Organization of work in case of detection of a patient or a suspected UN in a hospital or outpatient facility. Particularly dangerous infections

Memo on the prevention of especially dangerous diseases for those traveling to exotic countries

When traveling to foreign countries, you need to know that in some of them there is a real possibility of contracting especially dangerous infectious diseases that are characterized by a severe clinical course, damage to vital organs and body systems and can lead to death.

Particularly dangerous infections are recorded mainly in the countries of Asia, Africa and South America. But in connection with the development of international and commercial tourism, cases of infection of Russian citizens with especially dangerous infectious diseases have become more frequent, which is associated with their failure to comply with mandatory preventive measures.

CHOLERA AND ITS PREVENTION

According to the World Health Organization (WHO), more than 50 countries around the world trouble for cholera. Of the countries of Southeast Asia, China and Vietnam are traditionally disadvantaged. In European countries, Japan, Korea, cases of cholera were imported from foci, where it is constantly recorded. Due to the high level of culture of the population, the spread of infection in these countries was not observed. The most disadvantaged for cholera are currently:

• on the European and Asian continents: India, Laos, Indonesia, Iran, Iraq, Turkey, Afghanistan;
• on the American continent: Bolivia, Brazil, Guatemala, Honduras, Mexico, Nicaragua, Peru, El Salvador;
• on the African continent: Angola, Burundi, Ghana, Guinea, Nigeria, Somalia, Chad, Uganda, Tanzania, Sierra Leone.
• In some CIS countries, cases of cholera are also recorded.

The causative agent of the disease- cholera vibrio, survives for a very long time in open water, resistant to low temperatures, survives on food for 2-5 days, on household items and linen - up to 2 weeks. Disinfectants, boiling, and sunlight have a detrimental effect on the pathogen.

The source of the disease is only a person (sick or carrier). The number of vibrios released into the external environment is large (each milliliter of feces and vomit contains up to 1 billion vibrios).

The pathogen enters the human body through the mouth, is released into the external environment with feces and vomit. Cholera is a typical intestinal infection, the spread of which occurs through water, food, household way. Flies are a mechanical carrier of vibrios from feces to food, household items.

Susceptibility to cholera is high. People who do not follow the basic rules for the prevention of intestinal infections, who live in unsanitary conditions, and who consume food and water of unguaranteed quality, get sick more often.

Manifestations of cholera are diverse. Different severity of the disease is possible: along with severe forms ending in death, cholera can occur as a moderate disorder of the gastrointestinal tract. Carriage of the pathogen is possible when there is no clinic, and a person releases a large number of microbes into the external environment with feces and vomit (from 10 to 100 carriers per 1 clinical form). Such people are the most dangerous in epidemiological terms, because. if the rules of personal hygiene are not observed, they can infect a large number of people.

The incubation period (from the onset of infection to the appearance of the first signs of the disease) lasts from several hours to 5 days. The disease begins acutely. The first sign of cholera is sudden diarrhea. In the next few hours from the onset of the disease, fluid loss can be several liters, which leads to a worsening of the patient's condition. Vomiting appears suddenly after diarrhea, without any tension and feeling of nausea. Soon there are strong muscle cramps, more often in the calf area. Facial features are sharpened, the skin is cold to the touch, easily gathers into folds (spreads out slowly). The voice becomes hoarse and disappears, shortness of breath appears, body temperature drops below normal .

Distinguishing cholera from other intestinal infections by clinical manifestations can be very difficult. Therefore, patients are required to conduct a bacteriological examination.

After isolation of the patient, disinfection measures are taken, the circle of contacts is determined, in respect of which a complex of anti-epidemic measures is also carried out, provided for by sanitary legislation to localize the outbreak.

PLAGUE AND ITS PREVENTION

The time that passes from the moment the plague bacillus enters the body of a healthy person until the first symptoms appear is from several hours to 6 days. Infection through items such as luggage is unlikely. Only with timely access to a doctor, the treatment of plague is successful. In order to prevent plague, it is necessary to strictly observe the restrictive measures specified for each country where there are natural foci of plague.

