Vaccination against meningococcal infection and preventive measures in the outbreak. IV

Mandatory registration and urgent notification to the Central State Sanitary and Epidemiological Service of cases of a generalized form of meningococcal infection.

Immediate hospitalization in specialized departments or boxes.

In the focus, quarantine is established for a period of 10 days from the moment of isolation of the patient and daily clinical monitoring of contacts is carried out with an examination of the nasopharynx (in teams, it is mandatory with the participation of an otolaryngologist), skin and daily thermometry for 10 days.

Bacteriological examination of contacts in preschool institutions is carried out at least twice with an interval of 3-7 days, and in other groups - once.

Patients with bacteriologically confirmed meningococcal nasopharyngitis, identified in the foci of infection, are hospitalized for clinical and epidemiological indications, but can be isolated at home if there are no more children in the family or apartment preschool age and persons working in preschool institutions, as well as subject to regular medical supervision and treatment. Convalescents are allowed to preschool institutions, schools, sanatoriums after one negative bacteriological examination, carried out no earlier than 5 days after discharge from the hospital or recovery at home.

Carriers of meningococci, identified during bacteriological examination in children's institutions, are removed from the team for the period of sanitation. Carriers are not isolated from a group of adults, including educational institutions. Bacteriological examination of the groups that visited these carriers is not carried out, with the exception of somatic hospitals, where, when a carrier is detected, the department staff is examined once. 3 days after the end of the sanitation course, the carriers are subjected to a single bacteriological examination and, in the presence of a negative result, are allowed into the teams.

Discharge from the hospital of patients with meningococcal infection is made after clinical recovery and a single bacteriological examination for the carriage of meningococci, carried out 3 days after the abolition of antibiotics. Convalescents of meningococcal infection are allowed in preschool institutions, schools, sanatoriums and educational institutions after one negative bacteriological examination, carried out no earlier than 5 days after discharge from the hospital.

Final disinfection in the foci is not carried out. The room is subject to daily wet cleaning, frequent ventilation, exposure to UV or germicidal lamps.

Prevention of meningococcal infection

The airborne mechanism of transmission in meningococcal infection and the widespread nasopharyngeal carriage of meningococci (4-8%) in the population hinder the effectiveness of anti-epidemic measures against the source of infection and the causative agent of the disease.

A radical measure that prevents the spread of the disease is specific vaccination.

The procedure for carrying out prophylactic vaccinations against meningococcal infection, the definition of population groups and the timing of prophylactic vaccinations are determined by the bodies exercising state sanitary and epidemiological supervision.

Organization of immunoprophylaxis against meningococcal infection.

Preventive vaccinations against meningococcal infection are included in the calendar of preventive vaccinations according to epidemic indications. Prophylactic vaccination is started when there is a threat of an epidemic rise: obvious signs of epidemiological trouble are identified in accordance with paragraph 7.3, an increase in the incidence of urban residents by a factor of two compared to previous year or with a sharp rise in the incidence of more than 20.0 per 100,000 population.

Planning, organization, conduct, completeness of coverage and reliability of accounting for preventive vaccinations, as well as timely submission of reports to the bodies exercising state sanitary and epidemiological supervision, are provided by the heads of medical institutions.

The plan of preventive vaccinations and the need of medical and preventive organizations for medical immunobiological preparations for their implementation is coordinated with the bodies exercising state sanitary and epidemiological supervision.

Immunization of the population.

With the threat of an epidemic rise in meningococcal infection, vaccination, first of all, is subject to:

Children from 1.5 years old to 8 years old inclusive;

First-year students of secondary and higher educational institutions, as well as persons who arrived from different territories Russian Federation, near and far abroad countries and united by cohabitation in dormitories .

girl from Corinth

LIST OF ANTI-EPIDEMIC MEASURES IN FOCI OF SEROUS MENINGITIS
1. Compulsory hospitalization of a patient with suspected serous meningitis.

2. Carrying out the final disinfection by the population in domestic outbreaks and by medical personnel in organized groups, in outbreaks with two or more cases of serous meningitis of enteroviral etiology (at the request of epidemiologists) by the disinfection station.

3. Medical supervision for 14 days for children under 14 years of age who have been in contact with a patient with serous meningitis, with a daily examination of the throat, skin, and thermometry.

4. Examination of contact children by a neuropathologist in order to identify patients with signs of serous meningitis and their hospitalization.

5. A single virological examination of all contact children (taking fecal samples) when registering two or more cases of serous meningitis in the home or in a children's institution.

6. Quarantine in preschool institutions and schools is imposed for 14 days from the moment the child last visited these institutions

DISPENSERIZATION OF RECONVALENTS OF SEROUS MENINGITIS
Due to the fact that the outcomes of acute neuroinfections, both immediate and long-term, are directly dependent on the timely diagnosis and the start of active targeted therapy, as well as on the management of patients after the end of the acute period of the disease and discharge from the hospital, dispensary observation is mandatory. for convalescents at the neuropathologist of the polyclinic at the place of residence or at the NIIDI (children). The main goal of clinical examination is the maximum use of all means and methods for the most complete elimination of the consequences of the disease, control over the correctness of complex rehabilitation measures, prevention of complications, and, if they appear, timely correction.

The minimum terms of active dispensary observation after discharge from the hospital: after 1 month, then 1 time in 3 months during the first year, 1 time in 6 months thereafter, if necessary, the frequency of examinations increases. Upon discharge from the hospital, the patient is issued a certificate describing the monitoring of his condition, the treatment and laboratory examination, as well as recommendations for the further management of the convalescent.

Within 3 weeks after discharge from the hospital, the child must undergo rehabilitation in a polyclinic at the place of residence, following the instructions of the attending physician. Schoolchildren are exempted from physical education and other physical activities for 6 months.

It is necessary to provide those who have been ill with a protective regime: a calm environment, stay in the fresh air, gradual inclusion in the general mode, limiting TV viewing and working with a personal computer to 1 hour a day. According to the indications for schoolchildren, the provision of either a day off in the middle of the week, or a reduction in the teaching load at school during the day, depending on the neurological status.

During the dispensary examination, attention is drawn to the dynamics of neurological symptoms, the degree of functional compensation of motor, mental and speech capabilities, liquorodynamics, the implementation of the established regimen and the punctuality of the recommended therapy. According to the indications, an EEG or ECHO examination, ultraneurosonography (US) of the brain, as well as magnetic resonance imaging (MRI) of the brain and CT scan(CT) of the brain.

Often, the issue of involving other specialists for the purpose of consultation is decided: an oculist, an otolaryngologist, a psychiatrist, an orthopedist, a massage therapist, and an exercise therapy methodologist.

If necessary, the issue of either re-hospitalization or regional sanatorium treatment is resolved, where convalescents can be sent at any time, but not earlier than 3 months after the acute period of the disease.

Removal from active dispensary observation of convalescents of enteroviral serous meningitis is possible 2-3 years after the persistent disappearance of residual effects.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Do they have the right to refuse to issue sick leave for the period of quarantine in the clinic? kindergarten?
No, they don't! Even if your child is completely healthy and has not been in contact with a carrier of the infection. Although in this case you can demand to provide you with a place in another kindergarten group.

The law that regulates the issue of issuing sick leave, including in the event of a quarantine being declared in kindergarten, is Federal Law No. 255-FZ of December 29, 2006.

I ACKNOWLEDGE
Chief State Sanitary Doctor of the Russian Federation
G.G. Onishchenko
2008
Introduction date

3.1.2. PREVENTION OF INFECTIOUS DISEASES.
RESPIRATORY INFECTIONS

PREVENTION OF MENINGOCOCCAL INFECTION
Sanitary and epidemiological rules
SP 3.1.2. -08

1 area of ​​use

1.1 These sanitary rules establish the basic requirements for a set of organizational, sanitary and anti-epidemic (preventive) measures, the implementation of which is aimed at preventing the occurrence and spread of meningococcal disease.
1.2 Compliance with sanitary rules is mandatory for citizens, legal entities and individual entrepreneurs.
1.3 Control over compliance with these sanitary rules is carried out by the bodies exercising state sanitary and epidemiological supervision in the Russian Federation.

2.General information about meningococcal infection

Meningococcal infection Anthroponotic acute infectious disease caused by meningococcus (Neisseria meningitidis).
According to its antigenic structure, meningococcus is divided into 12 serogroups: A, B, C, X, Y, Z, W-135, 29E, K, H, L, I.
Until now, epidemic rises of meningococcal infection of varying intensity have been caused by three serogroups - A, B and C. Special studies have shown that meningococcal serogroups are divided in turn into subgroups that differ in genetic characteristics. The last epidemic rise in Russia was caused by meningococcus serogroup A subgroup 111-1. In the inter-epidemic period, a small number of diseases with a generalized form can also be caused by meningococcus serogroup A, but other subgroups.
Meningococcal infection is characterized by periodicity. Periodic rises in incidence occur after long inter-epidemic periods (from 10 to 30 years or more) and are caused by one of the meningococcal serogroups. Large epidemics in the 20th century, covering simultaneously many countries of the world, were caused by meningococcus serogroup A. Local epidemic rises within the borders of one country - meningococcus B and C serogroups.
The sporadic incidence of the inter-epidemic period is formed by different serogroups, of which the main ones are A, B and C.
During the epidemic rise in 86 - 98% of the foci there is one disease with a generalized form, in 2 - 14% of the foci - from 2 cases or more. The lowest percentage of secondary diseases occurs in families - 2.3%. The highest (12-14%) - in preschool institutions and hostels, respectively. The occurrence of secondary diseases is facilitated by overconsolidation, increased humidity in the room, and violations of the sanitary and hygienic regime.
With a sporadic incidence rate in almost 100% of foci, 1 case of a generalized form of meningococcal infection is recorded.
The source of meningococcal infection is an infected person. The causative agent is transmitted from person to person by airborne droplets (aerosol) through direct close contact at a distance of up to 1 m from an infected person). Meningococcus is unstable in the external environment and infection through household items has not been registered. However, it can be assumed that infection can be carried out through a common cup and spoon while eating and drinking.
There are 3 groups of sources of infection:
1. Patients with a generalized form of meningococcal infection (meningococcemia, meningitis, meningoencephalitis, mixed form - make up about 1-2% of the total number of infected persons).
2. Patients with acute meningococcal nasopharyngitis (10-20% of the total number of infected persons).
3. "Healthy carriers" - persons without clinical manifestations, are detected only during bacteriological examination. The duration of the carriage of meningococcus averages 2-3 weeks, in 2-3% of individuals it can last up to 6 or more weeks. The wide prevalence of bacteriocarrier in the human population maintains the continuity of the epidemic process.
The highest incidence both during the epidemic and in the inter-epidemic period is recorded among children and adolescents.
Meningococcal infection is characterized by winter-spring seasonality.
An increase in the incidence of meningococcal infection is noted during the formation of teams of children's educational institutions, schoolchildren, students - after the summer holidays.
The increased risk groups for morbidity are children and recruits.

