EPIDEMIOLOGY DESCRIPTION OF GROUP OF INTESTINAL INFECTIONS AND GROUP OF RESPIRATORY INFECTIONS

1. THEME: EPIDEMIOLOGY DESCRIPTION
OF GROUP OF INTESTINAL INFECTIONS AND
GROUP OF RESPIRATORY INFECTIONS.
Department of infectious diseases with epidemiology
Assistant Mizyuk R.M.
EPIDEMIOLOGY
Lecture № 4

2. LECTURE PLAN
• Actuality of the problem
• General characteristics group of intestinal infections
• Epidemiology of hepatitis A and E
• Epidemiology of typhoid
• Epidemiology of shigellosis
• Epidemiology of salmonellosis
• Epidemiology of botulism and poliomyelitis
• General characteristics of respiratory infections
• Epidemiology of diphtheria
• Epidemiology of Influenza
• Epidemiology of meningococcal disease
• Epidemiology of measles
• Conclusions

3. Actuality of theme
Problem of morbidity of acute intestinal infections (AII)
takes on special urgency today. In the structure of infectious
diseases AII occupy a leading position. According to WHO experts,
annually in the world, recorded over 1 billion cases of diarrhea.
Scientists of our faculty have long engaged in the study of
course of intestinal infections on the background of comorbidity. On
this subject we have defended one doctor and several master’s
dissertation. This particular professor Dykiy B.M., docents
Nikiforova T.O., Pyuryk V.F., Hryzhak I.G., Kobryn T.Z., Boychuk O.P.
Diseases of the upper respiratory tract is also among the
most common infectious diseases. Among the reasons for
temporary disability they occupy the first place: even in the
between epidemic period them has one sixth of the world
population. WHO experts stress that it ARI occupy the leading
position in the infectious diseases of man with a tendency toward
continued growth.

4. The diseases with the faecal-oral
mechanism of transmission belong to the
group of intestinal infections.
TYPES OF
INTESTINAL INFECTIONS
VIRAL INFECTIONS
viral hepatitis A and E,
enterovirus diseases,
poliomyelitis,
rotavirus gastroenteritis
BACTERIAL INFECTIONS
Typhoid fever,
paratyphoids,
cholera,
shigellosis (dysentery),
salmonellosis,
yersiniosis,
esherihiosis,
campylobacter infections

5. Epidemiological characteristics of viral hepatitis A
Pathogen: Hepatitis A virus contains RNA, family
Pikornavirus (enterovirus 72), the size of virus 20-27 nm,
one serotype, 7 genotypes. Replication - cytoplasm of
hepatocytes.

6. Epidemiological characteristics of viral hepatitis A
Virus is good survives in the environment:
- at 20 dg. C - 1 month
- at 4 dg. C - some years
- рН of a stomach from 3 up to 10 not influence a
survival virus!!!
- at рН is lower 3 - survives till 4 hours
- at 60 dg. C - maintains 12 hours
- desinfectants inactivate it for 15 minutes
- resistance during
boiling - 5 minutes

7. GEOGRAPHIC DISTRIBUTION OF
VIRAL HEPATITIS A

8. EPIDEMIOLOGY- antroponosis
The sourse - the patient with any form illnesses
The mechanism of transmission - fecal-oral
The factors of transmission:
- personal contact to the patient or contaminated they by
subjects (do not have seasonal prevalence!!!)
- Contaminated nutrition and water
Susceptibility general !!!
Outbreaks in families, villages, in kindergartens, schools,
organized groups.
The main risk group are children after 1 year of life .
Seasonality - Autumn and winter

9. FACTOR OF TRASMISSION :
Contaminated food
Infected water
Object of environment
(tools, utensil, dishes)

10. Epidemiological characteristics of viral
hepatitis E
Pathogen: Hepatitis E virus containing RNA, size
32-34 nm, 1 serotype, 3 genotypes.
Resistance during boiling - 3-5 minutes.
Replication place - cytoplasm of hepatocytes.
Virus is good survives at temperature (-) 20 dg.
C, but at temperature is higher 0 dg. C are fast
inactivated. Are very sensitive to desinfection agents.
The disease is spread mainly in Asia, Africa and
South America. Epidemics have an explosive character
associated with water pollution during floods, rains.

