Anti-epidemic measures in the focus of dysentery. Clinical examination of patients with acute intestinal infections (AII)

Chronically ill and bacterial carriers.

Name Observation duration Recommended activities

, 3 months regardless of profession. Medical observation with thermometry weekly in the first 2 months, in the next month + 1 time in 2 weeks; monthly bacteriological examination of feces, urine and at the end of observation + bile. Convalescents belonging to the group of food workers, in the 1st month of observation, are examined bacteriologically 5 times (with an interval of 1-2 days), then 1 time per month. Before deregistration, a bacteriological examination of bile and a blood test are performed once. Diet therapy and medication are prescribed according to indications. Employment. Mode of work and rest.

3 months. Medical supervision, and for food workers and persons equated to them, in addition, a monthly bacteriological examination of feces; with generalized forms, a single bacteriological examination of bile before deregistration. Diet therapy is prescribed enzyme preparations according to indications, treatment of concomitant diseases. Mode of work and rest.

acute Employees of food enterprises and persons equated to them + 3 months, non-declared + 1-2 months depending on the severity of the disease Medical supervision, and for food workers and persons equated to them, in addition, a monthly bacteriological examination of feces. Diet therapy, enzyme preparations according to indications, treatment of concomitant diseases are prescribed. Mode of work and rest.

Dysentery chronic Decreed category + 6 months, non-declared category - 3 months after clinical recovery and negative results of bacological examination. Medical supervision with monthly bacteriological examination, sigmoidoscopy according to indications, if necessary, consultation with a gastroenterologist. Diet therapy, enzyme preparations according to indications, treatment of concomitant diseases are prescribed.

Acute intestinal infections of unknown etiology Decreed category + 3 months, non-declared + 1-2 months depending on the severity of the disease Medical supervision, and for food workers and persons equated to them, a monthly bacteriological examination. Diet therapy and enzyme preparations are prescribed according to indications.

12 months regardless of illness Medical observation and bacteriological examination of feces in the 1st month 1 time in 10 days, from the 2nd to the 6th months + 1 time per month, then + 1 time per quarter. Bacteriological examination of bile in the 1st month. Mode of work and rest.

Viral hepatitis A At least 3 months, regardless of profession Clinical and laboratory examination within 1 month by the attending physician of the hospital, then 3 months after discharge + in the KIZ. In addition to a clinical examination + a blood test for bilirubin, ALT activity and sedimentary samples. Diet therapy is also prescribed according to indications + employment.

Viral hepatitis B At least 12 months, regardless of profession In the clinic, convalescents are examined 3, 6, 9, 12 months after discharge. Conducted: 1) clinical examination; 2) laboratory examination + total bilirubin, direct and indirect; ALT activity, sublimate and thymol samples, determination of HBsAg; detection of antibodies to HBsAg. Those who have been ill are temporarily unable to work + within 4-5 weeks, depending on the severity past illness, are subject to employment for a period of 6-12 months, and if there are indications, even longer (they are exempted from severe physical work business trips, sports activities). They are removed from the register after the observation period has expired in the absence of a chronic and 2-fold negative result of studies for the HBs antigen conducted at intervals of 10 days.

Chronic active hepatitis First 3 months + 1 time in 2 weeks, then 1 time per month. Same. Medical treatment according to testimony

carriers viral hepatitis B. Depending on the duration of carriage: acute carriers + 2 years, chronic + as sick chronic hepatitis . Tactics for acute and chronic carriers are different. Acute carriers are observed for 2 years. Examination is carried out upon detection, after 3 months, and then 2 times a year until deregistration. In parallel with the study on the antigen, the activity of AlAT, AsAT, the content of bilirubin, sublimate and thymol tests are determined. Deregistration is possible after five negative tests during follow-up. If the antigen is detected for more than 3 months, then such carriers are regarded as chronic with the presence of chronic disease in most cases. infectious process in the liver. In this case, they require observation, as patients with chronic hepatitis

Brucellosis Until complete recovery and 2 more years after recovery Patients in the stage of decompensation are subject to inpatient treatment, in the stage of sub-compensation to monthly clinical examination, in the stage of compensation are examined once every 5-6 months, with latent form diseases - at least once a year. During the observation period, clinical examinations, blood tests, urine tests, serological examinations, as well as consultations of specialists (surgeon, orthopedist, neuropathologist, gynecologist, psychiatrist, oculist, otolaryngologist) are carried out. Employment. Physiotherapy. Spa treatment.

