Anti-epidemic measures in the focus of meningococcal infection. Activities in the focus and prevention of meningococcal infection Activities in the focus of meningococcal infection

After receiving an emergency, specialists of the territorial bodies of sanitary and epidemiological surveillance within 24 hours conduct an epidemiological investigation to determine the boundaries of the outbreak, the circle of contact persons and organize anti-epidemic and preventive measures to localize and eliminate the outbreak.

After hospitalization of the patient, contact persons are quarantined for a period of 10 days from the moment of separation from the patient. Anti-epidemic measures are limited to a circle of people from the immediate environment of the patient. These include people living in the same apartment with the sick person, and close friends with whom communication occurs constantly. The list of persons subject to quarantine can be expanded by the epidemiologist depending on the specific situation in the outbreak.

Final disinfection in the focus of meningococcal infection after hospitalization of the patient is not carried out. The premises are subjected to daily wet cleaning, frequent ventilation, maximum decompression in the sleeping quarters.

Medical observation in the focus consists in daily thermometry, examination of the nasopharynx and skin. Identified patients with acute nasopharyngitis are subject to bacteriological examination.

Chemoprophylaxis

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.

Ciprofloxacin. Persons over 18 years of age: 750 mg orally once. Not recommended for persons under 18 years of age, pregnant women (safety and effectiveness of use in women during pregnancy has not been established) and nursing mothers.

Rifampicin. Adults: 600 mg every 12 hours for 2 days. It is not recommended for pregnant women (contraindicated in the first trimester of pregnancy, in the second and third trimesters - only according to strict indications, after comparing the expected benefits for the mother and the potential risk to the fetus).

Elimination of the nasopharyngeal carriage of meningococci occurs in 85% of patients who received rifampicin, and in 95% of those who received ciprofloxacin.

Reserve drug ceftriaxone(250 mg intramuscularly once) is more effective against group A meningococci than rifampicin. In addition, ceftriaxone can be used during pregnancy, since the expected effect of therapy outweighs the potential harm to the fetus.

Vaccination

Vaccines have been developed that protect against one (type A or type B), two (A + C) or four (A, C, Y, W-135) serotypes of meningococcus. Vaccination provides protection 10-14 days after injection.

In Russia, routine vaccination against meningococcal infection is not carried out. Vaccinations are included in the National calendar of preventive vaccinations according to epidemiological indications (from 1 year of age, revaccination after 3 years) - emergency vaccination is used in the focus of meningococcal infection among contact persons.

In the United States, routine vaccination of children aged 11-12 years is carried out; adolescents under the age of 15 attending educational institutions; college students. In addition, the CDC recommends a 3-5 year revaccination interval if high risk(splenic dysfunction, military recruits, travel to countries where the risk of epidemic disease is high).

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 outbreak, 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 in children's 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 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 conducting 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 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 .

CHIEF STATE SANITARY PHYSICIAN OF THE RUSSIAN FEDERATION

RESOLUTION

On approval of the sanitary and epidemiological rules SP 3.1.3542-18 "Prevention of meningococcal infection"

In accordance with the Federal Law of March 30, 1999 N 52-FZ "On the sanitary and epidemiological well-being of the population" (Collected Legislation of the Russian Federation, 1999, N 14, Art. 1650; 2002, N 1, (Part I), Art. 2 ; 2003, N 2, article 167; N 27 (part I), article 2700; 2004, N 35, article 3607; 2005, N 19, article 1752; 2006, N 1, article 10; N 52 (part I), article 5498; 2007, No. 1 (part I), article 21; No. 1 (part I), article 29; No. 27, article 3213; No. 46, article 5554 ; N 49, art. 6070; 2008, N 29 (part I), art. 3418; N 30 (part II), art. 3616; 2009, N 1, art. 17; 2010, N 40, art. 4969; 2011, N 1, art. 6; N 30 (part I), art. 4563, art. 4590, art. 4591, art. 4596; N 50, art. 7359; 2012, N 24, art. 3069 ; N 26, article 3446; 2013, N 27, article 3477; N 30 (part I), article 4079; N 48, article 6165; 2014, N 26 (part I), article 3366, 3377; 2015, N 1 (part I), art. 11; N 27, art. 3951, N 29 (part I), art. 4339; N 29 (part I), art. 4359; N 48 (part I), art. 6724; 2016, N 27 (part I), art. 4160; N 27 (part II), art. 4238; 2017, N 27, art. 3932; N 27, art. .3938; N 31 (part I), art. 4765; N 31 (part I), art. 4770; 2018, N 17, art. 2430; N 18, art. 2571; N 30, art. 4543; N 32 ( Part II), Art. 5135) and Decree of the Government of the Russian Federation of July 24, 2000 N 554 "On approval of the Regulations on the State Sanitary and Epidemiological Service of the Russian Federation and the Regulations on the State Sanitary and Epidemiological Rationing" (Collected Legislation of the Russian Federation, 2000, N 31, art. 3295; 2004, N 8, article 663; N 47, art. 4666; 2005, N 39, art. 3953)

I decide:

1. Approve the sanitary and epidemiological rules SP 3.1.3542-18 "Prevention of meningococcal infection" (Appendix).

2. Recognize as invalid the sanitary and epidemiological rules SP 3.1.2.2512-09 "Prevention of meningococcal infection", approved by the Decree of the Chief State Sanitary Doctor of the Russian Federation of May 18, 2009 N 33 (registered by the Ministry of Justice of Russia on June 29, 2009, registration number 14148).