YELLOW FEVER AND ITS PREVENTION

Yellow fever- is an acute viral disease transmitted by mosquitoes and has a distribution in tropical and subtropical zones. Yellow fever can be contracted both in natural conditions and in the city. The incubation period from the moment of infection to the first clinical signs of the disease is from 3 to 6 days. The disease is characterized by severe toxicosis: headache, fever, hemorrhagic rash. Then there is an infection of the kidneys, liver with the development of jaundice and acute renal failure. The course of the disease is extremely severe: death occurs in 25% of cases. The World Health Organization has identified 47 countries of the South African and African continents where there are unfavorable territories and human diseases are recorded. When traveling to these countries, preventive vaccinations are required, which are the only and mandatory measure to prevent this dangerous disease. Vaccinations are carried out no later than 10 days before departure.

Immunity is maintained for 10 years. Residents of the Perm Territory are recommended to be vaccinated against yellow fever with the issuance of an International Certificate of Vaccination in the Immunoprophylaxis Room of the Professor's Clinic LLC (Perm, Druzhby St., 15 "a"), which has permission from the executive authorities in the field of health protection to carry out vaccination against yellow fever in the subjects of the Russian Federation in 2012.

Without an international certificate of vaccination against yellow fever, travel to disadvantaged countries is prohibited.

MALARIA AND ITS PREVENTION

Malaria is a serious infectious disease that is widespread in countries with a tropical and subtropical climate. Infection occurs through the bites of malarial mosquitoes. Four forms of malaria are known, of which the most severe is tropical, common in African countries. The incubation period is from 7 days to 1 month for tropical malaria and up to 3 years for other forms.

Symptoms - fever, chills, severe sweating, headache, weakness. With tropical malaria, without timely specific treatment, death is possible in a very short time from the onset of the disease.

For the purpose of prevention, it is necessary to take antimalarial drugs regularly. Taking medications should be started 1 week before leaving for the "tropics", continue the entire period of stay and 1 month after returning. The choice of the drug depends on the country of residence, the dose is determined by the doctor. During your stay in a malarial area, you must protect yourself from mosquito bites. To prevent mosquitoes from entering the premises, windows and doors must be meshed. To protect against mosquitoes, it is recommended to use repellents (repellents), electric fumigators. It is advisable to use canopies during sleep. It must be remembered that during your stay in a country that is unfavorable for malaria and within 3 years after your stay at home, with any increase in temperature, you should immediately contact a medical institution and inform the doctor that you were in the "tropics".

For personal prevention, remember the following:

• use only guaranteed safe water and drinks (boiled water, drinking water and drinks in factory packaging),
• do not consume ice and ice cream unless you are sure that they are made from safe products,
• avoid eating raw seafood,
• thoroughly wash fruits and vegetables with safe running water, scald with boiling water,
• avoid eating from stalls and in cafes and restaurants that are not certified by the state,
• eat food that has been carefully cooked and remains hot when served,
• swim only in specially designated places, do not allow water to enter your mouth,
• carefully monitor the cleanliness of hands, wash them with soap before cooking and eating, before feeding the child, after each visit to the toilet, to prevent the accumulation of dirt under the nails,
• maintain cleanliness in the apartment and common areas,
• protect food products from flies, do not leave food open, clean and wash dirty dishes immediately,
• especially carefully protect food products that are consumed without prior heat treatment from contamination, boil milk,
• at the first signs of any intestinal disorder, you should seek medical help,

if within 5 days after returning from cholera-prone countries, symptoms of the disease occur, then you should consult a doctor.

Algorithm of actions of medical staff in case of detection of a patient suspected of having OOI

If a patient suspected of having an OOI is identified, a doctor will organize work in the outbreak. Nursing staff is required to know the scheme of anti-epidemic measures and carry them out by order of the doctor and administration.

Scheme of conducting primary anti-epidemic measures.

I. Measures to isolate the patient at the place of his detection and work with him.

If a patient is suspected of having ASI, health workers do not leave the room where the patient was identified until the arrival of consultants and perform the following functions:

1. Notification of suspicion of OOI by phone or through the door (by knocking on the door to attract the attention of those outside the outbreak and verbally convey information through the door).
2. Request all packing according to the OOI (laying for the prevention of medical staff, packing for taking material for research, packing with anti-plague suits), disinfectants for yourself.
3. Prior to the receipt of styling for emergency prevention, make a mask from improvised means (gauze, cotton wool, bandages, etc.) and use it.
4. Before the laying arrives, close the windows, transoms, using improvised means (rags, sheets, etc.), close the cracks in the doors.
5. When receiving packing to prevent your own infection, carry out emergency prevention of infection, put on an anti-plague suit (for cholera, a lightweight suit - a dressing gown, an apron, possibly without them).
6. Paste windows, doors, gratings with adhesive tape (except for the focus of cholera).
7. Provide emergency assistance to the patient.
8. To carry out a sampling of material for research and prepare records and referrals for research to the bacteriological laboratory.
9. Carry out current disinfection in the room.

