BASIC PRINCIPLES IN THE FIGHT BASIC PRINCIPLES IN THE FIGHT AGAINST INFECTIOUS DISEASES. AGAINST INFECTIOUS DISEASES.

PROPHYLACTIC AND PROPHYLACTIC AND ANTIEPIDEMIC ANTIEPIDEMIC MEASURES

Prof. Dr. N. Ribarova, MDProf. Dr. N. Ribarova, MD

STRUCTURE OF THE STRUCTURE OF THE EPIDEMIOLOGICAL PROCESSEPIDEMIOLOGICAL PROCESS Source of infectionSource of infection Mechanism of transmissionMechanism of transmission Susceptibility of the Susceptibility of the PopulationPopulation

Changes in these factors caused by the Changes in these factors caused by the social and natural environment reflect social and natural environment reflect on the intensity of the epidemic process.on the intensity of the epidemic process.

Thus the efficacious prophylactics and effective Thus the efficacious prophylactics and effective fight against infectious diseases are possible fight against infectious diseases are possible only when the antiepidemic measures are only when the antiepidemic measures are directed in three ways:directed in three ways:

measures eliminating or decontaminating measures eliminating or decontaminating the source of infection;the source of infection;

measures stopping the mechanism of measures stopping the mechanism of transmission of infection;transmission of infection;

measures stimulating insusceptibility of the measures stimulating insusceptibility of the population to a certain disease.population to a certain disease.

I. MEASURES ELIMINATING OR I. MEASURES ELIMINATING OR DECONTAMINATING THE SOURCE OF DECONTAMINATING THE SOURCE OF INFECTIONINFECTION

It is the main trend in the fight against infectious diseases.It is the main trend in the fight against infectious diseases.* measures for extermination * measures for extermination - elimination of the sick - elimination of the sick

animals (carriers of infection). The method is the best one animals (carriers of infection). The method is the best one in case of infected wild animals as well as domestic in case of infected wild animals as well as domestic animals;animals;

* measures for derattization * measures for derattization - used at rodents, reservoirs of - used at rodents, reservoirs of infections;infections;

* sanitary measures * sanitary measures - concerning domestic and farm - concerning domestic and farm animals (for example, carriers of brusellosis). In this way animals (for example, carriers of brusellosis). In this way animals are used for the purposes of the farms animals are used for the purposes of the farms simultaneously with the measures for their recovery.simultaneously with the measures for their recovery.

Measures for extermination are not applicable at Measures for extermination are not applicable at anthroponosus infectious diseases where the source anthroponosus infectious diseases where the source of infection is the man - a sick person or a carrier of of infection is the man - a sick person or a carrier of infection. In this case the aim is to decontaminate the infection. In this case the aim is to decontaminate the source of infection putting it in such conditions in source of infection putting it in such conditions in which the possibilities for transmission of infection which the possibilities for transmission of infection are cut off.are cut off.

*isolation of the sick persons *isolation of the sick persons - in an infectious - in an infectious ward or at home. Complete influencing of the source ward or at home. Complete influencing of the source of infection is impeded also by the characteristics of of infection is impeded also by the characteristics of the clinical course of the disease - inapparent, mild the clinical course of the disease - inapparent, mild clinical forms, chronic forms, etc.clinical forms, chronic forms, etc.

Localization and decontamination of the source of Localization and decontamination of the source of infection depend on:infection depend on:

* living conditions * living conditions - conditions facilitating - conditions facilitating transmission of infection to other persons should be transmission of infection to other persons should be eliminated;eliminated;

* attitudes of the population * attitudes of the population - whether people - whether people seek doctors' help immediately, refusal of hospitali-seek doctors' help immediately, refusal of hospitali-zation, etc. as well as degree of health knowledge zation, etc. as well as degree of health knowledge and responsibility for the economic costs. and responsibility for the economic costs.

* * possibilities for specific, possibilities for specific, etiologic treatment of etiologic treatment of the sick persons and carriers of infection.the sick persons and carriers of infection.