3. Set the validity of the sanitary and epidemiological rules SP 3.1.3542-18 "Prevention of meningococcal infection" until 12/15/2028.

A.Yu.Popova

Registered

at the Ministry of Justice

Russian Federation

registration N 53254

Application. Sanitary and epidemiological rules SP 3.1.3542-18. Prevention of meningococcal infection

Application

APPROVED
decision of the Chief
state sanitary doctor
Russian Federation
dated December 20, 2018 N 52

Sanitary and epidemiological rules
SP 3.1.3542-18

I. Scope

1.1. These Sanitary and Epidemiological Rules (hereinafter referred to as the Sanitary Rules) establish mandatory requirements for sanitary and anti-epidemic (preventive) measures taken to prevent the occurrence and spread of meningococcal disease.

1.2. Compliance with sanitary rules is mandatory for citizens, individual entrepreneurs and legal entities.

1.3. Control over the implementation of the Sanitary Rules by the bodies authorized to exercise federal state sanitary and epidemiological supervision, in accordance with the legislation of the Russian Federation.
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II. General provisions

2.1. Meningococcal infection is an acute infectious disease, anthroponosis, with an aerosol transmission mechanism, characterized by various forms of the infectious process: from a local form (nasopharyngitis) to generalized forms (hereinafter - GFMI) in the form of general intoxication (meningococcemia) and damage to the soft meninges of the brain with the development of meningitis, as well as the asymptomatic form (bacteriocarrier).
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Code A39 - meningococcal infection according to the International Classification of Diseases ICD-10.

2.2. The causative agent of meningococcal infection - meningococcus (Neisseria meningitidis) is unstable to various environmental factors: at a temperature of +50°C it dies after 5 minutes, at +100°C - after 30 seconds; at temperatures below + 22 ° C, as well as when dried, meningococcus dies within a few hours. The average survival rate on environmental objects is 7.5-8.5 hours at a microbial load density of 10 per 1 cm. Disinfectants have a bactericidal effect on meningococcus (it dies instantly).
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Uniform sanitary-epidemiological and hygienic requirements for products (goods) subject to sanitary-epidemiological supervision (control), approved by the Decision of the Commission of the Customs Union of 28.05.2010 N 299 "On the application of sanitary measures in the Eurasian Economic Union" (official website of the Commission of the Customs Union http:// ://www.tsouz.ru/, 06/28/2010) as amended by the decisions of the Customs Union Commission dated 08/17/2010 N 341 (official website of the Customs Union Commission http://www.tsouz.ru/, 08/23/2010), dated November 18, 2010 N 456 (official website of the Customs Union Commission http://www.tsouz.ru/, November 22, 2010), dated March 2, 2011 N 571 (official website of the Customs Union Commission http://www.tsouz.ru/ , 03/09/2011), dated 04/07/2011 N 622 (official website of the Customs Union Commission http://www.tsouz.ru/, 04/26/2011), dated 10/18/2011 N 829 (official website of the Customs Union Commission http:// www.tsouz.ru/, 10/21/2011), dated 12/09/2011 N 889 (official website of the Customs Union Commission http://www.t souz.ru/, 15.12.2011), decisions of the Board of the Eurasian Economic Commission dated 04.19.2012 N 34 (official website of the Customs Union Commission http://www.tsouz.ru/, 04.29.2012), dated 08.16.2012 N 125 ( official website of the Eurasian Economic Commission http://www.tsouz.ru/, 16.08.2012), dated 06.11.2012 N 208 (official website of the Eurasian Economic Commission http://www.tsouz.ru/, 07.11.2012), dated January 15, 2013 N 6 (official website of the Eurasian Economic Commission http://www.tsouz.ru/, January 18, 2013), dated November 10, 2015 N 149 (official website of the Eurasian Economic Union http://www.eaeunion.org/, November 16, 2015), dated January 23, 2018 N 12 (official website of the Eurasian Economic Union http://www.eaeunion.org/, January 26, 2018), dated May 10, 2018 N 76 (official website of the Eurasian Economic Union http://www .eaeunion.org/, 05/14/2018).


According to the structure of the polysaccharide capsule, meningococcus is divided into 12 serogroups: A, B, C, X, Y, Z, W, E, K, H, L, I.

2.3. Meningococcal infection is characterized by periodicity. Periodic rises in incidence, on average, occur after long inter-epidemic periods from 10 to 30 years. Epidemics covering simultaneously several dozen countries of the world were caused by meningococcus serogroup A, and local epidemic rises within the borders of one country were caused by meningococcus serogroups B and C.

The sporadic incidence of the inter-epidemic period is formed by different serogroups, of which the main ones are A, B, C, W, Y, X.

