In the Middle Ages, such terrible diseases as plague or smallpox devastated entire cities in a short time - even wars did not take so many lives. Typhoid and cholera were equally terrible diseases, the epidemics of which claimed millions of human lives. Only at the end of the 19th century did the first vaccine appear, created by Vladimir Khavkin, a student of Mechnikov.
Dangerous infections
There are diseases that are extremely contagious and have a high probability of death - especially dangerous quarantine infections. The general characteristics of quarantine infections define them as a process of interaction with the human body of pathogens that can lead to the occurrence of an infectious pathology. The presence of an infectious agent in the body does not necessarily lead to the development of an infectious process. It can stay there for a long time without any signs of presence, until some factor provokes the start of an infectious process.
In the early 19th century, the most dangerous quarantine infections were identified for the first time. The list included four diseases at the time.
1. Cholera is an infectious disease, one of the most ancient, the situation with which is still tense. Until the beginning of the 19th century, cholera was considered characteristic of the regions of Bengal, where its occurrence was determined by factors such as hot climate, high population density, and low living standards. However, with the expansion of economic ties with the countries of Southeast Asia, it became possible for the disease to spread around the world. Since the beginning of the 19th century, there have been six epidemics of cholera within a hundred years, and all of them originated mainly in India, spreading from there to Southeast Asia, the Middle East and further Europe and Russia. These epidemics have claimed millions of lives. In the middle of the 20th century, there was a noticeable decrease in the incidence, but in the 60s a new type of cholera vibrio appeared - El Tor. Until now, periodically in different regions there are outbreaks of cholera, which are marked by an increase in the duration of the period of incidence.
2. Plague - a description of the epidemics of this terrible disease can be found in historical chronicles and even in the Bible. It should be noted that the rapid spread of the epidemic in the first millennium was possible only during wars, since there were no developed trade relations yet. In the 14th century, the Black Death, as the plague was then called, claimed a third of Europe's population. Having penetrated from Asia, it quickly spread along the already established trade routes. These years were terrible for Europe. Another epidemic, nicknamed the Great Plague, broke out in Europe in the mid-17th century. No wonder people were so afraid of the plague, considering it the wrath of God. And now the plague remains dangerousinfection. Of those who become ill, half die each year, often due to misdiagnosis and poor treatment.
3. Smallpox is a dangerous disease that belongs to quarantine infections, known to mankind since ancient times. In Europe, it first appeared in the sixth century, and since then the epidemics of this disease have not stopped. In the early 16th century, the disease was brought to America by Spanish colonizers. Of the sick, up to forty percent died. Only at the end of the 18th century did a smallpox vaccine appear, however, smallpox foci remained in some regions and posed a threat to the development of epidemics. Therefore, it was decided by the combined efforts of international organizations to eliminate smallpox as a disease. In 1980, the victory was won, thanks to the mass vaccination of several human generations.
4. Yellow fever. It is assumed that yellow fever originated in Africa and then spread to Asia and America. In European countries, yellow fever epidemics were accompanied by high mortality. The study of the disease made it possible to find out that the mosquito is the carrier of the infection. Later, the role of monkeys in the spread of the disease was also revealed. Natural foci of yellow fever, as a rule, are tropical forests with a hot climate and too high humidity - the equatorial regions of Africa, South America.
In Russia, anthrax and tularemia are also considered especially dangerous. The first of them was already known in ancient times - itscalled "sacred fire", but in Russia it received a different name due to its greater distribution in this region. Tularemia was first reported in the 20s of the last century, although it is possible that it was earlier.
Convention diseases
All of these diseases are called "quarantine infections" because when they occur, all infected people, as well as those who have been in contact with them, are isolated and monitored until the situation is cleared up. For the first time, quarantine infections began to be fought back in the 14th century, when ships in Italy were detained in the raid until it was found out that there were any dangerous diseases in the crew. Later, in the 15th century, medical facilities were placed on trade routes - infirmaries, in which patients who arrived from the centers of the plague were placed, and their clothes were also burned. However, effective infection control began only after the combined efforts of many countries. For the first time, a joint document - the International Convention on the Fight against Dangerous Infections, was adopted only at the beginning of the 20th century. Infectious diseases began to be called conventional. Measures and rules of conduct for medical staff during the outbreak of epidemics were developed, which periodically changed according to new realities.
After the victory over smallpox, it was excluded from the list of dangerous infections, but at the beginning of the 21st century it was again included in the well-known list due to the assumption of the presence of the smallpox virus as a biological weapon in the laboratories of any countries. The list of quarantine infections was also expanded, receivedamendments to some guidelines. The pace of development of modern civilization, the expansion of international contacts, the increase in the speed of means of communication were taken into account - everything that contributes to its rapid spread throughout the world.