II. Measures to prevent the spread of infection.

Head department, the administrator, when receiving information about the possibility of detecting OOI, performs the following functions:

1. Blocks all the doors of the floor where the patient is identified, puts up posts.
2. At the same time, organizes the delivery to the room with the patient of all necessary packing, disinfectants and containers for them, medicines.
3. The reception and discharge of patients is stopped.
4. Notifies the higher administration of the measures taken and awaits further orders.
5. Lists of contact patients and medical staff are compiled (taking into account close and distant contact).
6. Explanatory work is carried out with contact patients in the outbreak about the reason for their delay.
7. Gives permission for consultants to enter the hearth, provides them with the necessary suits.

Exit from the focus is possible with the permission of the head physician of the hospital in the prescribed manner.

Rabies

Rabies is an acute disease of warm-blooded animals and humans, characterized by progressive damage to the central nervous system (encephalitis), which is fatal to humans.

The causative agent is a neurotropic virus of the Rabdoviridae family of the Lyssavirus genus. It has a bullet shape, reaches a size of 80-180 nm. The nucleocapsid of the virus is a single-stranded RNA. The exceptional affinity of the rabies virus for the central nervous system was proved by the work of Pasteur, as well as by microscopic studies by Negri and Babesh, who invariably found peculiar inclusions, the so-called Babesh-Negri bodies, in sections of the brain of people who died from rabies.

Source - domestic or wild animals (dogs, cats, foxes, wolves), birds, bats.

Epidemiology. Infection of a person with rabies occurs as a result of bites by rabid animals or when they salivate the skin and mucous membranes, if these covers have microtraumas (scratches, cracks, abrasions).

The incubation period is from 15 to 55 days, in some cases up to 1 year.

clinical picture. Conventionally, there are 3 stages:

1. Harbingers. The disease begins with an increase in temperature to 37.2–37.5 ° C and malaise, irritability, itching at the site of the animal bite.

2. Excitation. The patient is excitable, aggressive, fear of water is pronounced. At the sound of pouring water, and sometimes at its sight, convulsions can occur. Increased salivation.

3. Paralysis. The paralytic stage lasts from 10 to 24 hours. At the same time, paresis or paralysis of the lower extremities develops, paraplegia is more often observed. The patient lies motionless, muttering incoherent words. Death comes from paralysis of the motor center.

Treatment. Wash the wound (bite site) with soap, treat with iodine, apply a sterile bandage. Therapy is symptomatic. Lethality - 100%.

Disinfection. Treatment with a 2% solution of chloramine dishes, linen, care items.

Precautionary measures. Since the patient's saliva contains the rabies virus, the nurse must work in a mask and gloves.

Prevention. Timely and complete vaccinations.

Yellow fever

Yellow fever is an acute viral natural focal disease with transmissible transmission of the pathogen through a mosquito bite, characterized by a sudden onset, high biphasic fever, hemorrhagic syndrome, jaundice and hepatorenal insufficiency. The disease is common in tropical regions of America and Africa.

Etiology. The causative agent, yellow fever virus (flavivirus febricis), belongs to the genus flavivirus, family Togaviridae.

Epidemiology. There are two epidemiological types of yellow fever foci - natural, or jungle, and anthropourgical, or urban.
The reservoir of viruses in the case of the jungle form are marmoset monkeys, possibly rodents, marsupials, hedgehogs and other animals.
The carrier of viruses in natural foci of yellow fever are mosquitoes Aedes simpsoni, A. africanus in Africa and Haemagogus sperazzini and others. Human infection in natural foci occurs through the bite of an infected A. simpsoni or Haemagogus mosquito, capable of transmitting the virus 9-12 days after infecting bloodsucking.
The source of infection in urban foci of yellow fever is a sick person in the period of viremia. Virus carriers in urban outbreaks are Aedes aegypti mosquitoes.
Currently, sporadic incidence and local group outbreaks are recorded in the tropical forest zone in Africa (Zaire, Congo, Sudan, Somalia, Kenya, etc.), South and Central America.

