Dysentery (shigellosis). Sanitary and epidemiological requirements for dispensary observation of persons who have recovered from acute intestinal infections

1. Measures aimed at the source of infection

1.1. Detection is carried out:
when applying for medical care;
during medical examinations and when observing persons who have interacted with patients;
in case of epidemic trouble for acute intestinal infection (AII) in a given territory or object, extraordinary bacteriological examinations of decreed contingents can be carried out (the need for their conduct, the frequency and volume are determined by the CGE specialists);
among children attending preschool institutions who are brought up in orphanages, boarding schools, vacationers in summer recreational institutions, during examination before registration in this institution and bacteriological examination in the presence of epidemic or clinical indications; when receiving children returning to the listed institutions after any illness or a long (3 days or more, excluding weekends) absence (admission is carried out only if there is a certificate from a local doctor or from a hospital indicating the diagnosis of the disease);
at the morning admission of a child to a kindergarten (a survey of parents is conducted about the general condition of the child, the nature of the stool; if there are complaints and clinical symptoms characteristic of OKI, the child is not allowed in kindergarten, but is sent to LPO).

1.2. Diagnosis is based on clinical, epidemiological data and laboratory results

1.3. Accounting and registration:
Primary documents for recording information about the disease:
outpatient card (f. No. 025/y); history of the child's development (form No. 112/y), medical record (form No. 026/y).
The case of the disease is registered in the register of infectious diseases (f. No. 060 / y).

1.4. Emergency notification to the CGE
Patients with dysentery are subject to individual registration in the territorial CGE. The doctor who registered the case of the disease sends an emergency notification to the CGE (f. No. 058 / y): primary - orally, by phone, in the city in the first 12 hours, in the countryside - 24 hours; final - in writing, after the differential diagnosis and the results of bacteriological examination
or serological examination, no later than 24 hours from the moment of their receipt.

1.5. Insulation
Hospitalization in an infectious disease hospital is carried out according to clinical and epidemic indications.
Clinical indications:
all severe forms infections, regardless of the age of the patient;
moderate forms in children early age and in persons over 60 years of age with a burdened premorbid background;
diseases in persons who are sharply weakened and burdened with concomitant diseases;
protracted and chronic forms of dysentery (with exacerbation).

Epidemic indications:
with the threat of the spread of infection at the place of residence of the patient;
employees of food enterprises and persons equated to them, if suspected as a source of infection (in without fail for a complete clinical examination)

1.7. Extract
Employees of food enterprises and persons equated to them, children attending preschool institutions, boarding schools and summer health institutions are discharged from the hospital after complete clinical recovery and a single negative result of bacteriological examination conducted 1-2 days after the end of treatment. In the case of a positive result of bacteriological examination, the course of treatment is repeated.
Categories of patients who do not belong to the above-mentioned contingent are discharged after clinical recovery. The question of the need for bacteriological examination before discharge is decided by the attending physician.

1.8. The procedure for admission to organized teams and work
Employees of food enterprises and persons equated to them are allowed to work, and children attending kindergartens, brought up in orphanages, orphanages, boarding schools, vacationing in summer recreational institutions, are allowed to visit these institutions immediately after discharge from the hospital or treatment at home on the basis of a certificate of recovery and in the presence of a negative result bacteriological analysis. Additional bacteriological examination in this case is not carried out.

Patients who do not belong to the above categories are allowed to work and to organized teams immediately after clinical recovery.

Employees of food enterprises and persons equated to them, with positive results of a control bacteriological examination conducted after a second course of treatment, are transferred to another job not related to the production, storage, transportation and sale of food and water supply (until recovery). If the isolation of the pathogen continues for more than 3 months after past illness However, as chronic carriers, they are transferred for life to work not related to food and water supply, and if transfer is impossible, they are suspended from work with the payment of social insurance benefits.

Children who have had an exacerbation of chronic dysentery are allowed to join the children's team if the stool has been normalized for at least 5 days, in good general condition, and at normal temperature. Bacteriological examination is carried out at the discretion of the attending physician.

1.9. Dispensary supervision.
Employees of food enterprises and persons equated to them who have recovered from dysentery are subject to dispensary observation within 1 month At the end of dispensary observation, the need for bacteriological examination is determined by the attending physician.

Children who have had dysentery and attend preschool institutions, boarding schools are subject to dispensary observation within 1 month after recovery. A bacteriological examination is prescribed by him according to indications (the presence of a long unstable stool, the release of a pathogen after a completed course of treatment, weight loss, etc.).

Employees of food enterprises and persons equated to them, with positive results of a control bacteriological examination conducted after a second course of treatment, are subject to dispensary observation for 3 months. At the end of each month, a single bacteriological examination is carried out. The need to perform sigmoidoscopy and serological studies is determined by the attending physician.

Persons with a diagnosis of chronic are subject to dispensary observation for 6 months (from the date of diagnosis) with a monthly examination and bacteriological examination.

