[The dynamics of anxious depression under the treatment with antidepressants with different mechanisms of action].

Peculiarities of the dynamics of anxious depression under the treatment with selective serotonergic antidepressants with different mechanisms of action on the serotonin reuptake were investigated. It was examined 61 patients with anxious depression (ICD-10 F32.1, F33.1, F34.1) treated with zoloft (sertraline) or coaxil (tianeptine) as a monotherapy. The following methods were used: clinical-psychopathological, psychometric (Hamilton Rating Scales for Depression and Anxiety, the Sheehan Patient-Related Anxiety Scale) and statistical analysis. The comparative investigation has shown that both zoloft and coaxil are practically equally effective in the treatment of anxious depression with some peculiarities in the dynamics of clinical parameters.

[Dynamics of biochemical parameters in patients with anxious depression treated with serotonergic antidepressants with different mechanisms of action].

The aim of the study was to compare the dynamics of some biochemical parameters in patients with anxious depression treated with tianeptine (coaxil) - serotonin reuptake enhancer and sertraline (zofort) - selective serotonin reuptake inhibitor. Forty-three patients with ICD-10 diagnosis of anxious depression (F32.1 and F33.1) were included in the study. Comparing to healthy volunteers, the significant increase of platelet monoamine oxidase activity by 95% and concentration of middle molecules (middle-mass endotoxic molecules) by 86% and decrease of serum amine oxidase activity by 43% and functional albumin activity by 38% was found in patients. An analysis of the biochemical profiles revealed the changes in opposite directions of all investigated parameters for antidepressants with different effects on serotonin reuptake though both tianeptine and sertraline were effective in the treatment of anxious depression.

[Immunization of adult population of Russia against diphtheria in 2006-2007].

The vaccination coverage against diphtheria in the adult population of Russia in 2006-2007 was analyzed in different age, professional and social groups and reasons of absent immunization. Vaccination coverage in adults was 95.3%, of them 92.5% were boosted (i.e. completely immunized) and only 7.5% were in process of vaccination. Vaccination coverage was high in the majority of regions. Mean vaccination coverage in adults aged 25-49 ages was 96.2-96.5% whereas in adults > or =50 years it was lower (91.8-94.8%). Mean coverage in groups of high risk for severe diphtheria was 97.7% in professional high-risk groups and somewhat lower in social high-risk groups (94.4%). The lowest vaccination rate was registered in group of migrants (81.7%). In unvaccinated persons from professional groups 33.1% were not vaccinated due to medical contraindications, 22.8%--because of vaccination refusal, and 38.1%--due to non-medical reasons. In social groups these figures were 21.8%, 28.4%, and 49.8% respectively. Reported mean adult vaccination coverage in Russia is confirmed by results of serological studies. Protective titers were detected in 91.3% tested adults. However in the group aged > or =50 years rate of protected persons was lower (84-85%).

[Diphtheria morbidity in Russia today].

The data on diphtheria morbidity and the occurrence of carrier state for its causative agent at the period of 2001-2002 were analyzed. The rates of morbidity and detected carrier state for these years were 0.63-0.55 and 0.65-0.64 respectively. Nevertheless, in spite of the relatively low morbidity rates the presence of the toxic forms of diphtheria (400 patients for two years) and lethal cases (with lethality rate reaching 5.4%) indicated that the epidemic situation in diphtheria remained tense. The most unfavorable situation was observed in the North-Western and Central regions of Russia. In urban areas morbidity rates were still 2- to 3-fold higher in than in rural ones, but the latter showed a higher percentage of severe cases (46.6% in 2001 and 39.7% in 2002) and lethal outcomes (13.6% and 19.2%). The latter was indicative of drawbacks in the immunoprophylaxis, diagnostics and treatment of diphtheria in rural areas. In the total structure of diphtheria patients adults prevailed: 75%. The highest morbidity rates were registered among children aged 3-6 years, among adults in the age groups of 18-19 years and 50-59 years. The epidemic process developed mainly among the immunized population, which was indicated by a high proportion of vaccinated persons among those affected by this infection (62.8-66.6%) and a mild course of the disease in the majority of them. The present epidemiological situation in diphtheria was determined by patients not vaccinated against this infection. The proportion of severe cases among nonvaccinated children was 42.4-51.6% and lethal outcomes, 12.9-15.1%. Among nonimmunized adults these figures were equal to 43.1% and 9.3% respectively. The highest percentage of children, not vaccinated during the first years of their life, was registered among those in the asocial families, refugees and homeless persons. Among adults these were persons above 50 years old, as well as jobless persons of working age, pensioners and invalids, who had limited possibilities of undergoing vaccination due to their social position. It was these social and age groups that should be regarded as risk groups with respect to the severity of the course of diphtheria and lethality. To stabilize diphtheria morbidity, the full complex of prophylactic and antiepidemic measures, and primarily the immunization of the population, should be systematically carried out.