Modern definition of quarantine infections
Today, the World He alth Organization defines quarantine infections as diseases capable of creating a global he alth emergency. The list of them has been expanded and represents two groups of diseases:
- diseases that pose a threat to human he alth, which include polio, smallpox, new forms of influenza and others;
- diseases that can not only dangerously affect human he alth, but also quickly spread over large areas - these include dangerous infections, as well as new forms of fever that have appeared in recent years.
Some diseases pose a local, regional threat, as they have certain foci of occurrence associated with the presence of a carrier or the climatic conditions of the area. These include different types of fever, in particular, Dengue fever, which is characteristic of areas with a tropical climate. In Russia, anthrax and tularemia are quarantine infections. The list of them contains exactly the pneumonic form of the plague, this is due to the high speed of its spread.
After the victory over smallpox, the world was confident that it would eventually be possible to eradicateall dangerous infections in the world. However, time has shown that, unfortunately, their number is only increasing. Microorganisms - causative agents of infections mutate, adapting to new drugs and new environmental conditions, which are gradually deteriorating and becoming an additional risk factor for the human immune system. Therefore, the new international rules do not limit the list to a set of specific diseases, allowing for the possibility of the emergence of new, as yet unknown.
Preventive quarantine measures
When a focus of infection occurs, immediate action must be taken to eliminate it. A feature of infections is not only their rapid spread, but also the presence of an incubation period that complicates the fight against them. The incubation period is called the period during which the disease does not show its symptoms, this time can be several days or several weeks, then the disease can be detected only with the help of laboratory tests. Actions taken to eliminate the infection include both medical and sanitary measures to get rid of the infection, as well as administrative measures to prevent its further spread. The complex of such measures is called quarantine. Quarantine measures can be divided into two large groups.
1. The first group includes quarantine measures taken to prevent the occurrence of foci of infection.
2. The second group includes radical measures to destroy the existing source of infection.
All quarantine activitiesare regulated by the Rules for the sanitary protection of the country's territory, drawn up taking into account the requirements of the World He alth Organization. This international organization includes 194 countries that report weekly on the state of the epidemiological situation in their countries and ongoing sanitary measures. WHO monitors compliance by participating countries by summarizing the reports it receives. However, in 2005, she made changes to the IHR, according to which she can draw conclusions about the sanitary and epidemiological situation in the country not only from reports, but also from press reports, which are sometimes much more objective.
Quarantine measures are being taken at railway stations, airports, and at border checkpoints. They consist in the inspection of transport, cargo, passengers, international sanitary documents, identification of persons who arrived from territories that are unfavorable in sanitary and epidemiological terms. They are subject to incubation, that is, stay in hospitals during the incubation period of the disease that is suspected.
Quarantine measures in the focus of infection
If especially dangerous and quarantine infections have arisen, emergency anti-epidemic commissions (EPCs) organize and carry out quarantine measures in an epidemic focus, their decisions are binding on the entire population and institutions located in the given territory. Quarantine measures at the source of infection include the following actions:
- ban on the movement of people and the transportation of goods through the focus of infection, as well as for itslimits;
- urgent hospitalization of identified patients, as well as persons in contact with him;
- research and burial of corpses;
- mass vaccination of the population;
- disinfection of the territory;
- epidemiological survey of the focus of infection;
- he alth education of the population;
- ban on mass events;
- establishing a system of entry and exit passes.
A cordon is set up along the perimeter of the focus of infection, which is provided by the troops of the Ministry of Internal Affairs or the Ministry of Defense. They are located outside the contaminated territory, and internal protection is provided by representatives of the internal affairs bodies. The decision to end the quarantine is made only after the end of the incubation period of the last identified patient. Quarantine measures in the focus of infection may vary slightly depending on the type of disease. For example, the timing of isolation or the form of exposure to sources of infection may differ.
In order for quarantine measures to be carried out efficiently and effectively, sufficient availability of material resources and high professionalism of medical personnel are necessary.
Childhood Infectious Diseases
There are childhood infectious diseases that occur mainly in childhood and have a high degree of contagiousness. As a result, they cause epidemics in children's institutions. These diseases include diphtheria, whooping cough, measles, scarlet fever, chickenpox and others. ThemThey are called children's, because children who have been ill receive immunity and do not get sick with these diseases in the future. Quarantine-isolation measures for childhood infections include the following actions:
- isolation of the patient to prevent the spread of the disease;
- Prohibiting the admission of children to a quarantine facility;
- dissociation - a ban on transferring children from one group to another until the end of quarantine;
- child immunization.
Preventive measures for childhood infections are timely vaccination, as well as measures to strengthen the child's body. Quarantine-isolation measures for childhood infections are aimed at breaking the continuity of the chain of the infectious process, which should accelerate the end of the epidemic.