At the end of the established period of medical examination, the observed person is removed from the register by an infectious disease specialist or a local doctor, provided that he has made a full clinical recovery and is in an epidemic state of well-being in the outbreak.

2. Activities aimed at the transmission mechanism

2.1 Current disinfection

In apartment centers, it is carried out by the patient himself or by persons caring for him. It is organized by the medical worker who made the diagnosis.
Sanitary and hygienic measures: the patient is isolated in a separate room or a fenced off part of it (the patient's room is subjected to wet cleaning and ventilation daily), contact with children is excluded;
the number of objects with which the patient can come into contact is limited;
the rules of personal hygiene are observed;
a separate bed, towels, care items, dishes for food and drink of the patient are allocated;
utensils and items for patient care are stored separately from the utensils of other family members;
dirty linen of the patient is kept separately from the linen of family members.

Maintain cleanliness in rooms and common areas. In the summer, indoor activities are systematically carried out to combat flies. In apartment foci of dysentery, it is advisable to use physical and mechanical methods disinfection (washing, ironing, airing), as well as the use of detergents and disinfectants, soda, soap, clean rags, etc.

In kindergarten it is carried out for a maximum incubation period by personnel under the supervision of a medical worker

2.2. Final disinfection
In apartment centers after hospitalization or treatment of the patient, it is performed by his relatives using physical methods disinfection and washing-disinfectants. Instruction on the procedure for their use and disinfection is carried out by medical workers of the LPO, as well as an epidemiologist or an assistant epidemiologist of the territorial CGE.

In kindergartens, boarding schools, orphanages, dormitories, hotels, health-improving institutions for children and adults, nursing homes, in apartment centers where large and socially disadvantaged families live, it is carried out upon registration of each case by a disinfection and sterilization center (CDS) or disinfection department of the territorial CGE within the first day from the date of receipt emergency notice at the request of the epidemiologist or his assistant. Chamber disinfection is not carried out. Use disinfectants approved by the Ministry of Health

2.3. Laboratory studies of the external environment

The question of the need for research, their type, volume, multiplicity is decided by the epidemiologist or his assistant.
For bacteriological research, as a rule, sampling of food residues, water and washings from environmental objects is done.

3. Activities aimed at persons who have been in contact with the source of infection

3.1. Revealing
Persons who had contact with the source of infection in preschool institutions are children who visited the same group as the sick person at the approximate time of infection; staff, employees of the catering unit, and in the apartment - living in this apartment.

3.2. Clinical examination

It is carried out by a local doctor or an infectious disease doctor and includes a survey, assessment of the general condition, examination, palpation of the intestine, measurement of body temperature. Specifies the presence of symptoms of the disease and the date of their occurrence

3.3. Collecting an epidemiological history

The presence of similar diseases at the place of work (study) of the sick person and those who communicated with him, the fact that the sick person and those who communicated consumed food products that are suspected as a transmission factor.

3.4 Medical supervision

It is set for 7 days from the moment of isolation of the source of infection. In a collective focus (child care center, hospital, sanatorium, school, boarding school, summer health institution, food enterprise and water supply enterprise) it is carried out by a medical worker of the specified enterprise or territorial healthcare facility. In apartment centers, food workers and persons equated to them, children attending kindergartens are subject to medical supervision. It is carried out by medical workers at the place of residence of those who communicated.

Scope of observation: daily (in kindergarten 2 times a day - in the morning and in the evening) a survey about the nature of the stool, examination, thermometry. The results of the observation are entered in the journal of observations of those who communicated, in the history of the development of the child (form No. 112 / y), in the outpatient card (form No. 025 / y); or in medical card child (f. No. 026 / y), and the results of monitoring the workers of the catering department - in the journal "Health".

3.5. Regime-restrictive measures

Conducted within 7 days after isolation of the patient. The admission of new and temporarily absent children to the DDU group, from which the patient is isolated, is stopped.
After isolation of the patient, it is prohibited to transfer children from this group to others. Communication with children of other groups is not allowed. Participation of the quarantine group in general cultural events is prohibited.
Quarantine group walks are organized subject to group isolation at the site; leaving and returning to the group from a walk, as well as getting food - last.

3.6. Emergency prevention
Not carried out. You can use a dysenteric bacteriophage

3.7. Laboratory examination
The question of the need for research, their type, volume, multiplicity is determined by the epidemiologist or his assistant.
As a rule, in an organized team, a bacteriological examination of communicating persons is performed if a child under 2 years of age who attends a nursery, a food enterprise worker or equivalent to him falls ill.