[A large-scale epidemic of diphtheria in Moscow in recent years: patterns of development]. / Krupnaia pidemiia difterii v Moskve v poslednie gody: zakonomernosti razvitiia.

Data on the dynamics of diphtheria morbidity in Moscow in 1958-1999 are presented. The last epidemic which started at the end of the 1980s and reached its peak in 1994, giving a 59-fold rise in morbidity in comparison with the pre-epidemic period, is characterized in detail. During the epidemic 12,267 persons fell ill, 454 of them died (mortality rate was 4%). Having started in Moscow, the epidemic gradually spread not only over the territory of Russia, but also over some other republics of the former Soviet Union (Ukraine, Belarus, etc.). Possible causes of this epidemic emergency are considered. The ever increasing share of adult population among persons affected by the epidemic (75%) is noted. The infection adults is characterized by severity of clinical manifestations and increased morbidity among adults, is shown. Under complicated social and economic conditions (crisis situation) the increase of groups of high risk which included unemployed adults of working age, retirees as well as socially non-adapted persons, was registered. Mainly these groups determined tense epidemiological situation in diphtheria in Moscow.

Diphtheria in the Russian Federation in the 1990s.

A resurgence of diphtheria spread throughout the Russian Federation in the early 1990s; diphtheria had been well controlled, but circulation of toxigenic strains of Corynebacterium diphtheriae had persisted since the implementation of universal childhood vaccination in the late 1950s. More than 115,000 cases and 3,000 deaths were reported from 1990 to 1997, and, in contrast to the situation in the prevaccine era, most of the cases and deaths occurred among adults. Contributing factors included the accumulation of susceptible individuals among both adults and children and probably the introduction of new strains of C. diphtheriae. Vaccine quality, vaccine supply, or access to vaccine providers did not significantly contribute to the epidemic. Mass vaccination of adults and improved childhood immunization controlled the epidemic. High levels of population immunity, especially among children, will be needed to prevent and control similar outbreaks in the future.

[A system for the mass combined vaccination of the adult population against influenza, viral hepatitis, typhoid, meningitis and diphtheria]. / Sistema massovoi kompleksnoi vaktsinatsii vzroslogo naselennia protiv grippa, virusnogo gepatita, briushnogo tifa, meningita i difterii.

A safe, moderately reactogenic and immunologically effective scheme of complex (combined) immunization against meningitis A, diphtheria, typhoid fever, viral hepatitis A and influenza has been developed as the result of experimental and clinico-immunological studies. Depending on the epidemiological situation, the newly developed scheme can be used in two variants. According to the first variant of this scheme, the following preparations are injected subcutaneously into three different sites: a mixture of group A meningococcal vaccine and diphtheria toxoid, typhoid vaccine and influenza vaccine. The second variant of the scheme differs from its first variant in using intramuscular injection of normal human immunoglobulin instead of injection of influenza vaccine. Moreover, in practical realization these variants may be altered by excluding vaccines, unnecessary under present conditions. The newly developed scheme of vaccinal prophylaxis is recommended for practical use.

