What anti-epidemic measures need to be taken. Organization and implementation of anti-epidemic measures
Epidemiology is a medical science about the objective patterns of the occurrence and spread of infectious diseases in the human community, as well as the prevention and elimination of these diseases.
Epidemiology is divided into general and specific.
General epidemiology studies the patterns of spread of infectious diseases among the population, characterizes the source of infection, the mechanisms of transmission of the infectious principle, human susceptibility, and develops measures to combat pathogens of infectious diseases.
Particular epidemiology examines the epidemiological characteristics of each group of infection, measures to combat them, and anti-epidemic measures in the outbreak.
Characteristics of the epidemic process. The epidemic process is the emergence and spread of infectious diseases among people. It arises and is maintained only through the interaction of three factors (links) - the source of infection, the transmission mechanism and the population susceptible to the disease.
Source of infection– this is an infected person (or animal), whose body is the natural habitat of pathogenic microorganisms, from where they are released and can infect a susceptible person (or animal). The place or environment of natural activity of pathogenic microorganisms is called a reservoir.
Depending on the nature of the source, infectious diseases are divided into anthroponoses (the source of infection is humans), zoonoses (the source of infection is animals) and anthropozoonoses (the source of infection is humans and animals).
In addition, there is a group of sapronotic diseases, in which the causative agents of the disease not only persist, but also accumulate in the inanimate environment (soil, water bodies, some plants) - botulism, tetanus, legionellosis, etc.
The main role in the spread of infection belongs to a person with a typical or erased form of the disease, as well as a healthy or convalescent carrier of the bacteria. In healthy bacteria carriers, the release of the pathogen is short-term (transient), i.e., their infection has not turned into a disease. Convalescent bacterial carriage is the result of a previous illness and, depending on the duration of bacterial excretion, can be acute with the release of microbes for up to three months and chronic - from three months to several years and even throughout life (typhoid fever).
For an epidemic process to occur, only one source of infection is not enough, since the pathogen can persist as a species if it moves from one organism to another. The set of methods that ensure the movement of pathogens from an infected organism to an uninfected one is called mechanism of infection transmission.
In accordance with the primary localization of the pathogen in the body, four types of transmission mechanisms are distinguished: 1) fecal-oral; 2) airborne; 3) transmission; 4) contact.
There are three phases of movement of a pathogen from one organism to another: the first is elimination from the infected organism; the second is being in the environment; the third is introduction into a healthy body.
Several main transmission factors are involved in the transmission of pathogens (elements external environment containing an infectious principle): air, water, food products, soil, household items, arthropods - living carriers. The forms of implementation of the mechanisms of transmission of infection, including the combination of factors involved in the spread of the corresponding disease, are called routes of transmission of infectious agents.
It is necessary to dwell on the characteristics of the mechanisms of infection transmission.
1. Fecal-oral mechanism - the pathogen is localized mainly in the intestines, enters the external environment and, through various infection transmission factors (food, water, etc.), enters the digestive tract of susceptible people. Depending on the transmission factors, transmission routes are distinguished: food (alimentary), water, contact and household - through environmental objects (dishes, toys, clothes, etc.). Thus, infection occurs through the food route due to intestinal infections: typhoid fever, dysentery, salmonellosis; water - for cholera, typhoid fever, dysentery. The role of flies as mechanical (nonspecific) carriers is currently insignificant.
2. With the airborne transmission mechanism, the pathogen is localized in the mucous membrane of the upper respiratory tract, enters the air (when coughing, sneezing, etc.), remains there in the form of an aerosol and is introduced into the body of a healthy person when contaminated air is inhaled. This transmission mechanism is expressed in influenza, meningococcal infection, diphtheria, measles, scarlet fever, etc. If the microorganism is resistant to desiccation, an airborne dust route of infection is possible (anthrax, tularemia, etc.).
3. Transmissible mechanism - the pathogen is localized in the blood and lymph of the patient, then when bitten by blood-sucking arthropods it enters their body. In the body of biological (specific) carriers, the pathogen multiplies, accumulates and subsequently enters the body of a susceptible person through blood sucking. In case of typhus, the carrier is body louse and head louse, in case of malaria - mosquitoes, in case of plague - fleas, in case of Lyme borreliosis and spring-summer encephalitis - ixodid ticks.
4. Contact mechanism - the causative agent of the disease is localized on the skin, mucous membranes of the oral cavity, genitals, wound surfaces, then enters the various items external environment and upon contact with them is introduced into the body of a susceptible person (indirect contact). Thus, infection occurs through indirect contact with erysipelas, anthrax, and brucellosis. In some cases, transmission of infection occurs through direct contact (sexually transmitted diseases, rabies).
Depending on the mechanism of infection, the entrance gate of infection (the point of entry of the pathogen into the macroorganism) for individual infectious diseases will be different - the respiratory or digestive tract, skin, mucous membranes, etc.
In addition to the above mechanisms and routes of transmission of infection, there are others: vertical, blood-contact, sexual. With the vertical (transplacental) route of infection, the pathogen passes through the placenta from mother to fetus - rubella, toxoplasmosis, viral hepatitis B, etc. The parenteral (blood-contact) route is divided into blood transfusion - as a result of transfusion of infected blood or its components and instrumental (injection), which develops after medical procedures accompanied by damage to the integrity of the skin or mucous membranes using insufficiently sterile medical instruments (viral hepatitis B and C, HIV infection). HIV infection and viral hepatitis B are transmitted through sexual contact.
In the spread of infectious diseases, along with the source of infection and the mechanism of transmission of pathogens, there must be the presence of people susceptible to the disease.
Susceptibility– the property of the body and its tissues to be an optimal environment for the development and reproduction of microorganisms. It is the third link in the epidemic process. Susceptibility is a species property that is inherited. In the presence of susceptibility, infection occurs; in its absence, it does not occur. And only with the simultaneous presence of three links in the epidemic process is there a possibility of infection with the subsequent development of an infectious disease.
Great importance in the development of the epidemic process are the social conditions of people’s lives: the presence and condition of water supply and sewerage, improvement of populated areas, sanitary culture of the population, the nature of nutrition, climatic conditions and etc.
Intensity of the epidemic process has three stages of quantitative changes: sporadic incidence, epidemic and pandemic.
Sporadic incidence– the minimum incidence rate of a certain disease in a given area in the form of individual cases.
Epidemic– an incidence rate that significantly (3–10 times) exceeds the sporadic incidence of a given disease in a given area.
Pandemic– massive spread of an infectious disease over large areas, covering entire countries and continents. Thus, influenza pandemics were registered in 1899, 1919, 1957.
Infectious diseases are distributed unevenly across the globe. There are endemic and exotic diseases. Endemic are diseases that are constantly encountered among the population of a given area. Thus, in the Republic of Belarus, trichinosis, Western tick-borne encephalitis, Lyme borreliosis, etc. are endemic.
Exotic diseases– these are infectious diseases that do not occur in a given area and can arise as a result of introduction or importation from other countries (plague, cholera, malaria, etc.).
Anti-epidemic measures in the outbreak. An epidemic focus is the location of the source of infection with the surrounding territory, within which transmission of the infectious principle is possible. Only by influencing three links of the epidemic process (the source of infection, the transmission mechanism and the susceptible community), can it be possible to prevent or even eliminate an epidemic process that has already arisen.
Measures regarding the source of infection begin immediately upon suspicion of an infectious disease or after diagnosis. After identifying an infectious patient, it is necessary to isolate him for the entire epidemic-hazardous period and provide him with the necessary therapeutic care in a hospital setting or at home. A doctor or paramedic who has diagnosed an infectious disease sends an emergency notification card in two copies - one to the district or city center of hygiene and epidemiology (CGE), the second to the local doctor.