Pathogenesis. The inoculated yellow fever virus hematogenously reaches the cells of the macrophage system, replicates in them for 3-6, less often 9-10 days, then re-enters the blood, causing viremia and clinical manifestation of the infectious process. Hematogenous dissemination of the virus ensures its introduction into the cells of the liver, kidneys, spleen, bone marrow and other organs, where pronounced dystrophic, necrobiotic and inflammatory changes develop. The most characteristic are the occurrence of foci of colliquation and coagulation necrosis in the mesolobular sections of the hepatic lobule, the formation of Councilmen's bodies, the development of fatty and protein degeneration of hepatocytes. As a result of these injuries, cytolysis syndromes develop with an increase in ALT activity and a predominance of AST activity, cholestasis with severe hyperbilirubinemia.
Along with liver damage, yellow fever is characterized by the development of cloudy swelling and fatty degeneration in the epithelium of the tubules of the kidneys, the appearance of areas of necrosis, which cause the progression of acute renal failure.
With a favorable course of the disease, stable immunity is formed.

clinical picture. During the course of the disease, 5 periods are distinguished. The incubation period lasts 3-6 days, rarely extended to 9-10 days.
The initial period (phase of hyperemia) lasts for 3-4 days and is characterized by a sudden increase in body temperature to 39-41 ° C, severe chills, intense headache and diffuse myalgia. As a rule, patients complain of severe pain in the lumbar region, they have nausea and repeated vomiting. From the first days of the disease, most patients experience pronounced hyperemia and puffiness of the face, neck and upper chest. The vessels of the sclera and conjunctiva are brightly hyperemic (“rabbit eyes”), photophobia, lacrimation are noted. Often you can observe prostration, delirium, psychomotor agitation. The pulse is usually rapid, and bradycardia and hypotension develop in the following days. Preservation of tachycardia may indicate an unfavorable course of the disease. Many also have an enlarged liver, and at the end of the initial phase one can notice icterus of the sclera and skin, the presence of petechiae or ecchymosis.
The phase of hyperemia is replaced by a short-term (from several hours to 1-1.5 days) remission with some subjective improvement. In some cases, recovery occurs later, but more often a period of venous stasis follows.
The patient's condition during this period noticeably worsens. The temperature rises again to a higher level, jaundice increases. The skin is pale, in severe cases cyanotic. A widespread hemorrhagic rash appears on the skin of the trunk and extremities in the form of petechiae, purpura, and ecchymosis. Significant gum bleeding, repeated vomiting with blood, melena, nasal and uterine bleeding are observed. In severe cases, shock develops. The pulse is usually rare, weak filling, blood pressure is steadily decreasing; develop oliguria or anuria, accompanied by. Often there is toxic encephalitis.
The death of patients occurs as a result of shock, liver and kidney failure on the 7-9th day of illness.
The duration of the described periods of infection averages 8-9 days, after which the disease enters the convalescence phase with slow pathological changes.
Among local residents of endemic areas, yellow fever can be mild or without jaundice and hemorrhagic syndrome, which makes it difficult to identify patients in a timely manner.

Forecast. Currently, the mortality rate from yellow fever is approaching 5%.
Diagnostics. Recognition of the disease is based on the identification of a characteristic clinical symptom complex in individuals belonging to the high-risk category of infection (unvaccinated people who visited the jungle foci of yellow fever for 1 week before the onset of the disease).

The diagnosis of yellow fever is confirmed by the isolation of the virus from the patient's blood (in the initial period of the disease) or to it (RSK, NRIF, RTPGA) in the later periods of the disease.

Treatment. Yellow fever patients are hospitalized in mosquito-proof hospitals; prevent parenteral infection.
Therapeutic measures include a complex of anti-shock and detoxification agents, correction of hemostasis. In cases of progression of hepatic-renal failure with severe azotemia, hemodialysis or peritoneal dialysis is performed.

Prevention. Specific prophylaxis in the foci of infection is carried out with live attenuated 17 D and less often with the Dakar vaccine. Vaccine 17 D is administered subcutaneously at a dilution of 1:10, 0.5 ml. Immunity develops in 7-10 days and lasts for 6 years. Vaccination is registered in international certificates. Unvaccinated individuals from endemic areas are quarantined for 9 days.

Especially dangerous infections include: plague, cholera, yellow fever and other viral hemorrhagic fevers. Common to these diseases is that they all proceed extremely hard, with late treatment often end in death, quickly and widely spread.

