[L. V. Gromashevskiĭ's theory and the problem of eradicating infectious diseases].
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Biomedical subjects
Publications and source records attributed to L A Favorova.
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The work deals with the prospects of scientific research in the prophylaxis of diphtheria. The authors consider the necessity of creating the complex goal-oriented program of scientific research, such program being the basis of forward planning.
As the result of epidemiological survey of diphtherial infection, carried out in conformity with the unified methodological recommendations in 21 regions of the RSFSR during 1980-1981, the expediency of such experiment was established. Immunity to diphtheria in children aged up to 14 years was high: children with negative Schick tests constituted 96.9-99.1%. No biological changes in Corynebacterium diphtheriae occurred during the term of observation. Toxigenic C. diphtheriae showed a high level of pathogenicity. The epidemiological survey contributed to a more thorough detection of diphtheria patients and carriers releasing toxigenic C. diphtheriae. The quality of clinical bacteriological diagnosis improved. In rare cases angina with the concomitant carriership of toxigenic C. diphtheriae could be diagnosed with the indispensable serological examination of the patients by Jensen's method.
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The authors present characteristics of meningococcus infection epidemic process in case of sporadic cases and under epidemic conditions (1965--1976). A scheme of epidemiological analysis suggested by the authors permitted to differentiate and to record the incidence of various clinical forms of meningococcus infection, to present data on the age, seasonal characteristics, focality, etc. Comparison of intensive morbidity indices for 10 years, both at the individual administration territories and in the Republic as a whole demonstrated morbidity level of 1.5--2.0 to be one of prognostic signs of the beginning epidemic. The main features differentiating the sporadic and epidemic morbidity periods were revealed. The presence of group diseases, a greater percentage of children among those who fell ill, and marked signs of seasonality and territorial difference characterized the period of rise caused by meningococcus of serological group A.
Corynephage distribution was studied in the nasopharyngeal washings of 252 persons infected with C. diphtheriae of gravis type, toxigenic (21 patients and 147 carriers) and non-toxigenic ones (84 carriers), and in 468 uninfected persons in collective bodies under different epidemic conditions. Corynephages were isolated from the nasopharyngeal washings only in persons infected with toxigenic C. diphtheriae--in 4 (of 21) patients, and in 21% (of 147) carriers. Phages tox+ (4--6.2%) were revealed only in carriers of toxigenic C. diphtheriae with numerous bacteria in the nasopharynx and in diphtheria patients. Carriers of nontoxigenic diphtheria bacilli can become infected with phage tox+ only together with the toxigenic strains (reinfection). The data obtained indicated that toxigenic and nontoxigenic C. diphtheriae strains were individual variants.
The authors consider rational foundations underlying creatin of realistic models. The principal condition for the successful mathematical modelling is obtaining of the most full value primary materials on the course of the epidemic process. For this purpose the authors suggest definite principles of the methodical approach to the mathematical modelling. Possibilities of the use of mathematical methods for various groups of infections are consideder. Particular attention is paid to the works on the study of the infection risk in "small" collective bodies.
Controlled epidemiological trial was applied to the study of the use of placental gamma-globulin for prophylaxis of generalized forms of meningococcus infection in the foci (creches and kindergartens). A group of the vaccinated children (16 140) and control group (16 080) were the same age and sex. Gamma-globulin was administered in a dose of 3 ml to every other child attending creches and kindergartens not later than the 10th day after the patient's isolation. It was shown that the efficacy coefficient of gamma-globulin in the foci of meningococcus infection constituted 68% (the efficacy index was 3.2) for one month after the administration.
The authors present experimental-epidemiological data permitting to give an objective quantitative characteristics of the hazard of infection in meningococcus infection (including the carrier state and nasopharyngitis). In 70% of cases meningococcus infection occurred at a distance of less than 0.5 meters. With increase of the distance and reduction of the time of contact the risk of meningococcus infection in a collective body falls to the zero (no such phenomenon is observed in other droplet infections).
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