Identification of bacteria carriers is carried out through bacteriological examination of persons in contact with the patient, as well as during mass surveys of the population. It is mandatory to bacteriologically examine all those applying for work at food enterprises, child care institutions, hospitals, sanatoriums, and rest homes.
In the outbreak of an infectious disease, all persons who have been in contact with the patient are subject to medical supervision for the maximum duration of the incubation period and, if necessary, are examined in a laboratory.
Impact on the second link of the epidemic process(mechanism of infection) is carried out using disinfection measures. Disinfection (disinfection) is the process of destroying or removing pathogens of infectious diseases, their carriers and rodents from the human environment. The concept of “disinfection” in the broad sense of the word includes disinfection itself, disinfestation and deratization.
The task of disinfection is to break the transmission routes of infection by destroying pathogenic agents in the external environment.
There are preventive and focal disinfection, the latter in turn is divided into current and final.
Preventive disinfection is carried out constantly, regardless of the presence of infectious diseases, in order to prevent the emergence and spread of pathogens of infectious diseases in the external environment and includes washing hands before eating and after visiting the toilet, chlorinating water, boiling milk, heat treatment of products, if necessary, etc.
Focal disinfection is carried out at the source of infectious diseases.
Current disinfection is carried out at the source where the source of infection is located (apartment, isolation ward, hospital ward).
Final disinfection is carried out at the source of the infectious disease after removal (hospitalization, recovery, death) of the source of infection.
Remains of food, dishes, linen, patient secretions and all items that could be infected are subject to disinfection.
Increasing the individual immunity of the body to infectious diseases (impact on the third link) is carried out with the help of preventive vaccinations - vaccination, for which vaccines and toxoids are used.
Vaccines– preparations obtained from microbes, viruses and their metabolic products, used for active immunization of people and animals with preventive and therapeutic purpose. There are live, killed, and chemical recombinant vaccines used for active immunization.
Live vaccines are obtained from pathogenic strains of microbes with weakened virulence, i.e., deprived of the ability to cause disease, but retaining the ability to multiply in the body of vaccinated individuals and cause a benign vaccination process (vaccines against tuberculosis, brucellosis). They provide lasting immunity.
Killed vaccines are prepared from highly virulent strains of microorganisms by inactivating them with physical and chemical methods using heating, exposure to phenol, formaldehyde (vaccines against intestinal infections, leptospirosis).
Chemical vaccines are prepared by extracting from microbes the main antigens that have immunogenic properties (vaccines against typhoid-paratyphoid infections, dysentery, etc.).
Anatoxin– a neutralized exotoxin that can cause the development of active antitoxic immunity (diphtheria, tetanus toxoid).
For specific emergency prevention (passive immunization) and treatment, drugs containing ready-made antibodies are used - immune sera and immunoglobulins. Unlike immune sera, immunoglobulins contain antibodies in coitrated form. According to the mechanism of action, antitoxic serums are distinguished (antidiphtheria, antitetanus, antibotulinum) and antimicrobial (antianthrax). Antitoxic serums are dosed in international antitoxic units (IU), and antimicrobial serums are dosed in milliliters. There are broad-spectrum immunoglobulins (donor normal human immunoglobulin) and specific ones (anti-influenza, anti-staphylococcal, anti-rabies).
Sera and immunoglobulins obtained from humans are called homologous, and from animals - heterologous.
Passive immunity after the administration of serums and immunoglobulins develops immediately and does not last long - 2 - 4 weeks.
Emergency specific prevention carried out to persons exposed to infection or located in the source of infection. Thus, anti-tetanus or anti-gangrenous serum is administered when the wound is contaminated with soil, anti-rabies immunoglobulin is administered when bitten by dogs or foxes, and anti-encephalitic immunoglobulin is administered to persons after sucking ixodid ticks. Children who have not been vaccinated against measles and who have been in contact with people with measles are given measles immunoglobulin.
Preventive vaccinations in the form of vaccinations are carried out as planned and according to epidemic indications.
Scheduled vaccinations are carried out to the entire population in accordance with age, regardless of the local epidemic situation. Routine vaccinations are carried out against tuberculosis, diphtheria, whooping cough, measles, rubella, mumps, viral hepatitis B. The timing of vaccination and revaccination is strictly regulated by the “Calendar of Preventive Vaccinations” approved by the Ministry of Health of the Republic of Belarus.
Vaccinations according to epidemic indications are carried out in case of increased morbidity in a given region for persons with a high risk of infection (against Western tick-borne encephalitis) or groups with a high occupational risk of infection (against hepatitis B).
To organize and conduct routine preventive vaccinations, vaccination rooms have been created in clinics. Vaccinations are carried out by doctors and nursing staff after a thorough examination of those vaccinated in order to identify contraindications to vaccination. Monitoring the implementation of the vaccination plan is carried out by the local center of hygiene and epidemiology (CHE).
Disinfection, disinfestation, deratization. Disinfection– is the destruction of pathogens of infectious diseases in the external environment. When disinfecting, mechanical, physical, chemical and biological methods are used to destroy microorganisms.
Mechanical methods provide only removal, not destruction of pathogens. These include washing, cleaning, shaking out, vacuuming, ventilation, filtration. A type of filtration is a mask that traps tiny droplets containing microorganisms.
Physical methods Disinfections are based on the action of high temperature, ultraviolet rays, ultrasound, and radioactive radiation. Exposure to high temperature is used when calcining loops in microbiological practice, tweezers, scalpels, when boiling surgical instruments, brushes, dishes, as well as in steam-air chambers under high pressure. Disinfection with ultraviolet rays is carried out using special bactericidal lamps. Radioactive radiation is used in production of sterile products.
Biological method used in laboratory conditions by adding certain antibiotics to the nutrient medium to inhibit the growth of foreign flora - when growing whooping cough bacillus, penicillin is added to casein-charcoal agar.
Chemical methods disinfection are the most common. Disinfectants can be used in dry form, but most often in the form of aqueous solutions. Chemical disinfectants include chlorine-containing preparations, phenols, aldehydes, iodine preparations, etc.
Chloride of lime is a white powder with the smell of chlorine, has high antimicrobial activity, and is used to disinfect feces, urine, sputum, vomit, and food debris.
Chloramine has a bactericidal, virucidal, fungicidal effect and is used in the form of 0.5%, 1% and 3% aqueous solutions for intestinal and airborne infections.
Sulfochloranthin contains 15% activated chlorine and is used in the form of a 0.1 - 3% solution for disinfecting premises, equipment, furniture, linen, toys for intestinal infections.
Crystalline iodine is used in the form of 5 - 10% alcohol solutions and 5% aqueous solution for disinfecting hands, skin, surgical field, medical gloves.
Perhydrol - 30% solution of hydrogen peroxide, used in the form of 1 - 6% solution in combination with 0.5% detergents(“Progress”, “Lotus”, “Astra”) for disinfection of premises, equipment, ambulance transport, patient care items.
Lysol is a solution of cresol in potassium soap, used in the form of a 2% solution to disinfect objects during the plague and other especially dangerous infections.
Phenol is used in the form of a 3% and 5% aqueous solution or a soap-phenol mixture (3% phenol, 2% soap, 95% water), and is used for intestinal and airborne infections.
Hydrogen peroxide can be used in the form of a 3–6% solution in areas of infection in poorly ventilated areas.
Currently in the Republic of Belarus there are two enterprises for the production and sale of disinfectants “BelAseptika” and “Inkraslav”, which produce effective means for disinfection and antiseptics: septocid-synergy, deskocid, triacid, polydez, ultracide-spray, inkrasept-10A, 10B , T, anasept, slavin, aquin, sinol, etc. The methods of using these disinfectants and antiseptics are described in detail in the annotations attached to them.
Pest control– destruction of insects, and in a broader sense, arthropods in order to prevent their transmission of infectious agents.
