Types of socially dangerous diseases. The concept of "socially significant diseases"

Socially significant diseases are diseases caused by a low quality of life of the population ( low level wages, pensions, deterioration of living conditions, work, recreation, environmental conditions, quality and structure of nutrition, etc.), a decrease in sanitary and hygienic culture, and a person's lifestyle.

Ways of infection and transmission

Sex is the norm of our life. SEXUAL ROUTE IS ONE OF THE MOST COMMON WAYS OF TRANSMISSION OF DISEASES OF BEHAVIOR. During unprotected sexual contact, semen or vaginal secretions from an infected person to a sexual partner enter the body. THE MOST DANGEROUS VIRUS THAT CAN BE SEXUALLY TRANSMITTED IS HIV. ALSO TRANSMITTED HEPATITIS B VIRUS, SYPHILIS, STD, RARELY HEPATITIS C VIRUS.

Parenteral route (through the blood) - when infected blood enters the bloodstream healthy person through damaged skin and mucous membranes when sharing or reusing non-sterile needles, syringes and other injection equipment.

The vertical route is from an infected mother to a child during pregnancy (through the placenta), during childbirth (if the skin of the newborn is damaged), while breastfeeding (with mother's milk).

In 90% of cases, infection with tuberculosis is carried out by airborne droplets when coughing, sneezing, communicating.

Contact-household transmission is carried out either through direct contact (direct), or through contaminated environmental objects (indirect contact). As a result of direct contact, pathogens of tuberculosis, herpes, and scabies are transmitted. With indirect contact through infected objects, linen, toys, dishes, tuberculosis is transmitted.

Prevention measures

· Abstaining from sexual contact with unfamiliar partners, observing the rules of personal hygiene.

· 2 Avoid contact with someone else's blood, secretions (saliva, semen, vaginal discharge) of another person.

· Say "no" to drugs, unprotected sex and casual sex. Say yes to mutual fidelity, condoms, personal hygiene.

Vaccination is an important area of ​​specific prevention of tuberculosis. Therefore, even in the maternity hospital, all healthy babies are vaccinated against tuberculosis on the 3-4th day of life, which is the main preventive measure for children in the first year of life. Subsequently, revaccination is done again at 7 and 14 years. Adults over 15 years of age should undergo a fluorographic examination at least once every two years.

Volunteer action algorithm

In the event of a household emergency (contact with human blood in violation of the integrity skin or mucous membranes) - contacting the AIDS center within 24 hours from the moment of contact in order to examine the source possible infection and the appointment of specific prevention of infection to the victim.

· Follow the rules of personal hygiene, use a mask (if tuberculosis is suspected), do not forget such simple rules as thorough hand washing after contact with the sick person, before preparing food, before eating, after going to the toilet.

· If you are entrusted with information of an intimate nature in a personal conversation, for example, about questionable sexual contact, you should explain that you do not need to postpone contacting a medical institution. To avoid uncertainty and not get lost in doubts about your status regarding sexually transmitted diseases, you need to contact specialists.

HIV INFECTION- an infection caused by the human immunodeficiency virus. it infection characterized by a specific lesion immune system leading to its slow and steady destruction until the formation of acquired immunodeficiency syndrome (AIDS), accompanied by the development of opportunistic infections and secondary malignant neoplasms, leading to death.

ROUTES OF TRANSMISSION- sexual, hemocontact, vertical. Other modes of transmission of the infection have not been established to date.

PREVENTION: use of a condom during sexual intercourse In the event of a domestic emergency (contact with human blood with a violation of the integrity of the skin or mucous membranes), contact the AIDS center within 24 hours from the moment of contact in order to examine the source of possible infection and prescribe specific prevention of infection to the victim.

Viral hepatitis

The term viral hepatitis combines a group of infectious diseases manifested by damage to the liver and other organs and systems. The most studied and epidemiologically dangerous are viral hepatitis A, B, C. Hepatitis D, E, G is more rare in Russia.

HEPATITIS A is the most common and benign of all viral hepatitis. A person becomes infected with the hepatitis A virus when eating food, water, in the household way (hands infected with the virus, dishes, other household items). The incidence of hepatitis A registered in the Republic of Tatarstan is quite low, but many researchers believe that up to 90% of the population is ill with this hepatitis.

HEPATITIS B is the most epidemically dangerous. The virus is easily transmitted sexually, from mother to fetus, and any contact with micro-quantities of the blood of a patient or carrier of the virus is also dangerous.

In everyday life, the sharing of toothbrushes, washcloths, towels, toothpicks, razors, manicure and sewing accessories plays a special role.

Chronically ill or asymptomatic carriers of the virus pose the greatest danger. In the outcome of chronic viral hepatitis B (an average of 10-15 years), cirrhosis of the liver or primary liver cancer develops.

HEPATITIS C in acute form proceeds easily, the patient does not go to the doctor, however, the process becomes chronic in 60-80% of cases. In the outcome of chronic hepatitis C, cirrhosis or primary liver cancer rapidly develops.

In general, the symptoms of viral hepatitis are similar: heaviness and pain in the right hypochondrium, darkening of the urine, a slight increase in body temperature, yellowing of the sclera and skin. Weakness, drowsiness, nausea, vomiting, diarrhea, joint pain may appear. If you notice these symptoms, you should immediately contact a specialist.

Mechanisms and ways of transmission of HIV infection, hepatitis B and C are practically the same.

Preventive measures are:

For hepatitis A and E: use only good-quality food and water, observe the rules of personal hygiene. When using non-alcoholic and low-alcohol drinks, semi-finished products and ready-made food products, you should use only products of proven and well-known manufacturers. A specific vaccine has been developed against the hepatitis A virus.

For hepatitis B, a specific vaccine has been developed that also protects against the hepatitis D virus. emergencies» emergency prevention of infection is carried out with a combination of a vaccine and a specific immunoglobulin, which allows you to repeatedly reduce the risk of infection.

For hepatitis C, G, E specific means of prevention have not been developed.

TUBERCULOSIS is an infectious disease with the formation of specific inflammatory changes and with a tendency to a chronic course.

The main source of the spread of tuberculosis is a person-bacterio-excretor, scattering tubercle bacilli when coughing, sneezing, laughing. Infection occurs when tubercle bacilli enter the lungs, both directly from an aerosol of saliva and sputum, and with dust, with food. With all methods of infection, the duration of contact with the source of infection and the massiveness of the infection matter.

The first symptoms of tuberculosis are non-specific: a slight increase in body temperature, sweating at night, deterioration in sleep and appetite, increased fatigue, tearfulness, irritability, deterioration of health, night sweats, cough, usually dry, less often with the release of mucopurulent sputum. With the collapse of the lung, hemoptysis or pulmonary hemorrhage may occur. Tuberculosis can be masked by influenza, chronic bronchitis, prolonged pneumonia, or other illnesses.

PREVENTION. Measures aimed at increasing the body's resistance, a rational hygienic regimen are important. For the purpose of specific prevention, vaccinations are used.

SYPHILIS is a chronic systemic sexually transmitted disease affecting the skin, mucous membranes, internal organs, bones, nervous system with a successive change in the stages of the disease.

Syphilis is transmitted mainly sexually (even in the absence of visible pathological foci on the skin and mucous membranes of the patient), it is possible to transmit syphilis through the blood, in everyday life when using a common toothbrush, razor, manicure accessories, dishes, towels, linen and other contact with mucous membranes shells or skin of the patient with objects. It is possible to infect the child with mother's milk.

The incubation period of the primary stage of syphilis is from 8 to 190 days.

The first manifestation of syphilis is usually a hard chancre-inflammatory tissue infiltrate, in the center of which a painless ulceration appears. This formation persists in the patient from 1-2 weeks to a month. Primary manifestations of syphilis can occur both on the genitals and on the fingers, in the oropharynx. Patients may report malaise, weakness, dizziness, fever.

In the next stage of the disease, generalized lesions of the skin and mucous membranes occur, often in the form of a pale spotted rash or in the form of multiple small hemorrhages in the skin and mucous membranes. Characterized by inflammation lymph nodes. There may be slight malaise, sub-febrile temperature (about 37 ° C or slightly higher), weakness, cough, runny nose, conjunctivitis phenomena. Often the disease looks like a catarrh of the upper respiratory tract (that is, a common cold).

In the third stage, a deep lesion of the nervous system and internal organs gradually develops.

PREVENTION. Strict observance of the rules of personal hygiene helps to avoid the domestic route of infection. Protected intercourse prevents infection of the genital organs, but does not exclude the transmission of syphilis. Does not guarantee against infection and the use of local antiseptics.

