Than freezing to death in the big city


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Whooping cough and diphtheria returned from antireligioznik. Industrial air conditioners may be the droppings of rodents and tularemia. Viral hepatitis In General no one is safe. What infections threaten people living in big cities and how they protect themselves said chief specialist on infectious diseases, Ministry of health of Russia, MD Professor Department of infectious diseases and epidemiology of MSMSU them. A. I. Evdokimov, Irina Shestakova.

Photo: from the private archive of Irina Shestakova

Irina Viktorovna, whether resident of the big city every step of the lurking some kind of infection, or this danger is greatly exaggerated?

— Naturally, in cities with lots of public transport and density of the population the probability to get infected is much higher than that of the villager who lives in a small house and does not use public transport. Although in rural areas this is possible (for example, if the settlement is in the area of natural-focal diseases).

Ways of transfer of infectious diseases — fecal-oral and airborne, in which any outbreak is quickly developing in conditions of great overcrowding. Therefore, in the epidemic season in the big cities is always a high incidence of acute respiratory infections, influenza, intestinal infections. At the same time, to catch the viral infection can not only in metro, but in a small unventilated room where during a lecture someone sneezes at least once. And where there is also air conditioning, the probability of infection increases.

By the way, when 25 years ago first talked about Legionnaires ‘ disease, is conditioned. The danger is not only in the contrast of temperatures that increase the danger of catching cold. And that the pathogen may not be sufficiently long to survive in the water conditioning and get out in the air. A particularly nasty situation can happen with industrial air conditioners, where, as practice shows, can get a litter of rodents. Known cases when dealing with the replacement of air conditioning employees were admitted to hospital with pneumonic variant of tularemia.

What “attack” You would put in second place?

— Parenteral infections that can be transmitted sexually, through blood, as a result of using non-sterile instruments. At the same time, risk is always evaluated in a specific group of diseases. For example, if we are talking about HIV, of course, the most vulnerable are persons who use drugs, practicing unprotected sex, suffering from alcoholism, patients with sexually transmitted diseases without a certain residence.

About 55% of cases of HIV infection today are associated with injecting drug use, and already on the second place — heterosexual intercourse between a man and a woman (and only 1.5% among all people living with HIV last year were men practicing same-sex relationships).

The same can be said about the way parenterally transmitted viral hepatitis. In fact, viral hepatitis, no one is immune. You can become infected personal life or in professional activity caused by direct contact of blood or damaged mucous membranes with the bodily fluids of an infected person (blood, semen, vaginal secret, etc.).

Unfortunately, unsterilized instruments are used not only by addicts, poetand to apply only to proven institutions, even if you just want to get a manicure. All the tools you want to open when you need to see that, for example, in a nail parlor is a device to sterilisatie of tools used by the master. A manicure should be wearing gloves and a mask. If these elementary rules are not observed, it is better to turn around and leave. By the way, employees of communal services and physicians of the risk of infection is much higher than that of a layman, and all safety requirements clearly spelled out for them.

And yet people are more afraid of catching any infection are not at the hair salon, and subway or railway stations.

— It is clear that the stations remain the main sanctuaries of persons without a certain dream residence and antisocial personalities. Those groups who, because of low immunity and characteristics of the sanitary conditions around, not only are the carriers of the diseases, but they themselves stand in the forefront of the contamination. It is clear that among these people a great spread of scabies, many sexually transmitted infections, a large number of lice (a louse, and lice carry a variety of pathogens, until typhus). But, in my opinion, the CPS, which in this situation is a big burden, a very good cope. At least in recent years, there were no major outbreaks of migrants, illegal stations and their inhabitants.

How solid is the fears of citizens about tuberculosis? Because this disease is transmitted by airborne droplets, and do not have close contact with the patient.

Tuberculosis — very rare we have an infection. And not only here, in the former Soviet space and in Eastern Europe is a serious social problem. But now in Russia situationals, thanks to working in the country programme of prevention of tuberculosis. The main problem is the pathogen’s resistance to available chemotherapeutic agents, making the number of multidrug-resistant tuberculosis is growing. In addition, on the background of HIV infection tuberculosis has become even more important. HIV-infected patients more likely to die from tuberculosis.

Is it true that today is a return of the infection, which have not been? For example, why there are more whooping cough?

