Doctor's tactics in case of suspected especially dangerous infections. Emergency prevention of OOI - especially dangerous infections in cases of detection in healthcare facilities or other institutions Emergency prevention of contact with OOI

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, a 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.

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 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 are called diseases of an infectious nature, representing an extreme epidemic danger to others.

Particularly dangerous infections appear suddenly, spread at lightning speed, covering a significant part of the population in the shortest possible time. Such infections occur with a pronounced clinical picture, as a rule, have a severe course and high mortality.

To date, the World Health Organization (WHO) has included more than 100 diseases in the list of especially dangerous infections.

A list of quarantine infections has also been established: poliomyelitis, plague (pulmonary form), cholera, yellow fever, smallpox, Ebola and Marburg fever, influenza (new subtype), acute respiratory syndrome (TARS).

In countries with a hot climate, especially dangerous infectious diseases are common, such as cholera, dengue, Zika, yellow fever, plague, malaria and a number of others. Every year imported cases of malaria and tropical helminthiases are registered in the Russian Federation.

Every year, about 10-13 million Russian citizens travel abroad for tourism purposes and about 1 million citizens travel on business trips. More than 3.5 million foreigners enter our country for tourism and business purposes, including from countries with an unstable epidemiological situation.

List of especially dangerous infections for Russia:

Plague

Cholera

Smallpox

Yellow fever

anthrax

Tularemia

Infection occurs through the skin either as a result of a flea bite, or when plague sticks enter the wound when the skin is broken (butchering the carcasses of an infected animal, skinning). The most common form of plague when infected through the skin is bubonic. In this case, the pathogen lingers in the lymph node closest to the bite, this node becomes inflamed, becomes noticeable, painful. A swollen lymph node is called a bubo.

To protect yourself from infection with plague, you must:

Do not camp near rodent burrows

Avoid contact with people who are sick, especially people who have a fever

If you have a fever or swollen lymph nodes, seek medical attention immediately.

Infection occurs through contact with infected rodents (trapping, carcass cutting, skinning) and water contaminated with rodent secretions. The pathogen enters the human blood through the unprotected skin of the hands. At agricultural work - during harvesting, when eating food that was touched by mice with tularemia, when eating undercooked meat. When drinking contaminated water from open water (for example, sick animals could get into the well). When bitten by blood-sucking arthropods (mosquitoes, horseflies, ticks).

The incidence is predominantly professional in nature, single and group cases are recorded in rural areas in the summer-autumn period, but are possible at any time of the year.

The source of infection is farm animals sick or dead from anthrax. The infection is transmitted through microtrauma, the use of products that have not undergone heat treatment, by airborne dust, as well as by insect bites (gadflies).

How to protect yourself?

1. Specific prophylaxis according to epidemic indications.

2. Vaccination of pets.

3. Compliance with the rules for the burial of dead animals and the arrangement of cattle burial grounds;

4. Compliance with safety regulations when working with livestock and livestock raw materials.

5. Meat, milk of sick animals are subject to destruction, and skins, wool, bristles are disinfected.

6. Persons at risk of infection are subject to medical supervision for 2 weeks. They are undergoing emergency chemoprophylaxis.

7. If you suspect a disease - emergency hospitalization.

8. In the room where the patient was, final disinfection is carried out.

Infection occurs through water, food, objects, hands contaminated with cholera vibrios.

To protect yourself and others from contracting cholera, you must:

Get vaccinated before traveling to cholera-prone countries.

Strictly observe the rules of personal hygiene - washing hands.

• Food products must be protected from flies.

If diarrhea occurs, consult a doctor promptly.

The causative agent of the infection is transmitted by contact, airborne droplets, from healthy carriers, is able to remain viable on clothing and bedding.

Symptoms: general intoxication, characteristic rash covering the skin and mucous membranes. Patients who have suffered smallpox, partial or complete loss of vision and in almost all cases, scars left after ulcers.