SCABIES is a contagious skin disease caused by the scabies mite.

The disease is localized in organized groups, united by common bedrooms, or in antisocial strata of society.

Infection with scabies almost always occurs through prolonged direct skin-to-skin contact, sexual transmission predominates. Children often become infected when they sleep in the same bed with sick parents. In crowded groups, other direct skin contacts are also realized (contact sports, children's fuss, frequent and strong handshakes, etc.). Through household items (household items, bedding, etc.), infection is less likely. Infection can also occur from animals with scabies, in which case the rash is localized mainly in those areas that have been in contact with a sick animal.

The characteristic signs of scabies are intense itching, which worsens at night in the warmth of the bed. At the site of the introduction of the tick, a vesicle with transparent contents appears, an itch tract leads from it (a thin strip on the skin of a grayish color up to 1 cm long), a vesicle is visible at the end of the itch tract. The rash is located on the flexor surfaces of the upper and lower extremities, in the interdigital folds of the hands, on the trunk, especially in the belt, abdomen and along the anterior edge of the axillary cavities. Scabies elements can be located on the palms of the soles, face.

PREVENTION scabies is carried out by early diagnosis of the disease and active identification of patients and persons in contact with the patient. In the process of treatment and after its completion, current and final disinfection is carried out at home.

The active spread of the disease occurs in places of mass congestion of people from various social groups where a person least expects infection with pediculosis (public transport, metro, hiking, mass celebrations, working contacts with people from disadvantaged social groups). The main symptoms of pediculosis include:

Constant itching, accompanied by scratching and bloody crusts;

Insomnia and irritability;

Visual detection of lice or nits on the pubis, head or clothing

With head lice, accumulations of lice and nits are observed in the occipital and temporal parts of the head; with clothes pediculosis, lice are found in the folds and seams of clothes and underwear, rarely on the skin of the body; with pubic pediculosis, lice are found in the hair of the lower abdomen and pubis, sometimes in the mustache and beard, eyelashes and eyebrows

There is no specific prevention of pediculosis. Preventive measures of pediculosis are reduced to the identification and complete cure of patients in early stage diseases, as well as the mandatory treatment of all sexual partners of a patient with pubic pediculosis, including examination for sexually transmitted diseases. An important role is played by the thorough disinfection of bedding and clothes of the patient, common areas and upholstered furniture, as well as strict adherence to personal hygiene rules.

Certain socially significant diseases, which include cancer, tuberculosis, HIV infection, and AIDS, alcoholism, drug addiction, sexually transmitted diseases (STDs), mental disorders and some others are subject to special consideration. The organization of their special accounting is connected with the fact that they, as a rule, require early detection, a comprehensive examination of patients, taking them to a dispensary, constant monitoring and special treatment, and in some cases, identifying contacts.

To analyze the incidence of socially significant diseases for each of the diseases, indicators of primary morbidity are calculated.

For chronic diseases (for example, mental disorders), in addition to primary morbidity, general morbidity is also calculated.

The calculation is carried out by the methods given earlier, however, not 1000, but 100,000 are usually taken as the basis of the indicator.

Infectious incidence:

1. In order to carry out current and future medical and organizational measures to combat infectious diseases, the Russian Federation has a strict system for controlling infectious diseases.
2. Infectious diseases are subject to special registration throughout Russia, regardless of the place of infection and the citizenship of the sick person.
3. Territorial Centers for Hygiene and Epidemiology are notified of each case of a detected infectious disease. The list of infectious diseases mandatory for notification is determined by the Ministry of Health and Social Development of the Russian Federation.
4. The main document for the study of epidemic morbidity is the "Emergency notification of an infectious disease, food, acute, occupational poisoning, an unusual reaction to the vaccination ”(f. 058 / y).
5. Information about the sick person is also recorded in the "Journal of Infectious Diseases" (f. 060 / y).
6. A medical worker who has established a diagnosis or suspected an infectious disease is obliged to draw up an emergency notice within 12 hours and send it to the territorial Center for Hygiene and Epidemiology (CGE) - at the place of registration of the disease, regardless of the patient's place of residence.
7. Medical workers paramedical services make up an emergency notice in 2 copies: 1 - sent to the CGE, 2 - to the health facility in charge of this FP or FAP.
8. Ambulance station medical workers medical care who have identified or suspected an infectious disease, in cases requiring emergency hospitalization, report to the CGE by phone about the identified patient and his hospitalization, and in other cases inform the clinic at the patient's place of residence about the need to send a doctor to the patient's home.
9. An emergency notice in this case is drawn up by the hospital where the patient was hospitalized, or by the clinic, whose doctor visited the patient at home.

For the completeness, reliability and timeliness of accounting for infectious diseases, as well as the prompt and complete reporting of them to the CGE, the responsibility lies with the head physician of the health facility.

In addition to operational documents, on the basis of notifications and journals, the territorial CGE monthly draws up a report “On the movement of infectious diseases” (f. 52-inf.), which is the only source of information for higher organizations on infectious morbidity.

For a detailed analysis of infectious morbidity, the "Map of the epidemiological examination of the focus of infectious diseases" (f. 357 / y) is used.

Morbidity with temporary disability (TDD):

It occupies a special place in the incidence statistics due to its great socio-economic significance.

The indicator of MST is influenced by:

1. Disability pay legislation;
2. Status of examination of working capacity;
3. Working conditions of the patient;
4. Organization and quality of medical care;
5. Quality medical expertise;
6. Composition of employees.

The incidence may be the result of:

1. Overwork;
2. Violations of the organization of the ore;
3. Harmful impact of a complex of production factors;
4. Psychological incompatibility in the team;
5. Insufficiently clear organization of the provision of medical and preventive care, etc.

Morbidity with temporary disability is closely related to the effectiveness of measures of a socio-economic, hygienic, medical nature, age, gender, professional composition of workers. Morbidity with temporary disability reflects the morbidity of the working population, therefore, in addition to socio-hygienic, it also has a great socio-economic significance. Patients with VUT account for about 70% of all patients.

The unit of accounting for morbidity with temporary disability is a case of disability due to the disease. An exacerbation of one chronic disease can result in several cases of disability during the year. In this regard, the study and analysis of only morbidity with temporary disability does not provide an exhaustive description of the health of workers, but allows us to determine the impact of morbidity on working capacity.

Documents certifying temporary disability and confirming temporary release from work (study) are "Disability sheet".

To analyze the incidence with VUT, the following indicators are calculated:

1. Number of cases of incapacity for work per 100 employees
2. Number of days of incapacity for work per 100 employees
3. Average duration (severity) of temporary disability

The statistical document registering the incidence with VUT is “Information on the causes of temporary disability” (f. 16-VN). The main task of the analysis with VUT is the development of measures to reduce the incidence of workers in each specific unit and at the enterprise as a whole.

In the analysis of MTD, the incidence rates are compared with the average indicators for the enterprise, with the indicators of other enterprises in the same industry.

in Russia in 2007. the number of cases of VN for all reasons per 100 employees was 63.3 (14% less compared to 2000 -73.8); the number of days of temporary disability is 820.3 per 100 employees (also 14% less than in 2000 - 958.8). The average duration of one case of temporary disability was 13.0 days in both 2000 and 2007.

Other types of morbidity:

Occupational diseases include diseases caused by exposure to adverse factors in the working environment. The classification of occupational diseases is regulated by the list of occupational diseases approved by the order of the Ministry of Health

Importance has an analysis of incidence by age. In official statistics, morbidity is subject to mandatory accounting:

1. children (up to 15 years old),
2. teenagers (from 15 to 18 years old)
3. and adults (over 18).
4. In addition, in the system of maternal and child health, the incidence of newborns, children of the first year of life, the first three years of life, etc. is distinguished.
5. It is also necessary to take into account the gender (sex) characteristics of morbidity, since some diseases occur only in women (gynecological, diseases associated with pregnancy and childbirth), and some only in men (andrological), and the calculation of these diseases for the entire population is incorrect and leads to to mistakes.

Based on a long-term study of morbidity problems, based on an analysis of the literature and our own data, the following incidence classification:

1. By sources of information and accounting methods:

· Morbidity according to the data of appeals to healthcare organizations (primary morbidity, general morbidity, accumulated morbidity)

Morbidity according to medical examinations (pathological lesion)

Incidence by cause of death

2. According to the contingent of the population:

Occupational morbidity

morbidity in pregnant women

Morbidity of women in childbirth and puerperas

The incidence of schoolchildren

The morbidity of military personnel

3. By age

4. By classes, groups of diseases, nosological forms - (infectious morbidity, incidence of the most important socially significant diseases, injuries)

5. At the place of registration

Outpatient clinic

Hospitalized

6. By gender

The incidence of men

The incidence of women

Exhausted (true) incidence- general morbidity according to attendance, supplemented by cases of diseases detected during medical examinations, and data on causes of death.