Hemorrhagic fevers Until recovery The follow-up period is set depending on the severity of the disease: from easy flow 1 months, with moderate to severe with expression pattern kidney failure+ long term. Those who have been ill are examined 2-3 times, according to indications, they are consulted by a nephrologist and a urologist, blood and urine tests are performed. Employment. Spa treatment.

Malaria 2 years Medical observation, blood test by thick drop and smear method at any visit to the doctor during this period.

Chronic typhoid-paratyphoid bacteria carriers for life Medical supervision and bacteriological examination 2 times a year.

Carriers of diphtheria germs(toxigenic strains) Until 2 negative bacteriological tests are obtained Sanation chronic diseases nasopharynx.

Leptospirosis 6 months Clinical examinations are carried out once every 2 months, while clinical blood and urine tests are prescribed for those who have had an icteric form + biochemical liver tests. If necessary - consultation of a neuropathologist, ophthalmologist, etc. Mode of work and rest.

Meningococcal infection 2 years Observation by a neuropathologist, clinical examinations for one year once every three months, then examination once every 6 months, according to indications, consultation with an ophthalmologist, psychiatrist, relevant studies. Employment. Mode of work and rest.

Infectious mononucleosis 6 months. Clinical examinations in the first 10 days after discharge, then 1 time in 3 months, clinical analysis blood, after icteric forms + biochemical. According to indications, convalescents are consulted by a hematologist. Recommended employment for 3-6 months. Before deregistration, it is desirable to be tested for HIV infection.

2 years Observation by a neuropathologist, clinical examinations are carried out in the first 2 months 1 time per month, then 1 time in 3 months. Consultation on cardiologist's testimony, neuropathologist and other specialists. Mode of work and rest.

erysipelas 2 years Medical observation monthly, clinical blood test quarterly. Consultation of a surgeon, dermatologist and other specialists. Employment. Sanitation of foci of chronic infection.

ornithosis 2 years Clinical examinations after 1, 3, 6 and 12 months, then 1 time per year. An examination is carried out - fluorography and RSK with ornithosis antigen once every 6 months. According to indications + consultation of a pulmonologist, a neuropathologist.

Botulism Until full recovery Depending on the clinical manifestations diseases are observed either by a cardiologist or a neuropathologist. Examination by specialists according to indications 1 time in 6 months. Employment.

Tick-borne encephalitis The timing of follow-up depends on the type of disease and residual effects Observation is carried out by a neuropathologist once every 3-6 months, depending on the clinical manifestations. Consultations of a psychiatrist, ophthalmologist and other specialists. Mode of work and rest. Employment. Physiotherapy. Spa treatment.

1 month Medical observation, clinical analysis of blood and urine on the 1st and 3rd week after discharge; according to indications + ECG, consultation of a rheumatologist and nephrologist.

Pseudotuberculosis 3 months. Medical supervision, and after icteric forms after 1 and 3 months + biochemical examination, as in convalescents of viral hepatitis A.

HIV infection(all stages of the disease) for life. Seropositive persons 2 times a year, patients + according to clinical indications. Study of immunoblotting and immunological parameters. Clinical and laboratory examination with the involvement of an oncologist, pulmonologist, hematologist and other specialists. Specific Therapy and treatment of secondary infections.

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SHIGELLOSIS (DYSENTHERIA)

Dysentery An anthroponotic infectious disease characterized by a predominant lesion distal large intestine and manifested by intoxication, frequent and painful defecation, loose stools, in some cases with mucus and blood.