The incidence rate of meningococcal infection in developed countries in modern conditions is 0.1-5.0 per 100 thousand population. In the Russian Federation, the incidence rate over the past decade (2006-2017) does not exceed 2 per 100 thousand of the population, and the average mortality rate is determined at 15%.

In the Russian Federation, the serogroup characteristics of meningococcal strains isolated from individuals diagnosed with HFMI are predominantly represented by serogroups A, B, C in equal proportions, and there is also an increase in the heterogeneity of the meningococcal population due to the growth of strains of rare serogroups (W, Y).

2.4. During the epidemic rise in 86%-98% of foci, one case of HFMI occurs, in 2%-14% of foci - from 2 cases of HFMI or more. The lowest percentage of secondary (consecutive) diseases of the GFMI (2-3%) occurs in families, the highest (12%-14%) - in preschool educational organizations and in hostels.

With a sporadic level of incidence in the foci, 1 case of HFMI is registered (in exceptional cases, 2 cases of HFMI and more).

2.5. The source of meningococcal infection is an infected person.

The causative agent of meningococcal infection is transmitted from person to person by airborne droplets (within a radius of up to 1 m from an infected person). Infection with the causative agent of meningococcal disease is also possible through household items (for example, shared cups and spoons) during meals.

2.6. There are 3 groups of sources of meningococcal infection:

patients with HFMI (meningococcemia, meningitis, meningoencephalitis, mixed form);

patients with acute meningococcal nasopharyngitis;

bacterial carriers of meningococcus - persons without clinical manifestations, which are detected only during bacteriological examination.

The level of carriage of meningococcus in the human population with active detection averages 4-10%. The duration of the carriage of meningococcus is on average 2-3 weeks (in 2%-3% of persons it can last up to 6 or more weeks).

2.7. Meningococcal infection is characterized by winter-spring seasonality. An increase in the incidence of meningococcal infection is noted during the formation of teams educational organizations(preschool, general education, vocational, higher education), including after the summer holidays, groups of persons called up for military service.

2.8. Risk groups for infection and meningococcal disease are:

persons subject to conscription for military service;

persons traveling to areas endemic for meningococcal disease (eg, pilgrims, military personnel, tourists, athletes, geologists, biologists);

medical workers of structural units providing specialized medical care in the field of "infectious diseases";

medical workers and employees of laboratories working with a live culture of meningococcus;

pupils and staff of inpatient institutions social services with round-the-clock stay (orphanages, orphanages, boarding schools);

persons living in hostels;

persons participating in mass international sports and cultural events;

children under 5 years old inclusive (due to the high incidence in this age group);

adolescents aged 13-17 years (due to the increased level of carriage of the pathogen in this age group);

persons over 60;

persons with primary and secondary immunodeficiency states, including those infected with HIV;

people who have undergone cochlear implantation;

persons with liquorrhea.

2.9. Incubation period with meningococcal infection is from 1 to 10 days, on average up to 4 days.

III. Identification, recording and registration of patients with HFMI, persons with suspicion of this disease, patients with acute nasopharyngitis

3.2. Identification of patients with GFMI, as well as persons with suspected GFMI, should be carried out when providing medical care to the population on an outpatient and inpatient basis (including in a day hospital), including the provision of medical care in educational and recreational organizations, as well as outside medical organizations.

3.3. About each case of HFMI disease, as well as in case of suspicion of GFMI, medical workers are required to report by phone within 2 hours, and then within 12 hours send an emergency notification to the territorial body (organization) of the federal executive body authorized to implement the federal state sanitary - epidemiological surveillance, at the place of detection of the patient (regardless of the place of residence and temporary stay of the patient). The transmission of messages and emergency notices can be carried out using electronic means of communication and specialized information systems.

3.4. A medical organization that has changed or clarified the diagnosis of the GFMI shall, within 12 hours, submit a new emergency notification to the territorial body (organization) of the federal executive body authorized to exercise federal state sanitary and epidemiological surveillance at the place where the patient was detected, indicating the initial diagnosis, changed (specified) diagnosis and date of diagnosis.

3.5. Each case of the GFMI is subject to registration and recording in the register of infectious diseases at the place of their detection, as well as in the territorial bodies (organizations) of the federal executive body authorized to carry out federal state sanitary and epidemiological surveillance.
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3.6. Identification of patients with acute nasopharyngitis is carried out in the focus for the purpose of treatment. Patients with acute nasopharyngitis in the focus of the GFMI are not subject to registration and accounting.

3.7. Individual entrepreneurs engaged in medical activities, heads of medical , health-improving, educational and other organizations that identified the patient.
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SP 3.1/3.2.3146-13 dated 12/16/2013 N 65.

3.8. Information on the registration of GFMI cases based on final diagnoses is entered into the federal state statistical observation forms in accordance with sanitary and epidemiological requirements.
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SP 3.1/3.2.3146-13 dated 12/16/2013 N 65.

3.9. In the territorial bodies (organizations) of the federal executive body authorized to carry out federal state sanitary and epidemiological surveillance, the available data on registered cases of HFMI are analyzed by specialists as part of the epidemiological surveillance of meningococcal infection in order to draw up an epidemiological forecast and improve the effectiveness of preventive and anti-epidemic measures.