General morbidity by negotiability (prevalence, morbidity)- a set of primary in a given year cases of people seeking medical care for diseases identified both in this and in previous years.

Primary morbidity (by negotiability)- a set of new, nowhere previously recorded and for the first time in a given year, registered cases of diseases when the population applied for medical care.

Accumulated morbidity (by negotiability)- all cases of primary diseases registered during a number of years when seeking medical help.

The frequency of diseases additionally identified during medical examinations,- all cases of diseases additionally detected during medical examinations, but not registered in a given year when the population applied for medical help.

The frequency of diseases additionally identified in the analysis of causes of death,- all cases of diseases established during a forensic medical or pathoanatomical examination, for which no appeals were registered during the patient's lifetime.

International Statistical Classification of Diseases and Related Health Problems:

The main normative document used in all countries of the world to study morbidity and causes of death is the International Statistical Classification of Diseases and Related Health Problems (ICD).

1. ICD is a system for grouping diseases and pathological conditions, reflecting the current stage of development of medical science.
2. The ICD is reviewed and approved by WHO approximately every 10 years. Currently, ICD-10 (tenth revision) is in force.
3. The ICD consists of 3 volumes. Volume 1 contains a complete list of 3-character rubrics and 4-character subcategories, basic terms and lists for developing mortality and morbidity data.
4. Volume 2 includes a description of the ICD-10, instructions, rules for using the ICD-10 and rules for coding causes of death and diseases, as well as basic requirements for statistical presentation of information.
5. Volume 3 consists of an alphabetical list of diseases and the nature of injuries (injuries), a list of external causes of injuries and tables of drugs.
6. ICD-10 consists of 21 classes of diseases, which have a letter designation from the English alphabet and two numbers.

Introduction

2. Tuberculosis

3. Syphilis

4. Viral hepatitis

5. Anthrax

6. Malaria

7. Helminthiases

Conclusion

Introduction

Socially significant diseases - diseases caused mainly by socio-economic conditions, causing damage to society and requiring social protection person.

Social diseases are human diseases, the occurrence and spread of which to a certain extent depend on the influence of unfavorable conditions of the socio-economic system. To S. b. include: tuberculosis, venereal diseases, alcoholism, drug addiction, rickets, beriberi, and other diseases of malnutrition, some occupational diseases. The spread of social diseases is facilitated by conditions that give rise to class antagonism and exploitation of the working people. The elimination of exploitation and social inequality is a necessary prerequisite for a successful fight against social diseases. However, socio-economic conditions have a direct or indirect impact on the emergence and development of many other human diseases; it is also impossible to underestimate the role of the biological characteristics of the pathogen or the human body when using the term "social diseases". Therefore, since the 1960s and 70s the term is becoming more and more limited.

In connection with the aggravated problem of socially significant diseases, the Government Russian Federation issued Decree of December 1, 2004 N 715 Moscow "On approval of the list of socially significant diseases and the list of diseases that pose a danger to others"

The Resolution includes:

1. List of socially significant diseases:

1. tuberculosis.

2. infections transmitted mainly through sexual contact.

3. hepatitis B.

4. hepatitis C.

5. disease caused by the human immunodeficiency virus (HIV).

6. malignant neoplasms.

7. diabetes.

8. mental and behavioral disorders.

9. diseases characterized by high blood pressure.

2. List of diseases that pose a danger to others:

1. disease caused by the human immunodeficiency virus (HIV).

2. viral fevers transmitted by arthropods and viral hemorrhagic fevers.

3. helminthiases.

4. hepatitis B.

5. hepatitis C.

6. diphtheria.

7. sexually transmitted infections.

9. malaria.

10. pediculosis, acariasis and others.

11. glanders and melioidosis.

12. anthrax.

13. tuberculosis.

14. cholera.

Consider some of the most common and dangerous diseases from the above list, included in the 1st and 2nd group.

1. Human immunodeficiency virus (HIV) disease

HIV infection, like a wildfire, has now engulfed almost all continents. For extraordinarily a short time it has become the number one concern for the World Health Organization and the United Nations, pushing cancer into second place and cardiovascular diseases. Perhaps no disease has given scientists such serious riddles in such a short period of time. The war against the AIDS virus is being waged on the planet with increasing efforts. Every month, the world scientific press publishes new information about HIV infection and its causative agent, which often force a radical change in the point of view on the pathology of this disease. As long as there are more mysteries. First of all, the unexpected appearance and speed of the spread of HIV. Until now, the question of the causes of its occurrence has not been resolved. The average and maximum duration of its latent period is still unknown. It has been established that there are several varieties of the causative agent of AIDS. Its variability is unique, so there is every reason to expect that the next variants of the pathogen will be found in different regions of the world, and this can dramatically complicate the diagnosis. More mysteries: what is the relationship between AIDS in humans and AIDS - similar diseases in animals (monkeys, cats, sheep, cattle) and what is the possibility of embedding the genes of the causative agent of AIDS in the hereditary apparatus of germ cells? Further. Is the name itself correct? AIDS stands for Acquired Immune Deficiency Syndrome. In other words, the main symptom of the disease is the defeat of the immune system. But every year more and more data is accumulating, proving that the causative agent of AIDS affects not only the immune system, but also the nervous system. Completely unforeseen difficulties are encountered in the development of a vaccine against the AIDS virus. The peculiarities of AIDS include the fact that it is, apparently, the first acquired immunodeficiency in the history of medicine, associated with a specific pathogen and characterized by epidemic spread. Its second feature is an almost “targeted” defeat of T-helpers. The third feature is the first epidemic human disease caused by retroviruses. Fourth, AIDS, in terms of clinical and laboratory features, is unlike any other acquired immunodeficiency.

Treatment and prevention: Effective Methods treatment for HIV infection has not yet been found. At present, at best, it is only possible to delay the fatal denouement. Particular efforts should be focused on infection prevention. Modern medicines and measures used for HIV infection can be divided into etiological, affecting the immunodeficiency virus, pathogenetic, correcting immune disorders and symptomatic, aimed at eliminating opportunistic infections and neoplastic processes. Of the representatives of the first group, preference, of course, should be given to azidothymidine: thanks to it, it is possible to weaken clinical manifestations, improve general state patients and prolong their lives. However, recently, judging by some publications, a number of patients have developed refractoriness to this drug. The second group includes immunomodulators (levamisole, isopripozine, thymosin, thymopentin, impreg, indomethacin, cyclosporine A, interferon and its inducers, taktivin, etc.) and immunosubstitutes (mature thymocytes, Bone marrow, thymus fragments). The result of their use is rather doubtful, and a number of authors generally deny the expediency of any stimulation of the immune system in patients with HIV infection. They believe that immunotherapy may promote unwanted reproduction of HIV. Symptomatic therapy is carried out according to nosological principles and often brings noticeable relief to patients. As an illustration, we can refer to the result of electron beam irradiation of the main focus of Kaposi's sarcoma.

Prevention of its spread should form the basis of the modern fight against HIV infection. Here Special attention should be directed to health education to change behavioral and hygiene habits. In sanitary and educational work, it is necessary to reveal the ways of transmission of the disease, emphasizing that the main one is sexual; show the perniciousness of promiscuity and the need to use condoms, especially with casual contacts. Persons at risk are advised not to participate in donation, and infected women - to refrain from pregnancy; it is important to warn against sharing toothbrushes, razors and other personal hygiene items that may be contaminated with the blood and other body fluids of those infected.

However, infection is impossible by airborne droplets, through household contacts and through food. An important role in the fight against the spread of HIV infection belongs to the active identification of infected people through the use of test systems to determine antiviral antibodies. Donors of blood, plasma, sperm, organs and tissues, as well as homosexuals, prostitutes, drug addicts, sexual partners of patients with HIV infection and those infected with venereal diseases, primarily syphilis, are subject to such a definition. Serological testing for HIV should be Russian citizens after a long stay abroad and foreign students living in Russia, especially those who arrived from regions endemic for HIV infection. The urgent measure to prevent HIV infection remains the replacement of all single-use syringes, or at least strict adherence to the rules of sterilization and the use of conventional syringes.