Etiology. The causative agents of dysentery belong to the genus Shigella families Enterobacteriaceae. Shigella are gram-negative bacteria 2-4 microns long, 0.5-0.8 microns wide, immobile, do not form spores and capsules. Shigella are divided into 4 subgroups - A, B, C, D, which correspond to 4 types - S. dysenteriae, S. flexneri, S. boydii, S. sonnei. In the population S. dysenteriae allocate 12 serological variants (1-12); population S. flexneri subdivided into 8 serovars (1-5, 6, X, Y-variants), while the first 5 serovars are divided into subserovars ( 1 a, 1 b, 2 a, 2 b, 3 a, 3 b, 4 a, 4 b, 5 a, 5 b); population S. boydii differentiates into 18 serovars (1-18). S. sonnei do not have serovars, but they can be divided into a number of types according to biochemical properties, relation to typical phages, ability to produce colicins, resistance to antibiotics. The dominant position in the etiology of dysentery is occupied by S. sonnei and S. flexneri 2 a.

The causative agents of the main etiological forms of dysentery have unequal virulence. The most virulent are S. dysenteriae 1 (causative agents of Grigoriev-Shiga dysentery), which produce a neurotoxin. The infectious dose of Shigella Grigoriev-Shiga is dozens of microbial cells. infectious dose S. flexneri 2 a, causing disease in 25% of infected volunteers, amounted to 180 microbial cells. Virulence S. sonnei significantly lower - the infectious dose of these microorganisms is at least 10 7 microbial cells. However S. sonnei have a number of properties that compensate for the lack of virulence (higher resistance in the external environment, increased antagonistic activity, more often produce colicins, greater resistance to antibiotics, etc.).

Shigella (S. sonnei, S. flexneri) relatively stable in the environment and remain viable in tap water for up to one month, in wastewater - 1.5 months, in moist soil - 3 months, on food products - several weeks. Shigella Grigorieva-Shiga are less resistant.

The causative agents of dysentery at a temperature of 60С die within 10 minutes, while boiling - instantly. These pathogens are detrimentally affected by solutions of disinfectants in the usual working concentrations (1% chloramine solution, 1% phenol solution).

source of infection. Sources of infection are patients with an acute form, convalescents, as well as patients with protracted forms and bacteria carriers. In the structure of sources of infection in Sonne dysentery, 90% are in patients with an acute form, in which in 70-80% of cases the disease proceeds in a mild or erased form. Convalescents determine 1.5-3.0% of infections, patients with protracted forms - 0.6-3.3%, persons with subclinical forms - 4.3-4.8%. With Flexner's dysentery, the leading role in the structure of sources of infection also belongs to patients with acute forms, however, with this form of dysentery, the importance of convalescents (12%), patients with protracted and chronic forms (6-7%), and persons with a subclinical course of infection (15%) increases. .

The period of contagiousness of patients corresponds to the period of clinical manifestations. The maximum contagiousness is observed in the first 5 days of illness. In the vast majority of patients with acute dysentery, as a result of treatment, the release of pathogens stops in the first week and only occasionally continues for 2-3 weeks. Convalescents secrete pathogens until the end of the processes of restoration of the mucous membrane of the large intestine. In some cases (up to 3% of cases), carriage may continue for several months. Tendency to lingering current more typical for Flexner's dysentery and less for Sonne's dysentery.

Incubation period- is 1-7 days, on average 2-3 days.

Transfer mechanism- fecal-oral.