12. EPIDEMIOLOGY- antroponosis
The preferred mechanism for transmission -
fecal-oral, main transmission factor - water.
The main risk group - pregnant women, persons
aged 18-20 years.
• High lethality among the pregnant woman in 3rd
trimester ( to 25 %) and children in neonatal period
(Up to 77 %)
Chronic forms and carriers are not observed.
The time of greatest infectivity - preicteric and
icteric periods.
The virus is found in feces, blood in the acute
phase can detect IgM anti-HEV.

13. Antiepidemic measures
• Identify early (preicteric) period
• Compulsory hospitalization of patients
• Observation of contact persons for 35 days
• Clinical convalescents 1-3 months.
• The current epidemic foci conducted and the final
disinfection
• preseason immunoglobulin prophylaxis
• Vaccination in epidemic foci (vaccine "HAVRIKS")

14. ETIOLOGY
The causative agent of typhoid fever
- is Salmonella typhi from the
family Enterobacteriacea, genus
Salmonella, serogroup D, gram (-)
Salmonella typhi is not - spore-
forming rod, has size 0.5 – 0.8
microns of width and 1.5 – 3
microns of lengh. Motile by them
betray flagella

15. Salmonella typhi has 3 antigenes:
- O- antigene (somatic, thermostable)
- Н-antigene (flagellar, thermolabile)
- Vi-antigene (somatic, thermolabile, is disposed more
superficially, than O - antigine)
Salmonella typhi secrete only endotoxin at destroy of the
bacterial cell. It is potent pyrogen (from it had received a
medicinal preparation "Pyrogenalum") but
enteropathogenic by operation has no

16. S. can longly be survived in an organism as filtered or L-
forms.
S. are survived by months in environment.
S. not only are longly survived, but also are multiplied in
foodstuffs (milk, sour cream, cheese, jelly etc.) and not
changing their gustatory qualities.
S. well endure low temperature, but at warming up to 60
dg.C destroy through 30 minutes and at boiling - instantly
S. are inactivated desinfectants in usual concentrations
during 3 - 5 minutes.

17. Epidemiology: typhoid fever is anthroponosis
The source – sick person or the carrier which secrete
of S . typhi with the feces and urine
Path of transmission - fecal-oral
The factors of transmission:
- contaminated water (more often)
- contaminated foodstuffs
- contact to the sick the person or subjects enclosing him
Age of the patients: - from 15 up to 45 years more often
are sick
Seasonal prevalence - in summer-autumn.

18. Regions with high risk infection by typhoid fever

19. The rules of discharing of the infectious patient from a
hospital
- for 21 days of normal temperature
- 3 negative coprocultures and 1 bileculture, which start
to take away from the patient after 2 days after
cancellation of antibiotics
Prophylaxis: immunity after T.f. is often intensive but the
reinfections appear in 20 - 25 %
The vaccines do not create 100 % of protection, therefore
them will using:
- at close family contact to the carrier S.
- during flashouts T.f.
- before visiting endemic areas on T.f.

20. - keeping of rules of personal hygiene;
- control by preparation and storage of nutrition;
- the registration, sanitation and discharge from
operation of carriers of the decree groups
population;
- careful clearing of the drynking water;
- desinfection of the sewers;
- constant medical control for decree groups
population.
Antiepidemic measures

21. SHIGELLOSIS (DYSENTERY)
DEFINITION – acute anthroponosis disease describing by sets
of symptoms an intoxications and a preferred damage
distal of portions of a large intestine.
39 known serotypes Shigella are distributed on 4 groups:
А. - Sh. Dysenteria (12 serovars) - Grigoriev-Shiga-Kruze,
Schtucer - Schmitz, Lardj- Sachs
В. - Sh. Flexneri (6 serovars) in subtype Newcastle
С. - Sh. Boydii (18 serovars)
В. - Sh. Sonne (1 serovar)

22. Main properties of causetive agents:
- all shigellas are similar morphologically. They have
a size 0.3 – 0.6 on 1.5 - 3 microns, spores and capsules will
not derivate, gram (-), well grow on simple mediums.
- outside of an organism of the man survive from several
days - to several months,
- desiccation and low temperature transfer well, but at
60dg.C perish in 30 minutes, and at boiling is very
quickly!!!
- all desinfectants in usual concentrations are inactivated of
shigellas during 3 – 5 minutes.
- Sh. Sonei- will well be survive and is multiplied in nutrition
(milk)!!!