AIDS is one of the most important and tragic problems facing all mankind at the end of the 20th century. And it's not just that many millions of people infected with HIV have already been registered in the world and more than 200 thousand have already died, that every five minutes one person is infected on the globe. AIDS is the worst scientific problem. Until now, even theoretical approaches to solving such a problem as cleaning the genetic apparatus of cells from alien (in particular, viral) information are unknown. Without a solution to this problem, there will be no complete victory over AIDS. And this disease has raised many such scientific questions ...

AIDS is a major economic problem. Maintenance and treatment of sick and infected people, development and production of diagnostic and medical preparations, doing basic scientific research, etc. are already worth billions of dollars. The problem of protecting the rights of AIDS patients and those infected, their children, relatives and friends is also a very difficult one. It is also difficult to address the psychosocial issues that have arisen in connection with this disease.

AIDS is not only a problem for physicians and health workers, but also for scientists in many fields, statesmen and economists, lawyers and sociologists.

2. Tuberculosis

Tuberculosis occupies a special place among diseases related to social diseases. The social nature of tuberculosis has long been known. Even at the very beginning of the 20th century, this disease was called the "sister of poverty", the "proletarian disease". In old St. Petersburg on the Vyborg side, mortality from tuberculosis was 5.5 times higher than in the central regions, and in modern conditions the material well-being of people plays an important role in the emergence of tuberculosis. As shown by a study conducted at the Department of Public Health and Healthcare of St. acad. IP Pavlov, and at the end of the 20th century, 60.7% of tuberculosis patients were defined as unsatisfactory financial and material situation.

Currently, the incidence of tuberculosis in developing countries is much higher than in economically developed countries. Despite the great achievements of medicine in the treatment of patients with tuberculosis, this problem continues to be very relevant in many countries. It should be noted that in a certain period our country has made significant progress in reducing the incidence of tuberculosis. However, in the last decade of the 20th century, our positions on this issue have noticeably weakened. Since 1991, after many years of decline, the incidence of tuberculosis in our country began to grow. Moreover, the situation is rapidly deteriorating. In 1998, the number of newly diagnosed patients with tuberculosis in the Russian Federation more than doubled compared to 1991. In St. Petersburg, the incidence of active tuberculosis (per 100,000 population) increased from 18.9 in 1990 to 42.5 in 1996. A number of epidemiological indicators are used to characterize the effectiveness of tuberculosis control.

Morbidity. As noted above, the number of patients newly diagnosed with active tuberculosis in last years has an upward trend.

Of the total number of patients with a first diagnosis, 213 were men, and almost half of them are in persons 20-40 years old. More than 40% of those identified isolated VC, more than 1/3 were first diagnosed with advanced forms of tuberculosis. Firstly, all this indicates an unfavorable epidemiological situation for tuberculosis, and secondly, that the asocial part of society (homeless people, alcoholics, people deprived of liberty for crimes) makes up a significant part of the contingent of newly ill tuberculosis. When accounting for the first time cases, they do not include:

a) patients registered in another district;

b) cases of recurrence of the disease.

Soreness. Indices of morbidity, in connection with the success of the treatment of patients with tuberculosis, and in the period when there was a 5-fold decrease in the incidence, decreased only 2 times. That is, this indicator, with successful work to reduce tuberculosis, changes at a slower pace than the incidence.

Mortality. Thanks to advances in the treatment of tuberculosis over a 20-year period, the death rate from tuberculosis has decreased by 7 times. Unfortunately, in recent years, positive changes in reducing the prevalence of tuberculosis as a social phenomenon have stopped and, on the contrary, there are negative trends. The mortality rate from tuberculosis in the Russian Federation more than doubled, amounting in 1998 to 16.7 per 100,000 population.

World experience, as well as the experience of our country, has shown that the most effective treatment and preventive institution for working with tuberculosis patients is an anti-tuberculosis dispensary. Depending on the service area, the dispensary can be district, city, regional. The TB dispensary operates on a territorial-district basis. The entire service area is divided into sections, and a TB doctor is attached to each site. Depending on local conditions (the number of registered persons and foci of tuberculosis infection, the presence of large industrial enterprises, etc.), the population in one phthisiatric site can range from 20-30 thousand to 60 thousand. It is important that the border of several therapeutic sites polyclinics and one TB district coincided so that the local TB doctor worked in close contact with certain general practitioners, pediatricians, and general practitioners.

In the structure of the TB dispensary, the main part is the outpatient link. In addition to ordinary rooms (doctors' offices, a treatment room, a functional diagnostics room, it is highly desirable to have a dental office. Naturally, an integral part is a bacteriological laboratory and an X-ray room. Some dispensaries have fluorography stations. In addition, there may be hospitals.

The dispensary carries out all the work to combat tuberculosis in the area of ​​operation on the basis of a comprehensive alan. Participation in the implementation of such a plan is very important not only for medical institutions, but also for other departments. Real progress in reducing the incidence of tuberculosis can only be achieved through the implementation of the interdepartmental program "Tuberculosis", which was also developed in St. Petersburg. The main part of the comprehensive plan is sanitary preventive actions:

Organization of timely detection of patients and revaccination of uninfected;

Organization of timely detection of patients and mass targeted preventive examinations;

Improvement of foci of tuberculosis infection, housing of bacillus carriers;

Labor arrangement of patients;

Sanitary and educational work.

A significant place in the comprehensive plan is occupied by new methods of diagnosing and treating patients, inpatient and sanatorium treatment, and the training of doctors in phthisiology.

There are several ways to identify patients with tuberculosis. The main place is occupied (80% of all identified patients) by identification when patients seek medical help. The role of polyclinic doctors is very important here; as a rule, the sick person goes there first of all. Targeted preventive medical examinations play a certain role. An insignificant place is occupied by the observation of contacts and the data of pathoanatomical studies. The latter method testifies to shortcomings in the work of tuberculosis treatment and prevention institutions.

The TB dispensary is a closed institution, i.e. the patient is sent there by a doctor who detects such a disease. When tuberculosis is detected in any medical institution, a “Notice of a patient with an established diagnosis of active tuberculosis for the first time in his life” is sent to the anti-tuberculosis dispensary at the place of residence of the patient.

The doctor of the TB dispensary organizes a thorough examination and, when clarifying the diagnosis, puts the patient on a dispensary record.

In our country, tuberculosis prevention is carried out in two directions:

1. Sanitary prevention.

2. Specific prevention.

The means of sanitary prophylaxis include measures aimed at preventing infection of healthy people with tuberculosis, at improving the epidemiological situation (including current and final disinfection, education of hygienic skills of tuberculosis patients).

Specific prophylaxis is vaccination and revaccination, chemoprophylaxis.

For successful work to reduce the incidence of tuberculosis, significant state allocations are needed to provide housing for bacillus carriers, for sanatorium treatment of patients, to provide outpatients with free medicines, etc.

WHO's flagship TB control strategy is currently the DOTS program (abbreviation English words"Directly observed treatment, short-course", which can be translated as "controlled short-course chemotherapy"). It includes sections such as identifying contagious TB patients seeking medical care through analysis clinical manifestations lung diseases and microscopic analysis of sputum for the presence of acid-fast microbacteria; appointment of identified patients with two-stage chemotherapy.

As the main specific goal of the fight against tuberculosis, WHO puts forward the requirement to achieve recovery in at least 85% of new patients with infectious forms of pulmonary tuberculosis. National programs that succeed in doing this have the following impact on the epidemic; the incidence of tuberculosis and the intensity of the spread of the infectious agent immediately decrease, the incidence of tuberculosis gradually decreases, drug resistance develops less often, which facilitates the further treatment of patients and makes it more accessible.

By early 1995, some 80 countries had adopted the DOTS strategy or were beginning to adapt it to their own circumstances; With about 22% of the world's population living in areas where the DOTS program is being applied, many countries have achieved high TB ​​cure rates.

The adoption of the law of the Russian Federation "On the protection of the population from tuberculosis" (1998) suggests the development of new conceptual, methodological and organizational approaches to the formation of a system of outpatient and inpatient TB care. To stop the aggravation of the problem of tuberculosis in the changed socio-economic conditions in Russia is possible only with the strengthening of the role of the state in the prevention of this infection, the creation of a new concept for the conduct and management of anti-tuberculosis activities.

Preventive measures are taken in all foci, but first of all, in the most dangerous ones. The first step is hospitalization of the patient. After inpatient treatment, patients are sent to a sanatorium (free of charge).

Persons who were in contact with patients are observed in the TB dispensary according to the 4th group of dispensary registration. They are given chemoprophylaxis, if necessary, vaccination or BCG revaccination.

Organization of anti-tuberculosis work.