Ways and factors of transmission. Transmission factors are food, water, household items. In the summer, the "fly" factor is important. A certain relationship has been established between transmission factors and etiological forms of dysentery. In Grigoriev-Shiga dysentery, the leading factors in the transmission of shigella are household items. S. flexneri transmitted mainly through the water factor. The nutritional factor plays a major role in the distribution S. sonnei. As transmission factors S. sonnei, the main place is occupied by milk, sour cream, cottage cheese, kefir.

susceptibility and immunity. The human population is heterogeneous in susceptibility to dysentery, which is associated with factors of general and local immunity, the frequency of infection with shigella, age and other factors. The factors of general immunity include serum antibodies of classes IgA, IgM, IgG. Local immunity is associated with the production of secretory immunoglobulins of the class BUT (IgA s ) and plays a major role in protection against infection. Local immunity is relatively short-term and after the disease provides immunity to re-infections within 2-3 months.

Manifestations of the epidemic process. Dysentery is ubiquitous. AT last years in Belarus, the incidence of Sonne dysentery ranges from 3.0 to 32.7, Flexner dysentery - from 14.1 to 34.9 per 100,000 population. Most cases of dysentery are classified as sporadic; outbreaks in different years account for no more than 5-15% of cases. Risk time- periods of ups and downs in Sonne's dysentery alternate with intervals of 2-3 years, with Flexner's dysentery, the intervals are 8-9 years; The incidence of dysentery is on the rise warm time of the year; in the structure of causes leading to morbidity, seasonal factors account for 44 to 85% of annual morbidity rates; in cities, two seasonal rises in the incidence of dysentery are often detected - summer and autumn-winter. At-risk groups– children aged 1-2 years and 3-6 years old attending preschool institutions.Territories of risk- the incidence of dysentery in the urban population is 2-3 times higher than in the rural population.

Risk factors. Lack of conditions for fulfilling hygienic requirements, insufficient level of hygienic knowledge and skills, violation of hygienic and technological standards at epidemically significant facilities, reorganization of preschool institutions.

Prevention. In the prevention of dysentery incidence, measures aimed at breaking the transmission mechanism take leading place. First of all, these are sanitary and hygienic measures arising from the results of a retrospective epidemiological analysis to neutralize the spread of shigella through milk and dairy products. An important section of sanitary and hygienic measures is to provide the population with a benign and epidemically safe drinking water. Compliance with sanitary norms and rules at food industry and public catering enterprises, as well as in preschool institutions, makes a significant contribution to the prevention of dysentery. The rupture of the fecal-oral transmission mechanism of shigella is facilitated by pest control measures aimed at the destruction of flies, as well as preventive disinfection at epidemically significant objects.

Given the significant contribution of seasonal factors to the formation of the incidence of dysentery, early measures should be taken to neutralize them.

Anti-epidemic measures- Table 1.

Table 1

Anti-epidemic measures in the foci of dysentery

DYSENTERY

SHIGELLOSIS

Bacterial infection - is caused more often by Sonne and Flexner shchigella, less often by Grigoriev-Shig and Schmitz-Shtuzer. Incubation 1-7 (2-3) days. They usually proceed as hemocolitis, the Sonne form - as well as gastroenterocolitis (food infection). Accompanied by toxicosis varying degrees with vomiting, cardiovascular disorders, in infants - also exsicosis and acidosis.

Definition - a group of anthroponotic bacterial infectious diseases with a fecal-oral mechanism of pathogen transmission. It is characterized by a predominant lesion of the mucous membrane of the distal colon and general intoxication.

Pathogen - a group of microorganisms of the family Tnterobacteriaceae of the genus Shigella, including 4 species: 1) group A - Sh.dysenteriae, which included the bacteria Sh.dysenteriae 1 - Grigorieva-Shigi, Sh.dysenteriae 2 - Stutzer - Schmitz and Sh.dysenteriae 3-7 Large - Saks ( serovars 1-12, of which 2 and 3 dominate); 2) group B - Sh.flexneri with subspecies Sh.flexneri 6 - Newcastle (serovars 1-5, each of which is subdivided into subserovars a and b, as well as serovars 6, X and Y, of which 2a, 1c and 6 dominate) ; 3) Sh.boydii group (serovars 1-18, of which 4 and 2 dominate) and 4) group D - Sh.sonnei (biochemical variants Iie, IIg and Ia dominate). The most common species are Sonne (up to 60-80%) and Flexner.

