirus infection COVID­19. The results of in vivo and in vitro studies are summarized, which examine the mechanisms of influence of inosine pranobex on the human immune system and therapeutic effectiveness against a wide range of viral pathogens. The positive results of clinical studies conducted in different countries on ARVI and influenza are briefly described. A promising direction is the use of inosine pranobex in the treatment of COVID­19, which has been proven by its use in clinical trials in adults by researchers from different countries and is reflected in our review.

Goal. To investigate the spectrum of microorganisms, the level of antimicrobial resistance and to assess their effect on the outcomes of bacteremia among COVID­19 patients.

Materials and methods. A retrospective analysis of potentially resistant bacteria detected in blood and the mortality rate among COVID­19 patients and patients with other diagnoses in the period from 01.01. – 12/31/2020.

Results. In total, the analyzed pathogens were isolated from 168 patients, including 101 COVID­19 patients (group 1) and 67 patients with other diagnoses (group 2). Bloodstream infection were more often detected among COVID­19 patients (12.6 and 2.6 cases per 1000 patients, p<0.05). In group 1, the proportion of gram­-negative pathogens was higher than in group 2 (63.8% and 52.1%, p=0.012). The most commonly pathogen in group 1 is K. pneumoniae (31.5%, 41 cultures), in group 2 – S. aureus (35.2%, 25 cultures). Of particular importance is the identification of A. baumannii (32 and 4 cultures, p<0.001) and E. faecium (24 and 4 cultures, p=0.003) in group 1; S. aureus (25 and 11 cultures, p<0.001) and E. coli (9 and 6 cultures, p=0.038) – in group 2. Three leading types of microorganisms in group 1 have a high level of resistance: 96.9% of A. baumannii and 81.6% of K. pneumoniae were resistant to carbapenems, 36.8% of E. faecium was VRE. In group 1, several (22.8% and 6.0%, p=0.004) and resistant (70.3% and 41.8%, p<0.001) microorganisms were detected more frequently. The mortality rate of patients was higher in group 1 (68.3% and 50.7%, p=0.022). The occurrence of a bloodstream infection caused by a potentially resistant microorganism in COVID­19 patients is an unfavorable factor in the onset of death (p=0.022).

Conclusion. COVID­19 patients with bacteremia have a high level of polymicrobial associations with a predominance of gram­-negative bacteria both in their composition and as a monoinfection. The isolated microorganisms have a high level of antimicrobial resistance, which must be taken into account when choosing antibiotics.

Purpose of the study: Identification of predictors of survival of HIV-infected patients for further optimization of medical care.

Materials and methods. A retrospective study of data from 458 deceased HIV-infected patients who were registered at the Republican AIDS Center from 2000 to 2021 was conducted. The patient’s age, stage of HIV infection, comorbidity index, duration of follow-­up, duration of ART at the time of the patient’s death and causes of death were analyzed.

Results. ART contributed to an increase in patient life expectancy, with 46.5% of patients aged 40 to 49 years at the time of reaching the end point of life, 23% – from 50 to 59 years, and 8.5% – over 60 years. At the time of death, 11.5% of patients were in the initial stages, 88.5% were in advanced stages of HIV infection (P <0.05). Life expectancy after diagnosis in 28.6% of patients ranged from 1 year to 5 years, in 25.3% – from 6 to 10 years, in 24.6% – from 11 to 15 years, and in 9.1% – from 15 to 20 years. A high comorbidity index was associated with worse patient survival. The median survival in patients with IC scores of 6 or more was 7 years, with IC scores of 1­5 – 6 years, and with IC scores of 0 – 11 years.

Conclusion. For the first time in our country, a survival analysis of HIV-infected patients in long­term follow­up (more than 20 years) was carried out, which revealed that virological effectiveness 13­20 years after the start of ART was established in 95% of patients. It has been established that even with a low initial level of CD4 lymphocytes (<200 cells/μl), positive dynamics occur at the start of ART, but they weaken with life expectancy. The Charlson comorbidity index at detection was high in 59% – 6 or more points, despite the young and middle age of the patients. By the time of death, the comorbidity index had increased. It was found that survival of more than 15 years with ART was in 54% of HIV-infected patients, and without ART in 26% of patients, which shows the need to study factors that make it possible to live without ART.