When carrying out disinsection measures, mechanical, physical, chemical and biological methods are used.
Mechanical method– cleaning things with brushes, beating, vacuuming, using adhesive tapes, various traps, netting windows and doors, protective clothing.
TO physical methods refers to boiling and the use of steam and hot air in disinfection chambers to free clothing and bedding from body and head lice, nits, and scabies mites.
Biological methods are based on the use of specific pathogens of arthropod diseases (bacteria, viruses, fungi, protozoa) or their antagonists. Thus, larval-eating (gambusia, rotan, Amur chebak, gray loach) and herbivorous (grass carp, silver carp, etc.) fish are bred in reservoirs.
Chemical method consists in the use of respiratory, contact, intestinal poisons (insecticides) and deterrents (repellents).
Respiratory insecticides (fumigants) are used in the form of gases, aerosols, and evaporating liquids. They are toxic to humans and therefore require caution when using them. Intestinal poisons are used to destroy insects with gnawing or licking-sucking mouthparts (cockroaches, flies, mosquitoes). These include boric acid, sodium fluoride, borax.
The most commonly used insecticides are contact insecticides, which penetrate the body of insects through the outer integument. These include organophosphorus compounds - dichlorvos, karbofos, sulfidophos, etc.
Deterrent substances (repellents) are applied directly to the skin or clothing. These include DEET (diethyltoluamide), repellin - alpha, DMF (dimethyl phtholate), benzimine, etc.
Deratization– extermination of rodents not only to interrupt the mechanism of transmission of infection, but also to eliminate sources or reservoirs of a number of diseases.
Mechanical method– use of rat traps, mousetraps, traps, ALT glue.
Chemical method consists in the use of respiratory and intestinal poisons. Respiratory toxic substances (sulfur dioxide, chloropicrin, carbon dioxide) are used to treat warehouses, ships, and wagons. Intestinal toxic substances (ratfish, zinc phosphide, zoocoumarin, etc.) are used to poison baits.
Biological method includes the extermination of rodents using bacterial cultures and the use of natural enemies - cats, dogs.
In conclusion, it should be emphasized that the prevention of infectious diseases must be comprehensive, including a number of measures aimed at eliminating the source of infection, breaking transmission mechanisms, and increasing the reactivity (protective properties of the body) of the population susceptible to infection.
Not only medical workers are involved in the prevention of infectious diseases. There are national preventive measures aimed at increasing material well-being, improving working and rest conditions, medical provision of the population, and special ones carried out by employees of medical, preventive and sanitary-epidemiological institutions.
Preventive measures are aimed at preventing the occurrence of an epidemic process. The basics of preventing infectious diseases on a national scale include the following:
Increasing the material well-being of the population;
Sanitary protection of the territory from the introduction of particularly dangerous infections;
Preventive and current sanitary supervision;
Veterinary and sanitary prevention;
Providing the population with accessible medical care;
Mass immunization of the population;
Preventive disinfection measures;
Anti-epidemic measures in the source of infection.
Sanitary protection of the territory from the introduction of especially dangerousinfections is carried out in accordance with the “International Health Regulations”, in pursuance of which sanitary inspection of vehicles arriving from abroad and examination of people are carried out. If a patient with a quarantine infection is identified, federal health authorities are urgently notified, followed by operational information from WHO.
Preventive and current sanitary supervision is engaged in: prevention and elimination of pollution of surface and ground waters, soil and atmosphere; control over compliance with sanitary and technological regimes of water supply and nutrition of the population; ensuring communal improvement of populated areas, etc.
Veterinary and sanitary prevention comes down to the prevention and elimination of diseases dangerous to humans among agricultural and domestic animals.
Mass immunization of the population carried out plannedly or according to epidemic indications.
Vaccines, serums. Even in ancient times, people, describing the epidemic, pointed out: “Whoever suffered the disease was already safe, because no one got sick twice.” Long before civilization, Indians rubbed smallpox scabs into the skin of their children for preventive purposes. In this case, smallpox was usually mild. Since 1980, mandatory vaccination against smallpox in Russia has been abolished due to the complete elimination of this disease in the country.
Currently, a large number of vaccines and serums are available to prevent infectious diseases by artificially creating immunity in people.
Vaccines – These are preparations made from microbial cells or their toxins, the use of which is called vaccination. 1–2 weeks after the administration of vaccines, antibodies appear in the human body and specific immunity is developed.
Artificial acquired immunity occurs as a result of preventive vaccinations, when a vaccine (weakened pathogens of a particular disease - a “live” vaccine) or toxins (waste products of pathogenic microorganisms - a “dead” vaccine) is introduced into the body. In response to the introduction of the vaccine, a person seems to fall ill with the disease, but in a very mild, almost imperceptible form. His body actively produces protective antibodies. And although active artificial immunity does not appear immediately after the vaccine is administered (antibodies take some time to develop), it is quite strong and lasts for many years, sometimes throughout life. The closer a vaccine immunopreparation is to a natural infectious agent, the higher its immunogenic properties and the stronger the resulting post-vaccination immunity. Vaccination with a live vaccine, as a rule, provides complete immunity to the corresponding infection for 5–6 years, vaccination with an inactivated vaccine creates immunity for the next 2–3 years, and the introduction of a chemical vaccine and toxoid provides protection of the body for 1–1.5 years. At the same time, the more the vaccine is purified, the less likely it is that unwanted, side reactions will occur after its introduction into the human body. Examples of active immunity include vaccinations against polio, diphtheria, and whooping cough.
The bulk of vaccinations are carried out in pre-school and before school age. At school age, revaccination is carried out aimed at maintaining the proper level of immunity. There is a special, legally approved vaccination calendar for children and adolescents (general schedule of immunization regimens). The administration of serums is used in cases where the likelihood of a particular disease is high, as well as in the early stages of the disease, to help the body cope with the disease. For example, vaccinations against influenza when there is a threat of an epidemic, vaccinations against tick-borne encephalitis before leaving for field practice, after a bite from a rabid animal, etc.
Reactions to vaccination. In response to the introduction of a vaccine into the body, a general, local or allergic reaction (anaphylactic shock, serum sickness) may develop. The general reaction is characterized by chills, fever, general weakness, body aches, and headache. A local reaction usually occurs at the site of injection or inoculation of the immunologic drug and is characterized by skin redness, swelling, and tenderness at the site of vaccine administration. This is often accompanied by itchy skin. Typically, vaccination reactions are weak and short-lived. Severe reactions to the vaccine, requiring hospitalization and special medical supervision, occur quite rarely.
Allergic reactions to vaccinations are manifested by an itchy rash, swelling of the subcutaneous tissue, joint pain, temperature reaction, and less commonly, difficulty breathing.
Vaccinations to persons who have previously had allergic reactions are allowed only under special medical supervision.
Indications and contraindications for immunization.Main indication For planned, unscheduled and emergency immunoprophylaxis of infectious diseases, it is necessary to create immunity to infection by stimulating the production of specific immunity by the body's immune system.
Preventive disinfection measures include preventive disinfection, disinsection and deratization.
Pest control– destruction of insects in places of their mass breeding (mosquitoes, ticks) through the use of chemicals and biological methods.
Deratization – measures to prevent and reduce the penetration of rodents into premises, depriving them of access to water and food. This also includes organizing measures to clean up populated areas, timely removal of garbage and extermination of rodents.
A special role in the prevention of infectious diseases has an increase in the sanitary literacy of the population (education and training in hygiene rules in educational institutions, special training of personnel whose activities are related to providing the population with drinking water, food, etc.).
Anti-epidemic measures, carried out by the medical service are aimed at eliminating the epidemic outbreak. They suggest:
a) neutralization (elimination) of the source of the infectious agent and breaking the mechanism of its transmission;
b) increasing the immunity to the causative agent of this infection of persons exposed to the risk of infection in the outbreak.