3. Identification of patients with meningococcal infection, persons with suspicion of this disease and meningococcal bacteria carriers.

3.1. Identification of patients with a generalized form of meningococcal infection, persons with suspected disease is carried out by doctors of all specialties, paramedical workers of medical and preventive, children's, adolescent, health and other organizations, regardless of organizational and legal forms and forms of ownership, doctors and paramedical workers involved in private medical activities, with all types of medical care, including:
- when the population seeks medical help;
- when providing medical care at home;
- at reception at the doctors who are engaged in private medical activity.
3.2. Identification of patients with meningococcal nasopharyngitis and meningococcal bacteria carriers is carried out during anti-epidemic measures in the foci of a generalized form of meningococcal infection.
3.3. Patients with a generalized form of meningococcal infection or with suspicion of this disease are immediately hospitalized in an infectious diseases hospital.
3.4. Registration and registration of each case of meningococcal infection is carried out in accordance with established requirements.
4. Activities in the focus of a generalized form of meningococcal infection

4.1. After receiving an emergency notification in the event of a generalized form of infection or suspicion of this disease, specialists from the territorial bodies of Rospotrebnadzor conduct an epidemiological investigation within 24 hours to determine the boundaries of the outbreak and the circle of people who contacted the patient, and organize anti-epidemic and preventive measures to localize and eliminate the outbreak .
4.2 Anti-epidemic measures in foci with one case of a generalized form of the disease are limited to a circle of people from the immediate environment of the patient. These include relatives living in the same apartment with the sick person, close friends who have been in contact with the sick person for the last 3 days, pupils and staff of the children's institution group, roommates in the hostel.
4.3. In foci with a single disease, quarantine is not imposed. After hospitalization of the patient, during the first 24 hours, the otolaryngologist examines the persons who communicated with the patient in order to identify patients with acute nasopharyngitis. Identified patients with acute nasopharyngitis are subject to hospitalization (according to clinical indications), or remain in the team for the period of treatment. All persons without inflammatory changes in the nasopharynx undergo chemoprophylaxis with one of the antibiotics, taking into account contraindications. Refusal from chemoprophylaxis is documented in the medical records and signed by the responsible person and the medical worker.
Over the focus for 10 days after hospitalization of a patient with a generalized form, medical observation is established with thermometry, examination of the nasopharynx and skin.
In the event of the occurrence of secondary diseases in the outbreak (within the incubation period), quarantine is established for a period of 10 days with medical supervision of contacts. For the period of quarantine, it is not allowed to accept new and temporarily absent children, transfer personnel from groups (class, department) to other groups.
4.4. In outbreaks with 2 cases of a generalized form that occurred simultaneously in children's preschool educational institutions, orphanages, orphanages, schools, boarding schools, children's health institutions, organizations, quarantine is established for a period of 10 days. For the period of quarantine, the listed groups are not allowed to accept new and temporarily absent children, transfer personnel from groups (class, department) to other groups.
4.5. The sequence of anti-epidemic measures in foci with 2 or more cases of the disease is carried out according to the scheme presented in clause 4.3. After identifying patients with nasopharyngitis and before prescribing chemoprophylaxis, a bacteriological examination of all persons who were in varying degrees of communication with the sick (children and staff in the group of a preschool institution, school class, study group and hostel room) is carried out. Persons receiving chemoprophylaxis are not withdrawn from the team.
The emergence of foci with secondary diseases, as well as foci with simultaneously occurring diseases, is a warning sign of a possible rise in incidence.
Bacteriological examination in the foci is carried out in order to identify the circulation of the meningococcus serogroup, which was the cause of secondary diseases.
4.6. In foci with several cases of diseases with generalized forms of meningococcal infection, emergency prophylaxis is carried out with a vaccine containing an antigen corresponding to the meningococcal serogroup isolated from patients. Vaccination is carried out in accordance with the "Instructions for the use of the vaccine"
Vaccinations are subject to children older than 1-2 years, adolescents and adults:
- in a children's preschool educational institution, a children's home, an orphanage, a school, a boarding school, a family, an apartment - all persons who communicated with the patient;
- first-year students of secondary and higher educational institutions of the faculty where the disease occurred;
- senior students of a higher and secondary educational institution who communicated with the patient in a group and (or) a hostel room, as well as all first-year students of the faculty where the disease arose;
- persons who communicated with the patient in dormitories, in the event of a disease in teams staffed by foreign citizens.
The presence of nasopharyngitis in a vaccinated disease without a temperature reaction is not a contraindication for vaccination
4.6. In the focus of a generalized form of meningococcal infection, after hospitalization of a patient or suspected of this disease, final disinfection is not carried out. The premises are subjected to daily wet cleaning, frequent ventilation, maximum decompression in the sleeping quarters.
4.7 .. During the period of the epidemic rise in the foci of the generalized form of meningococcal infection, emergency vaccination is carried out without establishing the serogroup of the pathogen, quarantine is not established, bacteriological examination is not carried out.

5. Measures in relation to convalescents of the generalized form of meningococcal infection, meningococcal nasopharyngitis, carriers of meningococcus

5.1. An extract from the hospital of convalescents of a generalized form of meningococcal infection or meningococcal nasopharyngitis is carried out after clinical recovery.
5.2. Convalescents of a generalized form of meningococcal infection or meningococcal nasopharyngitis are admitted to preschool educational institutions, schools, boarding schools, children's health organizations, hospitals, secondary and higher educational institutions after a single bacteriological examination with a negative result, carried out no earlier than 5 days after the end course of treatment. While maintaining the carriage of meningococcus, sanitation is carried out with one of the antibiotics.
5.3. Convalescents of acute nasopharyngitis without bacteriological confirmation are admitted to the institutions and organizations listed in clause 5.2., after the disappearance of acute phenomena.

6. Organization of immunoprophylaxis of meningococcal infection
according to epidemic indications
6.1. Preventive vaccinations against meningococcal infection are included in the calendar of preventive vaccinations according to epidemic indications
6.2. Planning, organization, conduct, completeness of coverage and reliability of accounting for preventive vaccinations, as well as timely submission of reports to the bodies exercising state sanitary and epidemiological supervision, are provided by the heads of medical and preventive organizations in accordance with established requirements.
6.3. Preventive vaccination according to epidemic indications is carried out with the threat of an epidemic rise, namely, with an increase in the incidence of the prevailing meningococcal serogroup by two or more times compared to the previous year, by decision of the chief state sanitary doctor of the Russian Federation, the chief state sanitary doctors of the constituent entities of the Russian Federation to the following risk groups .
6.4. Vaccinations are subject to:
- children from 1 to 8 years old inclusive;
- first-year students of secondary and higher educational institutions, primarily in teams staffed by students from different regions of the country and foreign countries.
With the continuing increase in the incidence of meningococcal infection, the number of people vaccinated according to epidemic indications should be expanded by:
- students from grades 3 to 11;
- the adult population when applying to medical and preventive organizations for immunization against meningococcal infection.
6.5. Preventive vaccinations for children are carried out with the consent of parents or other legal representatives of minors.
Health workers inform adults and parents of children about the need for vaccination against meningococcal infection, the timing of vaccinations, and possible reactions and post-vaccination complications on the administration of the drug.
6.6. Refusal to carry out prophylactic vaccination is documented in the medical records and signed by the parent or legal representative of the child and a medical worker.
6.7. Information about the vaccination (date of administration, name of the drug, dose, batch number, control number, expiration date, nature of the reaction to the vaccination) is entered into the established accounting forms medical documents and "Certificate of preventive vaccinations".
6.8. Immunizations are administered by a health worker trained in immunoprophylaxis.
6.9. Preventive vaccinations in medical and preventive organizations are carried out in vaccination rooms equipped with the necessary equipment in accordance with established requirements.
6.10. Children attending preschool educational institutions, schools and boarding schools, as well as children in closed institutions (orphanages, orphanages) are vaccinated in the medical offices of these organizations, equipped with the necessary equipment and materials.
6.11. When organizing mass immunization, it is allowed to carry out vaccination at home by vaccination teams in accordance with established requirements.
6.12. Prophylactic vaccination against meningococcal infection is carried out with vaccines of domestic and foreign production, registered in the Russian Federation and approved for use in the prescribed manner, in accordance with the instructions for their use.
6.13. Storage and transportation of medical immunobiological preparations is carried out in accordance with established requirements.
6.14. Vaccination against meningococcal disease can be carried out simultaneously with vaccination against other infectious diseases, except vaccination against yellow fever and tuberculosis. Vaccines are administered with different syringes to different parts of the body.

7. Epidemiological surveillance of meningococcal disease
Epidemiological surveillance of meningococcal infection is carried out by bodies and institutions that carry out state sanitary and epidemiological surveillance in accordance with regulatory documents. Epidemiological surveillance includes:
- monitoring the incidence of meningococcal infection (monitoring of morbidity and mortality, age structure and contingents of patients, foci);
- analysis of the serogroup affiliation of strains isolated from patients with a generalized form of meningococcal infection and nasopharyngitis;
- tracking the immunological structure of the population to meningococcus of the main serogroups A, B and C;
- assessment of the effectiveness of ongoing activities;
- forecasting the development of the epidemiological situation.

Meningococcal infection - an acute infectious disease of an anthroponotic nature, characterized by damage to the upper respiratory tract and meninges and manifested by a polymorphic clinic - from asymptomatic carriage and nasopharyngitis to generalized forms (meningococcemia) with hemorrhagic rash and meningeal phenomena.