If the first principle of the fight against tuberculosis in our country is its state nature, then the second principle can be called treatment and prevention, the third principle is the organization of anti-tuberculosis work by specialized institutions, the broad participation of all medical institutions in this work.

The Comprehensive TB Control Plan includes the following sections: strengthening the material and technical base, incl. equipping healthcare facilities, providing the necessary staff and improving their skills, taking measures aimed at reducing the reservoir of tuberculosis infection and preventing its spread among the healthy population, identifying patients and treating them.

It must be remembered that tuberculosis is classified as controlled, i.e. controllable, infectious diseases and the implementation of clear and timely measures for the prevention of tuberculosis can achieve a significant reduction in the prevalence of this dangerous disease.

3. Syphilis

Social and economic transformations in Russia in the 1990s were accompanied by a number of negative consequences. Among them is the syphilis epidemic that has engulfed most of the territories of the Russian Federation. In 1997, the incidence of this infection increased by a total of 50 times compared with 1990, and the incidence of children increased by 97.3 times.

The population of all territories of the North-West region of Russia was involved in the epidemic. The highest rates of syphilis incidence occurred in the Kaliningrad region. It should be noted that this area turned out to be the first territory where the HIV epidemic began. The incidence of syphilis in children in 1997 (the year of maximum increase) in the territories of the North-West was characterized by different indicators.

They were the highest in Novgorod, Pskov, Leningrad and Kaliningrad regions. Such areas are called areas of risk. In recent years, the incidence of syphilis has begun to gradually decline, but it is still at a high level. In 2000, more than 230,000 patients with all forms of syphilis were diagnosed in the Russian Federation as a whole, including more than 2,000 cases registered among children under 14 years of age (in 1997-1998, more than 3,000 diseases were diagnosed annually, of which 700 800 cases among children under 1 year of age). According to the dermatovenerological dispensary, in the Leningrad region in 1990-1991. about 90 patients with syphilis were revealed. In 2000, more than 2,000 new cases of the disease were diagnosed. At the same time, it should be noted that among the sick, 34% were rural residents, that is, this problem is not only in big cities. A study of the age structure of those with syphilis in 2000 showed that the bulk (42.8%) were young people aged 20-29 (Fig. 4).

More than 20% in the structure were occupied by men and women of the age group of 30-39 years. However, the group of the highest risk of the disease are persons 18-19 years old. This group, which includes only two age categories, occupied about 10% in the structure of those with syphilis, while other groups include 10 or more age categories of the population. 133 cases of syphilis were also detected among children and adolescents.

To the above, it must be added that in recent years syphilis has taken first place among the causes of abortion for medical reasons. Unfulfilled life, along with the low birth rate in the last decade as a whole, also characterizes the incidence of syphilis as a serious problem. social problem. The high incidence of syphilis, which confirms the changes in the sexual behavior of the population, gives grounds to predict an increase in the incidence of other sexually transmitted infections, including HIV infection.

The epidemiological situation associated with the epidemic growth of sexually transmitted diseases, including syphilis, became so serious that it served as the subject of a special discussion at the Security Council of the Russian Federation, where a corresponding decision was made (Yu. K. Skripkin et al., 1967) . Since syphilis during an epidemic outbreak has significant features that contribute to the activation of the process, attention is paid to improving the effectiveness of treatment, rehabilitation and prevention measures. Attention is drawn to the presence of many factors that provoke and contribute to the increase in the incidence of syphilis.

1st factor - social conditions: extremely low level of information about venereal diseases among the population of the country; a catastrophic increase in drug use; progressive increase in alcoholism; active, immoral propaganda of sex by all types and media; economic trouble of the country; progressive increase in the number of unemployed; no legalized prostitution.

2nd factor: the general medical situation of the country; a pronounced decrease in immunity in a significant part of the population due to impoverishment; an increase in the number of manifest forms of syphilis and malignant, atypical manifestations; it is difficult to diagnose secondary fresh and recurrent syphilis due to the atypicality and small number of rashes, rare access to medical institutions; an increase in the number of patients with latent and unknown syphilis; tendency to self-treatment of a significant contingent of persons.

Serious attention is drawn to the fact that antibiotics are widely used in the country for intercurrent diseases that contribute to immunosuppression and change the clinic and course of the syphilitic process. Syphilitic infection has undergone significant pathomorphism over the past decades. So, V.P. Adaskevich (1997) emphasizes the milder course of syphilis without the severe consequences observed several decades ago. In recent years, tuberculous and gummous syphilis have become rare, as have severe CNS lesions (acute syphilitic meningitis, tabic pains and crises, tabetic atrophy optic nerves, manic and agitated forms of progressive paralysis, arthropathy), gumma of the bones of the skull and internal organs. Severe syphilitic lesions of the liver, aortic aneurysm, aortic valve insufficiency, etc. are much less common. However, diseases of a combined nature - tuberculosis and syphilis, syphilis and HIV infection - have become more frequent.

For the purpose of more detailed information about the features of the modern syphilis clinic, V.P. Adaskevich (1997) summarized the clinical peculiarity of the symptoms of the primary and secondary periods of syphilis, which are characteristic of the present.

Clinical features of the primary period are: the formation of multiple chancres in 50-60% of patients, an increase in the number of cases of ulcerative chancres; herpetic giant chancres are recorded; atypical forms chancres became more frequent; more often complicated forms of chancres with pyoderma are observed, viral infections with the formation of phimosis, paraphimosis, balanoposthitis.

The number of patients with extragenital chancres has increased: in women - mainly on the mucous membranes of the oral cavity, pharynx, in men - in the anus; draws attention to the absence of regional scleradenitis in 7-12% of patients.

Clinical features of the secondary period: roseolous and roseolous-papular elements are more often recorded; rashes of roseolous rash on the face, palms, soles are stated. Atypical roseolous elements are possible in a significant number of patients: elevating, urticarial, granular, confluent, scaly. The combination of palmar-plantar syphilides with leukoderma and alopecia has become more frequent in patients with secondary fresh syphilis.

In secondary recurrent syphilis, a papular rash predominates in patients, less often a roseolous rash. Often there are low-symptom isolated lesions of the palms and soles; in a significant number of patients, erosive papules and wide condylomas of the anogenital region are often recorded. Pustular secondary syphilides are less common, and if they occur, then superficial impetiginous ones.

Attention is drawn to the predominance of cases of secondary recurrent syphilis among the treated contingent of patients, which is a consequence of late negotiability and late detection of fresh forms.

V.P. Adaskevich (1997) and a number of authors note certain difficulties in detecting pale treponomas in the discharge of syphilides. The frequency of detection of pale treponomas in the discharge of chancre in primary syphilis does not exceed 85.6-94% and 57-66% in the discharge of papular elements during repeated studies.

Manifestations of the tertiary period of syphilis are currently rarely recorded and are characterized by the scarcity of clinical symptoms, a tendency to manifestations of a systemic nature from the internal organs, with a mild course. There are almost no cases of tertiary syphilis with abundant tuberculous rashes, gummas, significant bone deformities.

Over the past decades, there has been a pronounced increase in latent forms of syphilis, which, according to some data, account for from 16 to 28% of all cases of the disease detected per year, which can be complicated by significant epidemiological distress.

To successfully reduce the incidence of syphilis, the need for a set of measures has been established. Timely diagnostics with identification of sources and contacts is combined with active prescribing modern treatment in accordance with the characteristics of the patient's body and the originality of the symptoms of the process. Conducted by many research institutes, departments of skin and venereal diseases medical institutes work aimed at improving the methods of treatment of syphilis was repeatedly discussed at congresses and international symposia dermatovenereologists. At the same time, recommendations and instructions were developed for the use of methods and schemes that were theoretically substantiated and practically verified by many years of clinical observations, providing a full-fledged therapeutic effect.

Principles and methods of treatment. Drugs for the treatment of patients with syphilis are called antisyphilitic drugs. They are prescribed after the diagnosis is established with the obligatory confirmation of its laboratory data. It is recommended to start treatment as soon as possible early dates(with early active firms of syphilis - in the first 24 hours), since the earlier treatment is started, the more favorable the prognosis and the more effective its results.

Reducing the incidence of syphilis and its prevention is not only a medical task, but the state and society as a whole.

4. Viral hepatitis

Viral hepatitis is a group of nosological forms of diseases that differ in etiological, epidemiological and clinical nature, occurring with a predominant lesion of the liver. According to their medical and socio-economic characteristics, they are among the ten most common infectious diseases of the population of modern Russia.