IV. Laboratory diagnostics GFMI

4.1. For laboratory diagnosis of GFMI, bacteriological, molecular genetic and serological research methods are used. The priority is the use of cerebrospinal fluid (CSF) and blood as biological material.

4.2. Taking, transportation and terms of delivery to the laboratory for research of clinical material are carried out taking into account the conditions that ensure the preservation of a pathogen that is unstable to environmental factors in the clinical material.

4.3. Bacteriological examination is an obligatory stage in the laboratory diagnostics of GFMI and consists in obtaining a culture of the causative agent of meningococcal infection, identifying it to the species, determining the serogroup by identifying a group-specific antigen (capsular polysaccharide) and sensitivity to antibacterial drugs.

4.4. The most important component of laboratory diagnosis of HFMI is the use of an express method (latex agglutination reaction) to detect a specific antigen directly in the CSF and (or) blood in patients with a clinical diagnosis of HFMI or suspected HFMI. A positive result of the express method allows in the shortest possible time (15-20 minutes) to establish the presence of the causative agent of meningococcal infection and its serogroup in the material.

4.5. A molecular genetic study to identify specific DNA fragments of meningococcus in clinical material (for example, cerebrospinal fluid) is carried out by laboratories equipped to conduct such studies. Test systems registered in the Russian Federation are used.
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Decree of the Government of the Russian Federation of December 27, 2012 N 1416 "On approval of the Rules for the state registration of medical devices" (Collected Legislation of the Russian Federation, 2013, N 1, Art. 14; 2018, N 24, Art. 3523) (hereinafter referred to as the Decree of the Government of the Russian Federation dated December 27, 2012 N 1416); order of the Ministry of Health of Russia dated 06.06.2012 N 4n "On approval of the nomenclature classification of medical devices" (registered by the Ministry of Justice of Russia on 09.07.2012, registration number 24852), as amended by order of the Ministry of Health of Russia dated 09.25.2014 N 557n (registered by the Ministry of Justice of Russia on 17.12.2014 , registration number 35201) (hereinafter - the order of the Ministry of Health of Russia dated 06.06.2012 N 4n).


In the complex diagnosis of the disease, the molecular genetic method is used to improve the efficiency of laboratory diagnostics. In case of a negative result of the bacteriological method and the express method, a positive result of the molecular genetic study is taken into account only if there is clinical signs GFMI.

4.6. Serological research method for the detection of specific antibodies in the blood serum to meningococcal polysaccharides of various serogroups (direct hemagglutination test (hereinafter referred to as RPHA) is carried out using diagnostic kits registered in the Russian Federation.
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Decree of the Government of the Russian Federation of December 27, 2012 N 1416; order of the Ministry of Health of Russia dated 06.06.2012 N 4n.


RPGA is a retrospective auxiliary method that allows increasing the percentage of laboratory confirmation of GFMI.

4.7. Laboratory criteria confirming the clinical diagnosis of a HFMI case are:

detection in clinical material (cerebrospinal fluid, blood) of diplococci with characteristic morphological features;

characteristic growth of culture only on highly nutritious media;

typical Gram smear morphology;

saccharolytic activity of the culture in relation to glucose and maltose;

identification of a serogroup in a culture of meningococcus;

detection of specific antigens in cerebrospinal fluid and (or) blood serum in the reaction of latex agglutination;

detection of an increase in the titer of specific antibodies by 4 or more times within 10-12 days (paired sera method) in RPHA;

detection of meningococcal DNA using polymerase chain reaction (PCR) in clinical material (cerebrospinal fluid, blood, autopsy material).

V. Activities in the GFMI hotspot

5.1. After receiving an emergency notification in case of HFMI or in case of suspicion of GFMI, specialists of the territorial body of the federal executive body authorized to carry out federal state sanitary and epidemiological supervision, within 24 hours, conduct an epidemiological investigation to determine the boundaries of the outbreak (the circle of people who contacted the patient), and organize anti-epidemic and preventive measures to localize and eliminate the outbreak.

5.2. The circle of people who have been in contact with the patient at risk of infection includes all those who were within a radius of 1 meter from the patient of the GFMI (for example, people living in the same apartment with the sick person, neighbors in the apartment or hostel room, students (pupils) and staff of the group, class , department of the educational organization visited by the sick person (the list of such persons may be expanded based on the results of the epidemiological investigation).

In the outbreak of HFMI, a doctor (paramedic) examines the persons who communicated with the patient in order to identify persons with signs of HFMI and acute nasopharyngitis.

5.3. When identifying persons with suspicion of GFMI, the medical worker conducting the examination organizes their immediate hospitalization in a medical organization that provides specialized medical care in the field of "infectious diseases".

The medical organization informs the territorial body of the federal executive body authorized to exercise federal state sanitary and epidemiological surveillance at the place where the patient was detected ( regardless of where the patient lives).