Etiology. The causative agent of meningococcal infection is Neisseria meningitidis belongs to the genus Neisseria families Neisseriaceae. It is a gram-negative microorganism with a diameter of 0.6-1.0 microns, shaped like a coffee bean. Does not form spores, aerobe. In culture, meningococci are often arranged in pairs, with each pair surrounded by a common tender capsule.

According to the antigenic structure, meningococci are divided into serological groups: A, B, C, D, X, Y, Z, 29E, 135W, H, I, K, L. Periodically, strains of one of the serogroups can become active and cause large epidemics. Basically, large epidemic rises are caused by meningococci serogroups BUT And FROM, however, in the last 30 years, a number of epidemics have been associated with the activation of the serogroup IN.

Among the pathogenicity factors of meningococci are known: a capsule that provides resistance to phagocytosis; fimbria (pili), with the help of which meningococci attach to the surface of the epithelium; enzymes - hyaluronidase, neuraminidase, proteases; endotoxin, which is most associated with strains of serogroups A, B And FROM, isolated from the nasopharynx and cerebrospinal fluid.

The causative agent is highly sensitive to antibiotics and sulfonamides, but currently there is a process of acquiring resistance to these drugs, including penicillin. Under the influence of antibiotics, meningococci can form L- forms that are associated with a protracted course of the disease and a decrease in the effectiveness of treatment.

Meningococci are not very stable in the external environment and quickly die when dried out, as well as when the temperature deviates from 37С (boiling kills them instantly). At room temperature in dried sputum, they die after 3 hours, at 0С - after 3–5 days, in a sprayed state at a temperature of 18–20С - within 10 minutes. Disinfectants (1% phenol solution, 0.5–1.0% chloramine solution, 0.2% bleach solution) cause the death of the pathogen within a few minutes.

source of infection. There are 3 groups of sources of infection: patients with generalized forms; patients with acute meningococcal nasopharyngitis; “Healthy” carriers are persons who excrete meningococci and do not have inflammatory changes in the nasopharynx.

The most dangerous source of infection is a sick generalized form of meningococcal infection (meningitis, meningococcemia, meningoencephalitis, etc.), which poses a danger to others, mainly in the prodromal period, the duration of which is, on average, 4-6 days. The risk of infection from a patient with a generalized form, ceteris paribus, is six times higher than from a carrier, and twice as high as compared with a patient with meningococcal nasopharyngitis. However, such patients quickly isolate or “self-isolate”.

Significant epidemic importance belongs to patients with meningococcal nasopharyngitis, in which the duration of the infectious period is about two weeks.

A "healthy" carrier has a significantly lower infective capacity. However, the number of carriers is hundreds of times greater than the number of patients. For one patient, depending on the epidemic situation, there are from 100 to 2000 carriers. In the years preceding the rise in the incidence, the level of carriage is insignificant - no more than 1%, while in epidemically unfavorable years it ranges from 5 to 20%. In foci where generalized forms of meningococcal infection are recorded, the carriage is significantly higher than outside foci or in foci of nasopharyngitis (22% and 14%, respectively). In most cases, the duration of the carriage of meningococci is no more than 2–3 weeks (65–70% of meningococci excrete no more than 10 days), however, in 2–3% of individuals, the carriage may continue for 6 weeks or more. There is some information about a longer carriage - up to a year, especially in the presence of a chronic inflammatory condition of the nasopharynx.

Incubation period- ranges from 1 to 10 days, on average - 2-3 days.

Transfer mechanism- aerosol.

Ways and factors of transmission. From the source of infection, meningococci are excreted with droplets of mucus when coughing, sneezing, talking. The spread of the pathogen in the team is slower than with other aerosol infections. This is due primarily to the extreme instability of meningococci in the external environment. In addition, with meningococcal infection, catarrhal phenomena are not very pronounced, and meningococci are isolated only with droplets of mucus with a diameter of more than 10 microns, which quickly settle. Infection of a person is possible only at the time of isolation of the pathogen with close and prolonged contact with the source of infection.

susceptibility and immunity. The susceptibility of people to the pathogen depends on their genotypic and phenotypic characteristics. Children born from immune mothers receive transplacental protective antibodies of the class IgG. Specific antibodies can be detected within 2 to 6 months after the baby is born. Further, most children of the first two years of life have no immunity to meningococci. In subsequent years, it is gradually formed due to natural immunization as a result of a meeting with the pathogen. Postponed meningococcal infection leads to the development of intense type-specific immunity, which makes it rare for relapses and repeated cases of the disease.

Manifestations of the epidemic process. Meningococcal infection is recorded everywhere. The highest incidence over the past 50 years has been noted in African countries (Mali, Ghana, Nigeria, Somalia, Ethiopia, etc.), which are included in the so-called "meningitis belt". In some countries, the incidence reaches 200-500 cases per 100,000 population. In the Republic of Belarus in recent years, the incidence of meningococcal infection is about 3 cases per 100,000 population. Risk time- in economically developed countries, there is a gradual increase in the incidence by dozens of times over 3-4 years after a long (up to 30 years) inter-epidemic period; in the countries of the "meningitis belt" there are frequent irregular "explosive" rises in the incidence with an increase in the number of cases hundreds of times within 1-2 years; the maximum incidence in temperate countries occurs in the spring; the level of carriage increases in the spring months, as well as in autumn (the autumn rise in carriage is associated with the formation of organized teams). At-risk groups- mainly children under 14 years of age are ill, which account for 70-80% of generalized forms of meningococcal infection; during periods of upsurge, older children, youth and adults are also involved in the epidemic process.

Risk factors. Crowding, prolonged communication, especially in sleeping quarters, violations of temperature and humidity conditions, reorganization of organized teams.

Prevention. A set of measures to prevent the incidence of meningococcal infection includes careful implementation of sanitary and hygienic requirements in preschool institutions and other organized groups (daily filter for children, wet cleaning, ventilation, processing of toys, rational filling of groups, isolation between groups, etc.). Sanitation of chronic diseases of the nasopharynx is important.

A promising direction in the fight against meningococcal infection is vaccination. serogroup meningococcal vaccine BUT And FROM recommended for prophylactic purposes and for emergency prophylaxis in the foci of meningococcal infection. Groups of persons at increased risk of developing the disease are subject to vaccination: children from 1 to 7 years old inclusive; first-year students of institutes, technical schools, colleges, temporary workers and other persons who came from different localities to organized groups and united by living together in hostels (preferably during the formation of teams); children admitted to orphanages, students of the first grades of boarding schools. With the first sharp rise in the incidence and the rate of more than 20.0 per 100,000 population, a decision can be made to carry out mass vaccination of the population under the age of 20 years. According to epidemic indications, it is advisable to administer the vaccine in the focus of infection in the first 5 days after the detection of the first case of a generalized form of meningococcal infection.

Anti-epidemic measures– table 15.

Table 15

Anti-epidemic measures in outbreaks

meningococcal infection

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INTRODUCTION

CHAPTER 1. ETIOLOGY AND PATHOGENESIS OF MENINGOCOCCAL INFECTION

1.1 Epidemiology and clinic of meningococcal infection

1.2 Diagnosis of meningococcal disease

CHAPTER 2. NURSING IN MENINGOCOCCAL INFECTION

2.1 Identifying problems in a patient with meningococcal disease

2.2 Managing the problems of a patient with meningococcal disease

CHAPTER 3

3.1 Activities in the focus of meningococcal infection

3.2 Prevention of meningococcal disease

CONCLUSION

BIBLIOGRAPHY

INTRODUCTION

Meningococcal infection continues to be an urgent problem for public health and the sanitary and epidemiological service, due to a wide range of its clinical manifestations - from asymptomatic bacterial carriage and acute nasopharyngitis to lightning-fast meningococcemia and purulent meningoencephalitis, ending in death within the first three days. The disease most often occurs in the form of outbreaks in closed or closely contacting groups of the population (children in organized groups, the military, tourists, pilgrims). The main danger in the spread of meningococcal infection is that patients on early stages diseases feel good, but actively excrete the pathogen. There is also a category of bacterial carriers - these are people who can isolate the meningococcal bacterium without getting sick themselves. Every 3-5 years, outbreaks of meningococcal infection occur in Russia, claiming several lives. Meningococcal infection is especially dangerous for children, but adults who do not start treatment in a timely manner can die from inflammation of the meninges.

From January to December 2014, a decrease in the incidence of meningococcal infection was registered in the Russian Federation - by 22.9% (of which generalized forms - by 23.5%). A significant decrease in the incidence in the Rostov region occurred in meningococcal infections by 1.3 times. In June 2013, an outbreak of meningitis was recorded in the city of Rostov-on-Don in the Teremok kindergarten. According to the study, meningococcal infection was detected in 11 children, 1 child died at the age of 3 years. At the end of 2014, 6 laboratory-confirmed cases of meningococcal infection were registered, in 2013 - 8. In 2013, meningococcal infection was registered in Volgodonsk: serous meningitis in 1 child.

For effective infection management, it is important to diagnose this disease and start adequate therapy from the first hours of the disease, which determines the need to identify the timeliness of the clinical course and adequate diagnosis already at the early stages of the infection. In the case of diagnosis and proper treatment in the early stages of the disease, the risk of death is low. In 10-20% of human survivors, bacterial meningitis can lead to brain damage, hearing loss, or learning difficulties.

If left untreated, meningococcal infection is fatal in 50% of cases. But even in cases of early diagnosis and proper treatment, 5-10% of patients die, usually 24-48 hours after the onset of symptoms.

Object of study: in this work is meningococcal infection.

Subject of study: nursing activities in meningococcal infection.

The purpose of the work: the study of nursing activities in meningococcal infection.

To study theoretical sources on meningococcal infection.

To study the regulatory framework for meningococcal infection.

Identify patient problems with meningococcal infection.

Develop a nursing action plan for meningococcal disease.

Research methods:

1) Studying the analysis of the literature on meningococcal infection;

2) Description of the patient's problems with meningococcal infection;

3) Planning nursing activities for meningococcal infection.

CHAPTER1. ETIOLOGY AND PATHOGENESIS OF MENINGOCOCCAL INFECTION

1.1 Epidemiology and clinic of meningococcal infection

Meningococcal infection - an acute infectious disease caused by Neisseria meningitidis meningococcus, with a drop (aerosol) pathogen transmission mechanism; clinically characterized by damage to the mucous membrane of the nasopharynx (nasopharyngitis), generalization in the form of specific septicemia (meningococcemia) and inflammation of the meninges (meningitis).