The effectiveness of these measures largely depends on the level of sanitary culture of the population.
In the emerging epidemiological outbreak, the following anti-epidemic measures should be taken:
1) if a disease is suspected, the patient should be isolated until examined by a doctor (see section 5.3). The decision on hospitalization is made by the doctor;
2) to break the mechanism of transmission of the infectious agent, it is necessary to carry out focal disinfection , consisting of current and final disinfection. The current one is carried out in the presence of the patient at the source of infection; his secretions, care items, as well as the room, dishes and linen are subject to disinfection using disinfectants.
After disinfestation procedures, lice eggs (nits) are removed from the hair using cotton swabs soaked in cranberry juice or a 9% vinegar solution.
After hospitalization of the patient, final disinfection is carried out, aimed at disinfecting the room and the objects located there. In foci of infections caused by pathogens resistant in the external environment, for example, with tuberculosis, dermatomycosis, typhus, complete sanitization . Disinfection of bedding and personal items is carried out using chamber disinfection;
3) for persons who communicated with the source of infection (contacts), it is necessary to establish medical supervision for the maximum duration of the incubation period of this infection. Restrictive separation measures are sometimes used for persons under medical supervision; this most often applies to children attending preschool and school institutions, as well as adults working in child care institutions, in food industry enterprises, Catering etc.
In case of particularly dangerous infections, by decision of the Emergency Anti-Epidemic Commission formed under the administration of the republic (territory, region), a quarantine is established in the outbreak, from which entry and exit is prohibited. Persons exposed to the risk of infection are subject to observation before leaving the quarantine zone, i.e. isolation in specially adapted rooms for medical observation during the incubation period.
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Prevention(prophylaktikos - preventive) is a term meaning a set of various types of measures aimed at preventing any phenomenon and/or eliminating risk factors.
There are public and individual prevention. Individual prevention involves observing the rules of personal hygiene at home and at work, while public prevention includes a system of measures to protect the health of groups.
Measures to prevent infectious diseases can be divided into two: large groups- general and special.
TO general include government measures aimed at increasing material well-being, improving medical care, working and rest conditions of the population, as well as sanitary-technical, agroforestry, hydraulic engineering and land reclamation measures, rational planning and development of populated areas and much more, which contributes to the success of the prevention and elimination of infectious diseases diseases.
Special are preventive measures carried out by specialists of treatment-and-prophylactic and sanitary-epidemiological institutions. The system of preventive measures also includes international measures when the issue concerns particularly dangerous (quarantine) infections.
Anti-epidemic measures can be defined as a set of justified at this stage development of scientific recommendations that ensure the prevention of infectious diseases among certain groups of the population, reducing the incidence of the overall population and eliminating individual infections. Anti-epidemic measures are carried out when an infectious disease occurs (detection), preventive measures are carried out constantly, regardless of the presence or absence of an infectious patient. The basis for the prevention of infectious diseases on a national scale is improving the material well-being of the people, providing the population with comfortable housing, qualified and affordable medical care, developing culture, etc.
Medical aspects of the prevention of infectious diseases:
Systematic sanitary control over the water supply to the population;
Sanitary and bacteriological control over the quality of food products, the sanitary condition of food industry enterprises and public catering facilities, trade and children's institutions;
Carrying out planned disinfection, disinfestation and deratization measures;
Planned specific prevention among the population;
Implementation of measures for sanitary protection of borders in order to prevent the introduction of infectious diseases into the country from abroad, etc.
Fundamentals of organizing anti-epidemic work.
Organizational structure The system of anti-epidemic protection of the population includes medical and non-medical forces and means. Non-medical performers play an important role in ensuring the anti-epidemic regime. A set of activities of different nature and focus related to the cleaning of populated areas, food, water supply, etc. is carried out government bodies, institutions and enterprises with the active participation of the population. Many anti-epidemic measures are carried out by healthcare facilities. Employees of the medical network (clinics, outpatient clinics, rural medical stations, paramedic stations and children's institutions) ensure early detection of the epidemic focus in the area they serve. Without identifying an infectious disease, information about the presence of an epidemic outbreak is not available to workers of the sanitary-epidemiological service, since its activities include diagnostic (epidemiological diagnostics), organizational, methodological and control functions. The complexity of the management activities of sanitary and epidemiological institutions lies in the fact that in order to combat infectious diseases it is necessary to attract forces and means not subordinate to the sanitary and epidemiological control service.
As stated above, the emergence and maintenance of the epidemic process is determined by three factors: the source of infection, the mechanism of transmission of the pathogen and the susceptibility of the population. Elimination of one of the factors inevitably leads to the cessation of the epidemic process and, therefore, eliminates the possibility of the existence of an infectious disease. Therefore, preventive and anti-epidemic measures can be effective if they are aimed at neutralizing (neutralizing) the source of infection, interrupting the transmission routes of the pathogen and increasing the immunity of the population.
2. Measures regarding the source of infection:
Timely identification of patients and carriers of pathogenic microorganisms;
Ensuring early diagnosis of diseases;
Registration of patients and carriers;
Source isolation;
Treatment in outpatient settings;
Aftercare after discharge from hospital;
Sanitation of carriers and patients with chronic forms of diseases;
Carrying out bacteriological control to ensure complete freedom from pathogens;
Carrying out hygienic education for patients and carriers;
Providing dispensary observation for those who have recovered from the disease, those with a chronic form of infectious disease and chronic carriers.
In case of anthroponoses, measures aimed at the source of infection are divided into diagnostic, isolation, treatment and regime-restrictive, and in case of zoonoses - into sanitary-veterinary, disinsection and deratization.
Early and complete identification of infectious patients is a prerequisite for timely treatment, isolation and anti-epidemic measures in the outbreak. There are passive and active detection of infectious patients. In the first case, the initiative to seek medical help belongs to the patient or his relatives. Methods for actively identifying infectious patients include identifying patients based on signals from sanitary assets, door-to-door visits, identifying patients and carriers during various preventive examinations and examinations (risk groups). Thus, children are subject to mandatory medical examination and laboratory examination before entering a preschool institution (preschool), and adults are subject to mandatory medical examination when applying for a job at food enterprises. Active detection should also include the identification of infectious patients during medical surveillance in epidemic foci.
The effectiveness of measures against sources of infection is largely determined by diagnosis. The requirements for it from an epidemiological point of view are determined by the choice of reliable and, above all, early methods. The causes of diagnostic errors are associated with the difficulties of differential diagnosis of clinically similar infectious diseases, the polymorphism of clinical manifestations of many of them, underestimation of epidemiological data and insufficient use of laboratory confirmation capabilities. The quality of diagnostics is significantly improved by combined use various methods. For example, with measles, mumps, chicken pox, scarlet fever and some other diseases, the diagnosis is almost always made clinically, taking into account epidemiological data (if any). Laboratory diagnostic methods have not yet received significant use for these infections.
With a wide range of laboratory diagnostic methods available, each of them should be given a correct epidemiological assessment. For example, with typhoid fever, early diagnosis of the disease is carried out by isolating the pathogen from the blood (blood culture) and serological tests (Vi-hemagglutination, ELISA, PCR). When making a retrospective diagnosis, later diagnostic methods are used - isolation of the pathogen from feces, urine and bile. These methods are used to confirm the diagnosis and identify bacteria carriers. The complexity of many laboratory tests limits their widespread use. It is for these reasons that adenoviral and enteroviral infections are very often not recognized, although they are found everywhere.
Measures regarding the source of infection in an epidemic focus should be considered effective only if the patient is isolated (in accordance with the pathogenesis of the infection) before the onset of the infectious period and for its entire duration (typhoid and typhus). If the patient is isolated at the beginning, height or even the end of the infectious period (viral hepatitis, measles, chicken pox, etc.), such measures are assessed as ineffective.