Urgent preventionUrgent prevention is also one of the measures is also one of the measures for influencing the source of infection. for influencing the source of infection. Urgent Urgent preventionprevention - it is the use of prophylactic and - it is the use of prophylactic and curative means to prevent development of the curative means to prevent development of the disease from the carriers of infection in incubation. disease from the carriers of infection in incubation. For this purpose immune serums, vaccines, For this purpose immune serums, vaccines, bioproducts, chemotherapeutic agents – bioproducts, chemotherapeutic agents – sulfonamides, antibiotics, etc. are applied.sulfonamides, antibiotics, etc. are applied.

II. MEASURES STOPPING THE II. MEASURES STOPPING THE MECHANISM OF TRANS-MISSION OF MECHANISM OF TRANS-MISSION OF INFECTIONINFECTION

These measures are various ones. They are These measures are various ones. They are mainly related to the specific characteristics of mainly related to the specific characteristics of the mechanism of transmission of the different the mechanism of transmission of the different infectious diseases. Generally, it is very infectious diseases. Generally, it is very difficult to carry out such measures.difficult to carry out such measures.

1. Diseases belonging to the group of 1. Diseases belonging to the group of enteric enteric infections.infections.

The measures require the agents of infection The measures require the agents of infection in the faeces of the sick persons not to get in the faeces of the sick persons not to get through food, water, etc. into the through food, water, etc. into the gastrointestinal tract of the healthy people.gastrointestinal tract of the healthy people.

Sanitary measures eliminating the faecal-oral Sanitary measures eliminating the faecal-oral way of infection are of crucial importance: way of infection are of crucial importance:

development and urbanization of the built-up development and urbanization of the built-up areas;areas;

water supply, sewerage;water supply, sewerage; decontamination of the sewerage waters;decontamination of the sewerage waters; collection and decontamination of the hard collection and decontamination of the hard

wastes;wastes; sanitary measures in public catering;sanitary measures in public catering; following the regulations of sanitation;following the regulations of sanitation; school hygiene;school hygiene; health knowledge of the population.health knowledge of the population.

2. 2. Diseases belonging to the group of Diseases belonging to the group of respiratory infections:respiratory infections:

Gauze masks, aeration and ventilation, Gauze masks, aeration and ventilation, bactericidical lamps, disinfection.bactericidical lamps, disinfection.

3.3. Diseases belonging to the group of Diseases belonging to the group of blood blood infections:infections:

Character, access and effectiveness of the Character, access and effectiveness of the measures applied depend on the biological measures applied depend on the biological carrier: carrier:

agromeliorative measures; agromeliorative measures; hydrotechnical measures;hydrotechnical measures; disinsection and derattization; disinsection and derattization; means of individual prevention; means of individual prevention; stimulating accumulation of health stimulating accumulation of health

knowledge.knowledge.

4.4. Diseases belonging to the group of Diseases belonging to the group of covering covering infections:infections:

They are transmitted through the personal They are transmitted through the personal belongings, household goods, etc. belongings, household goods, etc.

* * disinfection;disinfection;

* hygienic measures for decontamination; * hygienic measures for decontamination;

* stimulating the accumulation of health * stimulating the accumulation of health knowledge of the population.knowledge of the population.

III. MEASURES STIMULATING III. MEASURES STIMULATING INSUSCEPTIBILITY OF THE INSUSCEPTIBILITY OF THE POPULATIONPOPULATION

A perspective for prevention and fight A perspective for prevention and fight against infectious diseases is against infectious diseases is development of specific development of specific insusceptibility of the population to insusceptibility of the population to infectious diseases.infectious diseases.

IMMUNITY IMMUNITY represents a complex of represents a complex of preventive physiologic responses of the preventive physiologic responses of the whole organism, i.e. it is a way of whole organism, i.e. it is a way of prevention of the organism from protein prevention of the organism from protein bodies carrying themselves foreign gene bodies carrying themselves foreign gene information.information.

Immune system recognizes the relevant Immune system recognizes the relevant antigens through its immunocompetent antigens through its immunocompetent cells and reacts against them producing cells and reacts against them producing IMMUNE RESPONSE IMMUNE RESPONSE as well as as well as developing immune memory and immune developing immune memory and immune tolerability.tolerability.