Cholera- a particularly dangerous infectious disease characterized by loss of fluid, salts, vomiting and diarrhea. The largest number of cases is recorded in the following regions of the world: Africa, Asia (India, Vietnam, Iraq, Iran, Nepal), South America.

Signs of the disease. Characterized by a sudden onset, profuse diarrhea, vomiting, body temperature is usually normal or slightly lowered. Dehydration of the body develops rapidly, which is the cause of death.

Prevention:

• do not drink raw water (use bottled, boiled water);
• do not eat thermally processed seafood;
• do not use raw water for oral hygiene procedures;
• scald fruits and vegetables with boiling water;
• do not swallow water when swimming in open water;
• carefully follow the rules of personal hygiene;
• do not drink draft drinks on the streets;
• do not try fruits and vegetables in the markets;
• at the first symptoms of the disease, consult a doctor.

Morbidity is recorded in people in countries: Asia (Vietnam, Tibet), America (USA, Ecuador, Bolivia, Brazil, Peru), Africa (Congo, Madagascar, Tanzania, Mozambique, Uganda). Natural foci are registered in the territories of states adjacent to Russia - Kazakhstan, Mongolia, China.

Signs of the disease. It begins acutely with chills and a sharp increase in body temperature up to 39-40 ° C, severe headaches, sometimes vomiting, later reddening of the face and conjunctiva, muscle pains, a rash may appear on the skin, lymph nodes increase.

Prevention:

• avoid contact with rodents and animals;
• in cases of the appearance of the slightest, even unclear, symptoms of the disease, after being bitten by fleas in the territory of the natural focus of the plague, you should immediately seek help from a health worker.

Yellow fever- acute especially dangerous natural focal viral infection.

Registered in countries: Africa (Ganna, Guinea, Cameroon, Angola, Congo, Liberia, Nigeria, Sudan), America (Bolivia, Brazil, Venezuela, Peru, Ecuador).

Signs of the disease. The disease begins acutely with an increase in body temperature to 39-40 ° C, after 3-4 days jaundice, nosebleeds, bleeding gums join.

Prevention:

• use mosquito repellents;
• the most reliable protection is preventive vaccinations, which are done at least 10 days before traveling to endemic countries. Vaccinations are organized in an organized manner at the vaccination center in Moscow, st. Neglinnaya, 14, polyclinic No. 13, tel: 8-495-621-94-65.

Viral hemorrhagic fevers - VHF (Lassa, Ebola, Marburg, etc.).

VGL- a group of acute contagious especially dangerous infections.

Registered: Africa (Sudan, Zaire, Guinea, Congo), America (Argentina, Bolivia), Crimea.

Signs of the disease. The disease always begins with a severe fever with fever up to 40 ° C, headache, muscle pain, later hemorrhages appear on the skin and mucous membranes, bleeding.

Prevention:

• beware of mosquito bites, mosquitoes, use protective creams, aerosols;
• exclude contact with monkeys, rodents;
• do not take pictures with exotic animals;
• use strictly individual personal hygiene products.

HIV infection.

Infection of Russian citizens with HIV infection occurs annually when traveling to foreign countries on business and tourist trips, mainly through sexual contact. It should be remembered that HIV infection can also be transmitted through blood and blood products. It is especially important to know this for tourists traveling to countries where a system for checking donor blood has not yet been established and there is a danger of using non-sterile instruments.

The virus is unstable in the external environment, it is not transmitted through household contacts, as well as through insects and animals.

Having become infected with the immunodeficiency virus, a person becomes a carrier of HIV infection and, remaining quite healthy for a long time, can infect sexual partners.

When traveling to foreign countries, all tourists need to remember that the most reliable way to avoid sexual infection is to abstain from questionable sexual contacts. A fairly reliable means of preventing infection is a condom.

To prevent infection through the blood, it is necessary to take care of the supply of disposable syringes. Infection with the virus is determined by a special blood test. If you have had HIV risk behavior, contact your doctor for advice.

Remember! The success of the prevention and treatment of the most dangerous infectious diseases for health depends on your interest in maintaining your health and the completeness of the implementation of these recommendations.

E.A. Chinkova - Deputy Head of the Health Department

Especially dangerous infections (SDI)- highly contagious diseases that appear suddenly and spread rapidly, covering a large mass of the population in the shortest possible time. AIOs occur with a severe clinic and are characterized by a high percentage of mortality.