Airborne infections
Most infections caused by viruses or bacteria are airborne. When sneezing or coughing, the patient releases particles of infected mucus into the air, which become a source of mass infection. These include almost all childhood infections, as well as tuberculosis, influenza, salmonellosis and others. In these cases, the isolation of patients and the termination of all contacts between people play a decisive role. Quarantine measures for airborne infections include the following measures:
- Identification and hospitalization of patients;
- wet cleaning, ventilation, disinfection of the room with a solution of a half-percent solution of chloramine, you can use chlorinelime;
- disinfection of dishes, linen and household items;
- hard contact restriction;
- in a children's institution, careful medical supervision of the group in which the patient was identified.
Intestinal infections
Among the many infectious diseases, intestinal quarantine infections still pose a serious problem. Quarantine intestinal infections include diseases that are united by the mechanism of localization of the pathogen in the intestine. Pathogenic microorganisms can also persist in the external environment for a long time, re-entering the body with food or water. An important symptom of these infections is diarrhea, which is why they are sometimes called diarrheal infections. They can occur in any age group, but they are more common in young children who still have unstable metabolic processes. By origin, intestinal infections are divided into four types.
1. Viral, which include poliomyelitis, rotavirus infection, some types of hepatitis. After infection of the intestine, viruses with feces enter the external environment. In most cases, children under nine years of age get sick. But there are viruses that cause gastroenderitis with less severe diarrhea. An example is rotavirus infection, which is the most common and occurs frequently in young children.
2. Bacterial intestinal infections include diseases such as cholera, dysentery, typhoid fever and many others. Atbacteria enter the body, they immediately begin to multiply with the release of toxins, on which the mechanism of development of intestinal infection depends:
- Typhoid fever is an acute infectious disease caused by bacteria from the genus Salmonella, and the source is a sick person. Recently, the incidence rate has been decreasing, the disease is well treated with antibiotics.
- Cholera is a dangerous disease with a very high degree of contagiousness, the causative agent of which can remain viable in the external environment for a long time, being transmitted with food or water. Vibrio cholerae also persists for a long time in marine and fresh water bodies. Infection can occur even when eating unprocessed seafood.
- Dysentery belongs to the group of quarantine infections - its causative agent is dysentery bacillus, which survive for a long time in dairy products. With self-treatment, dysentery can become chronic.
3. Fungal intestinal infections are represented by candidiasis, its causative agent is yeast-like fungi, which live in large numbers in the human body. With high immunity, fungi do not multiply in the body, so the development of the disease, first of all, indicates its weakening or violation in the immune system.
4. Protozoal infections - they differ in that they affect not only the intestines, but also other internal organs.
Quarantine measures for intestinal infections include:
- neutralizing the source of infection, that is, isolating the patient in a separate room orhospital;
- measures to decontaminate the source of infection;
- immunization of persons in the focus of infection.
Working order of junior medical staff
The complex of quarantine measures required to be carried out in an epidemic focus regulates not only the list of measures applied, but the scope and timing of their implementation, the duties of various services - medical, veterinary and others. The epidemiologist is the organizer and coordinator of all work. Other doctors, laboratory assistants, paramedics are subordinate to him. The action of junior medical staff in case of quarantine infections is determined by the plan of anti-epidemic measures and is as follows:
- current disinfection of excretions of patients;
- disinfection of all rooms in which the patient was kept;
- disinfection of medical offices;
- decontamination of overalls and tools that were used during the reception and examination of patients;
- disinfection of common areas.
These activities are carried out under the guidance and under the strict supervision of the head nurse and always in protective clothing, consisting of:
- special interchangeable footwear worn with rubber boots;
- Anti-plague robe, complete with oilcloth apron;
- medical respirator;
- rubber gloves;
- towels that are changed daily.
All protective suits must be decontaminated after work. Hands are disinfected with a half-percent solution of chlorhexidine or chloramine.
Doctor's actions whendetection of quarantine infection
If quarantine infections are detected, the doctor's tactics are determined by the plan of anti-epidemic measures:
- immediate notification of the sanitary and epidemiological station about the likely appearance of a dangerous infection;
- isolation of the patient during quarantine infection and provision of emergency care to him;
- collection of material and referral to a bacteriological laboratory to clarify the diagnosis;
- disinfection of the room where the patient was;
- compilation of lists of persons who were in contact with the patient;
- isolation of contact persons until the expiration of the incubation period and the establishment of medical supervision over them;
- carrying out restrictive measures, establishing observation posts, stopping the admission and discharge of patients;
- carrying out explanatory work with contact persons;
- providing the quarantine team with the necessary materials and medicines.
Diseases with quarantine infections require the most urgent control measures due to their danger to life and the high rate of development of the disease, as well as the speed of spread over a large area, which is fraught with environmental disaster. At present, thanks to the joint efforts of many countries, such diseases are quickly localized and eliminated, and preventive measures make it possible to protect the population from the appearance of outbreaks of epidemics.