IMMUNE RESPONSE IMMUNE RESPONSE is a complex is a complex reaction of the organism induced by the reaction of the organism induced by the antigen penetrated in it, which antigen penetrated in it, which morphologic base is proliferation and morphologic base is proliferation and differentiation of the immunocompetent differentiation of the immunocompetent cells.cells.

Recognition of the antigen is made with the help Recognition of the antigen is made with the help of two types of lymphocytes:of two types of lymphocytes:

* T-lymphocytes * T-lymphocytes - they have developed their - they have developed their immunologic competence through thymus and immunologic competence through thymus and that is why they are called "thymus-dependent";that is why they are called "thymus-dependent";

* B-lymphocytes * B-lymphocytes - they have developed their - they have developed their immunologic competence through the 'Fabricius immunologic competence through the 'Fabricius bursa" (for the birds) or through its equivalent bursa" (for the birds) or through its equivalent for the mammals, probably bone marrow or part for the mammals, probably bone marrow or part of the lymph tissue of the intestines - 'Payer's of the lymph tissue of the intestines - 'Payer's plaques', appendix and tonsils.plaques', appendix and tonsils.

In the course of the evolution the following In the course of the evolution the following types of immunity have been developed:types of immunity have been developed:

1. Hereditary (species) immunity:1. Hereditary (species) immunity:

It is formed during the philogenetic It is formed during the philogenetic development of the individual. It represents a development of the individual. It represents a state of insusceptibility of the organism state of insusceptibility of the organism related to the species to which the man or the related to the species to which the man or the animal belong. It is inherited (for example, animal belong. It is inherited (for example, people do not suffer from hen cholera, people do not suffer from hen cholera, animals - from measles).animals - from measles).

2. Acquired (individual) immunity.2. Acquired (individual) immunity. It is formed during the ontogenetic development of the It is formed during the ontogenetic development of the individual. The ability of the organism to develop individual. The ability of the organism to develop ontogenetic mechanisms is a result from its philogenesis. ontogenetic mechanisms is a result from its philogenesis. Individual immunity is divided as follows: Individual immunity is divided as follows: A. Naturally acquired immunity, A. Naturally acquired immunity, which, on its part, iswhich, on its part, is divided to:divided to: * passive * passive - due to antibodies, inherited from the mother;- due to antibodies, inherited from the mother; * active * active – postinfectious, domestic immunity.– postinfectious, domestic immunity.B. Non-naturally acquired (pos-timmunization) B. Non-naturally acquired (pos-timmunization) immunity, immunity, divided to:divided to: *active *active - developed after application of vaccines and- developed after application of vaccines and toxoids;toxoids; *passive *passive - after administration of readymade antibodies- after administration of readymade antibodies through serums and immunoglobulins.through serums and immunoglobulins.

The difference between these two types The difference between these two types of development of immunity is related to of development of immunity is related to the way of development as well as the the way of development as well as the level of its intensity and duration.level of its intensity and duration.

According to the mechanism of development of the According to the mechanism of development of the immune response immunity is divided as follows:immune response immunity is divided as follows:

• • humoral immunity humoral immunity - it acts thro-ugh B-lymphocytes as - it acts thro-ugh B-lymphocytes as well as antibo-dies circulating freely as immunoglobulins well as antibo-dies circulating freely as immunoglobulins in the blood and the other body liquids. The antibodies in the blood and the other body liquids. The antibodies react directly to the antigens forming a type of response react directly to the antigens forming a type of response "antigen-antibody" - precipitation, neutralization, "antigen-antibody" - precipitation, neutralization, accumulation,etc. dependingaccumulation,etc. depending on its conditions.on its conditions.

• • cell immunity cell immunity - it acts through the circulating T-- it acts through the circulating T-lymphocytes together with the non-immunoglobulin lymphocytes together with the non-immunoglobulin mediators of the lymph function (activated macrophages). mediators of the lymph function (activated macrophages).

Local immunity is an antigen (mainly IgA) and is cell Local immunity is an antigen (mainly IgA) and is cell mediated - in the immunosecretory system of the mucous mediated - in the immunosecretory system of the mucous of the gastrointestinal tract and respiratory ways (the of the gastrointestinal tract and respiratory ways (the entrance of infection).entrance of infection).