Identified persons with signs of acute nasopharyngitis are subject to hospitalization in a medical organization that provides specialized medical care in the profile of "infectious diseases" for treatment (according to clinical indications). It is allowed to treat them at home, provided that regular medical supervision is organized for them, as well as in the absence of preschool children and persons working in preschool educational organizations, institutions of stationary social services with round-the-clock stay (orphanages, orphanages, boarding schools) in the family or apartment providing medical care to children in outpatient and inpatient settings.

5.4. After hospitalization of a patient with HFMI or suspected HFMI, on the basis of an order from the territorial body of the federal executive body authorized to exercise federal state sanitary and epidemiological surveillance, quarantine is imposed in the outbreak for a period of 10 days. For the period of quarantine, a medical worker (doctor, paramedic, nurse) conducts daily medical monitoring of persons who have contacted a patient with GFMI, with thermometry, examination of the nasopharynx and skin. In preschool educational organizations, general educational organizations, institutions of stationary social services with a round-the-clock stay (orphanages, orphanages, boarding schools), in the organization of recreation and rehabilitation of children, it is not allowed to accept new and temporarily absent at the time of detection of sick children, transfer staff and children from groups (class, division) to other groups (classes, divisions).

5.5. For persons who have been in contact with a HFMI patient who does not have inflammatory changes in the nasopharynx, a medical worker (doctor, paramedic, nurse) conducts emergency chemoprophylaxis with one of the antibiotics, taking into account contraindications (appendix to the Sanitary Rules). Refusal of chemoprophylaxis is documented in the medical records, signed by the person who refused chemoprophylaxis, a parent or other legal representative of minors, and a medical worker in accordance with the legislation of the Russian Federation.
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Order of the Ministry of Health of Russia dated December 20, 2012 N 1177n "On approval of the procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical interventions, forms of informed voluntary consent to medical intervention and forms of refusal of medical intervention" (registered by the Ministry of Justice of Russia 06/28/2013, registration number 28924), as amended by the order of the Ministry of Health of Russia dated 08/10/2015 N 549n (registered by the Ministry of Justice of Russia on 09/03/2015, registration number 38783).

5.6. In the outbreak, persons who have been in contact with a HFMI patient are given emergency specific prophylaxis with a topical vaccine (in accordance with the serogroup of meningococcus isolated from the cerebrospinal fluid and (or) blood of a HFMI patient). In the absence of the possibility of determining the serogroup of meningococcus, emergency immunoprophylaxis is carried out without its establishment by multicomponent vaccines. Immunization of contact persons is carried out in accordance with the instructions for the use of the vaccine. Chemoprophylaxis is not a contraindication for immunization.

5.7. During the period of the epidemic rise in the incidence of meningococcal infection in the foci of GFMI, emergency immunoprophylaxis is carried out without establishing the serogroup of the pathogen with multicomponent vaccines.

5.8. In preschool educational organizations, general educational organizations, in organizations with round-the-clock stay of children, including medical organizations of a non-infectious profile, organizations for recreation and rehabilitation of children, in professional educational organizations and educational organizations of higher education, medical monitoring of persons who have been in contact with the patient, chemoprophylaxis and Immunoprophylaxis for persons who have been in contact with the patient is provided by medical workers of these organizations. In the absence of medical workers in these organizations, these activities are provided (organized) by the heads (administration) of medical organizations on the territory of which the above organizations are located.

5.9. In the outbreak of GFMI, after hospitalization of a patient or suspected of having GFMI, final disinfection is not carried out.

In the premises in which there are persons from among the contacts with the patient, twice a day they carry out wet cleaning of the premises with the use of detergents; soft toys are excluded from use, toys made of other materials are washed daily at the end of the day with hot water and detergent, airing is carried out (for 8-10 minutes at least four times a day).
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Sanitary and epidemiological rules SP 3.5.1378-03 "Sanitary and epidemiological requirements for the organization and implementation of disinfection activities", approved by the Decree of the Chief State Sanitary Doctor of the Russian Federation of June 9, 2003 N 131 (registered by the Ministry of Justice of Russia on June 19, 2003, registration number 4757).


In order to reduce the risk of transmission of the causative agent of meningococcal infection in the sleeping quarters of preschool educational institutions, the number of beds must comply with sanitary and epidemiological requirements.
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Sanitary and epidemiological rules and regulations SanPiN 2.4.1.3049-13 "Sanitary and epidemiological requirements for the arrangement, maintenance and organization of the working hours of preschool educational organizations", approved by the Decree of the Chief State Sanitary Doctor of the Russian Federation dated May 15, 2013 N 26 (registered by the Ministry of Justice of Russia on May 29. 2013, registration number 28564), as amended by the Decree of the Chief State Sanitary Doctor of the Russian Federation dated July 20, 2015 N 28 (registered by the Ministry of Justice of Russia on August 3, 2015, registration number 38312); dated August 27, 2015 N 41 (registered by the Ministry of Justice of Russia on September 4, 2015, registration number 38824); decision of the Supreme Court of the Russian Federation of 04.04.2014 N AKPI14-281 (Bulletin of the Supreme Court of the Russian Federation, 2015, N 1).

5.10. An extract from the hospital of GFMI convalescents and acute nasopharyngitis and their admission to preschool educational organizations, general educational organizations, organizations with round-the-clock stay of children, organizations for recreation and rehabilitation of children, professional educational organizations and educational organizations of higher education is carried out after complete clinical recovery.