The patient or carrier is usually isolated, placing him in an appropriate health care facility until complete clinical recovery or effective rehabilitation of the carrier is achieved. The terms and conditions of isolation are determined by special instructions. For many infectious diseases, it is possible to isolate the patient or carrier at home, subject to conditions that exclude the possibility of transmission of infection. The local doctor is responsible for the timely hospitalization of infectious patients. If the patient remains at home, the attending physician must ensure his treatment and epidemiological surveillance of the outbreak, carried out until the end of the infectious period in the convalescent. When leaving a sick person at home, the doctor is obliged to inform him and those living with him what epidemiological danger he poses and how he should behave to prevent new diseases. For some diseases, hospitalization is mandatory and provided for by legislative documents. Infectious patients are hospitalized by health care facilities on special transport that is subject to disinfection.
Regime and restrictive measures are carried out in relation to persons who have been or are at risk of infection. The duration of these activities determines the time of danger of infection of persons in contact with the patient or carrier, plus the time of the maximum incubation period. Three categories of regime-restrictive measures can be distinguished: enhanced medical surveillance, observation and quarantine.
Enhanced medical surveillance is aimed at actively identifying infectious patients among persons who have been in contact with the sick person (carrier) at home, at the place of work, study, etc. Among these individuals, during the maximum incubation period of the disease, a survey, medical examination, thermometry, laboratory tests, etc. are carried out.
Observation is enhanced medical monitoring of the health of people who are in the quarantine zone and intend to leave it.
Quarantine is a regime-restrictive measure in the system of anti-epidemic services to the population, providing for administrative, medical, sanitary, veterinary and other measures aimed at preventing the spread of infectious diseases and implying a special regime for economic or other activities, restriction of the movement of the population, vehicles, cargo, goods and animals. If outbreaks of particularly dangerous infections occur, contact persons are completely isolated, provided by armed guards. For less dangerous infections, quarantine includes separation of persons who have been in contact with the patient; prohibition of admitting new children or transferring children from group to group in organized groups; preventing persons who interacted with the patient from entering children's groups, food enterprises, limiting their contact with other persons. Employees of food enterprises, water supply facilities, child care institutions and persons providing direct care for patients in medical institutions, as well as children attending preschool institutions, are suspended from work in case of certain infections, and children are not allowed into child care institutions. The timing of the separation of persons from outbreaks varies. For example, with typhoid fever, dysentery and diphtheria, separation lasts for the period necessary for bacteriological examination. For other diseases, separation is carried out for the entire incubation period, counted from the moment the patient is isolated.
3. Measures aimed at interrupting transmission routes. Measures leading to a rupture of the pathogen transmission mechanism are called sanitary and hygienic:
Current and final disinfection of the outbreak;
Collection of samples from environmental objects for laboratory research;
Prohibition of the use of food, water, clothing and other items suspected of being pathogen transmission factors.
The nature of measures to break the transmission routes of infection depends on the characteristics of the epidemiology of the disease and the degree of resistance of the pathogen in the external environment. Success is ensured by general sanitary measures carried out regardless of the presence of diseases - sanitary control of water supply and food products, cleaning of populated areas from sewage, control of fly breeding, etc. General sanitary measures play a decisive role in the prevention of intestinal infectious diseases. In addition to general sanitary measures, disinfection, disinsection and deratization are of great importance in suppressing further transmission of infection.
For respiratory tract infections, the transmission factor is air, which is why measures to destroy the transmission mechanism are so difficult, especially in hospital settings and organized groups. The development of methods and devices for air disinfection in such conditions is necessary, and such work is being carried out. For individual prevention at the site of infection, it is recommended to wear gauze bandages. Interruption of the transmission mechanism for infections of the external integument is carried out by increasing the general and sanitary culture of the population, improving living conditions, sanitary conditions at home and at work. The enormous importance of measures to interrupt the transmission mechanism is clearly manifested in vector-borne diseases, where the transmission factor is live carriers (lice, mosquitoes, ticks, etc.).
4. Measures aimed at protecting the host population. These measures come down to both general strengthening measures that increase the body’s nonspecific resistance, and to the creation of specific immunity through preventive vaccinations.
For immunoprophylaxis, domestic and foreign medical immunobiological preparations registered in accordance with the law are used. All drugs used for immunoprophylaxis are subject to mandatory certification. Bacterial and
viral drugs are a type of product for which particularly stringent requirements are imposed on the production and control. All of this is due primarily to the fact that these drugs are usually prepared on the basis of pathogenic or weakened microorganisms. This circumstance requires compliance with clearly regulated conditions of production technology, guaranteeing, on the one hand, the safety of working personnel, and on the other, the harmlessness, effectiveness and standardization of drugs. The manufacturer is responsible for the quality of manufactured drugs.
In accordance with the National requirements and WHO recommendations, only drugs that are registered in the territory of the Republic of Belarus and meet the necessary requirements are allowed to be imported and used into the country. Currently, many drugs are registered and approved for use in the country: against measles, rubella, polio, Haemophilus influenzae, influenza, meningococcal infection, HBV, etc.
Considering the mechanism of action and the nature of immunobiological drugs, they are divided into the following groups:
Vaccines (live and killed), as well as other preparations prepared from microorganisms (eubiotics) or their components and derivatives (toxoids, allergens, phages);
Immunoglobulins and immune sera;
Immunomodulators of endogenous (immunocytokines) and exogenous (adjuvants) origin;
Diagnostic drugs.
All drugs used for immunoprophylaxis are divided into three groups:
1. creating active immunity;
2. providing passive protection;
3. intended for emergency prevention or preventive treatment of infected persons. Such drugs include some vaccines (for example, rabies), toxoids (in particular, tetanus), as well as bacteriophages and interferons (IFN).
Measures taken in relation to persons who were in contact with the source of infection:
Active identification of these individuals;
Their isolation;
Medical supervision;
Laboratory examination;
Sanitary education work;
Specific and nonspecific prevention.
A separate group consists of laboratory research and health education work, helping each of the areas.
5. Criteria for identifying the main measures in the prevention and control of infectious diseases . First– features of the epidemiology of individual groups and nosological forms of infectious diseases. For example, airborne infections are characterized by an abundance of sources of infection, high activity of the transmission mechanism, the basis for their prevention is dispositional measures - immunoprophylaxis, immunocorrection and emergency prevention.
The main thing in the prevention of intestinal anthroponotic diseases are exposure measures (isolation, regime-restrictive, sanitary-veterinary, sanitary-hygienic, deratization, disinfection, disinsection).
Second criterion for selecting main events– specific causes and conditions for the development of the epidemic process. The results of epidemiological diagnostics make it possible to assess the degree of influence of natural and social factors on the development of the epidemic process in each specific case, as well as factors of the internal development of the epidemic process.
Third criterion– the degree of effectiveness and accessibility of anti-epidemic measures for practical use.
In the epidemic focus, the following groups of activities are organized and carried out according to the direction of action (Fig. 10):
Measures aimed at the source of infection: identification; diagnostics; accounting and registration; emergency notification to the Center for State Examination; insulation; treatment; procedure for discharge and admission to groups; dispensary observation; in outbreaks of zoonoses - veterinary and sanitary measures; focal deratization.
Activities aimed at the transmission mechanism: ongoing disinfection; final disinfection; focal disinsection.
Measures taken in relation to persons who communicated with the source of infection (contact persons in the outbreak): identification; clinical examination; collection of epidemiological anamnesis; medical supervision; laboratory examination; emergency prevention; regime-restrictive measures.