In apartment centers, “food workers” and persons equated to them, children attending kindergartens, boarding schools, and summer recreational institutions are examined. Upon receipt of a positive result of a bacteriological examination, persons belonging to the category of "food workers" and equated to them are suspended from work related to food products or from visiting organized groups and are sent to the KIZ of the territorial polyclinic to resolve the issue of their hospitalization

3.8. Health education
A conversation is being held on the prevention of infection with pathogens of intestinal infections

TEST

Topic control work: Typhoid fever

By discipline: epidemiology of infectious diseases

The work was completed by: Faizova Aigul Aidarovna

Home address st. Vorovskogo 38v - 107

contact number +79634695243

Medical faculty, full-time education

Course: 5 Group No.: 503

Lecturer: assistant, Ph.D. Pechenkin

Estimate……………………………………………………………………………...

(read, unread)

Chelyabinsk, 2016

I. Epidemiological examination of the focus………………………………………………………………………………………………………………………………………………………………………………………………………

II. Activities in the focus:……………………………………………………..………………………3

2.1. Information about the sick person…………………………….……….……….……………………..3

2.2. Quarantine……………………………….………………………….……………………………….3

2.3. Measures regarding the source of infection:………….….……….……………………4

2.3.1. Indications for hospitalization………………………….……………………….………………4

2.3.2. Deratization………………………….……………….……………………..…………………..4

2.4. Measures regarding the ways and factors of transmission of the pathogen:…….……….………4

2.4.1. Disinfection………………………………..………………….………………………………….5

2.4.2. Disinsection……………………….…….……………………………………………………..6

2.5. Activities in relation to other persons in the focus:……….…….…………………………………6

2.5.1. Disconnection…………………………….…………….……………………………………………6

2.5.2. Emergency prevention……………………………….………………………………………6

III. Dispensary observation of the sick………..…………………………………………7

Bibliography................................................ ................................................. ...............................eight

TASK #18

Patient K., aged 28, went to the doctor with complaints of elevated temperature(38.2 C), headache, insomnia, lack of appetite, progressive general weakness. Sick 3rd day. Was diagnosed with typhoid fever.

Epidanamnesis: 15 days ago he returned from vacation, during which he traveled with a group of tourists for 2 weeks. They lived in tents and ate canned food. Water was used from open reservoirs. He lives with his family in a comfortable apartment. Works as an engineer in a factory. Wife and daughter are healthy. My wife works at a factory, my daughter (5 years old) attends a kindergarten.

I. Epidemiological examination of the focus

It is carried out in each case of the disease / detection of carriage in order to establish the boundaries of the focus, identify the source of infection, contact persons, ways and factors of transmission of the pathogen and the conditions that contributed to their activation.

In all cases, the focus of typhoid infection is examined by an epidemiologist with the involvement of assistant epidemiologists in this work.

In outbreaks and group diseases typhoid fever and paratyphoids, a specific factor (factors) of transmission of infectious agents is established on the basis of alternative epidemiological surveillance maps, the results of a survey of sick and, necessarily, healthy individuals (control group) in epidemic foci (the principle of alternativeness). First of all, the victims who fell ill among the first, as well as those in multiple family foci (with two or more cases of illness) are interviewed. An analysis of the results of alternative morbidity mapping, as well as the results of a survey of patients and control (healthy) individuals in the foci, should allow us to formulate a reliable preliminary version (hypothesis) about the cause and conditions for the occurrence of an epidemic outbreak / epidemic - the active route and the pathogen transmission factor in order to maximize its rapid suppression(neutralization) to prevent the mass spread of infection.

In territories (microsites) unfavorable for typhoid fever and paratyphoid fever, it is necessary to conduct door-to-door visits to early detection sick

II. Activities in the hearth

2.1. Information about the patient

Patient K., 28 years old, went to the doctor with complaints of fever (38.2 C), headache, insomnia, lack of appetite, progressive general weakness. Sick 3rd day. 15 days ago I returned from vacation, during which I traveled with a group of tourists for 2 weeks. They lived in tents and ate canned food. Water was used from open reservoirs. He lives with his family in a comfortable apartment. Works as an engineer at the plant (from the conditions of the problem).

2.2. Quarantine

Quarantine is not imposed, medical observation is carried out for contact persons for 21 days from the moment of isolation of the patient or bacteria excretor.

2.3. Measures regarding the source of infection

To identify the source of infection, a complex of clinical, epidemiological and laboratory methods research. A single bacteriological examination of feces and urine is carried out, as well as a single serological examination blood with the production of RPHA with V-antigen (to identify the state of chronic typhoid bacteriocarrier).

When isolating typhoid cultures, they are phage-typed, the results of which are compared with the data obtained when typing strains isolated from victims in the epidemic focus.

In the absence of the possibility of phage typing, the characteristics of the biochemical (enzymatic) properties of the isolated typhoid cultures are given and their typing (4 types) is carried out according to the ability to ferment xylose and arabinose.

Enzymatic types of typhoid bacteria:

2.3.1. Indications for hospitalization

All patients with typhoid fever are subject to mandatory hospitalization.

Hospitalization of patients is carried out within the first three hours, in rural areas within 6 hours after receiving an emergency notice.