The causative agent is Neisseria meningitidis meningococcus, which belongs to the Neisseriaceae family of the Neisseria genus. The Neisseria genus includes two species pathogenic microorganisms: N. meningitidis and N. gonorrhoeae, other members of this genus are resident mucosal flora.

Morphologically, meningococcus is a round, immobile, gram-negative bean-shaped diplococcus with a diameter of 0.6-0.8 microns. The three-layer membrane of the cell is represented by a cytoplasmic membrane, a peptidoglycan layer, and an outer membrane containing LPS and proteins. Many meningococci have a polysaccharide capsule and outgrowths known as pili. According to serological activity, which is determined by the capsular polysaccharide, meningococci are divided into serogroups within the species. There are 12 known serogroups of meningococci: A, B, C, D, Y, Z, X, W-135, 29E, H, I, K, but only three of them - A, B, C - are responsible for more than 90% of all generalized forms of meningococcal infection. Within individual serogroups, antigenic heterogeneity is also found in the proteins of the outer membrane, which determine the sero- and subtype of the pathogen.

To date, more than 20 serotypes of meningococcus are known, of which types 2, 4, 15, 16 are evaluated as markers of virulence, since meningococci with such serotypes were detected mainly during the period of rising incidence or during outbreaks.

The entrance gates of infection are the mucous membranes of the nasopharynx. However, only in 10-15% of cases, the ingress of meningococcus on the mucous membrane of the nose and pharynx leads to the development of inflammation (nasopharyngitis, catarrhal tonsillitis). Even more rarely, meningococcus is able to overcome local protective barriers. The main route of spread of the pathogen in the body is hematogenous. Bacteremia can be transient or prolonged (meningococcemia).

In the pathogenesis of meningococcemia, toxic shock is the leading one. It is caused by massive bacteremia with intense decay of microbes and toxinemia. Endotoxin impact, caused by toxins released from the cell walls of meningococci, leads to hemodynamic disorders, primarily microcirculation, disseminated intravascular coagulation, deep metabolic disorders (hypoxia, acidosis, hypokalemia, etc.). Sharp disturbances of the coagulation and anticoagulation systems of the blood develop: at first, the process of hypercoagulability predominates (an increase in the content of fibrinogen and other coagulation factors), then fibrin falls out in small vessels with the formation of blood clots. As a result of thrombosis of large vessels, gangrene of the fingers of the extremities may develop. The subsequent decrease in the content of fibrinogen in the blood (consumption coagulopathy) often causes massive bleeding and hemorrhages in various tissues and organs. With the penetration of meningococcus into the meninges, a clinical and pathomorphological picture of meningitis develops.

The inflammatory process first develops in the pia mater and arachnoid (causing the meningitis syndrome), and then it can spread perivascularly into the brain substance, more often limited to the outer layer of the cortex, reaching the white matter (encephalitis syndrome) (see Fig. 1).

Rice. 1 - Inflammatory process

The nature of inflammation in the first hours is serous, then purulent. The formation of pus into dense fibrinous masses occurs by the 5-8th day. Exudate localization: on the surface of the frontal and parietal lobes, on the base of the brain, on the surface of the spinal cord, in the sheaths of the initial segments of the cranial nerves and spinal roots (neuritis). When the ependyma of the ventricles is affected, ependymatitis occurs. With impaired CSF circulation, exudate can accumulate in the ventricles, which leads (in young children) to hydrocephalus or pyocephaly. An increase in intracranial pressure can lead to displacement of the brain along the cerebral axis and wedging of the tonsils of the cerebellum into the foramen magnum with compression of the medulla oblongata (death from respiratory paralysis).

Carriage of meningococci is quite widespread and subject to fluctuations. During periods of sporadic incidence, 1-3% of the population are carriers of meningococcus, in epidemic foci - up to 20--30%. The duration of carriage is 2-3 weeks, on average 11 days. Longer carriage is associated, as a rule, with chronic inflammatory lesions of the nasopharynx.

The source of infection is a person with a generalized form, acute nasopharyngitis, as well as healthy carriers.

The transmission mechanism is aerosol. The pathogen is transmitted with droplets of mucus when coughing, sneezing, talking. Due to the instability of meningococcus in the external environment and its localization on the mucous membrane of the posterior wall of the nasopharynx, it is transmitted through fairly close and prolonged communication. Infection is facilitated by crowding, prolonged communication, especially in sleeping quarters, violations of the temperature and humidity regime.

Manifestations of the epidemic process. The disease is ubiquitous.

It has all the features of the epidemiology of infections with an airborne transmission mechanism: periodicity, seasonality, a certain age distribution and foci. The widespread carriage of the pathogen and the low frequency of diseases with clinically pronounced forms determine the main epidemic manifestations of the infection. Periodic rises in incidence occur after 10-12 years and are determined by the change in the etiological role of meningococci of different serogroups. The urban population is predominantly affected. Children under 5 years of age account for more than 70% of all patients. The highest incidence rates persist in children under 1 year of age. During the period of rising incidence, in addition to young children, older children, adolescents and adults are involved in the epidemic process.

Meningococcal infection has a low foci: up to 95% are foci with one disease. Outbreaks can occur in organized groups of children and adults. The natural susceptibility of people is high, but the outcome of infection is determined both by the properties of the pathogen (virulence) and the resistance of the macroorganism. The immunological structure of the population is shaped by morbidity and carriage.

The most common manifest form of meningococcal infection is nasopharyngitis, its etiological interpretation is clinically difficult. Incubation period does not exceed 2-3 days.

Patients note an increase in body temperature, often in the form of low-grade fever, headache, catarrhal manifestations: cough, sore throat and sore throat, nasal congestion and runny nose with mucopurulent discharge. In some cases, patients complain of joint pain. The face is pale. There is hyperemia of the tonsils, soft palate, bow. Attention is drawn to the bright hyperemia and graininess of the posterior pharyngeal wall, covered with a mucopurulent coating. The submandibular glands may be enlarged and painful on palpation. The disease lasts 3-5 days and ends with recovery. With the generalization of the process, meningococcemia (meningococcal sepsis) may develop. In most cases, meningococcemia is preceded by nasopharyngitis, but sometimes the disease develops unexpectedly against the background of complete health.

The disease begins acutely, with an increase in temperature in a few hours to 40-41 ° C, which is accompanied by headache, indomitable vomiting, pain in the muscles of the back and limbs. The patient's face is pale, with a cyanotic tint, shortness of breath, tachycardia, a tendency to fall in blood pressure, up to the development of collapse, are noted. Oliguria or anuria develops very early. The most demonstrative symptom that allows a clinical diagnosis is exanthema (see Fig. 2).

Typical stellate hemorrhagic elements, dense to the touch. The rash tends to merge, is located on the buttocks, lower limbs, in the armpits, on the upper eyelid. With massive bacteremia and intoxication, the rash can be located on any surface of the body and becomes necrotic. With the reverse development of the rash, ulcerative-necrotic surfaces can form on the auricles, the tip of the nose, and the distal extremities.

In rare cases, meningococcemia can acquire a chronic course, accompanied by prolonged intermittent fever, polymorphic skin rashes, arthritis and polyarthritis, and the development of hepatolienal syndrome.

Rice. 2 - Exanthema

In hyperacute (fulminant) forms of meningococcemia, an infectious-toxic shock develops in a short time, which determines an emergency and often leads to death.

As with meningococcemia, the development of meningococcal meningitis is often preceded by nasopharyngitis. The disease begins acutely with a rise in temperature to high numbers, a sharp, excruciating headache, often uncontrollable vomiting without nausea, not associated with eating. Patients are agitated, euphoric, some of them have a disorder of consciousness in the first hours of the disease. The face is hyperemic, herpetic eruptions on the lips are not uncommon, tactile, auditory and visual hyperesthesia occurs. Convulsive syndrome is possible. marked tachycardia, arterial pressure has a tendency to fall. Urination is delayed. Meningeal symptoms appear as early as

the first day of the disease in the form of stiff neck, symptoms of Kernig, Brudzinsky, etc. (see Fig. 3). In infants, meningeal symptoms can be expressed only in bulging and tension of the large fontanel. Tendon reflexes are increased, their zones are expanded. Cranial nerve lesions are not uncommon.

Rice. 3 - Symptoms of Kernig, Brudzinsky

The concept of "meningococcal meningitis" is very conditional, since there is a close anatomical connection between the membranes and the substance of the brain. With the transition of the inflammatory process to the substance of the brain and the development of meningoencephalitis, mental disorders, drowsiness, persistent paralysis and paresis usually rapidly increase. Progressive weight loss up to cachexia is noted. Meningeal syndrome may be mild in this case. In different combinations, pathological reflexes of Babinsky, Oppenheim, Rossolimo, Gordon are determined, indicating damage to the brain substance.

Generalized forms also include mixed (meningococcemia + meningitis) meningococcal infection, clinically it is expressed in a combination of the symptoms of these two conditions.

Diagnosis of meningococcal infection

Diagnosis of meningococcal nasopharyngitis with lesions of the nasopharynx of another etiology is impossible without bacteriological examination. Meningococcal sepsis should be differentiated from influenza, sepsis of another etiology, and food poisoning.

Meningococcal meningitis should be distinguished from other diseases and conditions with meningeal syndrome: meningism, tuberculous meningitis, meningitis of viral and bacterial origin, subarachnoid hemorrhage.

For the final diagnosis, a lumbar puncture with a study of the obtained fluid is necessary (see Fig. 4).

Rice. 4 - Spinal puncture

Diagnosis of subarachnoid hemorrhage is possible on prehospital stage if it develops against the background of full health or in persons suffering from hypertension and defects in the hemostasis system. In these cases, unlike meningitis, the disease begins with a sudden sharp headache (a blow to the head), which is accompanied by nausea and vomiting. On examination, it is revealed meningeal syndrome, sometimes mild focal symptoms, increased blood pressure, bradycardia. Fever, intoxication are absent. The development of hemorrhage may be preceded by exercise stress, stressful situation. In some cases, post-traumatic hemorrhages are also easily differentiated (trauma in history, absence of common symptoms), but injuries may be sustained while intoxicated or may be hidden by the victim and their families, such as injuries inflicted on children. Diagnosis is complicated by late treatment, since in a number of patients on the 2-4th day after the hemorrhage, as a result of the development of aseptic inflammation around the blood clot, the increase in intracranial hypertension, the condition worsens, the body temperature rises, headache, vomiting, increased meningeal symptoms. In these cases, it is extremely important to identify anamnestic data, i.e. the onset of the disease with a sudden headache.