[The vaccinal prevention of diphtheria and tetanus in children suffering from bronchial asthma and asthmatic bronchitis]. / Vaktsinoprofilaktika difterii i stolbniaka u detei, stradaiushchikh bronkhial'noi astmoi i astmaticheskim bronkhitom.

The course of the vaccinal process was studied in 69 children with bronchial asthma and asthmatic bronchitis after the injection of adsorbed diphtheria-tetanus (DT) toxoid with reduced antigen content. After immunization all these children were found to form protective levels of anti-diphtheritic and antitetanus antibodies irrespective of the severity and duration of the remission of the main disease prior to vaccination; at the same time no obstructive changes in bronchial ventilation were observed after immunization with adsorbed DT toxoid with reduced antigen content. The schemes of the preparatory medicinal treatment of patients at the period of vaccination are given with due regard for the duration of the remissions of bronchial asthma and asthmatic bronchitis.

[The vaccination of children with allergic diseases with reduced doses of adsorbed DT-m anatoxin]. / Vaktsinatsiia detei s allergicheskimi zabolevaniiami umen'shennymi dozami ADS-M-anatoksina.

During a remission and drug therapy, 71 children suffering from allergic diseases were vaccinated with DT-M toxoid containing different dose of diphtheria (1, 2.5, 5 LF) and tetanus (1, 2.5, 5 EC) antigens. It has been shown that all the children responded to tetanus antigen by adequate serological tests, whereas as regards diphtheria toxoid, the patients immunized with the least dose of DT-M preparation (1 LF + + 1 EC antigens) produced specific antibodies later and at a lower level. During the postvaccinal period, they also manifested an increase of the content of IgE and exacerbation of the underlying disease in 17.8% of cases. The use of DT-M toxoid with 2.5 LF + EC antigens was shown to hold promise in vaccination of children suffering from allergic diseases.

[Duration of immunity in children who received a primary complex of inoculations with ADT-M anatoxin and an assessment of postponed secondary revaccination against diphtheria and tetanus (the results of an epidemiologic trial)]. / Dlitel'nost' sokhraneniia immuniteta u detei, poluchivshikh pervichnyi kompleks privivok ADS-M-anatoksinom, i otsenka otsrochennoi vtoroi revaktsinatsii protiv difterii i stolbniaka (rezul'taty épidemiologicheskogo opyta).

The prolonged observations of the immunological effectiveness of adsorbed diphtheria-tetanus toxoid with reduced antigen content in children who had received the primary course of immunization with this preparation showed that the preparation induced the development of prolonged and intensive immunity to both infections. In 2-3 years after the first booster immunization the protective level of diphtheria antitoxin was registered in 89.9% and that of tetanus antitoxin, in 99% of children. 6 years later the level of immunity remained practically unchanged: the titers of diphtheria antitoxin above the protection level were determined in 92% and those of tetanus antitoxin, in 97% of children. These data made it possible to increase intervals between booster immunizations to 6-7 years in children of this category. The results of the epidemiological trial made to find out the possibility of a change in the timing of the second booster immunization confirmed the expediency of postponing booster immunization from 6 and 11 years to 9 and 16 years of age.

[The immunological effectiveness of small doses of diphtheria and tetanus anatoxins in the revaccination of children with allergy-altered reactivity and adults]. / Immunologicheskaia éffektivnost' malykh doz difteriinogo i stolbniachnogo anatoksinov pri revaktsinatsii detei s allergicheski-izmenennoi reaktivnost'iu i vzroslykh.

The possibility of decreasing the content of antigens in adsorbed diphtheria-tetanus toxoid, used for the booster immunization of children with allergically altered responsiveness and adults, is shown. Diphtheria toxoid in doses of 1-2.5 Lf and tetanus toxoid in doses of 1-2.5 binding units possessed sufficiently high immunological effectiveness in combination with low reactogenicity and good tolerance. In 6-12 months after booster immunization with decreased doses of toxoids 100% of children with allergy of different character and, respectively, 86-94% and 95% of adults have developed protective levels of antibodies to diphtheria and tetanus.