1. Vaccination against smallpox

2. Do not visit places of mass congestion of people, do not go into rooms where there are acutely feverish people.

3. Immediately consult a doctor if you feel unwell, general weakness, sore throat, or fever.

With a lightning-fast form of the disease, the patient dies in 3-4 days.

Complications of the disease - gangrene of the extremities, soft tissues; sepsis (in case of secondary infection).

How to protect yourself?

1. When traveling to countries that are unfavorable for yellow fever diseases, get vaccinated against the disease for 10 years. Vaccination is carried out 30 days before the planned trip

2. Protect yourself from mosquito bites, protect resting places with nets, tightly close windows and doors.

While on vacation, avoid visiting swampy areas, forests and parks with dense vegetation. In case it is impossible to avoid a visit, put on clothes that exclude the possibility of insect bites - long sleeves, trousers, a hat.

How to prevent insect bites:

There are 2 main ways to prevent insect bites - repellents and alertness (avoiding bites).

The premises must have nets on windows and doors, if there are no nets, the windows must be closed. It is desirable to have air conditioning.

Repellent apply to the skin every 3-4 hours between dusk and dawn.

If mosquitoes enter the room, there should be a net tucked under the mattress above the beds, make sure that the net is not torn and there are no mosquitoes under it.

In rooms intended for sleeping, use aerosols and special spirals

Clothing must be closed.

In case of signs of an infectious disease (malaise, fever, headache), signs of bites of blood-sucking insects, rashes or any other skin manifestations, consult a doctor immediately.

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.

Currently, 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 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 areas 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.

REMINDER TO THE MEDICAL WORKER WHEN CARRYING OUT THE PRIMARY ACTIVITIES IN THE FOCUS OF THE AE

In the case of a patient suspected of being infected with plague, cholera, GVL or smallpox, it is necessary, on the basis of the clinical picture of the disease, to suggest a case of hemorrhagic fever, tularemia, anthrax, brucellosis, etc., it is necessary first of all to establish the reliability of its connection with the natural focus of infection.

Often the decisive factor in establishing the diagnosis is the following data of the epidemiological history:

• Arrival of a patient from an area that is unfavorable for these infections within a time period equal to the incubation period;
• Communication of the identified patient with a similar patient along the way, at the place of residence, study or work, as well as the presence of any group diseases or deaths of unknown etiology;
• Stay in areas bordering with the parties, unfavorable for the indicated infections or in a territory exotic for plague.

During the period of the initial manifestations of the disease, OOI can give pictures similar to a number of other infections and non-communicable diseases:

With cholera- with acute intestinal diseases, toxic infections of various nature, poisoning with pesticides;

With the plague- with various pneumonia, lymphadenitis with fever, sepsis of various etiologies, tularemia, anthrax;

For monkeypox- with chickenpox, generalized vaccine and other diseases accompanied by rashes on the skin and mucous membranes;

With fever Lasa, Ebola, b-ni Marburg- with typhoid fever, malaria. In the presence of hemorrhages, it is necessary to differentiate from yellow fever, Dengue fever (see clinical and epidemiological characteristics of these diseases).

If a patient is suspected of having one of the quarantine infections, the medical worker must:

1. Take measures to isolate the patient at the place of detection:

• Prohibit entry and exit from the hearth, isolate communication with a sick person of family members in another room, and in the absence of the possibility to take other measures - to isolate the patient;
• Before the patient is hospitalized and the final disinfection is carried out, it is forbidden to pour the patient's secretions into the sewer or cesspool, water after washing hands, dishes and care items, the removal of things and various objects from the room where the patient was located;

2. The patient is provided with the necessary medical care:

• if plague is suspected in a severe form of the disease, streptomycin or tetracycline antibiotics are administered immediately;
• in severe cholera, only rehydration therapy is performed. Cardiovascular agents are not administered (see evaluation of dehydration in a patient with diarrhea);
• when conducting symptomatic therapy for a patient with GVL, it is recommended to use disposable syringes;
• depending on the severity of the disease, all transportable patients are sent by ambulance to hospitals specially designated for these patients;
• on-site assistance to non-transportable patients with the call of consultants and an ambulance equipped with everything necessary.