At the moment, the concept of "especially dangerous infections" refers to infectious diseases that pose an extreme danger to health on an international scale. The list of especially dangerous infections of the World Health Organization currently includes more than 100 diseases. The list of quarantine infections has been determined.

List of quarantine infections

1. polio
2. plague (pulmonary form)
3. cholera
4. smallpox
5. yellow fever
6. ebola and marburg
7. influenza (new subtype)
8. acute respiratory syndrome (SARS) or Sars.

List of especially dangerous infections subject to international surveillance

1. typhus and relapsing fever
2. influenza (new subtypes)
3. polio
4. malaria
5. cholera
6. plague (pulmonary form)
7. yellow and hemorrhagic fevers (Lassa, Marburg, Ebola, West Nile).

Plague

Plague- an acute infectious disease belonging to the group of zoonoses. source of infection are rodents (rats, ground squirrels, gerbils, etc.) and a sick person. The disease proceeds in the forms of bubonic, septic (rare) and pulmonary. The most dangerous form of pneumonic plague. The causative agent of infection is a plague bacillus, stable in the external environment, well tolerated by low temperatures.

There are two types of natural foci of plague: foci of "wild", or steppe, plague and foci of rat, urban or port, plague.

Transmission routes plagues are associated with the presence of insects (fleas, etc.) - transmissible. With the pneumonic form of plague, the infection is transmitted by airborne droplets (by inhalation of droplets of sputum of a sick person containing the plague pathogen).

plague symptoms appear suddenly three days after infection, while there is a strong intoxication of the whole organism. Against the background of severe chills, the temperature quickly rises to 38-39 ° C, there is a severe headache, flushing of the face, the tongue is covered with a white coating. In more severe cases, delusions of a hallucinatory order develop, cyanosis and sharpness of facial features with the appearance of an expression of suffering, sometimes horror. Quite often, in any form of plague, various skin phenomena are observed: hemorrhagic rash, pustular rash, etc.

In the bubonic form of the plague, which occurs, as a rule, with the bite of infected fleas, the cardinal symptom is bubo, which is an inflammation of the lymph nodes.

The development of a secondary septic form of plague in a patient with a bubonic form can also be accompanied by numerous non-specific complications.

The primary pulmonary form is the most dangerous epidemically and a very severe clinical form of the disease. Its onset is sudden: body temperature rises rapidly, cough and copious sputum appear, which then becomes bloody. At the height of the disease, the characteristic symptoms are general depression, and then an excited-delusional state, high fever, signs of pneumonia, vomiting with blood, cyanosis, and shortness of breath. The pulse quickens and becomes thready. The general condition deteriorates sharply, the patient's strength fades away. The disease lasts 3-5 days and, without treatment, ends in death.

Treatment. All forms of plague are treated with antibiotics. Streptomycin, terramycin and other antibiotics are prescribed alone or in combination with sulfonamides.

Prevention. In natural foci, observations are made on the number of rodents and vectors, their examination, deratization in the most threatened areas, examination and vaccination of healthy population.

Vaccination is carried out with a dry live vaccine subcutaneously or cutaneously. The development of immunity begins from the 5-7th day after a single injection of the vaccine.

Cholera

Cholera- acute intestinal infection, characterized by the severity of the clinical course, high mortality and the ability to bring a large number of victims in a short time. The causative agent of cholera- cholera vibrio, having a curved shape in the form of a comma and having great mobility. The latest cases of cholera outbreaks are associated with a new type of pathogen - El Tor vibrio.

The most dangerous route for the spread of cholera is the waterway. This is due to the fact that Vibrio cholerae can persist in water for several months. Cholera is also characterized by a fecal-oral transmission mechanism.

The incubation period for cholera ranges from several hours to five days. It may be asymptomatic. There are cases when, as a result of the most severe forms of cholera, people die in the first days and even hours of illness. The diagnosis is made using laboratory methods.

The main symptoms of cholera: sudden watery, profuse diarrhea with floating flakes, resembling rice water, turning over time into mushy, and then into loose stools, profuse vomiting, decreased urination due to loss of fluid, leading to a condition in which blood pressure drops, the pulse becomes weak, there is a strong shortness of breath, cyanosis of the skin, tonic cramps in the muscles of the extremities. The patient's facial features are sharpened, the eyes and cheeks are sunken, the tongue and mucous membrane of the mouth are dry, the voice is hoarse, the body temperature is lowered, the skin is cold to the touch.

