Системный подход к анализу эпидемического процесса вакциноуправляемых инфекций (стр. 11 )

?ызылша ж?не ?ызамы?ты интегрирленген эпидемиологиялы? ?ада?алау, ?Р егу к?нтізбесі бойынша 1 жас,  6 жас ж?не 15 жаста ?ызамы??а ?арсы балаларды егу, 2005 жылы 2,7 миллион 15-35 жаста?ы  адамдар?а ?ызылша ж?не ?ызамы??а ?арсы ?лтты? Иммундау Кампаниясын ж?ргізу, 2009 жылы 8-14 жаста?ы 1,5 миллион балаларды ?ызамы??а ?арсы ?осымша егу кампаниясын ж?ргізу, республика хал?ыны? сыр?аттанушылы?ын,  100 мы??а ша??анда?ы  3,6 ?а дейін к?рт т?мендетуге м?мкіндік берді. 

Summary
"A systematic approach of analyzing the epidemic process of vaccine controlled infections"
Nazhmedenova Altyn Gabdreshovna
Speciality 14.00.30-epidemiology

Objective: To examine from the standpoint of socio-ecological concept of the epidemic manifestations of polio, measles and rubella and to justify the improvement of epidemiological surveillance of these infections and vaccination for their elimination in the Republic of Kazakhstan.
       Materials and methods. A retrospective epidemiological analysis (CEA) of the incidence of polio population for 1980-1999 among age groups 0-2, 3-6, 7-14 years of age and persons over 15 years, the incidence of children under 15 years of acute flaccid paralysis (AFP) for the period of 1997-2009 were conducted. Analyzed the following indices for epidemiological surveillance of poliomyelitis and AFP: the percentage of adequate stool samples taken from patients with poliomyelitis and AFP for the years 1980-2009; the percentage of coverage of the polio vaccination of children under 1 year of 1980-1994, percentage of coverage of second year children revaccination against polio for the years 1980-1994.; morbidity in children under 15 years of AFP with the most important indicator AFP surveillance in 16 regions of Kazakhstan and the country as a whole for 2005-2009.; virological studies of feces of patients with AFP for the detection of polioviruses (wild and vaccine) and non polio enteroviruses for 2005-2009.; virological studies of feces from the contact persons for the detection of poliovirus (wild or vaccine) and non polio enteroviruses for 2005-2009.; virological investigations of waste water samples for the detection of poliovirus (wild or vaccine) and non polio enteroviruses for 2005-2009.; serological studies of blood serum of healthy children up to 15 years from all regions of the country for the study of collective immunity against poliovirus of  1,2,3 type; maps of epidemiological survey of children under 15 years old with acute flaccid paralysis and vaccine associated poliomyelitis for 2005-2009.
       A CEA of children with measles under 2 years, 3-6 years, 7-14 years, 15-19 years and adults older than 20 years in the period vaccination against measles (1980-2009) was conducted, the percentage of children’s enrollment by vaccination and revaccination, simultaneous mass measles vaccination of the population of Kazakhstan (2005) were analyzed. The condition of the collective population immunity to measles (2005-2009) was studied. The results of national immunization campaign against measles and rubella in the population of 15-35 years and 45 years (2005) were analyzed. A CEA of population’s morbidity by rubella (1986-2009) was conducted. The efficiency of planed vaccination of children and adolescents against rubella (2008-2009) and the additional mass vaccination of children 8-14 years old against measles (2009) were analyzed.
       The structure of the epidemic process during the morbidity by poliomyelitis, measles and rubella in the socio-ecological concept from the molecular level to socioecosystematic was investigated.        On the base of long-term CEA of polio and acute flaccid paralysis of the population of the republic the regulatory influence of the state population immunity and vaccine quality on the manifestation of the epidemic process was established. The efficiency of preventive and anti-epidemical activities, which allowed to eliminate polio in the country in 2000 and to certify the territory of the republic by the WHO European Regional Office in 2002, as free from this infection, was estimated.        As a result of a systematic approach to the analysis of the epidemic process the surveillance of poliomyelitis and acute flaccid paralysis was improved, which revealed a few cases of vaccine-associated poliomyelitis among children and imported case of polio after the outbreak of this infection in Tajikistan. Enhanced surveillance enables to maintain the status of elimination of polio in the country. The strategy of vaccination by oral poliovirus vaccine, combined with inactivated polio vaccine for the prevention of post-vaccination complications, such as vaccine-associated poliomyelitis, was proposed. The epidemic process of measles over the 30-year period (1980-2009) appeared by epidemics for every 3-5 years, expressed by intensity, while the incidence rate per 100,000 people reached 280.9, and by interepidemic periods. During the last measles epidemic in 2004-2005, incidence rate per 100 thousand people stood at 106.4, and, in general, measles infected adult population above 35 with severe clinical course and complications. It was established that routine immunization of children against measles in 1968 with a high percentage of vaccination coverage in recent years (95%), the National Immunization Campaign of 2.7 million young people of 15-35 years old in 2005, improved epidemiological surveillance of measles allowed to stop the disease of population by measles since 2009. The termination of cases of measles since 2010 among the population within 3 years allows predicting the possibility of WHO European Regional Office certification status of measles elimination in the country.
       Rubella epidemic process for 1986-2009 years was characterized by a high incidence of rubella in the population rate per 100 thousand inhabitants 207.5 - 219.5, in some years due to the lack of routine vaccination against rubella before 2008.        Integrated epidemiological surveillance of measles and rubella, routine vaccination of children by vaccination schedule RK at 1 year, 6 years and 15 years against measles, National immunization campaign in 2005 to 2.7 million vaccination of young people of 15-35 years against measles and rubella, Additional immunization campaign of 1.5 million children 8-14 years of age against rubella in 2009 allowed dramatically reducing of the incidence of rubella among the republic's population to 3.6 per 100 thousand population. The epidemiological forecast of rubella’s elimination in recent years was compiled.