Shigella are gram-negative non-motile rods, facultative aerobes. Stick Grigoriev - Shigi forms Shigitoxin, or exotoxin, other species produce thermolabile endotoxin. The highest infectious dose is typical for Grigoriev-Shigi bacteria. Large - for Flexner bacteria and the largest for Sonne bacteria. Representatives of the last two species are the most stable in environment: on dishes and wet linen they can be stored for months, in soil - up to 3 months, on food - several days, in water - up to 2 months; when heated up to 60° With perish after 10 minutes, when boiling - immediately, in disinfectant solutions - within a few minutes.

Reservoir and exciter sources: a person with an acute or chronic form of dysentery, as well as a carrier - convalescent or transient.

Source infectivity period equal to the entire period of clinical manifestations of the disease plus the period of convalescence, while the pathogen is excreted in the feces (usually from 1 to 4 weeks). Carriership sometimes lasts several months.

Pathogen transmission mechanism fecal-oral; ways of transmission - water, food (transmission factors - a variety of food products, especially milk and dairy products) and household (transmission factors - contaminated hands, dishes, toys, etc.).

Natural susceptibility of people high. Post-infectious immunity is unstable, reinfections are possible.

Main epidemiological signs. The disease is ubiquitous, but the incidence prevails in developing countries among populations with poor socio-economic and sanitary-hygienic status. Children of the first 3 years of life get sick more often. Citizens get sick 2-4 times more often than rural residents. Typical summer-autumn seasonality. Outbreaks are not uncommon, with Flexner shigella predominating as an etiological agent in water outbreaks, and Sonne shigella in food (milk) outbreaks.

Incubation period from 1 to 7 days, more often 2-3 days.

Main clinical signs. In typical cases (colitis form), the disease begins acutely. There are cramping pains in the left iliac region. false urges for defecation. The stool is scanty, muco-bloody. Body temperature can rise up to 38-39° C. Loss of appetite, headache, dizziness, weakness, tongue coated. The sigmoid colon is spasmodic, painful on palpation. In atypical cases, acute dysentery occurs in the form of gastroenteritis or gastroenterocolitis with symptoms of intoxication, pain in epigastric region, loose stools. Chronic shigellosis can occur in recurrent or protracted (continuous) forms: an exacerbation usually occurs after 2-3 months. after discharge from the hospital, sometimes later - up to 6 months. Subclinical forms are usually detected only during bacteriological examinations according to epidemiological indications.

Laboratory diagnostics is based on the isolation of the pathogen from feces with the establishment of its species and genus, antibiotic resistance, etc. In order to identify the dynamics of dysentery antibodies in the blood, RSK, RPHA with paired sera, however, this reaction is not very suitable for the purposes of early diagnosis.

Dispensary observation of the sick. The procedure and terms of dispensary observation:

Persons suffering from chronic dysentery, confirmed by the release of the pathogen, and carriers that secrete the pathogen for a long time, are subject to observation for 3 months. with a monthly examination by an infectious disease specialist of a polyclinic or a district doctor and bacteriological examination. At the same time, a survey of persons suffering from unstable stools for a long time is carried out;

Employees of food enterprises and persons equated to them, after being discharged from work, remain under dispensary observation for 3 months. with a monthly examination by a doctor, as well as bacteriological examination; persons suffering from chronic dysentery are subject to dispensary observation for 6 months. with monthly bacteriological examination. After this period, with a clinical recovery, they can be admitted to work in their specialty;

Long-term carriers are subject to clinical research and re-treatment until recovery.

At the end of the observation period, the completion of studies, with clinical recovery and epidemiological well-being in the environment, the observed person is deregistered. Deregistration is carried out on commission by an infectious disease specialist of a polyclinic or a district doctor together with an epidemiologist. The decision of the commission is fixed by a special entry in the medical records.