[The sanitary and epidemiological assessment of the risk from economic and other activities that are a potential public hazard].
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Biomedical subjects
Publications and source records attributed to N N Filatov.
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The Government of Moscow allocates substantial funds for the development of a sociohygienic monitoring (SGM) system and for the guidance of the population's health status monitoring in relation to environmental factors. The risk-assessing studies made jointly with the investigators of the A. N. Sysin Research Institute of Human Ecology and Environmental Hygiene, Russian Academy of Medical Sciences, make it possible to determine priorities in risk control and to introduce new technologies for controlling the public health associated with the influence of social and environmental factors.
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The paper deals with the results of the comparative immunological survey of three groups: group I (450 persons), a special unit "Quarantine" undergoing training for hostilities in Afghanistan; group II (800 persons), an armored regiment assigned for home service; and group III (578 persons), students of a vocational technical school. Among the members of all three groups disturbances in the systems of humoral and local immunity were detected, but the number of immunodeficiency cases in group I considerably exceeded that in groups II and III, which correlated with considerably greater morbidity figures registered in group I. On the basis of these data immunological risk groups were formed and immunocorrective measures were recommended.
Conditions for the desorption of immunoglobulins from the surface of blood cells of animals used for the production of antitoxic therapeutic and diagnostic sera have been established. The possibility of obtaining, in principle, additional amounts of immunoglobulins and specific antibodies (in comparison with their initial content in sera) without increasing the number of producer animals has been demonstrated. The possibility of using desorbed immunoglobulins and specific antibodies in the production of therapeutic and diagnostic immunobiological preparations is discussed.
The average morbidity level in scarlet fever for the period of 1972-1990 in Moscow was 230.9 cases per 100,000 of the population and the annual economic damage was 2-2.5 million rubles. The highest morbidity rate values were registered among children attending children's institutions, and in this group among children aged 3-6 years. Cohort and disperse analysis revealed that age-dependent fluctuations of morbidity rate had a regular character and significantly differed. An increase in scarlet fever morbidity was registered simultaneously with elevated levels of morbidity in tonsillitis and acute respiratory diseases and occurred several weeks after a rise in tonsillitis morbidity. Contamination with group A streptococci was higher among "organized" children of preschool age than among other groups of the population. T serovars 4/28, 8/29/Imp.19, 3/13/B3254 and 1, constituting 44% of all isolated Streptococcus pyogenes strains, and OF type 2 (44%) and 22 (20%) occurred most frequently. Among the strains isolated from patients T-4 and OF-2 types prevailed.
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The weekly dynamics of registered morbidity in the whole complex of acute respiratory viral infections (ARVI) for 1960-1994 was studied. The duration of the annual epidemic cycle of ARVI was taken to be the period from week 26 of the given year to week 25 of the following year. The dynamics of the development of the epidemic process made it possible to distinguish 7 definite stages of the epidemic cycle. The assessment of the state of morbidity at the final stages of the completed epidemic cycle and at the first stages of the following epidemic cycle permits the prediction of the level of ARVI morbidity for the whole following epidemic cycle and the determination of the adequate set of prophylactic measures.
Dynamic observation of the national team of swimmers for a period of 3 years demonstrated that physical and psychosomal loadings of competitive sport led to the suppression of local immunity, depending on the level of competitive stress. In a certain number of sportsmen the phenomenon of the complete disappearance of some classes of immunoglobulins and normal antibodies from saliva was registered. The daily rhythms of immune reactions had no influence of the regularities of fluctuations in the levels of immunoglobulins and antibodies at different periods of sporting activities when these changes were most pronounced. Still the peaks of immunoglobulin levels were registered in the morning and those of normal antibodies, in the evening after physical strain. During the period of competitions at the time of a sharp drop in the content of immunoglobulins in saliva a rise in the level of anamnestic antibodies was observed. The dynamics of immune reactions in saliva did not essentially depend on the sex of swimmers. The results of these studies are indicative of the necessity of immunoprophylactic and immunocorrective measures in the group of immunological risk.
Zooanthroponotic Salmonella infections in Moscow are characterized, on the whole, by the same epidemiological characteristics as in other areas of Russia. Despite the pronounced polyetiological character of these infections, only a few Salmonella serovars were found to dominate in their dynamics for many years. The 1970s were characterized by a growth in morbidity due to a wide spread of S.typhimurium among children of early age in hospitals. This situation was stabilized by 1985, but since 1986 a sharp rise in morbidity was observed again, reaching its peak in 1989. This time its rise was determined by S.enteritidis, whose specific etiological importance grew from 13.3% to 81.3%. The growth of these bacteria was determined by a sharp increase in the epidemic role of such transmitter factors of Salmonella infection as chicken meat, prepared chicken meat products, as well as chicken eggs and their products, including confectionery, which production appreciably increased during this period simultaneously with the presence of a high level of infection among poultry in Russia with salmonellae of this serovar. High morbidity, observed all year round, with a high proportion of adults among patients (more than 60%) is the direct consequence of the preserved still present epidemic activity of the "chicken" factor and a high virulence of S.enteritidis.
In Moscow for a long time morbidity in acute enteric infections, and in Shigella infections as their main constituent, steadily decreased. In recent years the opposite tendency was noted: a rise in morbidity. A pronounced tendency for Shigella infections, especially Flexner's dysentery, to affect older ages was observed. New risk groups, including adults busy in "shuttle" commerce and different asocial elements, appeared. The number of lethal cases considerably increased. Unusual manifestations of the epidemic process are socially determined and reflect a decrease in the living standards of the population, sharp social changes in its way of life and social instability in the country. Sporadic morbidity with low focality prevails. The so-called chronic multifactor alimentary route of infection transmission is mainly realized; its neutralization presents great objective difficulties.
The paper deals with a pressing problem: activities of centers of sanitary and epidemiological survey under new economic conditions. The authors discuss problems of centralization and adaptation of sanitary epidemiological service under present-day economic conditions. They analyze the opinions of heads of sanitary epidemiological institutions from various regions of Russia on the present-day status of organization and management of the service. Assessment of the sources of additional financing of the institutions, of new forms of labor organization of departments and specialists, of distribution of additional allotments at sanitary epidemiological institutions is presented. Suggestions on improvement of the activities of institutions engaged in sanitary epidemiological survey under conditions of reformation of sanitary epidemiological service are offered.
Validates a complex of methodological approaches to assessing the efficiency of sanitary epidemiological institutions today. Shows the specificities of such assessment for the institutions of the first-level management. Validates a demonstration model for computer processing of data on the efficiency of departments of environmental hygiene and of specialists in this field and recommends this model for regional centers of State Sanitary and Epidemiological Surveillance.
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