Anti-epidemic measures in the outbreak
regime-restrictive measures
Rice. 10. Grouping of anti-epidemic measures in the outbreak
Measures aimed at the source of infection
The main goal of these measures is to minimize the epidemic danger of the source of infection for those around him. To achieve this goal, the following activities are carried out.
Revealing the source of infection can be active during the examination of persons subject to preliminary and periodic medical examinations, and passive, which is carried out directly when the patient seeks medical help.
Diagnostics carried out on the basis of clinical data, epidemiological history, results of laboratory examination of the patient.
After making a diagnosis of an infectious disease, the doctor carries it out accounting and registration and sends information about it to the territorial (district or city) center of hygiene and epidemiology (CGE).
The primary documents for recording information about an infectious disease are an individual outpatient card (form No. 025/u), a medical record of a child attending a preschool institution (form No. 026/u), and a child’s development history (form No. 112/u). After making a diagnosis of an infectious disease, the local doctor registers the identified patient in the “Register of Infectious Patients” (form No. 060/u).
If a disease is identified that is subject to individual registration in the district (city) Center for State Examinations, or if it is suspected, employees of an outpatient clinic or medical institution are required to inform the Center for State Examination by phone and send there an “Emergency notification of an infectious disease, acute occupational, food poisoning, or unusual reaction to vaccination" (form No. 058/u).
Thus, one of the important documents in the Center for State Examination, which contains information about infectious diseases, is the “Emergency Notice...” (form No. 058/u). It is sent to the Center by a medical worker (paramedic, general practitioner or pediatrician) when a diagnosis of an infectious disease is made, when it is changed or clarified, as well as when the patient is hospitalized in an infectious diseases hospital no later than 12 hours from the moment the patient is identified in the city and 24 hours in rural areas.
An infectious patient is a source of infection and is therefore subject to isolation, which may consist of isolation at home or hospitalization in an infectious diseases hospital. The decision on the nature of isolation depends primarily on the nosological form of the disease. For certain infectious diseases (typhoid fever, paratyphoid fever, typhus, diphtheria, bacterial tuberculosis, meningococcal infection, polio, cholera, viral hepatitis IN, leprosy, plague, anthrax, etc.) hospitalization is required. For other diseases, hospitalization is carried out according to clinical and epidemic indications. Clinical indications are the severity of the clinical course, and epidemic indications are the inability to provide an anti-epidemic regime at the patient’s place of residence. Hospitalization of persons belonging to epidemically significant populations (for example, “food workers” and persons equated to them with an intestinal infection) is necessary to clarify the nosological form of the disease, carry out full treatment and prevent the development of carriage of infectious disease agents. It is also advisable to hospitalize infectious patients from outbreaks where “food workers” or children attending preschool institutions live. Otherwise, persons communicating with the patient in the outbreak are not allowed to work or visit the team, and the period of observation for them is extended. Infectious patients are hospitalized by ambulance transport, after which it is disinfected. If an infectious patient is delivered by another vehicle, he is subjected to disinfection by the reception department of the infectious diseases hospital. Carriers of infectious disease agents and persons suffering from chronic infectious diseases are subject to long-term isolation only in exceptional cases, for example, in cases of tuberculosis or leprosy. In other cases, chronic carriers are transferred to work where they do not pose an immediate epidemic danger to the population.
Treatment treatment of infectious patients is not limited only to solving the problem of restoring their health, since it ensures the sanitation of sources of infection and the prevention of the formation of asymptomatic carriage of pathogens of infectious diseases. The basis for stopping the isolation of infectious patients is their clinical recovery and freedom from pathogens.
Admission procedure to work or in organized groups of persons who have recovered from an infectious disease, and, in necessary cases, order dispensary observation they are determined by the relevant instructional and methodological documents and are carried out by outpatient clinics and treatment and preventive institutions. Dispensary observation of convalescents is carried out with the aim of dynamic monitoring of their health status and early detection of relapses or exacerbation of the disease.
In cases where the sources of infection are farm or domestic animals, measures to limit their epidemic significance are carried out by the veterinary and sanitary service. If the sources of infection are rodents, then measures are taken to destroy them (focal deratization).
A little history:
Acquaintance with the history of “dramatic medicine” shows that wars that took place both in the distant past and at the present time, social upheavals, catastrophes, and natural disasters are often accompanied by an increase in the number of diseases of an infectious nature, an aggravation of the epidemiological situation, and epidemics.
I would like to note that destruction, a large number of victims, and the full implementation of evacuation measures during emergencies lead to the accumulation of large masses of the population in suburban areas. As a result, in places where workers and employees of enterprises are dispersed and the evacuated urban population is accommodated, unfavorable sanitary and living conditions develop, as a result of which preconditions are created for the occurrence of gastrointestinal and other infectious diseases among the population, especially in the summer.
The main measures to ensure sanitary and epidemiological well-being in these conditions are carried out by the SES. They carry out hygienic assessment of the sanitary situation and give recommendations on the optimal behavior of the population, participate in carrying out measures to protect and prevent the spread of infectious diseases.
To carry out sanitary, hygienic and anti-epidemic measures, the following are used:
Infectious diseases hospitals (departments);
Medical workers sanitary-hygienic and anti-epidemic profiles, working in medical and other institutions;
Disinfection (stationary and mobile) chambers and sanitary passages, regardless of departmental affiliation, baths, laundries and other communal institutions;
Hydrometeorological stations, veterinary agrochemical laboratories.
IN modern conditions An aggravation of the epidemiological situation can more often occur in the event of military conflicts and natural disasters. In addition, the recently increasing migration processes can lead to the spread of “new” infectious diseases (Lassa fever, Ebola, Marburg, Hunt syndrome, etc.). All of the above requires a special set of sanitary, hygienic, preventive and anti-epidemic measures. That's why Since the late 60s, a new scientific discipline has begun to develop abroad - the epidemiology of disasters., which studies, using epidemiological research methods, the nature of the impact on the health of the population of various types of extreme factors. Since 1964, many countries around the world have formed special medical rapid response units to work in disaster zones.
In 1971, the UN General Assembly decided to establish the UN Office of Disaster Relief Coordinators (UN technical agency - UNDRO) in Geneva. Currently, WHO has established a special emergency sector and a task force on natural disasters. Since 1975, the International Society of Disaster Medicine, which includes the Russian Federation, has been operating in Geneva.
In Russia, a modern disaster medicine service began to be created only with 1990 although the most severe mass disasters occurred on the territory of the former USSR, such as the accident at the Chernobyl nuclear power plant in 1986, the earthquake in Armenia in 1988, the flood in the Primorsky Territory in 1986, local conflicts arose with the conduct of hostilities. The creation of the All-Russian Disaster Medicine Service, which is in constant readiness, has significantly increased the timeliness and efficiency of providing assistance to the affected population.
Sanitary, hygienic and anti-epidemic provision:
Sanitary, hygienic and anti-epidemic provision of the population- this system of measures aimed at preserving and strengthening the physical condition of the population, as well as preventing the occurrence and development of infectious diseases.
Sanitary and hygienic measures:
The complex of sanitary and hygienic measures includes medical control over the accommodation of the population, water supply, food, bath and laundry provision, organization of sanitary educational work, compliance with personal hygiene rules, etc.
From the entire complex list of sanitary and hygienic measures Protecting food and water matters most. Main goal measures taken to protect food from possible contamination is to ensure maximum isolation of products from the external environment, which is achieved by using various types of containers, packaging and “covering” materials.
Sanitary and hygienic measures cover the following range of main issues:
Strict adherence to personal hygiene rules;
Regular monitoring of food quality, storage and processing conditions, the condition of containers and packaging, as well as the condition of water sources, water supply networks and water;
Daily improvement of the sanitary condition of public catering establishments, as well as food stores, stalls, and markets;
Providing food facilities, bases, warehouses, etc. the necessary amount of disinfectants, materials and equipment for disinfection, disinfestation, and deratization;
Tap water centralized water supply practically considered to be reliably underestimated from infection. The protection of local water supply sources: mine wells, reservoirs, and individual water supplies is of great importance.