With the development of subarachnoid hemorrhage against the background of acute febrile conditions, the correct diagnosis is possible only on the basis of the results of studies of the cerebrospinal fluid, which depend on the timing of the study. On the 1st day, the cerebrospinal fluid is uniformly stained with blood, turbid (to distinguish from damage to the choroid plexus during puncture, 2-3 portions must be compared), after centrifugation it is slightly xanthochromic, with microscopy, erythrocytes completely cover the field of view, the number of leukocytes is slightly increased - no more than a few tens in 1 μl, the protein content is increased in proportion to blood impurities, and an increase in glucose levels is also possible. A day later, due to hemolysis, the cerebrospinal fluid becomes transparent, red, "varnished", at a later date - xanthochromic, with a leukocyte content of up to 200-300 per 1 μl, with a predominance of neutrophils, an increased protein content, at the same time, the number of erythrocytes decreases.

With epi- and subdural hematomas, symptoms of brain compression are in the foreground, a history of head injury, an increase in protein content, a small admixture of leukocytes are possible in the cerebrospinal fluid. In strokes, primarily focal and cerebral symptoms due to cerebral edema are determined, meningeal syndrome is mild; at hypertensive crises- critically high blood pressure figures, cerebral and meningeal symptoms, which quickly regress after emergency antihypertensive therapy. It is important to remember that with strokes and hypertensive crises, an increase in body temperature is possible.

Acute febrile illnesses that occur with the syndrome of meningism can be reliably differentiated from meningococcal and other meningitis only on the basis of the results of a study of cerebrospinal fluid. Therefore, patients must be urgently hospitalized in infectious diseases or multidisciplinary hospitals, where there is a department of neuroinfections or neurological.

Poisoning by alcohol surrogates, tranquilizers may be accompanied by meningism or muscle hypertonicity, simulating meningism. The absence of fever, disturbances of consciousness, focal, in particular bulbar, symptoms, anamnestic data (drinking alcohol, drugs) usually easily make it possible to exclude the diagnosis of meningitis.

Meningococcal nasopharyngitis is confirmed by culture and identification of meningococcus from the nose and oropharynx. With generalized forms, blood and cerebrospinal fluid are cultured on nutrient media containing human protein. Direct microscopy of the cerebrospinal fluid and the detection of intracellular diplococci in it are possible. Methods of serological diagnostics (detection of meningococcal antigens in the ELISA reaction and antibodies to them using RNHA) are of secondary importance.

In cases of meningococcal (purulent) meningitis, the cerebrospinal fluid is turbid, cytosis reaches several thousand per 1 μl with a significant predominance of neutrophilic cells, a high protein content, positive sedimentary tests, and a reduced amount of glucose are determined. In some cases, a rough film is formed in a test tube with liquid on the surface or at the bottom.

CHAPTER2 . NURSING ACTIVITIES IN MENINGOCOCCAL INFECTION

2.1 Identifying problems in a patient with meningococcal disease

To determine the activities of a nurse, it is necessary to identify the problems of a patient with meningococcal infection.

Problems are:

1. Existing, actual, real - these are the problems that prevail in the patient for a given period of time.

2. Possible or potential - these are the problems that the patient has if the problems are not solved in a timely manner, if the time of care is not planned in time.

In patients with meningococcal disease, disturbed needs can also be identified, such as:

Be healthy, communicate, sleep.

Problems of a patient with meningococcal infection:

Physiological priorities:

Headache, feeling of heat due to high temperature.

Physiological Potential:

The appearance of bedsores, constipation, the patient cannot go to the toilet on his own due to bed rest.

2.2 Managing the problems of a patient with meningococcal disease

meningococcal infection focus immunization

Based on the identified problems of the patient, a plan of nursing interventions can be drawn up.

Some of the priority issues are:

Headache, to reduce the headache, it is necessary to inform the doctor, give painkillers as prescribed by the doctor, provide the patient with physical rest (exclude noise).

Feeling of heat due to high temperature, to solve this problem, it is necessary to help the patient with a feeling of heat, inform the doctor, Give plenty of fluids, introduce a lytic mixture as prescribed by the doctor, carry out symptomatic therapy as prescribed by the doctor.

The appearance of bedsores, it is necessary to prevent the formation of bedsores, inform the doctor, wiping the body with warm water with the addition of alcohol, make sure that the sheet under the patient's back does not gather in folds.

Constipation, to activate intestinal motility, release the rectal ampulla, recommend food rich in fiber, perform a cleansing enema, give laxatives as prescribed by the doctor.

The patient cannot go to the toilet on his own due to bed rest, help the patient to create conditions for going to the toilet with the help of a nurse for the duration of bed rest, serve the vessel to the patient, toilet the genitals, prepare the necessary equipment for this procedure.

Based on the identified disturbed needs, the plan for nursing interventions is to meet them:

To be healthy, a violation of this need occurs when a person loses independence in care, for a decision, the nurse will provide the patient with direct assistance in the activities of everyday life: she washes, feeds, serves the ship, dresses, undresses. The main thing for a person is independence and freedom, the nurse, at the slightest opportunity, will create conditions for the patient to independently satisfy his violated needs.

Communication, in meeting this need: the nurse organizes communication for the patient that is accessible to him.

Sleep disturbance, the patient is worried: insomnia, intermittent sleep.

To meet this need, it is necessary to provide comfortable conditions for sleep, find out the causes of sleep disturbance, and teach the patient skills that help regulate sleep.

CHAPTER3 . MEASURES IN THE FOCUS AND PREVENTION OF MENINGOCOCCAL INFECTION

3.1 Activities in the focus of meningococcal infection

Mandatory registration and urgent notification to the Central State Sanitary and Epidemiological Service of cases of a generalized form of meningococcal infection.

Immediate hospitalization in specialized departments or boxes.

In the focus, quarantine is established for a period of 10 days from the moment of isolation of the patient and daily clinical monitoring of contacts is carried out with an examination of the nasopharynx (in teams, it is mandatory with the participation of an otolaryngologist), skin and daily thermometry for 10 days.

Bacteriological examination of contacts in preschool institutions is carried out at least twice with an interval of 3-7 days, and in other groups - once.

Patients with bacteriologically confirmed meningococcal nasopharyngitis, identified in the foci of infection, are hospitalized for clinical and epidemiological indications, but can be isolated at home if there are no more children of preschool age and persons working in preschool institutions in the family or apartment, as well as subject to regular medical supervision and treatment. Convalescents are allowed to preschool institutions, schools, sanatoriums after one negative bacteriological examination, carried out no earlier than 5 days after discharge from the hospital or recovery at home.

Carriers of meningococci, identified during bacteriological examination in children's institutions, are removed from the team for the period of sanitation. Carriers are not isolated from a group of adults, including educational institutions. Bacteriological examination of the groups that visited these carriers is not carried out, with the exception of somatic hospitals, where, when a carrier is detected, the department staff is examined once. 3 days after the end of the sanitation course, the carriers are subjected to a single bacteriological examination and, in the presence of a negative result, are allowed into the teams.

Discharge from the hospital of patients with meningococcal infection is made after clinical recovery and a single bacteriological examination for the carriage of meningococci, carried out 3 days after the abolition of antibiotics. Convalescents of meningococcal infection are allowed in preschool institutions, schools, sanatoriums and educational institutions after one negative bacteriological examination, carried out no earlier than 5 days after discharge from the hospital.

Final disinfection in the foci is not carried out. The room is subject to daily wet cleaning, frequent ventilation, exposure to UV or germicidal lamps.

3.2 Prevention of meningococcal disease

The airborne mechanism of transmission in meningococcal infection and the widespread nasopharyngeal carriage of meningococci (4-8%) in the population hinder the effectiveness of anti-epidemic measures against the source of infection and the causative agent of the disease.

A radical measure that prevents the spread of the disease is specific vaccination.

The procedure for carrying out prophylactic vaccinations against meningococcal infection, the definition of population groups and the timing of prophylactic vaccinations are determined by the bodies exercising state sanitary and epidemiological supervision.

Organization of immunoprophylaxis against meningococcal infection.

Preventive vaccinations against meningococcal infection are included in the calendar of preventive vaccinations according to epidemic indications. Preventive vaccination is started when there is a threat of the development of an epidemic rise: obvious signs of epidemiological trouble are identified according to paragraph 7.3, an increase in the incidence of urban residents by a factor of two compared to the previous year, or with a sharp increase in the incidence of more than 20.0 per 100,000 population.

Planning, organization, conduct, completeness of coverage and reliability of accounting for preventive vaccinations, as well as timely submission of reports to the bodies exercising state sanitary and epidemiological supervision, are provided by the heads of medical institutions.

The plan of preventive vaccinations and the need of medical and preventive organizations for medical immunobiological preparations for their implementation is coordinated with the bodies exercising state sanitary and epidemiological supervision.

Immunization of the population.

With the threat of an epidemic rise in meningococcal infection, vaccination, first of all, is subject to:

Children from 1.5 years old to 8 years old inclusive;

First-year students of secondary and higher educational institutions, as well as persons who arrived from different territories of the Russian Federation, countries of near and far abroad and united by cohabitation in hostels.

Conclusion

Thus, completing the work, we briefly note the following.

Meningitis was known in ancient times, the first outbreaks of meningitis in Russia were noted in 1863-1864. Meningococcus was discovered and isolated in pure culture by Vekselbaum in 1887.

Meningococcal infection is an acute infectious disease caused by meningococcus Neisseria meningitidis, with a drip (aerosol) pathogen transmission mechanism.

The transmission mechanism is aerosol. The causative agent is transmitted with droplets

mucus when coughing, sneezing, talking. Due to the instability of meningococcus in the external environment and its localization on the mucous membrane of the posterior wall of the nasopharynx, it is transmitted through fairly close and prolonged communication. Infection is facilitated by crowding, prolonged communication, especially in sleeping quarters, violations of the temperature and humidity regime.

