Standard definition of a clinical case of mumps and diagnostic effectiveness of the test systems used in the modern period

Introduction. Registration of regular epidemic outbreaks of mumps infection among young people, difficulties in the clinical diagnosis of the disease, the presence of specific clinical manifestations in adults with a severe course of infection make it necessary the improvement of the quality of diagnosis of the disease. The aim of the work is to develop a standard definition of a clinical case of mumps and to conduct a comparative assessment of the effectiveness of the diagnostic test systems used for mumps diagnostics based on the determination of their sensitivity and specificity. Materials and methods. To develop a standard definition of a clinical case of mumps based on ten combined clinical and laboratory parameters, a mathematical model was built using the logistic regression method. The study included 84 patients with mumps infection (main group) and 66 patients with non-epidemic sialoadenitis (comparison group). For a comparative evaluation of the diagnostic systems VectoParotitis-IgM, VectoParotitis-IgG, ELISA-Mumps-IgM, ELISA-Mumps-IgG, Anti-Mumps Virus ELISA-IgM, and Anti-Mumps Virus ELISA-IgG, a blood serum samples from patients (n = 41) with a diagnosis mumps? were tested in dynamics to assess their sensitivity, specificity, and diagnostic effectiveness. Results. The clinical symptom dry mouth increased the chance of diagnosing mumps by 13.7 times, the presence of bilateral lesions of the salivary glands by 6.5 times, the increase in the level of diastase in the urine by 3.2 times. The coefficient of determination R2 was 61.1; the sensitivity was 93% and the specificity 67%; p 0.001. Diagnostic effectiveness of Anti-Mumps Virus ELISA-IgG test system was 84.4%, ELISA-Mumps-IgG 87.2%, and "VectoParotitis-IgG" 88.5%. Conclusions. Based on the combination of following clinical symptoms observed simultaneously in patient, of the general weakness, dry mouth, bilateral lesions of the salivary glands, an increase in the level of diastase in the urine, it is possible to establish a clinical diagnosis of mumps with a probability of 81%. The highest diagnostic effectiveness of domestically manufactured test systems for quantitation of IgG antibodies to mumps virus in sick people has been demonstrted

The Effect of Selective and Mass Immunization Against Pneumococcal Infection on the Morbidity and Mortality due to Community-Acquired Pneumonia in Children Under 5 Years of Age

Background. It is required to perform estimation of epidemiological and cost efficacy (regarding morbidity rate) of mass routine vaccination against pneumococcal infection in Russian children and carried out earlier selective vaccination of children from high-risk groups on the basis of four-year experience. It is also important to estimate the rate of hospital admissions in this patient group, long-term and annual cycles, morbidity age and etiology structure, and mortality due to community-acquired pneumonia as one of the most common form of pneumococcal disease. The aim is to study the effect of selective and mass immunization against pneumococcal infection on the morbidity and mortality due to community-acquired pneumonia in children under 5 years of age. Methods. The analysis of communityacquired pneumonia morbidity (in 2003–2018) and mortality due to pneumonias (in 2003–2018) in children under the 14 years old in Perm was carried out. Serotypes of circulating pneumococcus, etiology of community-acquired pneumonias and immunization cost efficacy (direct expense on health care) were further studied. The analysis of study indexes was carried out following selective (vaccination of at-risk children in 2011–2014) and mass (vaccination of infants in 2015–2018) immunization strategies. Results. The morbidity rate of community-acquired pneumonias decreased by 4.0 times (from 267.0 to 66.7 for 1000) after performing selective vaccination (2011–2014) in at-risk children (frequently and chronically ill children). The morbidity rate of community-acquired pneumonias in non vaccinated children of the same group increased by 2.0 times (from 40.0 to 80.0 for 1000 non-vaccinated). The prophylactic efficacy index was 46.0. Whereby the antibacterial index among vaccinated frequently and chronically ill children was 0.11 on one child. This index has decreased by 2.6 times (from 0.11 to 0.04 on one child) in a year within the framework of prospective controlled randomized clinical study. The antibacterial index among non-vaccinated children of this group remained slightly the same: 0.09 and 0.12 respectively. During the selective vaccination the mortality rate among infants decreased by 2 times: long-term average index was 17.9 (2011–2014) against 35.2 (2003-2010) on 100 thousand children. Mass vaccination of infants against pneumococcal infection has reduced the incidence of community-acquired pneumonias among children under 2 years of age and has led to absence of multiple sites of pneumococcal infection in children’s organizations. It also has reduced the number of hospitalized children and achieved zero mortality due to pneumonias in infants by the third year of this immunization strategy implementation. The obtained results were achieved mainly due to circulation of 7 pneumococcal serotypes (6A, 6B, 9V, 14, 19A, 19F, 23F) in children under 5 years of age. The threshold level of vaccination against pneumococcal infection advancing morbidity and mortality due to pneumonias in children was specified. The strategy of mass vaccination of infants was cost-effective. Conclusion. The new data on epidemiological and cost efficacy of various immunization strategies against pneumococcal infection in children was obtained

Bronchopulmonary Pathology Prevalence Among Premature infants and Estimation of Prophylactic Efficacy and Reactogenicity of 13-Valent Pneumococcal Conjugate Vaccine in Premature infants with Bronchopulmonary Dysplasia

Background. The most frequent chronic lung pathology among infants and especially in premature children with extremely low and very low body weight is bronchopulmonary dysplasia (BPD). The aim of the study is to study the prevalence of bronchopulmonary pathology among premature children and justify the need to vaccinate against pneumococcal disease premature children suffering from BPD. Methods. The official statistics (Form №32) and data from annual reports of the catamnesis department of “the Honourary order” Perm Regional Clinical Hospital were used in order to measure the number of premature children born alive in Perm region in 2015-2017 yy. The estimation of prophylactic efficacy and reactogenicity of 13-valent pneumococcal conjugate vaccine (PCV13) at immunization of premature children with BPD. Results. The study group included vaccinated premature children with BPD (n=29), the experimental group included non-vaccinated premature children with BPD (n=29) and 30 vaccinated term children. Administration of PCV13 in premature children suffering from BPD has revealed its high prophylactic efficacy (no cases of community-acquired pneumonia among vaccinated children during the prospective study for 3 years), high tolerability (no cases of broncho-obstructive syndrome or negative effects on respiratory system such as apnoea or desaturation among vaccinated children). Low reactogenicity (17.2 ± 0.57%) and similar vaccine tolerance with term children (16.5 ± 0.55%) has been revealed as well. The combination of PCV13 with other vaccines from immunisation schedule did not increase the number of vaccine-induced diseases in comparison with administration of PCV13 alone. Conclusion. The scientific necessity of vaccination of premature children with BPD against pneumococcal disease has been proved. The high prophylactic efficacy and low reactogenicity of PCV13 in this children group at tertiary neonatological care (catamnesis department of perinatal center) has been established within the national immunisation schedule