Currently, the following are subject to official registration in accordance with Form No. 2 of the Federal State Statistical Observation in accordance with ICD-X:

Acute viral hepatitis, including acute hepatitis A, acute hepatitis B and acute hepatitis C;

Chronic viral hepatitis (for the first time established), including chronic hepatitis B and chronic hepatitis C;

Carriage of the causative agent of viral hepatitis B;

Carriage of the causative agent of viral hepatitis C

The last five years have been marked by a significant increase in the prevalence of all nosological forms of viral hepatitis, which is associated both with the next cyclic rise and with a wide range of social conditions of the population that contribute to the implementation of infection transmission routes. In 2000, compared with 1998, the incidence of hepatitis A increased by 40.7%, hepatitis B - by 15.6% and hepatitis C by 45.1%. The rates of latent parenteral hepatitis B also increased by 4.1% and hepatitis C by 20.6%. Started only in 1999, the official registration of newly diagnosed cases of chronic viral hepatitis (B and C) revealed that the figure for the year increased by 38.9%. As a result, in 2000, 183,000 cases of acute viral hepatitis were detected and registered by the country's medical institutions (including: A - 84, B - 62, C - 31, others - 6 thousand cases); 296 thousand cases of carriage of the causative agent of viral hepatitis B and C (140 and 156 thousand cases, respectively); 56 thousand cases of newly diagnosed chronic viral hepatitis B and C (21 and 32 thousand cases, respectively).

Thus, the number of all cases of viral hepatitis in 2000 exceeded 500 thousand, including the number of acute cases of hepatitis (A, B, C), occurring in manifest and latent form - 479 thousand (of which B and C - 390 thousand cases). The ratio of registered manifest forms to non-manifest ones was 1:2.2 for hepatitis B and 1:5.0 for hepatitis C.

The total prevalence of all forms of hepatitis B and hepatitis C per 100,000 population is practically the same - 152.4 and 150.8. With the exclusion of the number of newly diagnosed cases of chronic viral hepatitis from the indicators, the values ​​will decrease to 138.2 and 129.6, respectively. As for the prevalence of hepatitis A, it is more than 3 times less than each of the considered parenteral hepatitis.

Differences in the frequency and proportion of morbidity in children with various forms viral hepatitis, which are reduced to a significant spread of hepatitis A in children. Among parenteral hepatitis, children are 2 times more likely to suffer from hepatitis B than hepatitis C (both acute and chronic forms).

Assessing the significance of hepatitis for public health, let us also present mortality statistics: in 2000, 377 people died from viral hepatitis in Russia, including hepatitis A - 4, acute hepatitis B - 170, acute hepatitis C - 15 and chronic viral hepatitis 188 people (mortality was 0.005%, 0.27%, 0.04% and 0.33%, respectively).

The analysis of official statistical information outlined the social, medical and demographic contours of the problem of viral hepatitis. At the same time, it is of no small importance to characterize the economic parameters of these infections, which allows using numbers to judge the damage caused to the economy, and ultimately make the only right choice about the strategy and tactics of dealing with them.

Comparison of economic losses associated with one case of hepatitis of various etiologies indicates that the greatest damage is caused by hepatitis B and C, which is associated both with the duration of the course (treatment) of these diseases, and with the possibility of chronicity of the process.

The given values ​​of damage (for 1 case), calculated for the Russian Federation, can be used to determine the total economic losses both for the country as a whole and for its individual regions. In the latter case, the size of the error in the obtained significance values ​​will mainly depend on how much the basic parameters of damage per 1 case of the disease differ (the ratio of sick children and adults, the duration of inpatient treatment, the cost of a hospital day, the wages of workers, etc.) in the region and in average for the country.

The greatest economic losses from morbidity in 2000 are associated with hepatitis B - 2.3 billion rubles. Somewhat less damage from hepatitis C - 1.6 billion rubles. and even less from hepatitis A - 1.2 billion rubles.

In 2000, the economic damage from all viral hepatitis in the country exceeded 5 billion rubles, which in the structure of the total damage from the most common infectious diseases (25 nosological forms without influenza and SARS) was 63% (Fig. 2). These data make it possible to characterize viral hepatitis not only in general, but also to compare the economic significance of individual nosological forms.

Thus, the results of the analysis of the incidence and economic parameters of viral hepatitis allow us to consider these diseases as one of the most priority problems of infectious pathology in modern Russia.

5. Anthrax

Anthrax is an acute infectious zoonotic disease caused by Bacillus anthracis and occurs mainly in the form of a cutaneous form, inhalation and gastrointestinal forms are less common.

From 2000 to 20000 cases of anthrax are registered annually in the world. This infection acquired particular relevance after the use of Bacillus anthracis spores as a bacteriological weapon in the USA in the fall of 2001.

Bacillus anthracis belongs to the family Bacilaceae and is a Gram-positive, non-motile, spore-forming and capsule-like bacillus that grows well on simple nutrient media; vegetative forms quickly die under anaerobic conditions, when heated, and under the action of disinfectants. Spores are highly resistant to environmental factors. The main reservoir for the pathogen is the soil. The source of infection is cattle, sheep, goats, pigs, camels. The entry gates are skin lesions, Airways, gastrointestinal tract, which determines the development of one of the three above-mentioned forms, each of which can turn into a septic one.

The main point of pathogenesis is the reproduction of the pathogen, accompanied by the production of toxins. B.anthracis produces at least 3 pathogenicity factors that determine its high virulence: edematous factor (EF), lethal factor (LF) and protective antigen (PA), which forms a polypeptide capsule. The incubation period for anthrax depends on the route of transmission of the infection, the infectious dose of the pathogen and ranges from 1 to 6-7 days (usually 2-3 days). However, sometimes with the inhalation route of entry of the pathogen into the body incubation period may be extended up to 8 weeks.

There are skin, inhalation (pulmonary) and gastrointestinal (intestinal) forms of anthrax. Approximately 95% of all sporadic cases of anthrax are cutaneous and only 5% are inhaled. Gastrointestinal (intestinal) anthrax occurs in developing countries. Currently, it is recorded extremely rarely: about 1% of cases.

There are the following clinical varieties skin form: anthrax carbuncle, edematous, bullous and erysipeloid. Anthrax carbuncle is more common than others. Approximately 80% of cases of cutaneous anthrax occur as a self-limiting localized infection, which ends in recovery after a few weeks, even if untreated. A typical symptom is a decrease or complete absence sensitivity in the area of ​​the ulcer. Most often, the ulcer has a rounded shape ranging in size from 1 to 3 cm in diameter and a characteristic black color. Other skin forms are rare.

Inhalation form: in the prodromal period, lasting 1-3 days, there is a clinical picture of a moderately severe flu-like syndrome. In the second clinical phase of the disease, signs of pneumonia and exudative pleurisy are revealed. With further progression of the disease, a picture of acute respiratory distress syndrome (RDS) and septic shock is formed, leading to death within a short period (from several hours to 2 days).

The gastrointestinal form of anthrax is characterized by signs acute inflammation upper and/or lower gastrointestinal tract. There are two typical variants of the gastrointestinal form - intestinal and oropharyngeal. Clinical picture intestinal variant of the gastrointestinal form of anthrax is represented by nonspecific symptoms of inflammation small intestine and to a greater extent thick - nausea, vomiting, anorexia and fever. Gradually, they are joined by pain in the abdomen of various localization, vomiting with an admixture of blood, bloody diarrhea. In the oropharyngeal variant of the gastrointestinal form of anthrax, edema and tissue necrosis develop in the neck.

Natural strains of B. anthracis, including strains isolated in the US in the fall of 2001, are sensitive to many antibiotics, including penicillin, amoxicillin, doxycycline, tetracycline, clarithromycin, clindamycin, rifampicin, vancomycin, chloramphenicol, and ciprofloxacin. Measures aimed at prevention are vaccination and emergency chemoprophylaxis. Currently, live attenuated and inactivated adsorbed anthrax vaccines are used to vaccinate people against anthrax. In recent years, research has begun on the creation of new genetically engineered vaccines based on the recombinant lethal toxin B.anthracis. Preventive antibiotic therapy (emergency chemoprophylaxis) aims to prevent the development of inhaled anthrax, which is the most common form of the disease when B.anthracis is used as biological weapons. According to CDC recommendations, the same drugs are used for preventive therapy as in the treatment of inhaled anthrax in conditions of mass influx of the affected. The simultaneous use of antibiotics and anthrax emergency vaccine is considered to be the most preferable and has been shown to be effective in animal experiments.