Treatment: massive intravenous administration of special saline solutions to replenish the loss of salts and fluids in patients. Prescribe antibiotics (tetracycline).

Cholera control and prevention measures. To eliminate the foci of the disease, a complex of anti-epidemic measures is being taken: through the so-called "household rounds", patients are identified, and persons who have been in contact with them are isolated; provisional hospitalization of all patients with intestinal infections, disinfection of foci, control over the good quality of water, food and their neutralization, etc. are carried out. If there is a real danger of the spread of cholera, quarantine is used as an extreme measure.

When there is a threat of the disease, as well as in territories where cases of cholera are noted, the population is immunized with the killed cholera vaccine subcutaneously. Immunity to cholera is short-lived and not high enough tension, in connection with this, after six months, revaccination is carried out by a single injection of the vaccine at a dose of 1 ml.

anthrax

anthrax is a typical zoonotic infection. The causative agent of the disease - a thick, immobile bacillus (bacillus) - has a capsule and a spore. Anthrax spores remain in the soil for up to 50 years.

Source of infection- domestic animals, cattle, sheep, horses. Sick animals excrete the pathogen with urine and feces.

The ways in which anthrax spreads are varied: contact, food, transmissible (through the bites of blood-sucking insects - horseflies and flies).

The incubation period of the disease is short (2-3 days). The clinical forms are skin, gastrointestinal and pulmonary anthrax.

In cutaneous anthrax, a spot develops first, followed by a papule, vesicle, pustule, and ulcer. The disease is severe and in some cases ends in death.

In the gastrointestinal form, the predominant symptoms are a sudden onset, a rapid rise in body temperature to 39-40 ° C, acute, cutting pains in the abdomen, hematemesis with bile, bloody diarrhea. Usually, the disease lasts 3-4 days and most often ends in death.

The pulmonary form has an even more severe course. It is characterized by high body temperature, disorders of the cardiovascular system, a strong cough with bloody sputum. After 2-3 days, patients die.

Treatment. The most successful is the early use of specific anti-anthrax serum in combination with antibiotics. When caring for patients, it is necessary to take personal precautions - work with rubber gloves.

Ulcer prevention includes the identification of sick animals with the appointment of quarantine, disinfection of fur clothing in case of suspected infection, immunization according to epidemic indicators.

Smallpox

This is an infectious disease with an airborne transmission mechanism of an infectious beginning. Smallpox causative agent- the Pashen-Morozov body virus, which has a relatively high resistance in the external environment. The source of infection is a sick person during the entire period of illness. The patient is contagious for 30-40 days, until the complete disappearance of smallpox crusts. Infection is possible through clothing and household items that the patient has come into contact with.

The clinical course of smallpox begins with an incubation period lasting 12-15 days.

There are three forms of smallpox:

• mild form - varioloid or smallpox without rash;
• natural smallpox of the usual type and confluent smallpox
• a severe hemorrhagic form that occurs with phenomena of hemorrhage in the elements of the rash, as a result of which the latter become purple-blue (“black pox”).

Mild smallpox characterized by the absence of a rash. The general defeats are expressed poorly.

Natural smallpox of the usual type begins suddenly with a sharp chill, a rise in body temperature to 39-40 ° C, headache and sharp pain in the sacrum and lower back. Sometimes this is accompanied by the appearance of a rash on the skin in the form of red or red-purple spots, nodules. The rash is localized in the area of ​​the inner thighs and lower abdomen, as well as in the pectoral muscles and the upper inner part of the shoulder. The rash disappears in 2-3 days.

In the same period, the temperature decreases, the patient's well-being improves. After that, a smallpox rash appears, which covers the entire body and the mucous membrane of the nasopharynx. At the first moment, the rash has the character of pale pink dense spots, on top of which a bubble (pustule) forms. The contents of the bubble gradually become cloudy and suppurate. During the period of suppuration, the patient feels a rise in temperature and acute pain.

Hemorrhagic form of smallpox(purpura) is severe and often ends in death 3-4 days after the onset of the disease.

Treatment based on the use of specific gamma globulin. Treatment of all forms of smallpox begins with the immediate isolation of the patient in a box or a separate room.