Collective immunity Collective immunity - it is the ability of the - it is the ability of the human collective to resist to the activity of the human collective to resist to the activity of the agents of the infectious diseases and to agents of the infectious diseases and to prevalence of the endemic process. It is prevalence of the endemic process. It is determined by the specific immune structure determined by the specific immune structure of the population as well as the possibility for of the population as well as the possibility for realization of the mechanism of transmission realization of the mechanism of transmission of infection in the real circumstances.of infection in the real circumstances.

Immune structure Immune structure is a concept reflecting the is a concept reflecting the distribution of the members of the group distribution of the members of the group depending on the degree of their susceptibility depending on the degree of their susceptibility to infectious diseases. to infectious diseases.

Non-specific immunologic structure Non-specific immunologic structure - it - it characterizes the degree of insusceptibility of characterizes the degree of insusceptibility of the population to all infectious diseases. It is the population to all infectious diseases. It is measured by different immunologic, measured by different immunologic, physiologic, and other methods.physiologic, and other methods.

Specific immunologic structure Specific immunologic structure - it - it characterizes insusceptibility of the characterizes insusceptibility of the population to a certain infectious disease. It population to a certain infectious disease. It is measured by the percentage of the is measured by the percentage of the individuals possessing immunity.individuals possessing immunity.

Collective immunity is not a simple sum of the Collective immunity is not a simple sum of the individual immunity of the separate members individual immunity of the separate members of the group. Different individuals may belong of the group. Different individuals may belong to the group as follows:to the group as follows:

with highly intensive immunity;with highly intensive immunity; with partial immunity;with partial immunity; with out developed immunity.with out developed immunity.

There are many different contingents of susceptible There are many different contingents of susceptible individuals:individuals:

newborns and toddlers (due to undeveloped immune newborns and toddlers (due to undeveloped immune system);system);

recovered individuals with short-term and slightly recovered individuals with short-term and slightly intensive immunity;intensive immunity;

individuals immigrating to regions, which are individuals immigrating to regions, which are endemic for certain diseases;endemic for certain diseases;

old-aged individuals (with reduced resistance of the old-aged individuals (with reduced resistance of the organism);organism);

individuals suffering from innate and acquired individuals suffering from innate and acquired impairments of the immune system, impairments of the immune system, ofimmunogenesis, etc.ofimmunogenesis, etc.

Characteristics of the three directions of Characteristics of the three directions of prevention and fight against infectious diseases prevention and fight against infectious diseases provide the possibility for achieving the necessary provide the possibility for achieving the necessary practical results at many infectious diseases if the practical results at many infectious diseases if the measures influencing the preventive directions are measures influencing the preventive directions are simultaneously carried out – decontamination of the simultaneously carried out – decontamination of the source of infection, stopping the mechanism of source of infection, stopping the mechanism of transmission of infection and stimulating the transmission of infection and stimulating the specific insusceptibility of the population. This is specific insusceptibility of the population. This is the basic principle of the antiepidemic fight.the basic principle of the antiepidemic fight.

One of these three ways of activity is the One of these three ways of activity is the basic one as the other two are basic one as the other two are complementary depending on the nature complementary depending on the nature of the infectious disease and the situation.of the infectious disease and the situation.

ANTIEPIDEMIC MEASURES IN THE EPIDEMIC CENTREANTIEPIDEMIC MEASURES IN THE EPIDEMIC CENTRE

I. Measures to the patientI. Measures to the patient

1. Early finding and recognition of the disease.1. Early finding and recognition of the disease.

2. Putting proper diagnosis.2. Putting proper diagnosis. clinical methods;clinical methods; laboratory methods;laboratory methods; epidemiological methods.epidemiological methods.

3. Registration and informing for the infectious disease.3. Registration and informing for the infectious disease. quick informing - form N 58;quick informing - form N 58; Registration book of infectious diseases - form N 60;Registration book of infectious diseases - form N 60; Registration book of hospital infections - form N 11.Registration book of hospital infections - form N 11.