The most dangerous contamination of open water sources: lakes, rivers, springs, irrigation ditches. There are practically no means of protecting them.
Water disinfection is a very complex and labor-intensive process, so the main efforts must be focused on carrying out protective measures.
Sanitary and hygienic measures also include timely cleaning of populated areas from garbage and sewage, maintaining cesspools, latrines and garbage bins in good sanitary condition, ensuring the operation of bathhouses, hairdressers and other public service institutions and maintaining sanitary order in them.
It is important to carry out among the population sanitary educational work aimed at explaining the causes of infectious diseases and measures to prevent them. This work is carried out by MS GO.
Anti-epidemic measures:
Anti-epidemic measures are carried out to prevent the occurrence of infectious diseases, prevent their spread among the population and eliminate epidemic foci if they appear. They are aimed at increasing the population's immunity to infectious diseases. This is achieved by improving working and living conditions, physical education and hardening, as well as creating immunity among the population through preventive vaccinations. The latter are an effective means of preventing and spreading infectious diseases, since they create a large layer of people resistant to the most threatened infections.
In peacetime, vaccinations are carried out against infections that are common in the area or for which there is a threat of introduction from outside. In conditions where the living conditions of the population are sharply disrupted, the number of people vaccinated and the number of components included in vaccines must be increased.
In the event of the emergence of infectious diseases, anti-epidemic activities include:
Early identification of sources and routes of transmission of infection, contact persons and monitoring of them.
Isolation of infectious patients.
Quarantine and disinfection measures;
Carrying out emergency prophylaxis of the population with antibiotics (preventive vaccinations), and after establishing the nature of the disease and its causative agent - specific prophylaxis;
Delivery of water, food and clothing to sick and quarantined people;
Anti-epizootic and anti-epiphytotic preventive measures;
The challenge is to prevent the further spread of infectious diseases and to eliminate them as quickly as possible. When foci of bacteriological infection occur, anti-epidemic measures become much more complicated, and their list expands. Work to eliminate the source of bacteriological infection includes:
Bacteriological reconnaissance;
Determination of the type of pathogens of infectious diseases;
Establishment of quarantine or observation;
Carrying out activities to identify, hospitalize and treat sick people.
When a bacteriological infection is established, quarantine is immediately introduced, even before the type of pathogen is determined.
Quarantine- a system of nationwide measures providing for the implementation of security, administrative and economic measures aimed at localizing infectious diseases in it.
Purpose of quarantine- complete isolation of the source of infection and elimination of it
emerging infectious diseases. Quarantine may be declared for the purpose
prevention of infectious diseases when the pathogen is not identified, but there are characteristic features diseases.
When establishing quarantine, activities carried out during observation
are strengthened by additional regime measures:
- armed forces are established on the external borders of the quarantine zone
security, a commandant service and patrols are organized for
ensuring the established order and regime in the quarantine area
catering, protection of water sources, etc.;
In populated areas and facilities, internal
curfew service, organizing the protection of infectious disease isolation centers and
hospitals, checkpoints, etc.;
The exit of people from quarantine areas and the export of animals is prohibited without special
permits, entry into the quarantine territory is allowed only to special
formations and special transport;
Transit passage of vehicles is prohibited (exception may be
compiled only for railway transport);
Objects National economy, continuing their activities, move
to a special regime of work with strict implementation of anti-epidemic measures
requirements;
- the population in the quarantine zone is divided into small groups.
Food, water, essentials are delivered by special teams. When performing work outside buildings, people must wear personal protective equipment (PPE). Door-to-door visits and examinations of individual professional groups are carried out with the aim of early and active identification of patients. Patients are isolated in specially designated medical institutions in compliance with a strict anti-epidemic regime. Contacts are isolated in specially designated rooms. Disinfection, disinfestation and deratization measures are carried out I am throughout the outbreak area, emergency prevention.
For general guidance and control of activities in the outbreak
An Emergency Anti-Epidemic Commission (EEC) is created.
When a quarantine is identified, the boundaries of the outbreak are immediately determined, taking into account the mechanism of transmission of the pathogen, the ecology of the vectors, and the results of contamination of objects environment and carry out observational activities.
Quarantine can be replaced by observation for infections such as brucellosis, typhoid fever, rickettsiosis, equine encephalomyelitis, deep mycoses, those. infections in which a person is not the source of infection or the pathogen does not belong to the causative agents of particularly dangerous infections.
Observation- a system of measures providing for a number of isolation, treatment and preventive measures aimed at preventing the spread of infectious diseases.
The observation does not provide for cordoning off the outbreak, although exit to the population and entry into the observation area is limited. Observation is also introduced in areas directly adjacent to the border of the quarantine zone.
During observation, anti-epidemic and treatment and preventive measures are carried out:
Restriction of exit, entry and transit passage of all types of transport through the observation area;
Disinfection of environmental objects;
Active early detection of infectious patients, their isolation and hospitalization;
Carrying out sanitary treatment of the affected population;
Carrying out emergency prevention among persons exposed to the threat of infection;
Strengthening medical control over sanitary, hygienic and anti-epidemic measures;
Strengthening veterinary and bacteriological control over contamination of farm animals and livestock products;
Introduction of an anti-epidemic regime for the operation of medical institutions.
It is important to prevent the development of infectious diseases emergency and specific prevention .
Emergency prevention held when there is a danger of mass diseases, but when the type of pathogen has not yet been precisely determined.
It lies in population taking antibiotics, sulfonamide and other medicines . Means of emergency prevention, when used in a timely manner according to predetermined schemes, can significantly prevent infectious diseases, and if they occur, alleviate their course.
Emergency prevention is divided into general and special . Until the type of microorganism in the disaster zone is determined, within 2-5 days held general emergency prophylaxis with antibiotics or broad-spectrum chemotherapy drugs. The main means of such prevention is doxycycline, reserve ones are rifampicin, tetracycline, sulfatene. After identifying the type of pathogen and determination of its sensitivity to antimicrobial drugs begins special emergency prevention, i.e. antimicrobial agents are used that have a selective effect on a certain type of etiological agent, taking into account its sensitivity to the drug. The duration of special emergency prophylaxis depends on the nosological form of the infectious disease (incubation period), the properties of the antimicrobial drugs used, as well as the previously used general emergency prophylaxis.
Specific prevention– creation of artificial immunity (immunity) through protective vaccinations (vaccinations) - carried out against some diseases (smallpox, diphtheria, tuberculosis, polio, etc.) constantly, and against others - only when there is a danger of their occurrence and spread (tetanus, rabies) .
It is possible to increase the population's resistance to infectious agents by mass immunization with protective vaccines, the introduction of special serums or gamma globulins. Vaccines are pathogenic microbes killed or weakened by special methods, and when introduced into the body of healthy people, they develop a state of immunity to the disease. They are introduced different ways: subcutaneously, cutaneously, intradermally, intramuscularly, through the mouth (into the digestive tract), by inhalation.
To prevent and mitigate infectious diseases in the form of self-help and mutual assistance, it is recommended to use the products contained in the first aid kit of an individual AI-2.
In the source of an infectious disease, disinfection, disinsection and deratization cannot be avoided.
Disinfection carried out with the aim of destroying or removing microbes and other pathogens from environmental objects with which a person may come into contact. For disinfection, solutions of bleach and chloramine, Lysol, formaldehyde, etc. are used. In the absence of these substances, hot water with soap or soda is used.