The use of anthrax spores as a biological weapon is due to the ease of obtaining, the possibility of covert use, and high efficiency. The most likely mode of application is by spraying an aerosol containing spores, which will lead to a predominance of pulmonary form disease with high mortality. WHO experts calculated that 3 days after the application of 50 kg of anthrax spores over a two-kilometer zone in the direction of the wind towards a city with a population of 500,000 people, 125,000 (25%) residents will be affected and 95,000 deaths. In connection with the increased incidence of terrorist attacks, the presence of the anthrax agent in service with at least 5 countries, the possibility of breeding strains resistant to antibacterial drugs, issues of prevention and treatment of anthrax are of particular relevance.

6. Malaria

The malaria situation in the world is not improving, and has worsened in a number of regions. Malaria continues to be one of the most serious public health problems in many regions of the world. More than 2 billion people live in 100 tropical and subtropical countries where the risk of infection is high. About 110 million people fall ill with malaria every year in the world, and 1 to 2 million people, mostly children under 5 years of age, die from malaria every year in these countries. In those states on whose territory it was previously eliminated, the number of "imported" cases of malaria and secondary cases from imported ones is increasing, and lethal outcomes of tropical malaria continue to be noted.

In the first half of the 20th century, malaria was the most serious tropical disease. In the 1950s, WHO launched the Global Malaria Eradication Programme. As a result of extensive antimalarial measures, the disease was eliminated in a number of areas, in others it was brought under control. However, even now malaria - the most widespread tropical disease in the world - is one of the most serious health problems for almost 100 countries in Asia, Africa and South America.

More than 2 billion people, or about half of the world's population, live at risk of contracting malaria. Every year, 110 million people fall ill in the world, of which 90 million - in Africa, in areas located south of the Sahara, where tropical malaria, the most severe form of infection, prevails. According to the WHO, between 1 and 2 million people die of malaria each year, mostly children under the age of 5. In general, the malaria situation in the world is not improving, and in a number of places it has worsened over the past 10 years. In many areas of the world where wars are taking place, in zones of social conflicts or mass concentrations of refugees, in areas of intensive economic development, the situation has dramatically worsened due to irrigation. The disease, largely defeated in the 1950s, has returned, and millions of people are suffering and dying.

Malaria endemic countries:

Asia and Oceania

Azerbaijan, Afghanistan, Bangladesh, Bhutan, Vanuatu, Vietnam, India, Indonesia, Iran, Iraq, Yemen, Cambodia, China, Laos, Malaysia, Myanmar, Nepal, UAE, Oman, Pakistan, Papua New Guinea, Saudi Arabia, Solomon Islands, Syria, Tajikistan, Thailand, Philippines, Sri Lanka

Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Djibouti, Egypt, Zaire, Zambia, Zimbabwe, Cameroon, Capo Verde, Kenya, Congo, Côte d" Ivoire, Comoros, Liberia, Mauritius, Mauritania, Madagascar, Malawi, Mali, Morocco, Mozambique, Namibia, Niger, Nigeria, Sao Tome and Principe, Swaziland, Senegal, Somalia, Sudan, Sierra Leone, Tanzania, Togo, Uganda , CAR, Chad, Equatorial Guinea, Ethiopia + Eritrea, South Africa

Central and South America

Argentina, Belize, Bolivia, Brazil, Venezuela, Haiti, Guyana, Guatemala, French Guiana, Honduras, Dominican Republic, Colombia, Costa Rica, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Suriname, Ecuador.

Approximately 9,000 imported cases of malaria per year are registered in Europe and North America among people who have returned from regions where it is common. Travelers to malaria-endemic countries are often unaware of the causes of malaria and ways to prevent it. One study found that only 30% of travelers from Europe knew that malaria was transmitted by the bites of mosquitoes that were active at dusk and dawn.

The danger also lies in the fact that in those countries where malaria is absent, doctors may not recognize its symptoms, do not conduct an examination and prescribe specific chemotherapy, and this in some cases, under the appropriate epidemiological situation, can contribute to the spread of malaria, and in tropical malaria creates threat to the life of the patient.

In the former Soviet Union, malaria has been virtually eradicated, with only isolated outbreaks remaining in the southern republics. However, now it has become active again in Tajikistan and Azerbaijan. In areas where refugees move across borders, malaria spreads particularly rapidly. In particular, it is extremely difficult to carry out malaria control activities with the movement of refugees from Afghanistan and Tajikistan. Every year, hundreds of cases of "imported" malaria are registered in Russia, including in Moscow, while in some cases of tropical malaria, due to late diagnosis and / or incorrect diagnosis, deaths were noted

7. Helminthiases

In addition to serious violations of the immune system, helminthiasis is especially dangerous for the body with its toxic and mechanical effects. The toxic effect is manifested in a decrease in appetite, a weakening of the absorption of nutrients in the intestines, growth retardation and a lag in mental and physical development. These phenomena are due to a decrease in the production of insulin-like growth factor (IGF-1) and an increase in the production of tumor necrosis factor-a (TNT-a), as well as a decrease in collagen synthesis. In addition, helminths are dangerous and their ability to induce life-threatening complications, such as blockage of the ducts of the pancreatobiliary system, abscesses of the liver and pancreas, intestinal perforation with the development of peritonitis, obstructive intestinal obstruction and etc.

So, timely diagnosis and adequate treatment are extremely important, especially in childhood.

The main indications for examination for helminthiases:

Stomach ache;

Frequent nausea, vomiting, change in appetite;

Diseases of the gastrointestinal tract;

Fatigue, irritability, disturbances in the process of sleep, grinding teeth in a dream (bruxism);

allergic conditions;

Perianal itching;

Vulvovaginitis;

Urinary tract infections;

Elevated levels of eosinophils in the blood;

lag in growth, weight;

Poor culture of personal hygiene of the patient.

It should also be noted here that such clinical and laboratory data are not characteristic only of helminthiases.

When it comes to helminthic invasions, it is necessary to pay attention not only to the features of treatment, but also to the mandatory implementation of preventive measures. It is necessary to draw the attention of the patient and the parent to recommendations for personal hygiene. Thoroughly wash greens, vegetables and fruits. Take thermally carefully processed fish and meat. Do not drink raw water from open reservoirs, and if contamination is suspected, boil the water. Deworming of pets (dog, cat) is mandatory. In case of infection of one person, it is recommended to treat all family members on the basis of a doctor's consultation.

Growing up, the baby begins to actively explore the world around him not only with the organs of perception - vision, hearing, smell, taste sensitivity, but also by expanding his motor activity. The older the child, the more places he happens to be, the more likely it is to be infected with helminths (colloquially, worms). At the age of 1.5-3 years, the scale of infection of children with helminths can reach 80%.

Conclusion

According to the Ministry of Health, the epidemiological situation in Russia is becoming increasingly tense. Economic and social instability in society entails an inexorable increase in the number of diseases that are called socially significant.

Epidemiological observations forced the Ministry of Health and the Government of the Russian Federation to think about compiling a list of socially significant diseases. Within the framework of the federal target program "Prevention and control of diseases of a social nature (2002-2006)", financed from the federal budget, intensive work is being carried out to stabilize the epidemiological situation in the country. The program includes improving measures to provide medical care, implementing preventive measures among the population, developing a system of dynamic control over socially significant diseases, and supporting regional medical and social services working in line with this problem. However, one of the most important federal program to combat socially significant diseases is to increase the level of knowledge about the existing epidemiological situation.

A society that has a significant amount of information about these diseases, about preventive measures and effective ways treatment can be of great help in the fight against socially significant diseases.

List of used literature

1. Khomenko A.G. Fundamentals of diagnosis of tuberculosis // Rossiyskiy med. magazine. - 2005. - No. 1. - S. 21-5.

3.. Guidelines for the epidemiological surveillance of malaria in the USSR (Ed. V.P. Sergiev). M., 2000; part 1, 264 pages; part 2, 135c.

4. Global epidemiology. B.L. Cherkassky, 2008, p.31-50

5. Slow infections. E.S. Belozerov, Yu.I. Bulankov, E.A. Ioanidi, 2009, p. 21-30.

6. infectious diseases. Shuvalova E.P., 2005, pp. 253-258.

7. Sexually transmitted infections. Skripkin Yu.K., Selisskiy G.D., Sharapova G.Ya. 2001, p. 57-65.

Socially Significant Diseases are caused mainly by socio-economic conditions, cause damage to society and require social protection of a person.

The social health of the individual is associated with the environment around him. Interacting with the living space, a person is included in its structure, spatial arrangement, which, in turn, forms the social health of a person. Since a person is always in the living space, stereotypical patterns of behavior arise and are revealed, increasing the risk of such diseases. Despite the fact that both the structural and content content of the living space changes with age, behavior patterns change, the level of awareness on various aspects of life, the characteristics of the living environment often determine the activity of the subject, regardless of mental and social development.