3. By phone or through a courier, notify the head physician of the outpatient clinic about the identified patient and his condition:

• Request appropriate medicines, packing of protective clothing, personal protective equipment, packing for material collection;
• Before receiving protective clothing, a medical worker with suspicion of plague, GVL, monkeypox should temporarily close his mouth and nose with a towel or mask made from improvised material. For cholera, measures of personal prevention of gastrointestinal infections should be strictly observed;
• Upon receipt of protective clothing, they put it on without taking off their own (except for heavily contaminated by the secretions of the patient)
• Before putting on PPE, carry out emergency prophylaxis:

A) in case of plague - the nasal mucosa, treat the eye with a solution of streptomycin (100 distilled water per 250 thousand), rinse the mouth with 70 gr. alcohol, hands - alcohol or 1% chloramine. Introduce IM 500 thousand units. streptomycin - 2 times a day for 5 days;

B) with monkeypox, GVL - as with the plague. Anti-small gammaglobulin metisazon - in isolation;

C) In cholera - one of the means of emergency prevention (tetracycline antibiotic);

4. If a patient with plague, GVL, monkeypox is identified, the medical worker does not leave the office, apartment (in case of cholera, if necessary, he can leave the room after washing his hands and removing the medical gown) and stay until the arrival of the epidemiological team.

5. Persons who were in contact with the patient are identified among:

• Persons at the place of residence of the patient, visitors, including those who left by the time the patient was identified;
• Patients who were in this institution, patients transferred or referred to other medical institutions, discharged;
• Medical and service personnel.

6. Take material for bakiistudy (before the start of treatment), fill in a simple pencil referral to the laboratory.

7. Carry out current disinfection in the outbreak.

8. after the departure of the patient for hospitalization, carry out a complex of epidemiological measures in the outbreak until the arrival of the disinfectant epidemiological team.

9. Further use of a health worker from the outbreak of plague, GVL, monkeypox is not allowed (sanitation and isolation). With cholera, after sanitization, the health worker continues to work, but he is under medical supervision at the place of work for the duration of the incubation period.

BRIEF EPIDEMIOLOGICAL CHARACTERISTICS OF OOI

MAIN SIGNALS OF OOI

PLAGUE- acute sudden onset, chills, temperature 38-40 ° C, severe headache, dizziness, impaired consciousness, insomnia, hyperemia of the conjunctiva, agitation, the tongue is coated (chalky), the phenomena of increasing cardiovascular insufficiency develop, after a day, characteristic for each forms of symptoms of the disease:

Bubonic form: the bubo is sharply painful, dense, soldered to the surrounding subcutaneous tissue, motionless, its maximum development is 3-10 days. The temperature lasts 3-6 days, the general condition is severe.

Primary pulmonary: against the background of the listed signs, chest pains, shortness of breath, delirium, cough appear from the very beginning of the disease, sputum is often foamy with streaks of scarlet blood, a discrepancy between the data of an objective examination of the lungs and the general serious condition of the patient is characteristic. The duration of the disease is 2-4 days, without treatment, 100% mortality;

Septicemia: early severe intoxication, a sharp drop in blood pressure, hemorrhage on the skin, mucous membranes, bleeding from internal organs.

CHOLERA- mild form: loss of fluid, loss of own weight occurs in 95% of cases. The onset of the disease is acute rumbling in the abdomen, loosening of the stool 2-3 times a day, maybe 1-2 times vomiting. The patient's well-being is not disturbed, working capacity is maintained.

Medium form: fluid loss of 8% of its own weight, occurs in 14% of cases. The onset is sudden, rumbling in the abdomen, indefinite intense pain in the abdomen, then loose stools up to 16-20 times a day, which quickly loses its fecal character and smell, green, yellow and pink in color of rice water and diluted lemon, uncontrollable defect without urge (for 500-100 ml is allocated 1 time, an increase in stool with each defect is characteristic). Vomiting appears with diarrhea, it is not preceded by nausea. A sharp weakness develops, an unquenchable thirst appears. General acidosis develops, diuresis decreases. The blood pressure drops.