In territories with an endemic incidence of typhoparatyphoid fever, persons with a fever of unknown origin lasting more than three days are subject to provisional hospitalization, with a mandatory blood culture test.

2.3.2. Deratization

Not carried out.

2.4. Measures regarding the ways and factors of transmission of the pathogen

The causative agent of typhoid fever spreads among humans through the fecal-oral transmission mechanism. This mechanism consists of water, food and household ways transmissions, the real epidemic significance of which varies significantly. The role of the main or primary route of transmission in typhoid fever is carried out by the waterway. Other ways of transmission have a purely additional, secondary value. Their relative epidemic role is ultimately determined by the activity of the aquatic transmission route, the suppression of which should be given priority.

The peculiarity of the spread of infectious agents by water lies in the active implementation of the so-called chronic water route of transmission, which determines the endemicity and hyperendemicity of this disease in areas with poor water supply to the population and insufficient sanitation. Along with the chronic, the acute water way of transmission is also realized, manifested by the occurrence of epidemic outbreaks and epidemics. different intensity. It is the water route of transmission of infection that remains the main total number registered outbreaks.

When implementing the food way, various ready-made dishes (salads, vinaigrettes, cold meat dishes) and others, secondarily polluted food products liquid and semi-liquid consistency. Currently, milk and dairy products in typhoid fever are not of great epidemic importance. However, given the ongoing illegal trade in dairy products, the significance of these products as potential agents of transmission of the pathogen is quite high.

The comparative epidemic value of the water, food and household transmission routes for typhoid fever in the country is characterized by a ratio of 10:1:0.1, which determines the general task of preventing this infection to provide the population with a benign, epidemically safe water supply.

Measures to limit the activity of the infection transmission mechanism are the main ones in the prevention and control of typhoid fever. The bodies of the State Sanitary and Epidemiological Supervision, together with the interested services, carry out constant control quality drinking water supplied to the population, the state of water treatment and sewerage facilities, water supply and sewerage networks.

Detection of water samples that do not meet hygienic standards for microbiological indicators, regulated by the relevant documents for each type of water use, should be considered as an indicator potential spread of pathogens of typhoid fever by water.

Detection of water samples that do not meet hygienic standards during repeated studies should be considered as an indicator of a real epidemic danger that requires acceptance. urgent measures to identify and eliminate the source of bacterial contamination. In the summer swimming season, special attention is paid to the sanitary-chemical and microbiological indicators of water in reservoirs in places of mass recreation of the population, to providing the population in places of recreation with good-quality imported water. drinking water and various soft drinks.

Particular attention should be paid to sanitary education among the population about the need to consume water for drinking purposes only of guaranteed quality.

It is not allowed to sell to the population dairy and other food products directly from the foci of bacteriocarrier.

When planning and carrying out activities that impede the implementation different ways transmission of infection, it is necessary to take into account the long-term persistence of the pathogen in environment.

2.4.1. Disinfection

Current disinfection is carried out at the place of stay of the patient in the period from the moment of detection to his hospitalization, during the period of convalescence after discharge from the hospital for 3 months (keeping in mind the possibility of recurrence of the disease and acute bacteriocarrier), as well as in the foci of chronic bacteriocarrier. The current disinfection is carried out by the person caring for the patient, the convalescent himself or the bacteriocarrier.

The medical worker (doctor, paramedic) of the territorial health facility organizes the current disinfection in the outbreak at home. Specialists of the State Sanitary and Epidemiological Supervision institutions visit the carrier at the place of his residence at least once a year to control the quality of anti-epidemic measures.

The final disinfection is carried out by specialists of organizations involved in disinfection activities, in rural areas - by employees of the central district hospital.

In the foci of typhoid fever, specialists from state sanitary and epidemiological surveillance institutions and organizations and institutions involved in disinfection activities conduct selective quality control of the final disinfection.

The final disinfection in cities is carried out no later than six hours, in rural areas - 12 hours after the patient's hospitalization.

The procedure and volume of final disinfection are determined by a disinfectologist or other medical worker.

In the event that a patient with typhoid fever is detected at an outpatient appointment or in a health care facility after his isolation in the premises where he was, the final disinfection is carried out by the personnel of this institution in accordance with the current regulatory documents.

2.4.2. Disinsection

Not carried out.

2.5. Activities in relation to other persons in the outbreak

Active identification of patients among contacts in the focus is carried out by therapists, infectious disease specialists and pediatricians on the basis of a survey, clinical and laboratory examination. For the purpose of early detection of new diseases, all contacts are subject to medical observation (examination, questioning, thermometry) for 3 weeks for typhoid fever and 2 weeks for paratyphoid fever.

In apartment outbreaks, the question of the epidemiological expediency of bacteriological and serological survey contact (or only parts of them) and its multiplicity is decided by an epidemiologist. When the pathogen is isolated, outwardly healthy (without signs of illness) persons are hospitalized to determine the nature of the carriage. Workers of certain professions, industries and organizations undergo a double bacteriological examination of feces and urine, as well as blood in RPHA with V-antigen.