4. Isolation of the patient in an infectious ward or at home:4. Isolation of the patient in an infectious ward or at home: transportation of the patient transportation of the patient - in a suitable way for - in a suitable way for

him/her; safe for the other persons; him/her; safe for the other persons; sanitary manipulation sanitary manipulation - bathing, decontamination of the - bathing, decontamination of the

clothes and underwear, eliminating parasites;clothes and underwear, eliminating parasites; specific etiologic therapy;specific etiologic therapy; dehospitalization of the patient:dehospitalization of the patient: * after full clinical recovery* after full clinical recovery * elimination of the pathogenic agent (the infect)* elimination of the pathogenic agent (the infect) * sanitary manipulation;* sanitary manipulation; * disinfection of the clothes, underwear, etc.* disinfection of the clothes, underwear, etc.

Chronically sick patients are under dispensary observation.Chronically sick patients are under dispensary observation.

II.II. Measures to the other persons Measures to the other persons (contacting (contacting ones as well as carriers of infection)ones as well as carriers of infection)

1.1. Measures to contacting persons:Measures to contacting persons: epidemiological investigation epidemiological investigation for finding of all for finding of all

contacting persons;contacting persons; registration registration - "Book for persons in contacts with - "Book for persons in contacts with

acutely infected patients" - form N 61;acutely infected patients" - form N 61; medical observation medical observation - a maximal incubation - a maximal incubation

period, thermometring, clinical examination;period, thermometring, clinical examination;

sanitary manipulation sanitary manipulation - when necessary;- when necessary; quarantine of the contacting persons quarantine of the contacting persons - -

highly infected ones in isolation highly infected ones in isolation -- serologic, serologic, microbiological, virusologic analyses;microbiological, virusologic analyses;

active or passive immunization;active or passive immunization; urgent prevention urgent prevention with antibiotics and with antibiotics and

chemotherapeutical agents.chemotherapeutical agents.

2.2. Measures to the carriers of infection:Measures to the carriers of infection: finding finding - epidemiological investigation;- epidemiological investigation;

- microbiological investigation; - microbiological investigation; sanation of the carriers of infection sanation of the carriers of infection - directed to - directed to

elimination and cleaning of the pathogenic micro-elimination and cleaning of the pathogenic micro-organisms;organisms;

isolation.isolation.

SPECIFIC PREVENTIONSPECIFIC PREVENTION

Definition: Definition: An approach for development of An approach for development of non-natural specific insusceptibility to the non-natural specific insusceptibility to the etiologic agent of a certain infectious disease.etiologic agent of a certain infectious disease.

Vaccination process: Vaccination process: An interaction between the An interaction between the vaccine agent and the human organism with its vaccine agent and the human organism with its individual characteristics. It is a complex individual characteristics. It is a complex reaction, which includes as follows:reaction, which includes as follows:

specific immune reorganization resulting in specific immune reorganization resulting in development of immunity (the aim of thedevelopment of immunity (the aim of theimmunization);immunization);

concomitant processes of non-specific concomitant processes of non-specific reorganization (directed to restoration of the reorganization (directed to restoration of the homeostasis) as well as allergization, clinically homeostasis) as well as allergization, clinically manifested or asymptomatic.manifested or asymptomatic.

Different preparations are used for Different preparations are used for development of immunity - vaccines, toxoids, development of immunity - vaccines, toxoids, serums, immunoglobulins.serums, immunoglobulins.

Live vaccines: Live vaccines: Immune preparations, containing Immune preparations, containing bacteria and viruses that have lost their bacteria and viruses that have lost their pathogenic properties but preserved their pathogenic properties but preserved their immunologic properties. Such types of vaccines immunologic properties. Such types of vaccines are as follows: against tuberculosis, are as follows: against tuberculosis, polyomielitis, measles, mumps, influenza, polyomielitis, measles, mumps, influenza, smallpox, tularemia, brucellosis, anthrax, plaque, smallpox, tularemia, brucellosis, anthrax, plaque, yellow fever, etc. These vaccines develop yellow fever, etc. These vaccines develop intensive and longterm immunity.intensive and longterm immunity.