Severe form: algid develops with a loss of fluid and salts over 8% of body weight. The clinic is typical: severe emaciation, sunken eyes, dry sclera.

YELLOW FEVER: sudden acute onset, severe chills, headache and muscle pain, high fever. Patients are safe, their condition is severe, nausea, painful vomiting occurs. Pain under the stomach. After 4-5 days after a short-term drop in temperature and improvement in the general condition, a secondary rise in temperature occurs, nausea, vomiting of bile, and nosebleeds appear. At this stage, three signal signs are characteristic: jaundice, hemorrhage, and a decrease in urine output.

LASS FEVER: in the early period, symptoms: - the pathology is often not specific, a gradual increase in temperature, chills, malaise, headache and muscle pain. In the first week of the disease, severe pharyngitis develops with the appearance of white spots or ulcers on the mucous membrane of the pharynx, tonsils of the soft palate, then nausea, vomiting, diarrhea, pain in the chest and abdomen join. During the 2nd week, diarrhea resolves, but abdominal pain and vomiting may persist. Often there is dizziness, decreased vision and hearing. A maculopapular rash appears.

In severe form, the symptoms of toxicosis increase, the skin of the face and chest becomes red, the face and neck are swollen. The temperature is about 40 ° C, consciousness is confused, oliguria is noted. Subcutaneous hemorrhages may appear on the arms, legs, and abdomen. Frequent hemorrhages in the pleura. The feverish period lasts 7-12 days. Death often occurs in the second week of illness from acute cardiovascular failure.

Along with severe, there are mild and subclinical forms of the disease.

MARBURG DISEASE: acute onset, characterized by fever, general malaise, headache. On the 3-4th day of illness, nausea, abdominal pain, severe vomiting, diarrhea appear (diarrhea can last several days). By the 5th day, in most patients, first on the trunk, then on the arms, neck, face, a rash appears, conjunctivitis develops, hemorrhagic diathesis develops, which is expressed in the appearance of pitechiae on the skin, emaptema on the soft palate, hematuria, bleeding from the gums, in places of syringe stakes, etc. The acute febrile period lasts about 2 weeks.

Ebola: acute onset, temperature up to 39 ° C, general weakness, severe headaches, then pain in the neck muscles, in the joints of the muscles of the legs, conjunctivitis develops. Often dry cough, sharp pains in the chest, severe dryness in the throat and throat, which interfere with eating and drinking and often lead to cracks and ulcers on the tongue and lips. On the 2nd-3rd day of illness, abdominal pain, vomiting, diarrhea appear, after a few days the stool becomes tar-like or contains bright blood.

Diarrhea often causes varying degrees of dehydration. Usually on the 5th day, patients have a characteristic appearance: sunken eyes, emaciation, weak skin turgor, the oral cavity is dry, covered with small ulcers similar to aphthous ones. On the 5-6th day of illness, first on the chest, then on the back and limbs, a spotty-potulous rash appears, which disappears after 2 days. On the 4-5th day, hemorrhagic diathesis develops (bleeding from the nose, gums, ears, injection sites, hematemesis, melena) and severe tonsillitis. Often there are symptoms indicating involvement in the CNS process - tremor, convulsions, paresthesia, meningeal symptoms, lethargy, or vice versa excitation. In severe cases, cerebral edema, encephalitis develops.