For the period of laboratory examinations (until the results are obtained) and in the absence of clinical symptoms of the disease, contact persons are not suspended from work and visiting organized groups.

In conditions of acute epidemic trouble caused by the action of a mass factor in the spread of infection, laboratory examination of contact persons in foci to identify bacteria carriers is not carried out. Medical surveillance is underway timely detection and diagnosis of new diseases.

Monitoring of contacts with patients and carriers is carried out at their place of work, study or residence (stay) medical workers organizations, territorial health facilities or insurance companies.

In apartment centers, all persons who have been in contact with patients with typhoid-paratyphoid are subject to medical supervision.

results medical supervision reflected in outpatient cards, in the histories of the development of the child (in special sheets for monitoring contacts in the outbreak), in hospitals - in the case histories.

In the event of the occurrence of single and group foci, as well as during epidemic outbreaks of typhoid fever and paratyphoid fever, people who have contacted patients or carriers are given prophylaxis with specific bacteriophages.

2.5.1. Disunion

Not carried out.

2.5.2. Emergency prevention

A bacteriophage is prescribed in the focus of typhoid fever - typhoid 3 times with an interval of 3-4 days; the first appointment - after taking the material for bacteriological examination.

III. Dispensary observation of the sick

All patients with typhoid fever who do not belong to the category of workers of certain professions, industries and organizations, after discharge from the hospital, are subject to dispensary observation for three months with a medical examination and thermometry - once a week during the first month and at least once every two weeks in the next 2 months. In addition, at the end of the specified period, they are subjected to a double bacteriological (with an interval of 2 days) and a single serological examination. If the result is negative, they are removed from dispensary registration, if positive, they are examined twice more during the year. With a positive bacteriological examination, they are registered as chronic bacteria carriers.

When typhoid/paratyphoid bacteria are isolated 3 or more months after recovery, workers in certain professions, industries and organizations are registered as chronic bacteria carriers/bacteria excretors and are suspended from work.

At a positive result serological examination, it is repeated. With a positive result again, an additional three-time bacteriological study of feces and urine and a single study of bile (with negative results of the study of feces and urine) are prescribed.

With negative results of the entire complex of studies, the patients who have been ill are removed from the dispensary record.

Bibliography

Main literature

1. Epidemiology of infectious diseases: textbook. allowance / N.D. Yushchuk, Yu.V. Martynova, E.V. Kukhtevich and others - 3rd ed., revised. and additional M.: GEOTAR - Media, 2014.-496 p.

2. Infectious diseases and epidemiology: textbook - 3rd ed. and additional / V.I. Pokrovsky, S.G. Pak, N.I. Briko and others - M.: GEOTAR - Media, 2013. - 1008 p.

additional literature

1. Zueva L.P. Epidemiology: textbook for universities / L.P. Zueva, R.Kh. Yafaev. - St. Petersburg: Folio, 2005. - 752 p.

2. Guide to practical exercises in the epidemiology of infectious diseases. – textbook / ed. IN AND. Pokrovsky, N.I. Briko. -2nd ed., rev. and additional - M.: GEOTAR - Media, 2007. - 768 p.

3. Epidemiology: textbook / N.I. Briko, V.I. Pokrovsky.- M.: GEOTAR - Media, 2015.- 368 p.

Similar information.

DISPENSARY SUPERVISION FOR REVERSE ILL

Dispensary observation of all categories of patients who have been ill acute dysentery and other intestinal diarrheal infections, as well as sanitized for bacterial carriage, is established for 3 months. Those who had dysentery after being discharged from medical institution dietary nutrition is prescribed "for 30 days. Dispensary observation is carried out by the doctor of the unit and the doctor of the office of infectious diseases. It includes: a monthly examination by the doctor of the unit, a survey of those who have been ill and a macroscopic examination of feces; if necessary, additional coprocytological and instrumental studies , as well as bacteriological studies at the times indicated below.

In the first month after being discharged from a medical institution, sick food and water supply workers from among military personnel and workers of the Ministry of Defense are subjected to bacteriological examinations three times with an interval of 8-10 days. next two months bacteriological research these categories are held once a month. Food and water supply workers are not suspended from work in their specialty for the period of dispensary observation.

For sick servicemen who are not food and water workers, bacteriological examinations are carried out once a month. They are not assigned to the dining room outfit for the period of dispensary observation.

In case of recurrence of the disease or detection of pathogens in the feces intestinal group all categories of those who have been ill again

" - Diet food appointed on the basis of the Order of the USSR Ministry of Defense No. 460 of December 29, 1989 "On measures to further improve the medical examination of military personnel" of the SA and the Navy. Appendix 1 - for officers, ensigns and long-term service employees. Appendix 2 - for enlisted personnel of military service.

stay in a medical institution, after which the examinations mentioned above are again carried out within 3 months.