Pest control carried out to destroy insects and ticks - carriers of pathogens of infectious diseases. For this purpose they are used various ways: mechanical (beating, shaking, washing), physical (ironing, boiling), chemical (use of insecticides - chlorophos, thiophos, DDT, etc.), combined. To protect against insect bites, repellents are used, which are applied to the skin of exposed parts of the body.
Deratization carried out to exterminate rodents that carry infectious disease pathogens. It is most often carried out using mechanical devices and chemicals.
Thus, anti-epidemic work in emergencies is one of components national system of emergency medical care to the population. The governing bodies of the disaster medicine service at the federal, regional and territorial levels are the relevant interdepartmental coordination commissions and centers for disaster medicine. At the local and facility levels, the functions of the commissions are assigned to the headquarters of the civil defense medical service.
General principles protecting the health of the population and maintaining its ability to work:
Qualified specialized medical care is provided and a range of measures are carried out to prevent the occurrence and spread of infectious diseases.
The system of anti-epidemic measures is based on data from sanitary and epidemiological reconnaissance of the territory of populated areas and adjacent areas.
Sanitary and epidemiological reconnaissance is carried out in order to understand the causes of the emergence and development of an epidemic outbreak in specific conditions, as well as to develop a set of measures to eliminate it. Its main tasks are similar to those of bacteriological reconnaissance. Bacteriological reconnaissance is carried out to confirm the use of biological weapons, assess the epidemic situation and take samples for indication. As a result of bacteriological reconnaissance, the approximate boundaries of the source of infection and the approximate area of the contaminated territory must be established and designated, the size of the population located there, the volume and nature of measures to eliminate the source and prevent the spread of infectious diseases must be determined. If highly contagious infections are detected, emergency prevention is carried out, the purpose of which is to prevent the occurrence of infectious diseases among people.
Sanitary and epidemiological reconnaissance is the temporary receipt of reliable information about the sanitary and epidemiological condition of the territory included in the emergency zone.
It is carried out by the sanitary and epidemiological service in order to identify conditions affecting the sanitary and epidemiological state of the emergency zone and the affected population.
The organization and implementation of sanitary, hygienic and anti-epidemic measures in emergency areas is entrusted to the territorial Centers of State Sanitary and Epidemiological Surveillance of the Russian Federation. They work in close cooperation with the emergency civil defense headquarters (CES) of the administrative territory.
In order to timely and effectively carry out a set of sanitary-hygienic, preventive and anti-epidemic measures in case of disasters within the framework of a single Russian system To prevent and eliminate emergencies, a number of specialized units have been created, which include:
Operational Anti-Epidemic Brigades (OPEB),
Anti-epidemic teams of constant readiness (PEBPG),
Sanitary and preventive teams (SPO),
Emergency Sanitary Assistance Teams (ESPT),
Infectious emergency specialized medical care teams (infectious EBSNMP),
Specialized anti-epidemic teams (SPEB)
Epidemiological intelligence groups (ERGs).
General management of emergency measures in the event of an outbreak of dangerous infectious diseases or an infection covered by the International Health Regulations, carried out by the Sanitary Anti-Epidemic Commission (SPC) created by a decision of the administration of a district, city, region, territory or republic consisting of Russian Federation. The SPK is headed by the Head of Administration, the deputy chairman of the SPK is the head of the regional health authority.
The SEC includes representatives of law enforcement agencies (Ministry of Internal Affairs, Ministry of Defense, FSB), Ministry of Railways, civil aviation, Agriculture, transport and other interested departments.
Main functions of the SEC:
Carrying out general management and monitoring the timely and complete implementation of measures to localize and eliminate the outbreak of diseases while maintaining economic activity in this territory;
Resolving the issue of imposing quarantine due to epidemiological problems;
Approval of the plan for eliminating the outbreak of diseases and monitoring its implementation;
Periodically hearing reports from the heads of operational groups and other specialists responsible for implementing measures to eliminate the outbreak of infectious diseases at meetings;
Preparation and submission of reports to higher authorities;
Providing all possible administrative and practical assistance in the implementation of activities provided for in the plan;
Mobilization of the necessary forces and means to carry out anti-epidemic measures;
Resolving the issue of lifting quarantine upon completion of the anti-epidemic measures provided for in the plan;
Mobilization of the necessary forces and means to carry out anti-epidemic measures and eliminate the outbreak.
An epidemic focus of a disaster is a territory in which, within certain boundaries of time and space, people were infected with a causative agent of an infectious disease.
The boundaries of the outbreak are determined by the presence of infectious patients and the possibility of implementing pathogen transmission routes; communal improvement and sanitary and hygienic living conditions of people in the disaster zone and places where the evacuated population is located.
There is a certain order in the disaster zone examination of epidemic foci:
1. Analyze the dynamics and structure of morbidity based on epidemiological characteristics, i.e. identify the prevailing group of infections and determine the leading route of transmission of the pathogen.
2. Clarify the epidemiological situation among the population remaining in the disaster zone at its location.
3. Conduct visual and laboratory examinations of environmental samples. Possible objects of the national economy are identified that aggravate the sanitary, hygienic and epidemiological situation (for example, a destroyed sewerage system, a flooded cemetery, the release of industrial waste in the form of toxic substances). Based on the materials received, cause-and-effect relationships are established and conclusions are drawn about the possible type of epidemic that has arisen.
Recognition of manifestations of the epidemic process and factors determining the morbidity of the population infectious diseases in emergencies, constitutes the main content of epidemiological diagnostics.
When making an epidemiological diagnosis at the source of infection in an emergency, the epidemiologist decides the following main questions:
The emerging outbreak of imported or local origin;
The emerging diseases are single or multiple, occurred simultaneously or extended over time, is there a carrier factor of the pathogen;
Is there a connection between diseases and a common source of infection or common routes and factors of transmission of the pathogen, what is the nature of this connection;
What are the boundaries of the outbreak, i.e. the range of infected environmental objects and the number of people at risk of infection and disease in the outbreak;
Are there natural and social processes that determine the paths and factors of pathogen transmission?
In case of an emergency with a complicated epidemiological situation, preventive and anti-epidemic measures are carried out in three ways: main directions:
Prevention of the spread of infectious diseases in disaster zones and elimination of epidemic foci;
Prevention of the introduction of infectious diseases into disaster areas;
Preventing the removal of infectious diseases from the area.
In the outbreak itself, anti-epidemic measures against dangerous infectious diseases are carried out according to the same principles:
Organization of identification, hospitalization and treatment of patients dangerous diseases;
Primary isolation of the patient;
Diagnosis, evacuation, subsequent hospitalization, treatment;
Alarm (emergency notification) about an identified patient;
Epidemiological examination of the outbreak (outbreak);
Quarantine or restrictive measures;
Identification, examination, isolation and monitoring of persons in contact with patients;
Carrying out disinfection and deratization in epidemic outbreaks;
Carrying out emergency and specific prevention;
Sanitary examination of food products and drinking water;
Provisional hospitalization and examination of all suspects for the disease;
Identification of the dead, examination and burial of corpses;
Sanitary educational work.
Conclusion:
Emergencies typically affect large populations over large areas, and there is a high likelihood of large numbers of people affected requiring emergency assistance. In this situation, the prevention of casualties can only be facilitated by a set of measures for the medical protection of the population, including medical and evacuation, sanitary and hygienic and anti-epidemic measures. Moreover, these activities must be carried out as quickly as possible and by special, professionally trained formations, which are the formations of the civil defense medical service. But besides this, the population of the affected territories themselves plays a large role in providing assistance to the victims (self- and mutual assistance), therefore the need to train the population in the basics of civil defense increases.
The success of eliminating an infectious outbreak is largely determined by the active actions and reasonable behavior of the entire population. Everyone must strictly follow the established regime and rules of behavior at work, on the street and at home, and constantly comply with anti-epidemic and sanitary-hygienic standards.