MONKEY POX: high temperature, headache, pain in the sacrum, muscle pain, hyperemia and swelling of the mucous membrane of the throat, tonsils, nose, rashes are often observed on the mucous membrane of the oral cavity, larynx, nose. After 3-4 days, the temperature drops by 1-2°C, sometimes to subfebrile, general toxic effects disappear, and the state of health improves. After a decrease in temperature for 3-4 days, a rash appears first on the head, then on the trunk, arms, legs. The duration of the rash is 2-3 days. Rashes on separate parts of the body occur simultaneously, the predominant localization of the rash on the arms and legs, simultaneously on the palms and soles. The nature of the rash is papular - vedic. The development of the rash - from spots to pustules slowly, within 7-8 days. The rash is monomorphic (at one stage of development - only papules, vesicles, pustules and roots). Vesicles do not collapse during puncture (multi-chamber). The base of the elements of the rash is dense (the presence of infiltrates), the inflammatory rim around the elements of the rash is narrow, clearly defined. Pustules form on the 8-9th day of illness (day 6-7 of the rash). The temperature again rises to 39-40°C, the condition of the patients deteriorates sharply, headaches, delirium appear. The skin becomes tense, swollen. Crusts are formed on the 18-20th day of illness. There are usually scars after the crusts fall off. There is lymphadenitis.

MODE OF DISINFECTION OF MAIN OBJECTS IN Cholera

ASSESSMENT OF THE DEGREE OF DEHYDRATION BY CLINICAL SIGNS

EMERGENCY PREVENTION IN THE FOCI OF QUARANTINE DISEASES.

Emergency prophylaxis is applied to those who have been in contact with the patient in the family, apartment, at the place of work, study, rest, treatment, as well as persons who are in the same conditions for the risk of infection (according to epidemiological indications). Taking into account the antibiogram of strains circulating in the focus, one of the following devices is prescribed:

TREATMENT SCHEMES FOR PATIENTS WITH DANGEROUS INFECTIOUS DISEASES

In cholera, an effective antibiotic can reduce the amount of diarrhea in patients with severe cholera, the period of vibrio excretion. Antibiotics are given after the patient is dehydrated (usually after 4-6 hours) and vomiting stops.

Doxycycline is the preferred antibiotic for adults (excluding pregnant women).

Furazolidone is the preferred antibiotic for pregnant women.

When cholerae vibrios resistant to these drugs are isolated in the foci of cholera, the question of changing the drug is considered taking into account the antibiograms of the strains circulating in the foci.

STAYING FOR SAMPLING MATERIAL FROM A PATIENT WITH SUSPECTED CHOLERA (for non-infectious hospitals, ambulance stations, outpatient clinics).

1. Sterile wide-mouth jars with lids or

Ground stoppers at least 100 ml. 2 pcs.

2. Glass tubes (sterile) with rubber

small necks or teaspoons. 2 pcs.

3. Rubber catheter No. 26 or No. 28 for taking material

Or 2 aluminum hinges 1 pc.

4.Polybag. 5 pieces.

5. Gauze napkins. 5 pieces.

7. Adhesive plaster. 1 pack

8. Simple pencil. 1 PC.

9. Oilcloth (1 sq.m.). 1 PC.

10. Bix (metal container) small. 1 PC.

11. Chloramine in a 300g bag, designed to receive

10l. 3% solution and dry bleach in a bag of

calculation 200g. per 1 kg. secretions. 1 PC.

12. Rubber gloves. Two pairs

13. Cotton - gauze mask (anti-dust respirator) 2 pcs.

Laying for each linear brigade of a joint venture, a therapeutic area, a district hospital, a medical outpatient clinic, a FAP, a health center - for everyday work when servicing patients. Items to be sterilized are sterilized once every 3 months.

SCHEME FOR SAMPLING MATERIAL FROM PATIENTS WITH OOI:

MAIN RESPONSIBILITIES OF THE MEDICAL STAFF OF THE ENT DEPARTMENT OF THE CRH WHEN DETECTING A PATIENT WITH ASI IN THE HOSPITAL (during a medical round)

1. Doctor who identified the patient with OOI in the department (at the reception) is obliged:
2. Temporarily isolate the patient at the place of detection, request containers to collect secretions;
3. Notify by any means the head of your institution (head of the department, head physician) about the identified patient;
4. Organize measures to comply with the rules of personal protection for health workers who have identified the patient (request and apply anti-plague suits, treatment of mucous and open areas of the body, emergency prevention, disinfectants);
5. Provide the patient with emergency medical care according to vital indications.