Meningeal symptoms appear already on the first day of the disease in the form of stiff neck, symptoms of Kernig, Brudzinsky, etc. In infants, meningeal symptoms can be expressed only in bulging and tension of the large fontanel.

For the final diagnosis, a lumbar puncture with a study of the resulting fluid is necessary.

Most effective antibacterial agent remains penicillin.

Specific prophylaxis is carried out with a meningococcal vaccine (mono- and divaccine) containing antigens (polysaccharides) of meningococci A and C.

Epidemiological surveillance includes an analysis of morbidity and mortality, clinical manifestations and factors contributing to the spread of infection (carriage of meningococci, the immunological structure of the population, the biological properties of the pathogen, social and natural factors), as well as an assessment of the effectiveness of the measures taken.

Measures aimed at sources of meningococcal infection include early and comprehensive identification of patients, sanitation of meningococcal carriers, isolation and treatment of patients. In the focus of infection, medical observation of contact persons is established for 10 days.

Measures aimed at breaking the mechanism of infection transmission consist in carrying out sanitary and hygienic measures and disinfection. Crowding should be eliminated as far as possible, especially in closed institutions (kindergartens, barracks, etc.). Wet cleaning is carried out in the premises using chlorine-containing disinfectants, frequent ventilation, ultraviolet air irradiation, etc.

Measures aimed at susceptible contingents include increasing the nonspecific resistance of people (hardening, timely treatment of diseases of the upper respiratory tract, tonsils) and the formation of specific protection against meningococcal infection. The most promising active immunization with meningococcal vaccines. To date, several vaccines have been developed, in particular polysaccharide vaccines A and C. A vaccine has also been obtained from group B meningococci.

Bibliography

1. Agababova V.V. Influenza in children [text] / - M .: Practice, 2011.-400s.

2. Bulkina I.G. Infectious diseases with nursing and the basics of epidemiology - M .: Medicine, 2009.-319c.

3. Bogdanov I.L. Viral meningitis - M.: Health, 2010-63s.

4. Vasiliev. A.I. Influenza and other SARS [text] / A.I. Vasiliev.-SPb.: Nevsky prospect, 2011.-200p.

5. Dadimova M.A. Acute serous meningitis and encephalitis in children [text] / Dadiomova M.A., Pratusevich R.M. M.: Medicine, 2009.-350s.

6. Zhukova N.G. Modern views of the etiology, pathogenesis, diagnosis and treatment of meningitis in children: / Tomsk: 2010.-123p.

7. Zimchenko A.P. Acute neuroinfections in children [text] / A.P. Zimchenko.-M.: Medicine, 2010.-450s.

8. Ivanov A.I. Care for infectious patients [text] / A.I. Ivanov. - M.: Medicine, 2009.-198s.

9. Kazantsev. A.P. Directory of an infectious disease doctor - M .: Medicine, 2009.-400 p.

10. Lobzina Yu.V. Guide to infectious diseases Rostov - on - Don: Phoenix, 2009-736s.

11. Lobzin V.S. Meningitis and arachnoiditis [text] / V.S. Lobzin.-M.: Medicine, 2009.-400s.

12. Mikheev V.V. Nervous diseases / A.A. Mikhailov. - M.: Medicine, 2010.-480s.

13. Reznikova L.S. Serological research methods in the diagnosis of infectious diseases M.: Medicine, 2009.-371s.

14. Ugryumov B.L.; Reference book differential diagnosis infectious diseases St. Petersburg: Nevsky prospect, 2009, -700s.

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Federal Service for Supervision of Consumer Rights Protection
and human well-being

3.1.2. PREVENTION OF INFECTIOUS DISEASES.
RESPIRATORY INFECTIONS

Prevention of meningococcal infection

Sanitary and epidemiological rules

SP 3.1.2.2156-06

1. Designed by: G.F. Lazikova, A.A. Melnikova, N.A. Koshkina, Z.S. Wednesday (consumer rights and human welfare); I.S. Koroleva, L.D. Spirikhin (FGUN "Central Research Institute of Epidemiology" of Rospotrebnadzor); T.F. Chernysheva (FGUN "Moscow Research Institute of Epidemiology and Microbiology named after G.N. Gabrichevsky); I.N. Lytkina (Department of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in Moscow).

3. Approved by the decision of the Chief State Sanitary Doctor of the Russian Federation G.G. Onishchenko dated December 29, 2006 No. 34

4. Registered with the Ministry of Justice of the Russian Federation on February 20, 2007, registration number 8974.

5. Introduced instead of the sanitary and epidemiological rules “Prevention of meningococcal infection. SP 3.1.2.1321-03 ", canceled by the Decree of the Chief State Sanitary Doctor of the Russian Federation dated December 29, 2006 No. 35 (registration number in the Ministry of Justice of the Russian Federation 8973 dated February 20, 2007 1 from January 1, 2007

the federal law
"On the sanitary and epidemiological well-being of the population"
No. 52-FZ of March 30, 1999

“State sanitary and epidemiological rules and regulations (hereinafter referred to as sanitary rules) - regulatory legal acts that establish sanitary and epidemiological requirements (including criteria for the safety and (or) harmlessness of environmental factors for humans, hygienic and other standards), non-compliance which poses a threat to human life or health, as well as the threat of the emergence and spread of diseases” (Article 1).

“Compliance with sanitary rules is mandatory for citizens, individual entrepreneurs and legal entities” (Article 39).

“For violation of sanitary legislation, disciplinary, administrative and criminal liability is established in accordance with the legislation of the Russian Federation” (Article 55).

FEDERAL SERVICE FOR SUPERVISION IN THE FIELD OF PROTECTION

CHIEF STATE SANITARY PHYSICIAN
RUSSIAN FEDERATION

RESOLUTION

On the basis of Federal Law No. 52-FZ of March 30, 1999 “On the Sanitary and Epidemiological Welfare of the Population” (Collected Legislation of the Russian Federation, 1999, No. 14, Article 1650, as amended on December 30, 2001, January 10, June 30, 2003 ., August 22, 2004, May 9, December 31, 2005) and the Regulations on State Sanitary and Epidemiological Rationing, approved by Decree of the Government of the Russian Federation of July 24, 2000 No. 554 (Collected Legislation of the Russian Federation, 2000, No. 31, Art. 3295, 2005, No. 39, item 3953)

RESOLVE:

1. Approve the sanitary and epidemiological rules “Prevention of meningococcal infection. SP 3.1.2.2156-06 "().

2. Enact the sanitary and epidemiological rules “Prevention of meningococcal infection. SP 3.1.2.2156-06" from April 01, 2007

G. G. Onishchenko

FEDERAL SERVICE FOR SUPERVISION IN THE FIELD OF PROTECTION
CONSUMER RIGHTS AND HUMAN WELL-BEING

CHIEF STATE SANITARY PHYSICIAN
RUSSIAN FEDERATION

RESOLUTION

In connection with the approval by the Chief State Sanitary Doctor of the Russian Federation on December 29, 2006 and the entry into force on April 1, 2007 of the sanitary and epidemiological rules “Prevention of meningococcal infection. SP 3.1.2.2156-06"

RESOLVE:

From the moment of the entry into force of the said sanitary and epidemiological rules, the sanitary and epidemiological rules “Prevention of meningococcal infection. SP 3.1.2.1321-03”, approved by the Chief State Sanitary Doctor of the Russian Federation on April 28, 2003 and registered with the Ministry of Justice of the Russian Federation on May 29, 2003, registration number 4609.

3.1.2. PREVENTION OF INFECTIOUS DISEASES.
RESPIRATORY INFECTIONS

Prevention of meningococcal infection

Sanitary and epidemiological rules SP 3.1.2.2156-06

1 area of ​​use

1.1. These sanitary and epidemiological rules (hereinafter - sanitary rules) establish the basic requirements for a set of organizational, sanitary and anti-epidemic (preventive) measures, the implementation of which is aimed at preventing the spread of meningococcal disease.

1.2. Control over compliance with sanitary rules is carried out by the bodies exercising state sanitary and epidemiological supervision in the Russian Federation.

1.3. Compliance with sanitary rules is mandatory for citizens (individuals), legal entities and individual entrepreneurs.

2. Introduction to meningococcal disease

Meningococcal infection is an anthroponotic disease caused by meningococcus and occurring in various clinical forms.

The causative agent is Neisseria meningitidis (meningococci are Gram-negative cocci). Depending on the structure of the polysaccharide, 12 serogroups are distinguished: A, B, C, X, Y, Z, W-135, 29E, K, H, L, I.

Meningococci of serogroups A, B, C are the most dangerous and can often cause diseases, outbreaks and epidemics.

Intragroup genetic subgrouping of meningococci and determination of enzyme types makes it possible to identify hypervirulent strains of meningococci (serogroup A meningococci - genetic subgroup III-1, serogroup B meningococci - ET-5, ET-37 enzymes), which is important in predicting epidemiological distress.

The pathogen is transmitted from person to person by airborne droplets. More often they become infected from asymptomatic carriers and less often through direct contact with a patient with a generalized form of meningococcal infection.

The risk of developing the disease in children is higher than in adults. All persons are susceptible to the disease, but the risk of infection is higher in people with a deficiency of terminal complement components and in people with splenectomy.

The incubation period is 1 to 10 days, usually less than 4 days.

3. Standard definition of the case of generalized
forms of meningococcal infection

A reliable record of diseases with generalized forms of meningococcal infection is based on objective indicators of a standard case definition with the following classification:

Suspected standard case of acute meningitis detected at the prehospital level. The main criteria: an unexpected rise in temperature to 38 - 39 ° C, an unbearable headache, tension (rigidity) of the neck muscles, a change in consciousness and other manifestations. In children under 1 year old, the rise in temperature is accompanied by a bulging of the fontanel.

Probable standard case of acute bacterial meningitis are detected, as a rule, immediately after hospitalization, taking into account one or more of the above criteria and: cloudy cerebrospinal fluid, leukocytosis of more than 100 cells per mm 3 with a predominance of neutrophils (60 - 100%), leukocytosis in the range of 10 - 100 cells per mm 3 with a predominance of neutrophils (60 - 100%) with a significant increase in protein (0.66 - 16.0 g / l) and a decrease in glucose.