[The epidemic process of diphtheria infection in the RSFSR during the introduction of epidemiological surveillance]. / Epidemicheskii protsesse difteriinoi infektsii v RSFSR v usloviiakh vnedreniia épidemiologicheskogo nadzora.

In this work the characterization of the epidemic process of diphtheria infection on the territory of the RSFSR under the conditions of epidemiological surveillance (1983-1986) is presented. In comparison with the period of 1979-1982, an increase in morbidity rate occurred, which accounts for more complete detection of patients with mild forms of diphtheria, including persons found to be carriers of toxigenic Corynebacterium diphtheriae. Beginning from 1983, the leveling out of seasonal morbidity rises is observed. In the total number of persons affected by this infection the prevalence of adults is noted. Among them, a decrease in the morbidity rate was registered in 1986 (the maximum decrease was observed in age and professional groups of risk), which confirms the effectiveness of measures carried out for the protection of the adult population from diphtheria. Among children, a tendency towards a decrease in morbidity rate was noted in all age groups. The existing system of epidemiological surveillance on the territory of the RSFSR is capable of stabilizing diphtheria morbidity on a sporadic level and minimizing the number of fatal outcomes. The intensification of the epidemic process in some areas of the RSFSR is due to shortcomings in the realization of different measures of epidemiological surveillance.

[Specific prevention of diphtheria in adults in foci of this infection]. / Spetsificheskaia profilaktika difterii u vzroslykh v ochagakh étoi infektsii.

The studies demonstrated the immunological and epidemiological effectiveness of a single injection of adsorbed diphtheria-tetanus toxoid with reduced antigen content for adults: intense antidiphtheria immunity in 92.3% of the vaccinees 1-3 months and in 94.5% of the vaccinees 1 year after the injection. This immunity remained sufficiently intense for 3 years (the term of observation). The geometric mean of antitoxic titers was 0.84 I. U./ml. The highest intensity of immunity appearing after the injection was observed in persons aged 18-20 years who showed the highest antitoxic titers (exceeding 0.5 I. U./ml) in 100% of cases, the lowest intensity was registered in the age group of 30-39 years; in 14.2% of these vaccinees antitoxic titers were below the protective level. In other age groups (40-49 years, 50 years and over) the intensity of immunity was high. The geometric mean of the titers of diphtheria antitoxin were 1.2 I. U./ml and 2.1 I. U./ml respectively. In none of the foci under study the spread of the manifest forms of the disease was observed.

[Immunological effectiveness of secondary revaccination against tetanus performed at prolonged intervals]. / Immunologicheskaia éffektivnost' vtoroi revaktsinatsii protiv stolbniaka, provedennoi s udlinennymi intervalami.

After primary immunization with adsorbed DPT vaccine antitetanus immunity was retained for 9-10 years in 90.6-98.4% of children covered by this study. The second booster immunization of children against tetanus with adsorbed DT toxoid with reduced antigen content, made at an interval prolonged to 7-10 years under the conditions of lower antitoxic immunity, ensured a high level of intense antitetanus immunity. These data point to the possibility of prolonging the interval between booster immunizations to 9-10 years and reducing the number of injections and antigenic load.

[Immunological effectiveness of a 2d revaccination against diphtheria performed at intervals extended up to 7-10 years]. / Immunologicheskaia éffektivnost' vtoroi revaktsinatsii protiv difterii, provedennoi s intervalami, udlinennymi do 7--10 let.

The present article deals with the data on the duration of antidiphtheria immunity, induced by the primary cycle of immunization with adsorbed DPT vaccine, with the aim of considering the problems of optimizing the immunization schedule for children. The prolongation of the interval before the second booster immunization to 7-10 years produces no negative influence on the effectiveness of immunization. Besides, the study has shown that after the main complex of immunizations with adsorbed DPT vaccine protective immunity to diphtheria is retained in 90.3-96.8% of children covered by this study for 9-10 years. These data point to high immunological effectiveness of adsorbed DPT vaccine and to the possibility of prolonging the intervals between booster immunizations to 10 years, as well as decreasing the number of booster immunizations in the immunization schedule for children.