If the bacteriocarrier continues for more than 3 months or after 3 months after discharge from a medical institution, they have intestinal dysfunctions and are found pathological changes mucous membrane of the rectum, then they are treated as patients chronic form dysentery, and military personnel and employees of the Ministry of Defense associated with food and water supply facilities are suspended from work in their specialty. They are allowed to work in their specialty only after complete recovery, confirmed by the results of clinical and bacteriological examinations, as well as sigmoidoscopy data.

Persons with chronic dysentery are on dispensary observation during the year. Bacteriological examinations and examination by an infectious disease doctor of these persons are carried out monthly.

Data on the state of health of the sick person during the dispensary observation, as well as the results of special laboratory and clinical examinations, are entered in the medical book of the subject.

Those who have been ill and do not have signs of the disease after the last bacteriological examination, the final examination by an infectious disease doctor and the expiration of the period of dispensary observation, are deregistered, and an appropriate mark is made in the medical book.

The military medical examination of military personnel is carried out in accordance with the Order of the Ministry of Defense of the Russian Federation No. 315 of September 22, 1995 “On the procedure for conducting a military medical examination in the Armed Forces of the Russian Federation”.

^ in accordance with Article 1 "Schedule of Diseases of the Order of the Ministry of Defense, No. 315, military personnel who are in military service on conscription with chronic dysentery, as well as bacteriocarrier-salmonella, are subject to inpatient treatment. In case of persistent

of the first bacteriocarrier for more than 3 months, they are recognized as limitedly fit for military service under item “a”, and those examined under column I of the Schedule of Diseases under item “b” are recognized as temporarily unfit for military service for 6 months for treatment. In the future, with continued bacteriocarrier, confirmed laboratory research, they are examined under paragraph "a".

Point "b" includes conditions after acute infectious diseases in the presence of temporary functional disorders, when, upon completion inpatient treatment the patient retains general asthenia, loss of strength, and malnutrition. A conclusion on sick leave can be issued only in cases of a severe and complicated course of the disease, when, in order to assess the persistence of residual changes and fully restore the ability of the person being examined to perform duties military service a period of at least one month is required.

Soldiers who have undergone mild and moderate form infectious disease sick leave is not available. Rehabilitation treatment of this category of patients is completed in the rehabilitation departments of military hospitals (special convalescent centers) or medical posts military units, where it can be organized necessary complex rehabilitation measures. In exceptional cases, rehabilitation is allowed in the infectious and therapeutic departments of military medical institutions.

Dysentery and most other acute intestinal diarrheal infections are anthroponoses with a fecal-oral mechanism of pathogen transmission. The place of the main localization of the pathogen in these infections is the intestine, the release of the pathogen

The generality of the mechanism of transmission determines the general laws of the development and manifestations of the epidemic process in cime infections. Therefore, the following epidemiological-characteristics of dysentery refers to in general terms to all vnne of acute intestinal infections. However, biological features different types pathogens are also determined by the peculiarity of the epipemiology of individual nosological forms, which must be taken into account when carrying out measures for their prevention.

The causative agents of dysentery are characterized by pronounced variability in the main biological traits. Shigella populations are heterogeneous in terms of virulence, antigenicity, biochemical activity, colicinogenicity and colicinosensitivity, sensitivity to antibiotics, environmental resistance, and other characteristics. The characteristics of the pathogen according to these signs change to different phases development of the epidemic process over a wide range.

The causative agents of dysentery, especially Shigella Sonne, are highly survivable in the external environment. Depending on the temperature and humidity conditions, they retain their biological properties from 3-4 days to 1-2 months, and in some cases up to 3-4 months or even more. At favorable conditions Shigella are capable of reproduction in food products (especially liquid and semi-liquid consistency). The optimum temperature for their reproduction is about 37°C, the range of permissive temperatures is from 18 to 40-48°C, the optimum pH of the medium is about 7.2. Shigella Sonne breed most intensively in foodstuffs.

The source of the infectious agent in dysentery is patients with acute and chronic forms, as well as bacterial carriers (persons with a subclinical form of infection), which excrete

to> t shigella in the external environment with feces. Most contagious-

s patients with acute, typically occurring forms of the disease. in an epidemic sense, the presenting and bacterial carriers from among permanent workers "ar>" with I and ^-^^^b^kiya, as well as persons on a daily order for table-horse dysentery are contagious from the onset of the disease, and sometimes from the incubation period. The duration of excitation

patient, as a rule, does not exceed a week, but can be delayed up to 2-3 weeks. The role of convalescents with acute and chronic dysentery as sources of infection is somewhat higher in Flexner's dysentery.

The fecal-oral mechanism of transmission of the pathogen-dysentery is realized by food, water and contact household routes. In the conditions of military collectives, the dense and water ways are of the greatest importance.

