The thesis for the degree of Doctor of Medical Sciences in the specialty 14.02.02 "Epidemiology". State Institution "Institute of Epidemiology and Infectious Diseases named after L.V. Gromashevsky, NAMS of Ukraine", Kiev, 2020.
The thesis is devoted to solving an actual scientific and practical problem - the development of ways to optimize epidemiological surveillance of the group of infectious diseases with fecal-oral transmission mechanism based on the new scientific data on changes in the course of the epidemic process, the structure of the incidence of acute intestinal infections, the etiological spectrum of pathogens, including viral pathogen, the variety of their genetic variants.
On the example of three southern regions of Ukraine, where the prevalence of acute intestinal diseases is the highest in the country, fundamental changes in the course of the epidemic process was shown – the constant increase in the intensity of the epidemic process of acute intestinal diseases with another established pathogen, acute intestinal diseases with an unknown pathogen, rotavirus infection and, in at the same time, a decrease in the incidence of salmonellosis, the sharp decrease in the incidence of shigellosis, changes in the etiological structure of acute intestinal diseases ("displacement" of pathogenic pathogens by opportunistic pathogens and viruses), the identification of a wide range of viruses as causative agents of acute intestinal diseases (noroviruses GI and GII, rotaviruses, astroviruses, adenoviruses, enteroviruses, sapoviruses).
The discovered wide variety of circulating genovariants of noroviruses GII, rotaviruses, enteroviruses and adenoviruses is harbinger of further increase in the intensity of the epidemic process of acute intestinal diseases with an unknown pathogen. An increase in the incidence of rotavirus infection and hepatitis A was established with a decrease in the role of the water factor in the transmission of rotaviruses and hepatitis A virus, which indicates the activity of other pathways of transmission of pathogens and the need to introduce virological control of food products.
A strategy was developed to optimize the epidemiological surveillance of acute intestinal infections. The strategy will be carried out by introducing sentinel epidemiological surveillance, expanding the diagnostic search for etiological decoding, identifying and studying the genetic characteristics of the pathogens, conducting of monitoring studies to identify the intestinal viruses in water bodies, food products, standardizing the case and expanding the form of statistical accounting by introducing new nosological units. The strategy will improve the quality of epidemiological diagnostics and allow timely forecasting and prevention of exacerbation of the epidemic situation.
Key words: epidemiological surveillance, epidemic process, optimization, infectious diseases with fecal-oral transmission mechanism, monitoring, etiological structure, genetic variants of viruses.