23. Antigenes:
Sh. contain 2 thermostabile of an antigenes (typical and
group) and 2 thermolabile antigenes (K - capsulated
antigene – (in groups shigellas A and B) and fimbrial (in
group В)
Toxinoformation - group A produces exotoxin, which
breaks synthesis of protein in cells, has neurotoxity and
enterotoxity by operation and hemolytic activity.
Enterotoxical the operation of other groups shigellas in
100- 1000 times is less expressed.
At shigellas breakdown the endotoxin is freed which
differs on operation from endotoxins gram- negative
bacteria a little

24. Epidemiology
Source of an infection the patients with the acute and chronic
forms of disease and bacteriocarriers.
The mechanism of transmission - fecal-oral (main) and contact
The factors of transmission:
- the water (is more often Flexneri)
- nutrition (Sonnei),
- the contacts (are more often the type А),
- the carriers (fly, cockroaches),
Seasonal prevalence summer-autumn, but not so legible as at a
salmonellosis!!! A sporadic case rate - the year round!!!
- the children in the age of from 1 tо 4 years often are sick
- meets often in prisons, psychiatric hospitals, barracrs, - as flashouts
(cause - lack of space and insanitary conditions)

25. - keeping personal, alimentary and hydrous hygiene,
disinsection (fly, cockroaches);
- registration of all patients and carriers and them
sanitation;
- planned inspection decree groups of the
population and unplanned at any episode of a
diarrhea;
- regular current disinfection in the closed collectives
of subjects of use (toy, pots etc.);
- on all patients and carriers the emergency notice in
SES ( sanitarno – epidemiologic station) and isolation
(house or in a hospital) is referred.
Antiepidemic measures

26. BOTULISM
BOTULISM - Acute severe food poisoning.
Characterized by lesion of CNS and autonomic nervous
system.
Pathogen - Clostridium botulinum. Strict
anaerobe. Exists in two forms - the vegetative and
spore. 7 types of pathogens known botulinum-A, B, C,
D, E, F, G, D.
Under anaerobic conditions, the spores germinate
into vegetative forms and releases a lethal neurotoxin
(lethal dose - 0.3 mg), it usually happens in canned
foods. Dispute withstand boiling and killed only
during autoclaving. The toxin is destroyed by boiling in
20 minutes.

27. Epidemiology
Reservoir and source - soil, wild and domestic animals,
fish, birds, with bowel which allocated disputes. A sick man is
not a source of infection.
Mechanism of transmission - fecal-oral, transfer factors
- foods that contain toxins - canned food made at home (fungi
spreads, stew), sausage, jerky and smoked fish.
Encountered - outbreaks, sporadic cases. Botulism is
born before 26 weeks, the high mortality rate of 20-70%, very
rare - wound botulism.
The incubation period of up to 5-7 days, more often -
12-16 hours.

28. Laboratory diagnosis - toxin neutralization reaction
in mice. Investigations are taking gastric washings, food,
vomit, blood.
Prevention - keeping technology of canned foods,
removal of trade networks of infected products of their
destruction.
Disease measures - obligatory hospitalization of
patients, emergency notification
Disinfection of utensils and clothes patient - 1-3%
chloramine 1 hour.
Emergency Prevention - antibotulinic serum for the
contact persons, medical surveillance - 10 days.

29. Poliomyelitis
Anthroponoses viral infection characterized by fever,
lesions of the spinal motor neurons and brain development
flabby atrophic paralysis and paresis of extremities, and
trunk.
Pathogen - RNA-containing enteroviruses, Picorno-
virus, poliovirus I, II, III type. Polioviruses in feces, survive - 3-
4 months., Killed by boiling, is not stable in the environment.
Source - a sick person or carrier. The virus is excreted
in nasopharyngeal patient for 1 week, with excrement up to
3-6 weeks.
Transfer mechanism - fecal-oral, airborne, airborne
dust, route of transmission - food, water, household.

30. Previously suffered children under 10 years. It was typical
of summer-autumn seasonality.
The incubation period is 3-35 days.
Laboratory diagnosis - the allocation of polioviruses from
stool, cerebrospinal fluid, swabs from the nasopharynx, blood for
3-7 day illness.
Serological - NT, CFT, UHAT in paired sera.
Prevention - planned vaccination in childhood. Polio
vaccine IPV, OPV - 3-4-5 months., Revaccination - 18 months., 6
years, 14 years.
Events - hospitalization, urgent message. Discharge - not
before 40 days from the onset of the disease.
Disinfection 2-3% by chloride lime, 1.5% hypochlorite Ca.
To contact persons - children under 15 years and decreed
separated by 20 days, all of the contact re-vaccinated OPV, medical
survilence for the contact person 20 days.