Inactivated vaccines: Inactivated vaccines: They are prepared from They are prepared from the cultures of different infects, inactivated the cultures of different infects, inactivated physically (heating up) or chemically (formalin, physically (heating up) or chemically (formalin, phenol, alcohol, etc.) - abdominal typhus, phenol, alcohol, etc.) - abdominal typhus, paratyphus, cholera, whoparatyphus, cholera, who--oping-cough, oping-cough, leptospyroses, etc. as their immunogenic leptospyroses, etc. as their immunogenic properties are preserved.properties are preserved.

Recombinant vaccines: Recombinant vaccines: They are made with the They are made with the help of gene engineering with hybridoma help of gene engineering with hybridoma technic, etc.technic, etc.

Chemical vaccines: Chemical vaccines: They are full antigen vaccines, They are full antigen vaccines, derived chemically from bacterial cultures.derived chemically from bacterial cultures.

They are maximally lacking ballast substances, side They are maximally lacking ballast substances, side protein components and cause relatively low protein components and cause relatively low allergization of the organism. They are stable. allergization of the organism. They are stable. (Against enteric infections – abdominal typhus, (Against enteric infections – abdominal typhus, paratyphus A and B, together with a tetanicus toxoid).paratyphus A and B, together with a tetanicus toxoid).

Toxoids: Toxoids: They are derived from the products of the They are derived from the products of the microorganisms, mainly their toxins, through their microorganisms, mainly their toxins, through their inactivation (by formalin or heating up) - against inactivation (by formalin or heating up) - against diphtheria, tetanus, staphylococcus infection, etc.diphtheria, tetanus, staphylococcus infection, etc.

Protective antigens: Protective antigens: Immunization substances Immunization substances related to the pathogenic factors of bacterial related to the pathogenic factors of bacterial and virus cells. Such antigens are discovered and virus cells. Such antigens are discovered lately in plaque and whooping-cough bacteria, lately in plaque and whooping-cough bacteria, streptococcus, staphylococcus, anthrax bacilli, streptococcus, staphylococcus, anthrax bacilli, Ricketsias, etc.Ricketsias, etc.

Serums: Serums: Immune preparations proving passive Immune preparations proving passive immunologic prevention for a short time (2 to 4immunologic prevention for a short time (2 to 4

weeks). They are ready-made antibodies (anthrax, weeks). They are ready-made antibodies (anthrax, whooping-cough, epidemic meningitis, tetanus, whooping-cough, epidemic meningitis, tetanus, diphtheria, botulism, staphylococcus infection).diphtheria, botulism, staphylococcus infection).

Bacteriophages: Bacteriophages: live agents, which are parasites live agents, which are parasites in the bacterial cell - abdominal typhus, in the bacterial cell - abdominal typhus, shigelloses, salmonelloses, cholera. They have shigelloses, salmonelloses, cholera. They have limited application.limited application.

Interferon: Interferon: a protein synthesized from the cells in a protein synthesized from the cells in response to a virus infection making the other cells response to a virus infection making the other cells resistant to infection. It inhibits virus proliferation resistant to infection. It inhibits virus proliferation through non-immunologic mechanisms (virus through non-immunologic mechanisms (virus interference) - application at influenza, interference) - application at influenza, parainfluenza, coxsackie B3, ECHO-13, parainfluenza, coxsackie B3, ECHO-13, adenoviruses, enteric infections, etc.adenoviruses, enteric infections, etc.

Immunoglobulins: Immunoglobulins: simple, hyperimmune.simple, hyperimmune.

Application of vaccines:Application of vaccines:

* * subcutaneous, intracutaneous, oncutaneous, subcutaneous, intracutaneous, oncutaneous,

peroral, intranasal, aerosol method.peroral, intranasal, aerosol method.

Application of serums and inimunoglobulins:Application of serums and inimunoglobulins:

* subcutaneous, intracutaneous (strictly * subcutaneous, intracutaneous (strictly

according to the method of Bezredka).according to the method of Bezredka).

Postimmunization reactions of the organismPostimmunization reactions of the organism:: generalgeneral - changes in the body temperature and - changes in the body temperature and

state of the organism;state of the organism; locallocal - hyperemia and edema. - hyperemia and edema.