In the part (on the ship), the introduction of the pathogen onto food products can be carried out:

By the hands of the sick or bacteria carriers from among catering workers, daily work order "in the canteen, as well as other persons involved in serving tables or distributing food if they do not comply with the rules of personal hygiene;

Infected water used for washing food and cooking;

Synanthropic flies in the presence of non-sewered latrines or sewer malfunctions;

Through tableware (kitchenware) and kitchen utensils injected with dirty hands, polluted water or flies.

Infection of products in the dining room (buffet, shop) part occurs most often when a patient or a bacteria carrier works as a bread cutter, dishwasher, distributor of prepared food or seller. This is facilitated by the non-compliance of the listed food workers with the rules of personal hygiene, the rules for washing and storing dishes.

In most ready-made meals included in the diet of military personnel, dysentery pathogens can multiply if the rules for processing and storing food are violated. The possibility of their reproduction is especially great in salads, vinaigrettes, boiled meat, minced meat, boiled fish, milk and dairy products, compotes and jelly. On bread, crackers, sugar, on washed dishes and kitchen utensils, pathogens do not multiply, but can persist for up to several days.

Infection of personnel with dysentery by water can occur when using water for household and drinking purposes that does not meet the requirements of GOST "Drinking Water" in terms of microbiological indicators, as well as when bathing in reservoirs polluted by sewage.

The misunderstanding of the water used in the part for household and drinking ^ occurs in most cases:

whole, g ddtsii sewage and surface water into the water supply

" "through ^ manholes or other areas with impaired ^ Inaccuracy, especially during interruptions in the water supply;

heroes of seepage into wells, sewage wells from non-canal

lavatory or sewer drains;

whether using non-disinfected containers for the supply and removal of water, when using contaminated hoses, buckets, and mugs while filling containers and taking water from them;

"- when outboard water enters the ship's drinking water system, especially while staying in a harbor or in a roadstead.

Dysentery is also possible through household contact- when the pathogen is introduced into the mouth with hands contaminated with the feces of patients or bacteria carriers through various environmental objects. This is facilitated by non-compliance with the rules of personal hygiene (hands are not washed with soap) after visiting the toilet, repairing or cleaning the sewer (4-way) system, cleaning or cleaning latrines, earthworks in areas contaminated by sewer effluent or feces.

In terms of susceptibility to shigellosis and other intestinal infections, people are very heterogeneous. It has been established that in people with blood group A (II), clinically pronounced forms of infection predominate. The greatest sensitivity to infection in persons with blood group A (II), Hp (2), Rh (-). The least immunoresistance of people to many intestinal infections is detected at the end spring period. Among adults, almost healthy people at least 3-5% are characterized by increased susceptibility to diarrheal infections.

After a disease with dysentery or an asymptomatic infection, a short species- and type-specific immunity is formed. In protecting the body from infection, the main role "belongs to the factors of local immunity (microphages, T-lymphocytes, secretory IgA). Sufficiently intense local immunity is maintained only with systematic antigenic attack. In the absence of antigenic influences, the duration

storage of specific IgA in a protective titer does not exceed 2 - 3

months for Sonne dysentery and 5-6 months for Flexnap dysentery

The resistance of the body to pathogens of intestinal infections can fluctuate under the influence of natural (climatic lyophysical, geomagnetic, etc.) and social (adaptation to new living conditions, mental and physical exercise, impact occupational hazards etc.) factors.

Quantitatively and qualitatively malnutrition, prolonged overwork, overheating of the body contribute to a decrease in resistance to shigellosis infection.

Recovery from desentery is usually accompanied by the release of the body from the pathogen. However, in case of insufficiency of the immune system, the cleansing of the body from the pathogen is delayed up to a month or more. A convalescent carriage is formed, and in some of those who have been ill, the disease acquires chronic course.

Dysentery in military groups is observed in the form of single cases and group diseases. The main route of transmission of the pathogen in single diseases is food, which is realized, as a rule, at food facilities. Infections may be associated with:

With the use of infected products, in (on) which the pathogen does not multiply (bread, sugar, confectionery, fruits, raw vegetables);

With the use by individual servicemen of infected products outside the unit or water from sources not intended for drinking water supply .; the probability of infection of servicemen outside the unit increases significantly during periods of an epidemic rise in the incidence among the population.

Group incidence of dysentery is a consequence of the activation of the food or water route of transmission of the pathogen at the facilities of the unit. In this case, the incidence can manifest itself in the form of a prolonged gradual increase in the number of isolated cases of dysentery (chronic epidemic) or rapid growth number of diseases (acute epidemic or epidemic outbreak).

Chronic food epidemic develops as a result of prolonged moderate contamination of food without subsequent accumulation (or with a slight accumulation) of the pathogen. Intermediate transmission factors in this case are the "dirty" hands of one-

several) a food worker - a patient (carrier), in-go (re-tsue vegetables or flies. The duration of the epidemic is op-

^""is eaten by the duration of food contamination. ^ "Flies" epidemics develop during mass reproduction

parts without sewerage and with insufficient effectiveness of flies „. „fly measures. In chronic food epidemics, cases of diseases are distributed diffusely among individuals. voluminous common food object. If the infection comes from

south source, then one type of o-causative agent is isolated from patients and carriers. In other cases, polyetiology is observed.