VI. Organization of immunoprophylaxis of meningococcal infection in the inter-epidemic period and with the threat of an epidemic rise in the incidence of meningococcal infection

6.1. Preventive vaccinations against meningococcal infection are included in the calendar of preventive vaccinations according to epidemic indications.
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"On Immunoprophylaxis of Infectious Diseases" (Collected Legislation of the Russian Federation, 09/21/1998, N 38, Art. 4736; 2018, N 11, Art. 1591) (hereinafter - Federal Law of 09/17/1998 N 157-FZ); order of the Ministry of Health of Russia dated March 21, 2014 N 125n "On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications" (registered by the Ministry of Justice of Russia on April 25, 2014, registration number 32115), as amended by orders of the Ministry of Health of Russia dated June 16, 2016 N 370n (registered by the Ministry of Justice of Russia on 07/04/2016, registration number 42728), dated 04/13/2017 N 175н (registered by the Ministry of Justice of Russia on 05/17/2017, registration number 46745) (hereinafter - the order of the Ministry of Health of Russia dated 03/21/2014 N 125н).

6.2. Vaccination against meningococcal infection is carried out with vaccines approved in the territory of the Russian Federation in accordance with the instructions for their use. When carrying out vaccination, vaccines with the largest set of serogroups of the pathogen are used, which makes it possible to ensure the maximum efficiency of immunization and the formation of population immunity.
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Federal Law of September 17, 1998 N 157-FZ; sanitary and epidemiological rules SP 3.3.2367-08 "Organization of immunoprophylaxis of infectious diseases", approved by the Decree of the Chief State Sanitary Doctor of the Russian Federation dated 04.06.2008 N 34 (registered by the Ministry of Justice of Russia on 06.25.2008, registration number 11881) (hereinafter - SP 3.3.2367 -08 dated 06/04/2008 N 34).

6.3. Vaccination during the inter-epidemic period is planned for persons from high-risk groups of infection in accordance with paragraph 2.8 of the Sanitary Rules, as well as for epidemic indications - persons who have been in contact with the patient in the outbreaks of the GFMI, in accordance with paragraphs 5.6-5.8 of the Sanitary Rules.

6.4. Harbingers of complications of the epidemiological situation are:

an increase in the incidence of GFMI by 2 times compared to the previous year;

an increase in the proportion of older children, adolescents and persons aged 18-25 years in the total age structure of cases by 2 times;

a pronounced (2 or more times) increase in cases of diseases in preschool educational, general educational organizations, among first-year students of professional educational organizations and educational institutions of higher education (for example, among visiting students living in hostels);

the appearance of foci with two or more cases of HFMI diseases;

a gradual change in the serogroup characteristics of meningococcal strains isolated from the cerebrospinal fluid and (or) blood of patients with HFMI and the formation of a monoprofile landscape of meningococcal strains in terms of serogroup characteristics with a simultaneous increase in incidence rates.

If there is a threat of an epidemic rise in the incidence (the appearance of precursors of a complication of the epidemiological situation), vaccinations in a planned manner are additionally subject to:

children up to 8 years old inclusive;

first-year students of professional educational organizations and educational institutions of higher education, primarily in teams (groups) staffed by students from different regions of the country and foreign countries.

With the continuing increase in the incidence of meningococcal infection, in order to strengthen population immunity, vaccinations in a planned manner are additionally subject to:

students of general education organizations from grades 3 to 11;

adult population (when applying to medical organizations).

6.5. Vaccination in case of a threat of an epidemic rise in the incidence of meningococcal infection is carried out 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.
________________
Federal Law of March 30, 1999 N 52-FZ "On the sanitary and epidemiological well-being of the population"; Federal Law of September 17, 1998 N 157-FZ; order of the Ministry of Health of Russia dated March 21, 2014 N 125n.

6.6. Planning, organization, implementation, completeness of coverage with preventive vaccinations, reliability of accounting and timeliness of reporting on preventive vaccinations are provided by the heads (administration) of medical organizations.
________________
Federal Law of September 17, 1998 N 157-FZ; SP 3.3.2367-08 of 06/04/2008 N 34.

VII. Epidemiological surveillance of meningococcal disease

7.1. Epidemiological surveillance of meningococcal infection is organized and carried out by the bodies exercising federal state sanitary and epidemiological surveillance in accordance with the legislation of the Russian Federation.
________________
and 50 of the Federal Law of March 30, 1999 N 52-FZ "On the sanitary and epidemiological well-being of the population" .

7.2. Measures to ensure federal state sanitary and epidemiological surveillance include:

monitoring of the epidemiological situation (morbidity, mortality, foci);

analysis of the structure of morbidity (age and contingents of patients);

tracking the circulation of pathogens isolated from patients with HFMI, their serogroup affiliation;

control of the organization and conduct of preventive vaccinations;

assessment of the timeliness and effectiveness of ongoing preventive and anti-epidemic measures;

timely adoption of managerial decisions and forecasting of morbidity.