NOTE: the skin of the hands, face is abundantly moistened with 70 ° alcohol. The mucous membranes are immediately treated with a solution of streptomycin (in 1 ml - 250 thousand units), and in case of cholera - with a solution of tetracycline (200 thousand mcg / ml). In the absence of antibiotics, a few drops of 1% solution of silver nitrate are injected into the eyes, 1% solution of protargol is injected into the nose, the mouth and throat are rinsed with 70 ° alcohol.

1. duty nurse, who took part in the medical round, is obliged:
2. Request laying and take material from the patient for bacteriological examination;
3. Organize the current disinfection in the ward before the arrival of the disinfection team (collection and disinfection of the patient's secretions, collection of soiled linen, etc.).
4. Make a list of the closest contacts with the patient.

NOTE: After the patient is evacuated, the doctor and nurse take off protective clothing, pack it in bags and hand it over to the disinfection team, decontaminate shoes, undergo sanitization and go to the disposal of their leader.

1. Head of department, having received a signal about a suspicious patient, is obliged:
2. Urgently organize the delivery to the ward of packing of protective clothing, bacteriological packing for collecting material, containers and disinfectants, as well as means for treating open areas of the body and mucous membranes, emergency prevention means;
3. Set up posts at the entrance to the ward where the patient was identified and exit the building;
4. If possible, isolate contacts in wards;
5. Report the incident to the head of the institution;
6. Organize a census of the contacts of your department in the prescribed form:
7. No. p.p., surname, name, patronymic;
8. was on treatment (date, department);
9. dropped out of the department on (date);
10. the diagnosis with which the patient was in the hospital;
11. location;
12. place of work.

1. Head nurse of the department, having received instructions from the head of the department, is obliged:
2. Urgently deliver to the ward a package of protective clothing, containers for collecting secretions, bacteriological packing, disinfectants, antibiotics;
3. Divide the patients of the department into wards;
4. Monitor the work of posted posts;
5. Conduct a census using the established contact form of your department;
6. Accept the container with the selected material and ensure the delivery of samples to the bacteriological laboratory.

OPERATIONAL PLAN

activities of the department in case of detection of cases of AIO.

NOTE: further activities in the department are determined by a group of consultants and specialists from the sanitary and epidemiological station.

Scroll

questions for the transfer of information about the patient (vibrio carrier)

1. Full Name.
2. Age.
3. Address (during illness).
4. Permanent residence.
5. Profession (for children - a children's institution).
6. Date of illness.
7. Date of request for assistance.
8. Date and place of hospitalization.
9. Date of material sampling for bacoexamination.
10. Diagnosis at admission.
11. final diagnosis.
12. Accompanying illnesses.
13. Date of vaccination against cholera and drug.
14. Epidanamnesis (connection with a reservoir, food products, contact with a patient, vibrio carrier, etc.).
15. Alcohol abuse.
16. Use of antibiotics before illness (date of last appointment).
17. The number of contacts and the measures taken to them.
18. Measures to eliminate the outbreak and its localization.
19. Measures to localize and eliminate the outbreak.

SCHEME

specific emergency prophylaxis for a known pathogen

NOTE: Extract from the manual,

approved deputy. Minister of Health

Ministry of Health of the USSR P.N. Burgasov 10.06.79

SAMPLING FOR BACTERIOLOGICAL INVESTIGATION DURING OOI.

MODE

Disinfection of various objects infected with pathogenic microbes

DESCRIPTION OF THE PROTECTIVE ANTIPLAGUE SUIT:

1. pajama suit
2. Stocking socks
3. Boots
4. Anti-plague medical gown
5. scarf
6. fabric mask
7. Mask - glasses
8. Oilcloth sleeves
9. Apron (apron) oilcloth
10. Rubber gloves
11. Towel
12. Oilcloth