Chronic water epidemic develops as a result of long-term use of non-disinfected water from open reservoirs or technical water pipelines, with periodic pollution of sources and water supply systems due to malfunction of wells, water supply networks, violation of operating rules, technology of water purification and disinfection at the main water supply facilities, as well as the rules for the removal and disinfection of feces and Wastewater. Epidemics of this type can occur at any time of the year, but relatively more often develop in winter and spring. They are characterized by a fairly uniform susceptibility to groups of people supplied with water from a single source or system, and a polytype of pathogens with a predominance of Flexner and Boyd species.

Acute food epidemics arise in military collectives only if the personnel consume food in which dysentery microbes have multiplied. This is possible in the case of storing infected dishes at a temperature favorable for the reproduction of the pathogen.

Acute food epidemics may occur at any time of the year. More often they develop against the background chronic epidemics when the likelihood of patients and bacteria carriers working at food facilities increases especially. In the inter-epidemic period, such outbreaks are rarely observed and are usually associated with gross violations in the organization of nutrition for military personnel. For acute food epidemics - a ^ edkte P HO t0 "that the bulk of diseases occur in the

" "Low to the average duration of the incubation period, and sro-inc to HKHOBe 1 ™ of all diseases fit into the maximum period of infection. In addition, in these epidemics there is a high frequency of pronounced clinical manifestations

diseases, including severe and moderate. As a rule, the monotype of the pathogen is revealed, but when piitis is infected with fecally contaminated water, polytypism is also possible.

Acute water epidemics occur when personnel use water contaminated with massive doses of the pathogen. Et is possible when water is contaminated due to an accident on water supply or sewer networks, during temporary shutdown of head water treatment facilities or during a break in water disinfection, when used by personnel for household and drinking purposes of water from heavily polluted reservoirs (outboard water).

Acute waterborne epidemics can develop at any time of the year. More often they occur during a period characteristic of a chronic water epidemic (autumn, winter, spring). It must be taken into account that a chronic water epidemic in a garrison, a settlement often manifests itself in the form of a series of acute water outbreaks that seem to be independent of one another in different communities. For water outbreaks, the pathogen is characterized by a polytypic nature, a relatively high frequency of mild and erased forms of infection.

Long-term dynamics of morbidity dysentery is characterized by a certain trend (growth, decrease, stabilization) and periodic fluctuations. The features of the trend are determined by the quality of measures aimed at eliminating the main causes of morbidity (primarily the causes of chronic water and food epidemics).

The main periodic fluctuations in the incidence of dysentery and other diarrheal diseases in the troops are observed at intervals of 5-8 years. Their causes are primarily related to changes natural conditions the development of the epidemic process, which determine the activity of the food (fly) and water routes of transmission of the pathogen, as well as the dynamics of human resistance and the dynamics of the virulence of the pathogen populations associated with it. Periodic rises in incidence are mainly associated with an increase in the intensity of seasonal rises and the frequency of episodic outbreaks developing against their background.

Annual dynamics of incidence dysentery is made up of year-round (off-season, inter-epidemic) incidence, its seasonal epidemic rises and episodic (irregular)

The level of year-round morbidity outbreaks is the most stable and permanently determined by the quality of household and drinking water, the quality of you-cause “adil personal hygiene for all personnel, and previously full of permanent and temporary workers of food facilities). All ^ "chonny epidemics of dysentery are associated with a regular

mvisation during a certain period of the food or water year ak 1 transmission of the pathogen, seasonal fluctuations in the body's immunoresistance to intestinal infections and, as a result, with the formation of the most favorable environmental conditions for Shigella cyoculation. seasonal epidemics, and summer-autumn epidemics predominate in the hot climate zone.The timing of the onset, duration and height of seasonal rises in incidence are largely determined by the natural and climatic conditions of the area and the meteorological conditions of a particular year.Most often, the development of seasonal epidemics is associated with the activation or the appearance of additional factors of pathogen transmission (deterioration of water quality in the autumn-winter and winter-spring periods, the breeding of flies in a non-sewered garrison, the receipt of infected fresh vegetables for the allowance of personnel). implementation of highly active pathways of transmission of the pathogen (for example, food vogo) the beginning of a seasonal rise in the incidence is possible without the appearance additional factors transmission. The seasonal rise in this case develops due to the accumulation of a layer of susceptible individuals that exceeds the threshold for the onset of an epidemic (loss specific immunity in those infected in the previous epidemic period, a seasonal decrease in the body's resistance). One of important factors activation of the epidemiological process in military collectives is the arrival of a young recruit more susceptible to infection.

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 of 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 latter two species are the most stable in the environment: on dishes and wet linen, they can persist 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 population groups 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.