Possible standard case of generalized form of meningococcal disease (meningococcal meningitis and/or meningococcemia) includes one or more of the above criteria and: detection of gram-negative diplococci in the cerebrospinal fluid and / or blood, the presence of specific hemorrhagic rashes on the skin, an epidemiological indication of a repeated case from the focus, or an unfavorable situation for meningococcal infection in the region.

A confirmed standard case of a generalized form of meningococcal infection (meningococcal meningitis and/or meningococcemia) includes one or more of the above criteria and: detection of a group-specific antigen to meningococcus in the cerebrospinal fluid and/or blood; .

The growth of a culture of meningococci from the nasopharynx and other non-sterile loci of the body is not a confirmation of the diagnosis of a generalized form of meningococcal infection.

4. Measures for patients with generalized
form of meningococcal infection

4.1. The generalized form of meningococcal infection is a serious infectious disease that requires immediate hospitalization of the patient in a hospital for diagnosis and treatment.

4.2. Identification of patients with a generalized form of meningococcal infection and persons with suspicion of it is carried out by doctors of all specialties, paramedical workers of medical and preventive, children's, adolescent, health and other organizations, regardless of departmental affiliation and legal form, medical workers engaged in private medical practice , for all types of medical care, including:

When the population seeks medical help;

When providing medical care at home;

When receiving from doctors engaged in private medical practice;

During medical supervision of persons who communicated with patients with meningococcal infection in the outbreak.

4.3. Upon admission to the hospital, the diagnosis should be confirmed by clinical examination and laboratory analysis (clinical and microbiological) of blood and cerebrospinal fluid samples. Material for microbiological examination is taken before intensive antibiotic therapy. Microbiological examination of material from patients with a generalized form of meningococcal infection and persons suspected of having this disease is carried out in accordance with current regulations.

4.4. About each case of a generalized form of meningococcal infection, as well as suspicion of a disease, doctors of all specialties, paramedical workers of medical and preventive, children's, adolescent and health organizations, regardless of departmental affiliation and legal form, as well as medical workers involved in private medical activities, report by phone within 2 hours and then send an emergency notification in the prescribed form within 12 hours to the bodies exercising state sanitary and epidemiological surveillance at the place of registration of the disease (regardless of the patient's place of residence).

4.5. A medical and preventive organization that has changed or specified the diagnosis of a generalized form of meningococcal infection shall, within 12 hours, submit a new emergency notification to the authorities exercising state sanitary and epidemiological supervision at the place where the disease was detected, indicating the initial diagnosis, the changed (refined) diagnosis and the date of establishment of the specified diagnosis .

4.6. The bodies exercising state sanitary and epidemiological supervision upon receipt of emergency notifications of a modified (specified) diagnosis of a generalized form of meningococcal infection inform the medical and preventive organizations at the place of detection of the patient that sent the initial emergency notification.

4.7. The results of the microbiological examination of the material from the patient on the etiological decoding of the disease and serogrouping of meningococci are reported by the medical institution to the authorities exercising state sanitary and epidemiological supervision at the place of registration of the patient (regardless of his place of residence) no later than the 4th day after his hospitalization.

4.8. Discharge of a patient with a generalized form of meningococcal infection from the hospital is carried out after clinical recovery. Convalescents of the generalized form of meningococcal infection are allowed to preschool educational institutions, schools, boarding schools, health organizations, sanatoriums, hospitals, secondary and higher educational institutions after the completion of the course of treatment.

4.9. The completeness, reliability and timeliness of recording diseases of meningococcal infection, as well as the prompt and complete reporting of them to the bodies exercising state sanitary and epidemiological supervision, is ensured by the heads of medical and preventive, children's, adolescent, health and other organizations, regardless of departmental affiliation and organizational and legal forms.

4.10. Each case of meningococcal infection is subject to registration and registration in medical and preventive, children's, adolescent, health and other organizations, regardless of departmental affiliation and legal form.

4.11. Reports on diseases of meningococcal infection are compiled according to the established forms of state statistical observation.

5. Interventions for contact persons
with a patient with a generalized form of meningococcal
infection, persons suspected of having this disease
and carriers of meningococci

5.1. Persons who have been in contact with a patient with a generalized form of meningococcal infection in a family (apartment), a preschool educational institution, a school, a boarding school, a health institution, a sanatorium, a secondary and higher educational institution are subject to daily medical observation for 10 days with a mandatory examination of the nasopharynx, skin covers and thermometry. The first medical examination of persons who communicated with the patient is carried out with the obligatory participation of an otolaryngologist.

5.2. In pre-school educational institutions, schools, boarding schools, orphanages, children's homes and health organizations, in secondary and higher educational institutions, medical supervision of the persons who communicated is provided by the medical personnel of these organizations. In the absence of medical workers in these organizations, this work is provided by the heads of medical and preventive organizations serving these organizations.

5.3. During medical observation, the doctor explains to those who had contact with the patient about the most important symptoms of the disease and indicates the need to immediately call the doctor if symptoms or signs of the disease appear. If persons with objective symptoms of the disease are identified, they are immediately hospitalized for further observation.

5.4. After identifying a case of the disease and hospitalizing the patient, all contact persons in the outbreak are given a course of chemoprophylaxis to prevent secondary cases (). In order to achieve the greatest effectiveness, chemoprophylaxis is carried out within the next 24 hours after the registration of a case of the disease. This measure is applied in foci during the period of sporadic non-epidemic morbidity and is limited. If a disease occurs, then chemoprophylaxis in the focus is carried out among: cohabiting family members; persons of institutions where there is cohabitation (students of boarding schools, roommates in a hostel); pupils and staff of preschool institutions (all persons who contacted in classrooms and dormitories); persons who had established contact with the nasopharyngeal secrets of the patient.

5.5. For the purpose of early detection of epidemiologically significant carriers of meningococci (possible sources of infection), a bacteriological examination of persons who communicated with the patient is carried out in foci with 2 or more cases of generalized forms of meningococcal infection and in those foci where the sequential occurrence of diseases is separated by a time interval exceeding the incubation period (more than 10 days). The sampling of material (nasopharyngeal mucus) is carried out among all those who were in close contact with the patient in the first 12 hours after the registration of the case of the disease before the start of chemo-prophylactic measures. Taking and transporting material for bacteriological examination of the nasopharynx for the presence of meningococci is carried out in the prescribed manner.

5.6. Bacteriological examination of persons who have been in contact with a patient with a generalized form of meningococcal infection in foci with 2 or more cases of the disease, as well as repeated examinations of identified carriers of meningococci, are carried out by bodies exercising state sanitary and epidemiological surveillance.

5.7. Patients with acute nasopharyngitis, identified in the focus of meningococcal infection, are examined bacteriologically and, depending on the severity clinical course are hospitalized in an infectious disease hospital for treatment. Their treatment at home is allowed subject to regular medical supervision, as well as in the absence of preschool children and persons working in preschool educational institutions, orphanages, orphanages and children's hospitals in the family or apartment.

5.8. Carriers of meningococci identified in foci with 2 or more cases of a generalized form of meningococcal infection are subject to clinical observation and chemoprophylactic measures at home.

5.9. Convalescents of acute nasopharyngitis are allowed to institutions and organizations after the completion of the full course of treatment and with the disappearance of the clinical manifestations of the disease.

5.10. Carriers of meningococci undergo a single bacteriological examination 3 days after the course of chemoprophylaxis, and if there is a negative result, they are admitted to preschool educational institutions, schools, boarding schools, health organizations, sanatoriums and hospitals. With a positive result of bacteriological examination, the course of chemoprophylaxis is repeated until a negative result is obtained,

6. Activities in the focus of meningococcal infection

6.1. The purpose of carrying out anti-epidemic measures in the focus of meningococcal infection (the team where the disease arose with a generalized form of meningococcal infection) is the localization and elimination of the focus.

6.2. Upon receipt of an emergency notification, specialists of the bodies exercising state sanitary and epidemiological supervision, within the next 24 hours after the patient's hospitalization, conduct an epidemiological investigation of the focus of infection with filling out an epidemiological investigation card, determine the boundaries of the focus, persons who communicated with the patient, organize bacteriological examinations of contact persons and patients nasopharyngitis, carry out anti-epidemic measures.

6.3. In the focus of meningococcal infection, after hospitalization of a patient or suspected of this disease, the final disinfection is not carried out, and in the premises where the patient or suspected of the disease previously stayed, wet cleaning, ventilation and ultraviolet irradiation of the room are carried out.

6.4. In preschool educational institutions, orphanages, orphanages, schools, boarding schools, health organizations, children's sanatoriums and hospitals, a quarantine is established for a period of 10 days from the moment of isolation of the last sick person with a generalized form of meningococcal infection. During this period, admission to these organizations of new and temporarily absent children, as well as transfers of children and staff from the group (class, department) to other groups is not allowed.

6.5. In groups with a wide range of people communicating with each other (higher educational institutions, secondary specialized educational institutions, colleges, etc.), if several diseases occur simultaneously with a generalized form of meningococcal infection or sequentially 1-2 diseases per week, the educational process is interrupted for a period of at least for 10 days.

7. Epidemiological surveillance of meningococcal disease

7.1. Epidemiological surveillance of meningococcal infection is the activity of the bodies exercising state sanitary and epidemiological surveillance aimed at identifying signs of epidemiological distress and taking preventive anti-epidemic measures to prevent the rise and spread of infectious disease. Identification of early signs of epidemiological trouble for meningococcal infection is carried out by constant dynamic assessment of the state and trends in the development of the epidemic process using methods of operational and retrospective epidemiological analysis.

7.2. The purpose of operational epidemiological analysis is to assess the current situation with meningococcal infection by registering emerging cases of diseases with fixing a block of personalized information (age, gender, address, date of illness, date of treatment, method and results of laboratory diagnostics with determination of the meningococcal serogroup, involvement in organized groups, outcome disease), allowing to identify the beginning of epidemiological trouble for the organization of timely preventive and anti-epidemic measures.