Smallpox prevention consists in the general vaccination of children from the second year of life and subsequent revaccinations. As a result, cases of smallpox are virtually non-existent.

In the event of smallpox diseases, the population is revaccinated. Persons who have been in contact with the patient are isolated for 14 days in a hospital or in a temporary hospital deployed for this purpose.

Yellow fever

Yellow fever is included in the list of especially dangerous infections in Belarus due to the danger of importing the infection from abroad. The disease is included in the group of acute hemorrhagic transmissible diseases of a viral nature. Widespread in Africa (up to 90% of cases) and South America. Mosquitoes are carriers of viruses. Yellow fever belongs to the group of quarantine infections. After the disease remains stable lifelong immunity. Vaccination of the population is an essential component of disease prevention.

The incubation period is 6 days. The disease is characterized by acute onset, fever, severe intoxication, thrombohemorrhagic syndrome, liver and kidney damage.

About half of those who develop a severe form of the disease die. There is no specific treatment for yellow fever.

Vaccination against yellow fever is carried out with vaccines certified by the WHO. Immunity after vaccination is developed after 10 days. Vaccinations are subject to adults and children from 9 months of age.

List of countries endemic for yellow fever

Yellow fever vaccination is recommended for every traveler entering these countries.

A medical worker who has identified a patient with plague, cholera, GVL or monkeypox must change into the protective clothing transferred to him (anti-plague suit of the appropriate type), without taking off his own (except for heavily contaminated with the patient's secretions).

* Before putting on an anti-plague suit, all exposed parts of the body are treated with a disinfectant solution (0.5-1% chloramine solution) or 70 ° alcohol.

* The mucous membranes of the eyes, nose, mouth are treated with a solution of antibiotics: for plague - with streptomycin solution, for cholera - tetracycline.

* Upon contact with patients with GVL or monkeypox, the mucous membranes of the mouth and nose are treated with a weak solution (0.05%) of potassium permanganate, the eyes are washed with a 1% solution of boric acid. The mouth and throat are additionally rinsed with 70 ° alcohol or a 0.05% solution of potassium permanganate.

Primary anti-epidemic measures in identifying a patient (corpse) suspected of being infected with plague, cholera, contagious viral hemorrhagic fevers, monkeypox.

At the reception in the clinic (first-aid post). Actions of the medical worker who identified the patient:

1. Measures are taken to isolate the patient at the place of detection (the door to the office is closed, a post is set up from the outside upon receipt of the signal) until his hospitalization in a specialized medical institution.

2. A medical worker, without leaving the room where the patient was identified:

A. by phone or through a courier (without opening the door), who was not in contact with the patient, notifies the head of the clinic (chief physician) of the identified patient and his condition,

B. asks for appropriate medicines, packing of protective clothing, means of personal prevention.

3. It is forbidden to take things out of the office, transfer outpatient cards to the reception until the final disinfection.

4. In the office where the patient is identified, close the doors and windows, turn off the ventilation. Ventilation holes are sealed with adhesive tape (except for cholera).

5. Before receiving protective clothing, a medical worker in case of suspicion of: plague, GVL (hemorrhagic viral fevers), monkeypox should temporarily cover his nose and mouth with a towel or mask made from improvised materials (cotton wool, gauze, bandage). Before putting on protective clothing, open parts of the body are treated with a 0.5-1% solution of chloramine or 70-degree alcohol, and mucous membranes with a solution of streptomycin (for plague) or a weak solution of potassium permanganate (for GVL, monkeypox). When identifying a patient with suspected cholera, strictly observe the measures of personal prevention of gastrointestinal infections.

In case of cholera, it is forbidden to use washbasins (separate containers are allocated for these purposes).

6. Protective clothing (anti-plague suit of the appropriate type) is put on without taking off one's own dressing gown (except for clothing heavily contaminated with the patient's secretions).

7. When identifying a patient with plague, GVL. monkeypox, the medical worker does not leave the office (if a patient with cholera is detected, the doctor or sister, if necessary, can leave the office after washing their hands and removing the medical gown) and remains with him until the arrival of the evacuation team. epidemiological teams.

8. When a patient with suspicions of cholera is identified and a laying is received, material is taken for bacteriological studies. Allocations (vomit, stool) are collected in separate containers.

9. In the office where the patient was identified, current disinfection is carried out.

BACTERIOLOGICAL STUDIES OF PATHOLOGICAL MATERIAL FOR CHOLERA.