VIII. Hygienic education and training of citizens on the prevention of meningococcal infection

8.1. Hygienic education of the population is one of the methods of preventing meningococcal infection, includes: providing the population with information about meningococcal infection, the main symptoms of the disease and preventive measures using means mass media, leaflets, posters, bulletins, conducting an individual conversation.

8.2. Measures for sanitary and educational work among the population on measures to prevent meningococcal infection, including vaccination, are carried out by bodies exercising federal state sanitary and epidemiological supervision, executive authorities in the field of health protection, and medical organizations.

Application. Drugs recommended by the World Health Organization for chemoprophylaxis in foci of meningococcal infection

Application
to health regulations
SP 3.1.3542-18

________________
* Official website of the World Health Organization: http://www.who.int/wer.

Treatment of nasopharyngitis is carried out with Rifampicin **, Ciprofloxacin ***, Ampicillin in accordance with the instructions for their use.
________________
** Not recommended for pregnant women.

*** Not recommended for persons under 18, pregnant or breastfeeding mothers.

Electronic text of the document

Meningococcal infection - an acute infectious disease of an anthroponotic nature, characterized by lesions of 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 AT.

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. The set of measures for the prevention of the incidence of meningococcal infection includes the 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 is important chronic diseases nasopharynx.

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 cohabitation 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

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 outbreak, 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 with 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 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 conducting 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 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.

Appendix 2. Recommendations for anti-epidemic measures in the focus of meningococcal infection and purulent bacterial meningitis

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COUNTER-EPIDEMIC MEASURES IN THE FOCUS OF MENINGOCOCC INFECTION

Information about the sick person in the Central State Sanitary and Epidemiological Service in the form of an Emergency Notification within 12 hours after the identification of the patient.

Epidemiological examination of the focus in order to identify and sanitize carriers and patients with erased forms; determination of the circle of persons subject to mandatory bacteriological examination.

Measures regarding the source of the pathogen.

Hospitalization of the patient, isolation of carriers.

Discharge from the hospital - with 2 negative bacteriological studies of nasopharyngeal mucus, carried out 3 days after the end of treatment.

Measures for transmission factors.

Disinfection: in the hearth, daily wet cleaning, ventilation, irradiation with UV radiation and bactericidal lamps. Final disinfection is not carried out.

Measures for contact persons in the outbreak.

Medical supervision 10 days from the last visit of the sick team / daily examination of the skin, throat with the participation of an ENT doctor, thermometry /. Children, personnel of preschool, school institutions, in universities and secondary specialized institutions in the 1st year - the entire course where the patient was identified, in senior years - students of the group where the patient or carrier was identified, are subject to bacteriological examination. Bacterial examination is carried out 2 times with an interval of 3-7 days in the kindergarten.

Emergency prevention. Children from 18 months. up to 7 years and students of the 1st course in the first 5 days from contact, active immunization of the meningococcal polysaccharide vaccine of serogroups A and C is carried out. In its absence, normal human immunoglobulin is administered. Immunoglobulin is not administered to previously vaccinated children.

Preventive and anti-epidemic measures in the focus of meningococcal infection.

2. An emergency notification (f.58 / y) is sent to the State Sanitary and Epidemiological Supervision Service about each case of the disease.

3. A quarantine is imposed on the focus where the patient is identified for a period of 10 days from the moment of separation. Contacts are identified, registered, and monitored daily (thermometry 2 times a day, examination of the mucous membranes of the nasopharynx, skin, medical records).

4. Double bacteriological examination of all contacts (taking swabs from the pharynx and nose for meningococcus) with an interval of 3-7 days.

5 Identified meningococcal excretors are isolated, they are given etiotropic therapy, after sanitation - a single bacteriological examination.

6. Immunoglobulin is administered to contact children up to a year according to indications.

7. Immunization with meningococcal vaccine is carried out according to epidemic indications (children under 7 years of age and first grade students with an increase in the incidence of more than 2.0 per 100,000 of the population, and with an incidence of more than 20.0 per 100,000 of the population - vaccination of the entire population up to 20 years.

8. Current disinfection in the hearth (thorough ventilation, wet cleaning and quartzization of the room). Final disinfection is not carried out.

9. Avoid the stay of young children in crowded places in enclosed spaces.

Nursing process in meningococcal disease

Possible patient problems:

sharp headache;

Violation of physical and motor activity (paresis, paralysis, convulsions)

violation of the integrity of the skin (hemorrhagic rash, necrosis);

the inability of the child to independently cope with the difficulties that arose as a result of the disease;

fear of hospitalization, manipulation;

disadaptation, separation from loved ones, peers

decrease in cognitive activity;

Possible problems for parents:

Disadaptation of the family due to the illness of the child

fear for the child, uncertainty about the successful outcome of the disease;

lack of knowledge about illness and care; psycho-emotional stress, inadequate assessment of the child's condition;

Severe complications, disability;

nursing intervention

Inform the patient and his parents about the transmission mechanism, clinical manifestations, features of the course, principles of treatment, preventive measures.

To convince parents and the child of the need for hospitalization in order to ensure a favorable outcome of the disease, to provide assistance in hospitalization.