Multisystem inflammatory syndrome associated with SARS­CoV­2 in children is a potentially life–threatening condition that develops several weeks after COVID­19 and is characterized by a hyperinflammatory response with damage to ≥2 organs and systems. At the moment, there is no understanding of how the mechanisms of development and course of this disease differ from other more studied similar conditions, for example, sepsis in infectious diseases.

The aim is to compare immunological parameters in multisystem inflammatory syndrome associated with SARSCoV­2 and infectious diseases with sepsis in children.

Materials and methods. The concentration of cytokines, chemokines and growth factors in serum was determined in 14 children with multisystem inflammatory syndrome associated with SARS­CoV­2, 19 children and 16 healthy children (control group) with IHS.

Results. Both common and distinctive signs of inflammation were found in patients with MVS­D and IHS. Patients with MVS­D, unlike healthy children, were characterized by a decrease in Basic FGF, IFN­a2, IL­1a, IL­1b, IL­2, IL­3, IL­4, IL­5, IL­9, IL­12(p40), IL­13, IL­18, PDGF­BB, RANTES, TRAIL and Boost G­CSF, HGF, IL­1ra, IL­2Ra, IL­6, IL­10, IL­16, IP­10, MCP­1, M­CSF, MIG. Statistically significant in MVS­D was a decrease in IL­2 and IL­5 levels compared with the control group, but significantly less pronounced than in IS (8.0 times and 3.5 times, respectively), a pronounced increase in MIG levels (12.0 times compared with children with IS). The RANTES index (a proinflammatory chemokine that attracts leukocytes to the focus of inflammation) decreased with MVS­D, while it increased with IS compared with the control group.

Conclusions. Immunological features of MISC have been found that distinguish the pathogenesis of the syndrome from infectious diseases occurring with sepsis. The identified markers can be used as criteria for the differential diagnosis of these diseases.

Introduction: against the background of the ongoing incidence of coronavirus infection, the selection of therapy often requires individual approaches, especially in comorbid patients. Despite the emergence of specific prevention methods and new antiviral drugs, there are risk groups for severe disease and high mortality.

Target. To evaluate the effectiveness and safety of the use of SARS­CoV­2 neutralizing antibodies for the treatment of comorbid patients with coronavirus infection.

Materials and methods: A retrospective study was conducted to evaluate the clinical efficacy of virus­neutralizing antibodies for the treatment of comorbid patients with coronavirus infection who were hospitalized in 2022. A total of 244 patient records (mean age 60.0±14.2 years) with confirmed SARS­CoV­2 coronavirus infection were analyzed. The first group consisted of patients who received monoclonal virusneutralizing antibodies (monotherapy with Sotrovimab or Regdanvimab, combination therapy with Casirivimab and Imdevimab, or Bamlanivimab and Etesevimab), and the second group consisted of patients without therapy. All patients were comorbid. The most frequently observed nosologies were: hypertension (74.1%), chronic kidney disease (55.2%), malignant neoplasms (31%), 1–3 degree of obesity (22.4%), diabetes mellitus (17.2%), and autoimmune diseases (17.2%). In the comparison groups, the duration of the disease, the area of lung tissue damage, the duration of respiratory support, the percentage of complications, the need to use immunosuppressive therapy, as well as the percentage of fatal outcomes, were assessed.

Results: The duration of the disease in patients who received monoclonal virus­neutralizing antibodies was 16.0±8.1 days, the area of lung tissue damage was on average 14.9±13.0%, the duration of respiratory support was 2.2±3.1 days, complications of coronavirus infection were noted in 31%, the mortality rate decreased to 1.7%. In patients without therapy with these drugs, complications of the disease were detected 2 times more often – in 64% of cases, the duration of the disease was 20.0±6.1 days, the area of lung tissue damage was on average 21.7±12.1%, and the duration of respiratory support was 8.0±6.1 days. Immunosuppressive therapy was used significantly more often in patients without therapy with antiviral monoclonal antibodies (51.2%) than with it (3.4%). A study of the clinical efficacy of various monoclonal antibodies showed an advantage in using Regdanvimab in comorbid patients, as indicated by the absence of fatal outcomes and a reduction in the duration of the disease to 9.8±4.8 days.

Conclusions: Preparations of synthetic recombinant monoclonal neutralizing antibodies to SARS­CoV­2, provided that they are used in the early stages of the disease, significantly reduce the severity of coronavirus infection, the development of complications and significantly reduce mortality in comorbid patients.