31. Poliomyelitis

32. The diseases with the airborne mechanism of
transmission belong to the group of respiratory tracts
infections.
TYPES OF
RESPIRATORY TRACTS INFECTIONS
VIRAL INFECTIONS
influenza, ARVI (acute
respiratory viral infections),
measles, rubella, chickenpox,
epidemic parotitis,
infectious mononucleosis,
enterovirus infection,
herpesvirus infection etc.
BACTERIAL INFECTIONS
meningococcal infection,
diphtheria, quinsy,
whooping-cough,
scarlet fever, ornithosis,
legyonelosis, respiratory
chlamidiosis
and micoplazmosis.

33. Are most widespread is influenza and
acute respiratory viral infections (ARVI):
adenoviral infection, paragrippe, rhinoviral
infection, coronaviral infection, respiratory-
syncytial infection.
Lately often, there are the flashes of
enterovirus infection, which is passing by both
an airborne way, and fecal-oral.
From the bacterial diseases with the
airborne mechanism of transmission most
dangerous there is diphtheria that
meningococcal infection.

34. influenza
F. Orthomyxoviridae, G. Mixovirus Influenza.
A spherical cover virus by a size 80 - 120 nm. The core
contains one-filamentous RNA (-), divided on 8 fragments,
(paired among themselves by common рrotein envelope
derivating a nucleocapsid) which 10 virus protein encode
derivation.
Covered bilayer by the lipide envelope, on a surface which 2
main antigenes of a virus are detected:
Hemagglutinin (Н) - 15 types (Н1, Н2, Н3 - for the man)
provides affixion of a virus to a cell!!!
Neuraminidase (N) - 9 types (N1, N2 - for the man)
provides infiltration of a virus into a cell and facilitates
escaping a cell of the viruses-descendants, preventing
their aggregation!!

35. The nucleoprotein (s-antigenes) is constant on to
structure also determines the type of a virus (A, B, C etc.)
Hemagglutinin and neuraminidase (v-antigenes)
permanently chageable also determine appearance of the
different strains one virus!!
The virus of an influenza A permanently varies
(drift), causing epidemics everyone 2 - 4 years, but
everyone 10-30 years there is a complete replacement of
antigenes (shift) - that promotes by appearance of
pandemics!!
The virus B varies slowly (epidemic through 4 - 7
years) and it has not of the hemagglutitin but shift is not
observed also pandemics do not arise!!

36. The virus of an influenza C does not change antigenes,
contains only 7 fragments RNA (instead of 8) and one
surface antigene (instead of 2) - supporting only sporadic
case rate!!
Are unstable in the external environment, being inactivated:
- at 20 dg.C - through 4 - 9 hours,
- at 60 dg.C - 3-5 minutes
- at boiling, effect of alcohol, bichloride of mercury, forma-
linum, disinfectants - is instantaneous. At fast freezing to
(-) 70 dg.C - is survived by years!!!

37. EPIDEMIOLOGY
Source - the sick man 24 hours prior to illness and all
acute period
Path of transmission - air-borne
Epidemics of an influenza A - are retried everyone 2-3 years,
duration 1 - 1,5 months with a damage up to 20 - 50 % of the
population
The pandemics - are retried everyone 10 - 40 years
Epidemics of an influenza B- are retried through 3 - 4 years
by duration 2,5 - 3 months with a damage 25 % of the
population.
At an influenza C an only sporadic case rate

39. Epidemics arise-
- autumn and winter (Northern hemisphere)
- spring and summer (Southern hemisphere)
- the year round (along equators)
The level of a case rate depends on number the population of
city:
- 1 million and more - ARVD -29,7 % of an Influenza - 11,3 %
- 500 т. - 1 million. - ARVD- 24,1 % of an Influenza - 10,3 %
- It is less 500 т. - ARVD- 22,1 % of an Influenza - 9,7 %
The village inhabitants are sick less often (less than density
the population)
Postinfectious immunity:
- at an influenza A -1 - 3 years
- at an influenza B - 3 - 6 years,
- at an influenza C- all children have immunity to it to 10 to
years of life.!!!