Organize strict bed rest during the acute period of the disease. Provide the patient with psycho-emotional peace, protect from unrest and loud sounds, traumatic manipulations, bright light.

Monitor vital functions (temperature, pulse, blood pressure, respiratory rate, heart rate, condition of the skin, mucous membranes, motor functions, physiological functions).

Provide first aid in emergency situations.

Several times a day, carry out an audit of the skin and mucous membranes, wash the toilet with antiseptic solutions, reparants, often change the position of the patient in bed, prevent bedsores, provide a sufficient amount of clean linen, change it as needed.

Arrange current disinfection, sufficient aeration of the ward (airing should be carried out several times a day).

Control the child's nutrition, the diet should be liquid and semi-liquid, easily digestible, excluding spicy foods and hard-to-digest foods. The frequency of feeding in the acute period is 5-6 times a day, in small portions, you can not force-feed the child, in the absence of appetite, offer him warm fortified drinks. After normalization of the temperature, you can proceed to the usual full-fledged, but not rough food.

With the help of a therapeutic game, prepare the child in advance for manipulations and laboratory and instrumental studies.

Constantly provide psychological support child and his family members. To help the child during the recovery period in the organization of leisure, given his long stay in the hospital.

After discharge from the hospital, teach parents to correctly assess the abilities and capabilities of the child, to control the level of his intellectual development.

Persuade parents to continue dynamic monitoring of the child after discharge from the hospital by doctors - pediatrician, ENT, neuropathologist, psychoneurologist, etc.

Nursing process in poliomyelitis

Polio- an acute infectious disease of a viral nature, accompanied by the development of flaccid paresis and paralysis due to damage to the motor cells of the anterior horns of the spinal cord.

Epidemiology.

The only source of infection is a person (sick or virus carrier). The virus is released into the external environment with secretions from the oral cavity, nose and feces. Children of the first 4 years of life have the greatest susceptibility to poliomyelitis. Currently, due to high post-vaccination herd immunity, the incidence of poliomyelitis is sporadic. Attention:

Etiology.

The causative agent belongs to the group of enteroviruses. They are stable in the environment, inactivated by boiling, UV irradiation, exposure to chlorine-containing substances.

Pathogenesis.

Initially, the pathogen enters the surface epithelium of the nasopharynx and digestive tract. With good local protection, the pathogen can be neutralized. With an insufficient level of protection, the pathogen penetrates into the lymphoid apparatus of the intestine and nasopharynx, where it reproduces. Then it penetrates into the blood and into the central nervous system. The gray matter of the brain and spinal cord is affected, most often the motor neurons of the anterior horns of the spinal cord.

Transfer mechanism

Transmission routes:

clinical picture.

There are typical (spinal, bulbar, pontine) and atypical (inapparent, catarrhal, meningeal) forms of poliomyelitis, according to the severity of the course - mild, moderate and severe forms. The course of the disease can be abortive (minor illness), acute with or without restoration of lost functions.

The most characteristic of the typical forms is spinal, in which 4 periods are observed:

• incubation, ranging from 3 to 30 days (average 7-14);

• preparalytic duration 3-6 days. It lasts from the onset of the disease until the first signs of damage to the motor sphere in the form of flaccid paralysis and paresis appear and is characterized by:

Increased body temperature, malaise, weakness, sleep disturbance, lethargy; - bowel dysfunction, anorexia

Catarrhal symptoms (rhinitis, tracheitis, tonsillitis)

On the 2nd-3rd day of the disease, meningeal and radicular symptoms join, the condition worsens - a sharp headache, vomiting, pain in the limbs and back are disturbing, hyperesthesia and stiffness of the muscles of the neck, back, shivering and twitching of individual muscle groups are expressed.

· paralytic lasting from a few days to 2 weeks:

Paresis and paralysis appear without disturbance of sensitivity, more often of the lower extremities;

With damage to the neck and thoracic spinal cord develop paralysis of the muscles of the neck and arms;

Possible violations of the pelvic organs, damage to the intercostal muscles and diaphragm. The depth of the lesion is different - from mild paresis to severe paralysis;

· restorative- lasts 2 years. Residual effects are observed: paralysis and atrophy of muscles, more often of the lower extremities.

The following forms are less common:

Pontine, in which paralysis of mimic muscles develops, more often on one side

Bulbar - with impaired swallowing, choking, nasal speech, sagging of the palatine curtain

Inapparent - "healthy" carriage without clinical symptoms

Catarrhal with a picture of only rhinitis, tonsillitis, etc.

Meningeal - meningeal symptoms come to the fore.

Thanks to many years of vaccination, the clinical picture poliomyelitis. Severe paralytic forms occur only in unvaccinated children. In vaccinated children, poliomyelitis occurs as a mild paretic disease, ending in recovery. The outcome of the paralytic form is lifelong paralysis and stunting of the affected limb in growth. The disease does not recur and does not progress.

Laboratory and instrumental diagnostics.

1. Virological examination (faeces, pharynx, blood, cerebrospinal fluid);

2. Serological tests(increase in titer of specific antibodies)

3. Electromyography determines the location of the lesion, function, motor neurons of the spinal cord and muscles).