The aim of this controlled study was to identify polymorphisms in the genome of COVID­19 patients associated with the frequency of hospitalization.

Materials and methods: Two groups of patients were formed: the main group – 56 patients with COVID­19, hospitalized at least twice during the study period, and the control group – 107 patients for whom only one hospitalization with COVID­19 was confirmed during the study period. Wholeexome sequencing of residual nasopharyngeal swabs from patients hospitalized with COVID­19 was performed on the MGI platform, followed by bioinformatics analysis and gene enrichment analysis.

Result: For the first time, exome sequencing was performed from oropharyngeal swabs from 163 patients hospitalized with COVID­19 using the MGI platform. In the main group, unique variants of genetic polymorphisms were identified, including six previously undescribed ones.

Conclusion: No genetic variants were statistically significantly associated with single or multiple hospitalizations of COVID­19 patients in the study. Nasopharyngeal swabs can be used for whole exome sequencing. Further studies are needed to identify unique genetic variants responsible for susceptibility to infectious diseases. Nasopharyngeal swabs can be used for whole­exome sequencing. Further studies are needed to identify unique genetic variants responsible for susceptibility to infectious diseases.

Seasonal vaccination against influenza is considered the most effective method of specific prevention of this infection. However, in recent years, the issue of non­specific, training effects of vaccines on the immune system has been widely studied. One of the mechanisms of implementation may be a change in the production of cytokines in vaccinated people.

Purpose of the study: to study the dynamics of pro­inflammatory and anti­inflammatory cytokines before and after vaccination against influenza.

Materials and methods: The study involved 75 young men, the average age was 18.7±0.8 years, who were vaccinated with the Sovigripp vaccine. Those included in the study had two blood samples: (1) – before the flu vaccination; (2) – one month after the flu vaccination. Serum levels of proand anti­inflammatory cytokines were determined by solid­phase enzyme immunoassay: IL1β, IL4, IL6, IL8, IL10, IL17, IFNγ, TNFα. The results were recorded using an automatic enzyme immunoassay analyzer. Statistical processing of the obtained results was carried out using the STATISTICA 10 software package.

Results: In the analysis of cytokines before vaccination, an increase in IL8, IL17 and IL6 levels was detected in 100% of cases – in 76% of cases. Within the generally accepted norms, only TNFa was determined in 92% of the surveyed population. The remaining indicators were reduced: IFNγ – in 100%, IL1β and IL4 – in more than 80% and IL10 – in 50% of cases. After influenza vaccination, there was a noticeable tendency to decrease the levels of all cytokines compared to baseline values.

Conclusion: The results of the study revealed features in cytokine levels before and after influenza vaccination in healthy young people, which were characterized by deviations from the norm in both directions.

Coronovirus SARS­CoV­2 has become a serious test for the entire global community in 2020. Its appearance and high speed of spread forced the heathcare system to reorient itself. In our work we focused on studying the mortality data from COVID­19 in Russia in 2020­2023. The exponential mortality increase is considered from the point of view of a secondorder phase transition. Also, using the Hurst method, we searched for the presence of a trend in mortality rate from year to year. Additional criteria are proposed in making decisions on the introduction and removal of restrictive measures. The obtained results should help in solving epidemiological problems when faced with a new infectious agent.

The issue of combating antimicrobial resistance has been relevant for several decades, since the arsenal of effective antibiotics used in infectious diseases is significantly reduced, and the development of new antibacterial drugs is significantly difficult and expensive. At the same time, the possibility of widespread use of bacteriophages in hospital settings is being discussed.

Goal. Evaluation of the sensitivity to bacteriophages of hospital strains of K.pneumoniae isolated from patients in the departments of surgery and intensive care and intensive care of the Structure Clinical Infectious Disease Hospital named after S.P.Botkin.

Materials and methods. The activity of bacteriophage preparations “Sextafag” (series p158, p220, p242), “Klebsiell polyvalent bacteriophage” (series y04, y07, y10, y16), “Polyvalent Pyobacteriophage purified” (series y10, y291022) (Manufacturer: NPO Microgen JSC, Moscow) was determined by preparing suspensions of microorganisms, their sowing on nutrient media with subsequent application of bacteriophages, taking into account and interpreting the results.