— Yes, it’s a problem: today return, it would seem that “long-forgotten” infection, and not just pertussis. In addition, these infections come back with a changed clinical picture. There is often uncharacteristic symptoms for diseases, which was many years ago, and it does not allow timely diagnosis. Often the late diagnosis related to lack of alertness of physicians for such infections and the lack of laboratory equipment diagnostic test-systems.

And the most insulting, when due to the total rejection prevention outbreaks occur vaccine preventable infections. I often hear from mothers of non-vaccinated children: “I have not sick, what do you want?”. But the child is not sick just because he surrounded by vaccinated people who are not a source of infection. And if there will be an infected adult or child, who once decided that he does not need to be vaccinated, he will surely get sick.

Infectious diseases do not forgive any failures on our part. After the collapse of the Soviet Union all began to blame the Soviet medicine and massively refuse to vaccinate, of course, creates a very large non-immune layer. The result returned diphtheria, which “old” the doctors told me that such severe forms they had seen before the war.

A more recent example is the rise in the incidence of mumps in the North Caucasus Federal district. The difficult situation in some areas in 1990-1996 and insufficient vaccination coverage of children in the period backfired now that the drift to the region of infection in the absence of sufficient immune segment has led to increased morbidity.And the sick and children and adults. But if you remember that the same mumps occurring in children easily, can have unpleasant complication in men — infertility, something to think about — whether to risk our sons?

Who else but antireligioznik, contributes to the emergence of new outbreaks of infection — travelers? Migrants?

— That’s all right. But you know that migration can never be overturned. Therefore, the protection here is one — vaccination and compliance with sanitary-epidemiological norms for each particular disease or group of infections. With regard to travelers, travel companies, unfortunately, do not inform tourists on what diseases are present in countries where they go. Yes, and not legally required to do so. Therefore, when planning a vacation, be sure to find out this information from a specialist, it is best to consult an infectious disease specialist, and after weighing all the risks, vaccinations.

As a resident of the metropolis to protect yourself from infections at home?

— The most reliable protection — specific prevention of diseases against which there are vaccines. And doctors need to find a way to explain to the public that immunization is not the machinations of the pharmaceutical companies, not the desire of doctors to create the appearance of work, but what you really need to preserve the health of the population.

National immunization schedule is based on the analysis of the epidemiological situation for a long time. It takes into account those infections that have developed historically here or was introduced and entrenched. As well as those that are relevant for cross-border territories and the places where people go most often. National calendar for people of all ages, but, unfortunately, we have very bad situation with a booster in adulthood. Each vaccine has a certain validity period (some six months or a year, some five to seven years, etc.), after which the effective protection of human anymore.

At the same time, the approach to immunization must be very individually, assessing the reality of risk for each individual, depending on where he lives, what he does. For example, kindergarten teachers and school teachers are at risk for infection childhood infections — whooping cough, measles, rubella.

If we are talking about sexually transmitted infections, for example syphilis or HIV, then everything comes to casual sex. It is desirable that they did not exist, and if they do happen, only with the use of mechanical means of protection from both men and women.Thatas for some parenteral infections, e.g. hepatitis b — this is again a vaccination.

A very significant example: when in Russia in the 90-ies started to vaccinate against hepatitis b, the prevalence was very high, and thanks to the advent of vaccines in the first five years of active vaccination campaigns, the incidence has fallen sharply. And now we have practically no cases of acute hepatitis b in children under the age of 17. And this is due to the fact that the hepatitis b vaccination included in national immunization schedule. But revaccination against hepatitis b virus infection among the adult population is already lame. Hepatitis C no vaccine is available, and, therefore, it all depends on the observance of basic precautions.

Now most people are concerned about the situation with the flu

— The flu epidemic in Russia is developing actively. And, according to the CPS, we have to date is dominated by the H3N2 strain. Prevention of influenza is what is called truths. Vaccination of the population (specific prevention) should begin at the end of August — beginning of September and ends approximately three weeks before the beginning of the epidemic season.

If you do get sick, it is not necessary to self-medicate, immediately call your doctor because only timely and correctly chosen treatment will save your life. And it is not necessary to reinvent the wheel and rely on “effective tools”, prompted by a neighbor! The world health organization with the most complete information about morbidity and mortality of patients with influenza every year before the start of the season publishes updated guidance on treatment and prevention, which are based on the doctors in the choice of tactics of conducting patients. Russian medicine is the same way.

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