10. Organization of immunization against
meningococcal infection

10.1. Preventive vaccinations against meningococcal infection are included in the calendar of preventive vaccinations according to epidemic indications. Preventive vaccination is started when there is a threat of an epidemic rise: obvious signs of epidemiological trouble are identified according to clause 2, the incidence of urban residents doubles compared to the previous year, or with a sharp increase in the incidence of more than 20.0 per 100,000 population.

10.2. Planning, organizing, conducting, completeness of coverage and reliability of accounting for preventive vaccinations, as well as timely

The regular submission of reports to the bodies exercising state sanitary and epidemiological supervision is provided by the heads of medical institutions.

10.3. The plan of preventive vaccinations and the need of medical and preventive organizations for medical immunobiological preparations for their implementation is coordinated with the bodies exercising state sanitary and epidemiological supervision.

11. Immunization of the population

11.1. With the threat of an epidemic rise in meningococcal infection, vaccination, first of all, is subject to:

Children from 1.5 years old to 8 years old inclusive;

First-year students of secondary and higher educational institutions, as well as persons who arrived from different territories of the Russian Federation, countries of near and far abroad and united by cohabitation in hostels.

11.2. With a sharp rise in the incidence (over 20 per 100,000 population), mass vaccination of the entire population is carried out with a coverage of at least 85%.

11.3. Preventive vaccinations for children are carried out with the consent of the parents or other legal representatives of minors after receiving from medical workers complete and objective information about the need for preventive vaccinations, the consequences of refusing them, and possible post-vaccination complications.

11.4. Health workers inform adults and parents of children about the required preventive vaccinations, the time of their implementation, as well as the need for immunization and possible reactions of the body to the administration of drugs. Vaccination is carried out only after obtaining their consent.

11.5. If a citizen or his legal representative refuses to be vaccinated, the possible consequences are explained in a form that is accessible to him.

11.6. Refusal to carry out prophylactic vaccination is recorded in medical documents and signed by an adult, a parent of a child or his legal representative.

11.7. Immunization is carried out by medical personnel trained in immunoprophylaxis.

11.8. For preventive vaccinations in medical and preventive organizations, vaccination rooms are allocated and equipped with the necessary equipment.

11.9. In the absence of a vaccination room in a medical and preventive organization serving the adult population, preventive vaccinations can be carried out in medical rooms that meet sanitary and hygienic requirements.

11.10. Children attending preschool educational institutions, schools and boarding schools, as well as children in closed institutions (orphanages, orphanages) are vaccinated in the vaccination rooms of these organizations, equipped with the necessary equipment and materials.

11.11. Vaccination at home is allowed when organizing mass immunization by vaccination teams provided with appropriate funds.

11.12. Medical staff with acute respiratory diseases, tonsillitis, having injuries on the hands, purulent lesions of the skin and mucous membranes, regardless of their location, are excluded from preventive vaccinations.

11.13. Storage and transportation of medical immunobiological preparations is carried out in accordance with the requirements of regulatory documents.

11.14. Prophylactic vaccinations against meningococcal infection are carried out with medical immunobiological preparations registered in the territory of the Russian Federation in the prescribed manner in accordance with the instructions for their use.

11.15. The meningococcal polysaccharide vaccine can be administered simultaneously with other types of vaccines and toxoids, except for the BCG vaccine and the yellow fever vaccine, but in different syringes.

11.16. Immunization is carried out with disposable syringes.

12. Accounting for preventive vaccinations and reporting

12.1. Information about the vaccination performed (date of administration, name of the drug, batch number, dose, control number, expiration date, nature of the reaction to the administration) is recorded in medical documents of the established form:

For children and adolescents - in the preventive vaccination card, the history of the development of the child, the child's medical card for schoolchildren, the insert sheet for the teenager to the outpatient medical record;

In adults - in the outpatient card of the patient, the register of preventive vaccinations;

In children, adolescents and adults - in the certificate of preventive vaccinations.

12.2. In a medical and preventive organization, registration forms of the established form are created for all children under the age of 15 years (14 years 11 months 29 days) living in the service area, as well as for all children attending preschool educational institutions and schools located in the service area.

12.3. Information about the preventive vaccinations carried out for children under 15 years old (14 years 11 months 29 days) and adolescents, regardless of the place of their implementation, is entered into the accounting forms of the established sample.

12.4. Accounting for local, general, strong, unusual reactions and post-vaccination complications to vaccinations against meningococcal infection in medical and preventive organizations and bodies and institutions of state sanitary and epidemiological supervision is carried out in the prescribed manner.

12.5. A report on preventive vaccinations carried out is carried out in accordance with state forms of statistical observation.

Attachment 1

Chemoprophylaxis of meningococcal infection

Chemoprophylaxis of meningococcal infection is carried out with one of the following drugs:

1) rifampicin- form of administration through the mouth (adults - 600 mg every 12 hours for 2 days; children - 10 mg / kg of body weight every 12 hours for 2 days);

2) azithromycin- form of administration through the mouth (adults - 500 mg 1 time per day for 3 days; children - 5 mg / kg body weight 1 time per day for 3 days);

amoxicillin - a form of oral administration (adults - 250 mg every 8 hours for 3 days; children - children's suspensions in accordance with the instructions for use);

3) spiramycin- form of administration through the mouth (adults - 3 million IU in two doses of 1.5 million IU for 12 hours);

ciprofloxacin - a form of administration through the mouth (adults - 500 mg once);

ceftriaxone - a form of intramuscular injection (adults - 250 mg once).

Annex 2

(reference)

Clinical manifestations and differential diagnosis
meningococcal infection

Clinical manifestations of meningococcal infection are diverse. There are: localized form - nasopharyngitis and generalized forms - meningitis, meningococcemia, combined form (meningitis + meningococcemia). Possible: meningococcal pneumonia, endocarditis, arthritis, iridocyclitis.

Acute purulent meningitis is the most common form of generalized meningococcal infection. Diagnosis of the disease is based on an assessment of the cerebrospinal fluid, so a lumbar puncture is performed in all cases with suspected purulent meningitis. Meningococcemia, sometimes its fulminant form, can occur alone or in combination with purulent meningitis. The first clinical manifestations of purulent meningitis are: a sudden intolerable headache, a rise in temperature above 38 ° C, nausea, vomiting, photophobia and tension (rigidity) of the neck muscles. Neurological symptoms may manifest as stupor, delirium, coma, and seizures. In infants, the first manifestations are not so pronounced, muscle rigidity, as a rule, is not pronounced, while the children are excited, cry inconsolably, piercingly cry, refuse to eat, have a tendency to gag reflex and convulsions, the skin is pale, a bulging fontanel is observed.

Meningococcemia, unlike meningitis, is difficult to diagnose, especially during the period of sporadic non-epidemic morbidity, since the suddenness and severity of clinical manifestations, heat, the state of shock is not always clearly expressed. Meningeal symptoms are usually absent. The most characteristic sign of meningococcemia is a hemorrhagic rash.

Lumbar puncture confirms the clinical diagnosis of purulent meningitis and makes it possible to identify meningococci, excluding other possible etiological agents of purulent meningitis, such as pneumococci, Haemophilus influenzae type "b" and other pathogens. A puncture is performed if meningitis is suspected in a hospital before antibiotic therapy is started. The cerebrospinal fluid in purulent meningitis is usually cloudy or purulent, but may be clear or bloody. Primary laboratory diagnosis of cerebrospinal fluid in purulent meningitis indicates: leukocytosis of more than 100 cells per mm (the norm is less than 3 cells per mm 3) with a predominance of neutrophils (more than 60%); an increase in protein levels from 0.8 g / l or more (the norm is less than 0.3 g / l); detection of extracellular and intracellular diplococci. Additional important laboratory criteria are: decrease in glucose; isolation, identification and serogrouping of the culture of meningococci; detection of specific meningococcal antigens or their genetic fragments.

The hemogram is characterized by a pronounced leukocytosis. With meningococcemia, blood cultures are often accompanied by the isolation of a culture of meningococci, serological reactions reveal specific antigens, and direct bacterioscopy of blood reveals extracellular and intracellular diplococci. The possibility of sowing meningococci directly from the elements of a hemorrhagic rash is not excluded.

Symptoms of meningococcal nasopharyngitis are similar to clinical manifestations acute respiratory disease. Observed - general weakness, headache, sore throat when swallowing, dry cough, nasal congestion, poor mucopurulent discharge. The back wall of the pharynx is edematous, hyperemic, covered with mucous discharge, from 2 to 3 days there is hyperplasia of the lymphoid follicles. The temperature is often subfebrile, rarely normal or reaches 38 - 39 ° C. Inclusion of the disease in the registration reports requires laboratory isolation of meningococci from the nasopharynx. Conducting laboratory procedures for the identification of isolated meningococci and the determination of their serogroup affiliation is a mandatory component of laboratory confirmation of patients with meningococcal nasopharyngitis.

Bibliographic data

1. Federal Law "On the sanitary and epidemiological well-being of the population" dated March 30, 1999 No. 52-FZ.

2. Federal Law "On Immunoprophylaxis of Infectious Diseases" dated September 17, 1998 No. 157-FZ.

3. Fundamentals of the legislation of the Russian Federation "On the protection of the health of citizens" of July 22, 1993

4. Regulations on the implementation of state sanitary and epidemiological surveillance in the Russian Federation, approved by the Decree of the Government of the Russian Federation of September 15, 2005 No. 569.

5. Regulations on the Federal Service for Supervision of Consumer Rights Protection and Human Welfare, approved by Decree of the Government of the Russian Federation of June 30, 2004 No. 322.

7. Orders in force as of January 1, 2006, guidelines, recommendations, instructions and guidelines for the use of vaccines and toxoids, approved by the Ministry of Health and Social Development of the Russian Federation, the Federal Service for Surveillance in the Field of Consumer Rights Protection and Human Welfare.

8. Order of the Ministry of Health of the Russian Federation No. 229 dated June 27, 2001 “On the national calendar of preventive vaccinations and the calendar of preventive vaccinations according to epidemic indications”.

9. MUK 4.2.1887-04 "Laboratory diagnosis of meningococcal infection and purulent bacterial meningitis" - M., 2005.

10. Savilov E.D., Mamontova L.M., Astafiev V.A., Zhdanova S.N. Application of statistical methods in epidemiological analysis. -M., 2004.

11. L.P. Zueva, R.X. Yafaev. Epidemiology. - S.-Pb., 2006.