Results. The majority of polyresistant K.pneumoniae strains showed sensitivity to the presented bacteriophage preparations, which allows them to be considered as additional antibacterial agents for the treatment of these groups of patients.

Conclusion. The presented results of the study showed that hospital polyand pan­resistant strains of K.pneumoniae are sensitive to preparations of monoand polyvalent bacteriophages, which can be considered as a potential alternative in conditions of antibiotic resistance. The study did not reveal a link between the antibiotic resistance profile of the culture and sensitivity to bacteriophages.

Vaccination against human papillomavirus infection is not included in the National Calendar of Preventive Vaccinations of the Russian Federation, and vaccination is only available through regional programs. At the same time, the cost­effectiveness of vaccination in the regions of the Russian Federation may vary significantly.

The aim of this study was to assess the cost­effectiveness of vaccination with the 4­valent HPV vaccine in 12­year­old girls in the regions of the Russian Federation.

Materials and methods. A Markov model with a lifetime horizon for 12­year­old girls based on epidemiological data for the Russian Federation was used. The cost­effectiveness analysis was carried out from societal perspective. Costs and life expectancy were discounted at 3% per year.

Results. In most regions of the Russian Federation, vaccination of girls is cost saving or highly cost­effective (the cost per additional quality­adjusted life year (QALY) does not exceed the value of gross regional product per capita). Only in Dagestan, Chechnya and Ingushetia the vaccination of girls can be considered as cost­effective, but not highly costeffective tool (incremental costs per QALY exceed the GRP per capita by 14,2­37,0%).

Conclusions. Vaccination of girls before the onset of sexual activity with the 4­valent HPV vaccine is highly costeffective in most regions of the Russian Federation.

This study is devoted to the analysis of the epidemiological situation of chronic hepatitis D in Yakutia, as a region where chronic viral hepatitis is widespread.

Aim: To characterize family foci of chronic hepatitis D in the Republic of Sakha (Yakutia).

Materials and methods: The study is based on data from the registry “Chronic viral hepatitis in the Republic of Sakha (Yakutia)” and official statistics of the Territorial Administration of Rospotrebnadzor in the Republic of Sakha (Yakutia) for 2013­2023. There was conducted an analysis of case histories of patients with chronic hepatitis D, including those from family foci of HDV infection (n = 13). Statistical data processing was carried out using the IBM SPSS Statistics 26.0 program.

Results: The article presents data on the number of registered cases of chronic forms of viral hepatitis B and D in Yakutia, analyzed family foci of HDV infection, highlights of the features of infection and the dynamics of disease development in family groups associated with infection of spouses and perinatal transmission.

Conclusion: The work reflects the importance of natural routes of transmission of HDV infection and emphasizes the relevance of perinatal prevention of hepatitis B, including the use of vaccination and specific HBV immunoglobulin for family members with replicative form of hepatitis B and D. This study has practical significance for the development of programs for the prevention and early detection of HDV infection.

In September 2024, an Expert Council via videoconference was held to discuss innovative approaches to the tactics of diagnosis and therapy of influenza in children and adolescents in Russian Federation.

Influenza is characterized by high morbidity and mortality, leading to 28,000 deaths annually worldwide among children.

Influenza causes significant economic damage, ranking 4th among all infectious diseases in 2023 in Russian Federation. During the 2022­2023 period, there was an increase in influenza incidence with a traditionally high rate of infection among children. Newborns, children under 5 years old, and children with comorbidities are at high risk for complications. An analysis of influenza mortality shows that comorbidity is an aggravating factor in almost half of the cases.

Timely diagnosis and etiotropic therapy are key in the treatment of influenza. The focus should be on etiological confirmation of the diagnosis within the first 24 hours from disease manifestation to prescribe specific antiviral therapy. Although laboratory confirmation of the diagnosis is recommended, during periods of high incidence, the diagnosis can be made based on clinical and epidemiological data. For final verification of the “influenza” diagnosis, the widespread use of certified rapid tests is proposed.

According to the updated WHO guidelines published in September 2024, two medicines are recommended for the treatment of influenza — baloxavir and oseltamivir. Baloxavir marboxil significantly reduces the virus shedding time and has a favorable safety profile for children and adolescents. This makes it the medicine of choice, especially in cases of high risk of complicated influenza infection.

Given the high importance of influenza in the structure of childhood morbidity, it is crucial to continue improving methods of prevention, diagnosis, and treatment of this disease, especially in children.