40. PROPHYLAXIS (common and special)
- Common - rise of stability of an organism
to catarrhal diseases (walk, vitamin therapy etc.)
- Specific - introduction of inactivated vaccines:
- subunit (containing only H and N antigenes)
Infuvac (Holland)
- split- Fluarix (Holland), Vaxigrip (France)
(At usage of split vaccines reduced in 2,6 times were sick by
others ARVD less often!!!
Emergency prophylaxis usage of remantadinum, аrbidol,
аdapromil in preventive doses, and intranose will be
utillized by 0,25 % oxolinic and florenalic of unguentum!!

41. DIPHTHERIA - ETIOLOGY
Definition- acute, anthroponosis, infectious disease caused by the
toxicogenic strains corynobacterium diphteriae, which is
characterized by an inflammation in a place of entry hiluses with
derivation of a fibrinous film both toxic lesion of cardiovascular
and nervous systems.
Corynobabacterium diphteriae (C.d.) Gram (+), - thin rods with
rounded, widening ends which contein of a clump in them of
grains of a volutin.
They are polymorphic and on cultural and enzymatic properties are
divided into 3 biotypes:
GRAVIS, INTERMEDIUS, MITIS.
Are steady against low temperatures.
At room temperature, in water, milk have survived 1 - 3 weeks.
Desinfectants inactivate С.d by 1- 2 minutes
At boiling were destroyed instantaneously.

42. EPIDEMIOLOGY
Sources of an infection:
epidemiological danger Danger infection
The sick 3 1
Convalescent 2 2
Bacteriocarrying 1 3
Sanitation of convalescents are completed through 15 - 20 days , but
about 90 days can be delayed.
The frequency of a carriage in a population makes 1-10 %
Mechanism of transmission - aerogenic (main), less often contact and
alimentary
Enlargement of a case rate - in autumn-winter period
Periodicity of uprise of a case rate – 5 - 7 years.
Controlled infection. The scheduled grafts in children's age have
given increase of diseases among the adult now!!!

43. PROPHYLAXIS (common and special)
Common: inspection of the contact persons,
- Closing disinfection in the center,
- Installation in the center of quarantine for 7 days
Special: introductions of a diphtherial anatoxin.
- primary immunization on 3,4,5 months of life
- revaccination per 18 months, and then in 6, 11, 14, 18
years
- the adult population is subject to a revaccination everyone
10 years

44. Antiepidemic measures at meningococcal disease
• All cases of meningococcal disease shall be
registered by sending an urgent message to the
SES.
• If there are 5 or more cases of generalized forms
of meningococcal infection in a single cell serves
special report on the country's Ministry of Health.
• Mandatory immediate hospitalization of patients
with generalized forms of meningococcal infection.
Patients with nasopharyngitis detected in the
cellscan be leave home if there are conditions for
isolation (no preschool children, people who work
in childcare).

45. Antiepidemic measures at meningococcal disease
• Extract from the hospital with clinical recovery without
bacteriological testing for carrier. Convalescents allowed in
kindergartens, schools, orphanages, health centers after a negative
result conducted 5 days after discharge from hospital.
• Preventive vaccination convalescents could be done through 2-6
months after suffering nasopharyngitis, generalized forms of
meningococcal infection carriers in 1 month.
• All contact under review Otolaryngology - doctor, medical
examination, hospitalization of those who are pathological changes
in the nose, throat, fever, rash.
• Quarantine in closed groups of 10 days from the date of the last
patient isolation.

46. Antiepidemic measures at meningococcal disease
• Bacteriological examination conducted: in children's institutions to
children interacting with patients, support staff in schools - pupils
and teachers of the class where found sick in boarding - students,
teachers, educators, interacting with patients in vocational schools
and universities -1 course, all students and teachers, senior courses -
only those who communicate with patients.
• The children's institutions bacteriological examination of contact
persons hold not less than 2 times at intervals of 3-7 days, other
groups - once. Carriers meningococcus identified by bacteriological
examination in childcare in school - removed from the team and
dignity, carriers adults not isolated.
• Specific preventive vaccination provided. There monovaccines A
and C, A bivalent C quart vaccine A C Y W135.

47. LITERATURE
1. Epidemiology. B.N. Dikiy, T.A. Niciforova, O.Y. Pryshlyak
– Ivano-Frankivsk: Publishing house of the Ivano-
Frankivsk State Medical University, 2008. – 142 p.
2. Epidemiology and fundamentals of infectious diseases.
M.L. Volovskaya – Mir Publishers Moscow, 1990. – 308
p.
3. Materials from Internet sites and electronic libraries.