Postimmunization complications:Postimmunization complications: serum disease, anaphylactic shock, postvaccination serum disease, anaphylactic shock, postvaccination

encephalitis, etc.encephalitis, etc.

ContraindicationsContraindications:: severe states of the organism: acute infectious severe states of the organism: acute infectious

diseases, active form of tuberculosis, diseases, active form of tuberculosis, decompensated valvular disease, hypertension, decompensated valvular disease, hypertension, renal diseases (nephritis), diabetes, bronclrenal diseases (nephritis), diabetes, bronclasthma, anemia, cachexia, the second half of asthma, anemia, cachexia, the second half of pregnancy, etc.pregnancy, etc.

specific for the disease.specific for the disease.

The effect of immunizations depends on:The effect of immunizations depends on: compatibility of the immunizations;compatibility of the immunizations; the scheme and dosage of the vaccines;the scheme and dosage of the vaccines; reactivity of the organism;reactivity of the organism; size of the immune layer.size of the immune layer.

Organization of application of immunizations:Organization of application of immunizations: bioproducts supply;bioproducts supply; quality of the bioproducts;quality of the bioproducts; storage conditions and transportation of the storage conditions and transportation of the

bioproducts.bioproducts.

Immunization calendar: Immunization calendar: importance.importance.

Inspection of the results of the immuniztions.Inspection of the results of the immuniztions.

Registrations, reporting, collective immunity.Registrations, reporting, collective immunity.

Possibilities for application of the vaccines:Possibilities for application of the vaccines: according to the aims of prevention;according to the aims of prevention; according to epidemiological according to epidemiological indications.indications.

Immune prevention with serums: when Immune prevention with serums: when necessary.necessary.

DISINFECTIONDISINFECTION

1. Generally, disinfection (decontamination) is a 1. Generally, disinfection (decontamination) is a complex of methods and means directed to complex of methods and means directed to elimination of the source of infection in the elimination of the source of infection in the environment. The concept includes the environment. The concept includes the following stages: disinfection itself together following stages: disinfection itself together with sterilization and antiseptic method, with sterilization and antiseptic method, disinsection and derattization.disinsection and derattization.

DISINFECTION (itself) means the elimination DISINFECTION (itself) means the elimination of the pathogenic microorganisms in the of the pathogenic microorganisms in the environmentenvironment

Types of disinfectionTypes of disinfection according to its goals according to its goals and tasks are as follows:and tasks are as follows:

Prophylactic Prophylactic (preventive) disinfection:(preventive) disinfection: It is carried out where a centre of infection It is carried out where a centre of infection

does not exist but there are facilitating does not exist but there are facilitating conditions of its development. It is performed conditions of its development. It is performed systemically under plans for certain periods of systemically under plans for certain periods of time - in nursery schools, schools, hospitals, time - in nursery schools, schools, hospitals, cinemas, theatres, railway stations, catering cinemas, theatres, railway stations, catering establishments, of drinking water, milk, food, establishments, of drinking water, milk, food, etc.etc.

Disinfection of the centre of infection. Disinfection of the centre of infection. It is It is carried out in the centre of infection. Its aim is thecarried out in the centre of infection. Its aim is theelimination of the pathogenic mechanisms in the elimination of the pathogenic mechanisms in the environment of the patient producing theenvironment of the patient producing themicroorganisms and contaminating the microorganisms and contaminating the environment. environment. Disinfection performed during the Disinfection performed during the course ofcourse ofthe disease is called current disinfectionthe disease is called current disinfection. . After After recovery of the patientrecovery of the patient, , its hospitalization or its hospitalization or after a lethal outcome the final (ending) after a lethal outcome the final (ending) disinfection is performeddisinfection is performed. The quality of the . The quality of the current disinfection determines the complex of current disinfection determines the complex of tasks, methods and means for the final tasks, methods and means for the final disinfection.disinfection.