The state of health of the population is a clear and objective evidence of the level of civilization of the state. It is of great socio-economic importance - as a criterion for a person's ability to adapt to environmental conditions. The changed picture of the increase in the general level of morbidity is in close causal relationship with shifts in demographic processes, which in economically developed countries are characterized by a trend towards a decrease in the birth rate, relative stabilization of the levels of general and infant mortality, and a high average life expectancy.

Of particular importance in clinical medicine acquired problems of distribution among the population of the country coronary disease heart disease (including myocardial infarction), hypertension and vascular lesions of the brain, which on average account for more than 80% of all deaths from cardiovascular diseases. The incidence of cerebrovascular disorders (cerebrovascular diseases, including stroke) due to arterial hypertension is 5776 cases per 100 thousand of the population, and mortality from cerebrovascular disorders (cerebrovascular diseases, including stroke) due to arterial hypertension is 325 cases per 100 thousand of the population. Factors that increase the risk of their occurrence (nervous tension, lack of physical activity, malnutrition, alcohol and tobacco abuse) indicate the social conditioning of the causes of these diseases.

One of the most acute problems of clinical and social medicine is malignant neoplasms. Mortality from them in most economically developed countries (USA, Japan, Germany, etc.) has increased over the past 70 years by 2-3 times. About 5 million people die of cancer every year in the world. The proportion of patients with visual localizations of malignant neoplasms detected at stages I and II of the disease in the total number of patients with visual localizations of the tumor is 67.6 percent, the proportion of deaths from malignant neoplasms within a year from the date of diagnosis in the number of patients first registered in the previous year - 31.6 percent, mortality from malignant neoplasms per 100 thousand of the population is 233.1 cases for men, 170.3 cases for women.

In economically developed countries, especially dangerous epidemic diseases have been eliminated, and the incidence of childhood infections has decreased. At the same time, the fight against tuberculosis, influenza, viral hepatitis, AIDS and other viral diseases remains a very pressing issue. It is with these diseases that the high level of morbidity of the population and causing enormous damage to the health of citizens and the economy of the state are associated.

The incidence of tuberculosis in correctional facilities of the Federal Penitentiary Service is currently 1515 cases per 100 thousand people, mortality - 153.4 cases per 100 thousand people, the proportion of cases of cessation of bacterial excretion - 73.5 percent, mortality from tuberculosis - 22.6 cases per 100 thousand population.

The number of newly registered cases of HIV infection reached 37.7 thousand cases, in correctional institutions of the Federal Penitentiary Service - 2 thousand cases, the proportion of HIV-infected pregnant women included in the program for the prevention of HIV infection in newborns was 75 percent.

The incidence of syphilis is 72 cases per 100 thousand of the population, in correctional institutions of the Federal Penitentiary Service - 176.6 cases per 100 thousand people, the incidence of syphilis in children is 21.2 cases, gonorrhea - 23.4 cases per 100 thousand of the child population . At the same time, the share of specialized medical institutions that monitor the variability of sexually transmitted infections in the total number of dermatovenerological institutions is 15 percent. The total number of specialized centers for the prevention and treatment of sexually transmitted infections for adolescents does not exceed 12 in the whole country.

The incidence of acute viral hepatitis B and C is currently 8.6 and 4.5 cases per 100 thousand of the population, respectively, chronic viral hepatitis B and C - 51.4 cases per 100 thousand of the population.

An important problem of our time is the growing number of neuropsychiatric disorders, which in a number of countries are called the number one problem. In the USA, Germany and other economically developed countries, on average, at least 10% of the population suffer from various neuropsychiatric disorders. Among them, the first place is occupied by alcoholism and drug addiction. The proportion of patients covered by brigade forms of psychiatric care in the total number of observed patients is 5 percent, the proportion of patients in need of inpatient psychiatric care in the total number of observed patients is 16 percent. Wherein average duration treatment of a patient in a psychiatric hospital is 75.6 days, and the proportion of repeated hospitalizations in a psychiatric hospital during the year is 20 percent.

The proportion of complications in diabetes mellitus is currently 35 percent. Limb amputations were performed in 1 percent of patients. In total, for the first time during the year, 38.6 thousand people were recognized as disabled due to diabetes.

Also, one of the most pressing issues of modern society is the problem of combating injuries.

Of particular social importance is the problem of protecting and improving the environment, pollution of which adversely affects human health and can cause genetic damage to the body.

There is a general aging of the population, i.e. an increase in the proportion of people aged 60 and over in society (in the above countries - up to 20%). The problem of demographic aging of the population affects the entire society and has become particularly relevant in the late 20th and early 21st centuries.

Significant efforts of the entire human community are required to maintain the life of the elderly and old people at the proper level in the face of socio-economic upheavals and the deteriorating environmental situation.

Fast growth The relative size of the elderly population in most countries of the world makes the traditional attitude to the problem of aging unusable. Active old age is necessary not only for the person himself, but is also useful for society as a whole, since it allows the fuller use of the production experience of older generations and contributes to a more favorable moral and ethical climate for each individual nation and humanity.

The degree of their participation in the productive and socially useful life of the country depends on the preservation of their personal health by older people. This circumstance makes the issues of widespread introduction of preventive and health-improving measures at earlier stages of aging particularly relevant. There is a need to develop new forms and methods of medical and social services for the population.

Thus, socially significant diseases include those that a) arise and develop as a result of unsatisfactory social and living conditions for people (tuberculosis, alcoholism, drug addiction, beriberi, malnutrition diseases, some occupational diseases, gastrointestinal infectious diseases, etc.). ), b) are widespread and are the main cause of death of the population (cardiovascular and oncological diseases, injuries, infectious diseases, etc.), c) pose a danger to others (sexually transmitted diseases, acute mental disorders, etc.).

Prevention of the spread of socially significant diseases

Diseases of this group pose a significant threat to public health, cause enormous damage to society, associated with the loss of temporary and permanent disability, the need for huge costs for prevention, treatment and rehabilitation, premature mortality, and crime.
Statistics show that socially significant diseases are widespread among teenagers. Young people are the most vulnerable group of the population, which is quickly involved in the epidemic process. The reasons for the growth of socially significant diseases among adolescents are social maladaptation, low level of hygiene knowledge, environmental conditions and early onset of sexual activity.
The solution to the problem of the spread of socially significant diseases among adolescents is associated with the organization primary prevention in educational institutions. The essence of preventive work is to expand the views of adolescent schoolchildren in this area, the formation of health-saving behavior strategies in risk situations associated with the possibility of infection, the onset of the disease.

What is meant by socially significant diseases? An elementary analysis of the phrase "socially significant" shows that the diseases of this group have great importance society, pose a threat to a large number of people.

The main features included in the concept of a socially significant disease are:

the mass nature of the disease, that is, a high percentage of the spread of the disease among the population, including the presence of a significant percentage of "hidden" patients in society, high rates of annual increase in the number of patients, diseases of this group have the peculiarity of spreading quite quickly, limiting the full functioning of the patient in society in the presence of such a disease, the risk of disease to others, infectious and non-infectious.

In addition, diseases belonging to this category not only destroy the health and body of a person, but also have negative social consequences: the loss of family, friends, work, livelihood and etc.

A characteristic feature of such diseases is that they take away the bulk of the lives of young people, people of working age. An important feature socially significant diseases is that if you know how not to get sick and follow certain rules, then the disease can be prevented or stopped at an early stage of the disease.
The situation with the spread of diseases of this group has become so acute that it causes concern at the level of the government of the Russian Federation. Epidemiological observations served as the basis for compiling list of socially significant diseases . In accordance with Article No. 41 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, the Government of the Russian Federation approved a list of diseases classified as socially significant. This list includes: a disease caused by the human immunodeficiency virus (HIV), tuberculosis, hepatitis, sexually transmitted infections, diabetes mellitus, malignant neoplasms, mental and behavioral disorders, diseases characterized by high blood pressure.
According to statistics, society shifts responsibility for health onto the shoulders of the state, medicine, schools, anyone but themselves. On the part of health care, certain preventive measures are being taken, but their volume and effectiveness directly depend on the desire of the population to live in a society that is healthy both in body and soul.
So, socially significant diseases are a group of diseases that pose a threat to modern society. Today, the situation with the spread of socially significant diseases is very serious, requiring the consolidation of many structures, not only state, medical, pedagogical, but also voluntary.