STERILIZATION. STERILIZATION. A method for elimination of A method for elimination of all microorganisms (pathogenic and saprophyte, all microorganisms (pathogenic and saprophyte, viruses, bacteria, mould) in their different forms - viruses, bacteria, mould) in their different forms - vegetative and sporesvegetative and spores

SANITATION. SANITATION. A method for the rapid A method for the rapid reduction of the microbial flora in an object in reduction of the microbial flora in an object in the environment (for example, after washing). It the environment (for example, after washing). It is widely applied in everyday life as a preventiveis widely applied in everyday life as a preventive measure.measure.

ANTISEPTIC METHOD. ANTISEPTIC METHOD. A method for A method for prevention of development of microorganisms prevention of development of microorganisms on the human skin and mucous.on the human skin and mucous.

DISINSECTION: DISINSECTION: elimination of the elimination of the arthropods, carriers of infectious diseases.arthropods, carriers of infectious diseases.

DERATTIZATION: DERATTIZATION: elimination of the elimination of the rodents, natural reservoirs of infections.rodents, natural reservoirs of infections.

Methods of disinfection:Methods of disinfection:

1.1. Biologic method: Biologic method: biological filters for biological filters for decontamination of the water (on the base of the decontamination of the water (on the base of the microbial antagonism).microbial antagonism).

2.2. Mechanical Mechanical mmethodethod:: cleaning, wash ect. cleaning, wash ect.

3.3. Physical method: Physical method: sun shining, ultra-violet rays, sun shining, ultra-violet rays, ionizing radiation, supersound, dry heat for ionizing radiation, supersound, dry heat for sterilization by dry air, wet heat – sterilization sterilization by dry air, wet heat – sterilization and vapour under pressure.and vapour under pressure.

4.4. Chemical method:Chemical method: use of chemical compounds- use of chemical compounds-disinfectants.disinfectants.

Methods of disinsection:Methods of disinsection:

1.1. Biological method: Biological method: use of the natural enemies of use of the natural enemies of the harm arthropods - predatory animalsthe harm arthropods - predatory animals(the fish gambusia), parasites, pathogenic (the fish gambusia), parasites, pathogenic microorganisms (Bacillus thuringiensis), microorganisms (Bacillus thuringiensis), genetically changed, sexually sterile populations.genetically changed, sexually sterile populations.

2.2. Mechanical method: Mechanical method: cleaning, wash, etc.cleaning, wash, etc.

3.3. Physical method: Physical method: high temperature - hot dry and high temperature - hot dry and wet air for vapouring, sterilization, burningwet air for vapouring, sterilization, burningout, etc.out, etc.

5.5. Chemical method: Chemical method: insecticides:insecticides: larvacideslarvacides - for elimination of larvae; - for elimination of larvae; acaricidesacaricides - for elimination of Acars; - for elimination of Acars; ovocidesovocides - for elimination of their eggs; - for elimination of their eggs; pesticidespesticides - for elimination of weeds; - for elimination of weeds;

* attractants * attractants - attracting insects;- attracting insects;

* * repellentsrepellents - repelling insects. - repelling insects.

Insecticides for arthropods depending on their Insecticides for arthropods depending on their way of penetration in the organism are as way of penetration in the organism are as follows:follows:

fumigants - gas insecticides - they act through the fumigants - gas insecticides - they act through the respiratory system;respiratory system;

intestinal insecticides - through the digestive intestinal insecticides - through the digestive tract;tract;

contact insecticides - act at contact to outer parts contact insecticides - act at contact to outer parts of the insects:of the insects:

a) with residual effect;a) with residual effect;

b) without residual effect.b) without residual effect.

Methods of derattization:Methods of derattization:1.Preventive (prophylactic) derattization:1.Preventive (prophylactic) derattization: a)a) sanitary and technical means – lack of access of sanitary and technical means – lack of access of the rodents to the buildings – openings of drainage,the rodents to the buildings – openings of drainage, doorstills, etc.doorstills, etc. b)b) sanitary and hygienic measures – lack of access to sanitary and hygienic measures – lack of access to food.food.Exterminatory derattization:Exterminatory derattization: a)a) biologic method – natural killers of the rodents. biologic method – natural killers of the rodents. b)b) mechanical method – use of traps; mechanical method – use of traps; c)c) chemical method – use of chemical compounds – chemical method – use of chemical compounds – rodenticides.rodenticides.