Analysis of the infectious morbidity in the children's population in the city of Krasnodar

Justina Oluwatoyin Aleksovna Oguntimehin, Aizanat M. Jalalova, Kristina M. Krasnikova, Olga V. Alekseenko, Ulyana Y. Senkov-ich, Sabina R. Zeynalova. Analysis of the infectious morbidity in the children's population in the city of Krasnodar. Cardiometry; Issue No. 27; May 2023; p. 96-100; DOI: 10.18137/cardiome-try.2023.27.96100; Available from: issues/no27-may-2023/analysis-infectious-morbidity-children's

Throughout the world, infectious diseases for many years continue to occupy a leading place in the structure of the total mortality, remaining second only to diseases of the circulatory system. The beginning of the epidemic of a new coronavirus infection in late 2019 and early 2020 has brought clear evidence that infectious agents are one of the main threats to human life and health [5].

Infectious diseases, especially those caused by highly pathogenic agents, pose a serious threat to the mankind, and an example of this is the new coronavirus infection caused by the SARS-CoV-2 virus, which has led to numerous death cases among the population in many countries of the world.

The results of thousands of scientific studies carried out indicate that infectious agents, which appeared long before the appearance of a human, have been evolving throughout the development of the mankind. The emergence of old forgotten infectious pathogens, the recording of new pathogens and/or new combinations of already known infections, the growth of the resistance of microorganisms, the transformation of the microbiota in the human body lead to the emergence of new problems associated with the diagnosis, treatment and prevention of infectious diseases [5, 8].

The health of the population reflects both the level of the economic and the cultural development of a society and the actual condition of medical care in a country. Children are the reproductive, recruitment-related and intellectual potential of the country, so their health is of particular importance for ensuring the life of any state [4]. Data on morbidity, physical development and certain groups of medical and demographic criteria are important indicators of the health status in the child population.

The share of infectious diseases in the structure of the overall childhood morbidity exceeds 90%. The infectious factor is important in 35% of the cases of death. Among the huge number of different infectious agents, a special place belongs to viruses. Thus, the share of viral infections accounts for more than 98% of all cases of the infectious diseases in childhood, while bacterial infections account for 2% only [4]. As a result, unreasonable prescription of antibacterial drugs causes alterations in the microbiome of a child that in its turn exacerbates the problem of increasing the resistance of pathogens responsible for a number of infectious diseases and, as a result, produces changes in the immunity of the population as a whole. According to the calculations of a group of independent experts-economists, if the existing rates of the spread of the microorganism resistance continue without relevant prevention and preventive measures, by 2050 up to 10 million people can die from infections caused by resistant bacteria every year [11]. Also of particular importance is the share of disable individuals due to the unfavorable outcomes of infectious and somatic diseases they suffered in childhood.

The combination of acute respiratory and acute intestinal infections in young children continues consistently to lead in the structure of infectious morbidity. The course of mixed infection against the background of an aggravated premorbid state increases the risk of developing severe forms and adverse outcomes of the disease [1, 2]

Within the territory of the Russian Federation (RF), an annual increase in cases of various infectious diseases is recorded in patients aged 0 to 17 years. The leading positions in terms of the incidence in childhood belong to acute respiratory viral infections (ARVI), which are represented by a group of numer- ous independent diseases characterized by damage to the upper and lower respiratory tract of a child by viruses belonging to various genera and families [9].

The most stressful epidemic situation, as a rule, is observed in megacities. So, for example, in 2020-2021, the share of ARVI in the Krasnodar Region Territory was more than 87% of all recorded infectious and parasitic diseases [6]. Thus, infectious diseases and, in particular, ARVI are one of the leading problems of the health care system in many regions of the Russian Federation, including the Krasnodar Region.

The aim hereof is to assess the actual state of the infectious morbidity of the pediatrics population on the territory of the Russian Federation and the city of Krasnodar for the period 2021-2022 by an example of the Pediatrics Polyclinic No. 2 at the City Health Department.

Materials and methods

A retrospective analysis was performed using data from the State Report “The state of sanitary and epidemiological well-being of the population in the Russian Federation in 2021”.

Our work has been completed with use of official statistical data of the Federal Service of the state statistics of the Russian Federation, the database of Rospotrebnadzor of the Krasnodar Region Territory, statistical data set collections of FGBI “The Central Research Institute of the Management and Information of Public Health Care” at the Ministry of Health Care of the Russian Federation. A retrospective analysis was performed using data from the State Report “The State of sanitary and epidemiological welfare of the population in the Russian Federation in 2021”.

Statistical processing was carried out using software GraphPad Prism 5.0 and Word Excel.

Results and discussion

According to the data on the sanitary and epidemiological well-being of the population in 2021, 50 million 716 thousand 531 cases of infectious and parasitic diseases were recorded in the Russian Federation that is 35.2% higher than the total number of diseases according to the 2020 data (see Figure 1 herein). The sharp rise in infectious diseases is directly related to the spread of the new COVID-19 infection [3].

The following diseases have the most significance among acute and newly diagnosed infectious diseases in 2021: acute infections of the upper respiratory tract,

Number of disease cases, abs.

Figure 2. Recorded diseases in children of the first year of life

Figure 1. Dynamics of the incidence of infectious diseases on the territory of the Russian Federation acute intestinal infections, varicella, rotavirus gastroenteritis, infectious mononucleosis, pediculosis and salmonellosis.

The increase in the incidence of the new coronavirus infection, which is of great epidemiological and socio-economic significance, was recorded to be 9,054,041 cases in 2021. Thus, in 85 regions of Russia in 2021, the incidence rate per 100 thousand people was 6181.93. The share of the child population among all cases was 10.1%. The incidence of children aged 0 to 17 years in 2021 is 2999.3 per 100 thousand population [3, 8, 12].

According to Rosstat, 38.44 million cases of acute infections of the upper respiratory tract of multiple and unspecified localization were reported in the Russian Federation that is 75.8% of all infectious and parasitic diseases that were detected in 2021 [10, 12]. The incidence of ARVI in children in 2021 was recorded to be 68,062.49 per 100,000 that is 15.4% higher than the incidence rate in 2020. The highest incidence of acute respiratory viral infections was reported in children aged 1–2 years (97,356.71 per 100,000 of the population of this age) and 3–6 years (95,071.80) [3].

According to the data on the incidence in the population by main classes of diseases in Krasnodar, in 2021, 236,332 patients were recorded with a diagnosis of infectious and parasitic diseases that is 1.4% more than the number of patients with a newly diagnosed infectious disease in 2020 (219,462 people) [ 6].

According to the data of the 2nd Branch of the Pediatrics Polyclinic No. 2 at the Department of Health of the city of Krasnodar (further referred to as DGP No. 2), the overall incidence of children in the first year of life decreased in 2022 (see Figure 2 herein). This clinic institution renders services for children and adolescents aged up to 18 years.

According to monitoring of potential foci of infections, which is carried out by the above medical institution DGP No. 2 in the framework of compliance with the rules and norms of Russian National SanPiN 3.3686-21 “Sanitary and epidemiological requirements for the prevention of infectious diseases” (as amended on May 25, 2022), there were no cases of diphtheria, pertussis, poliomyelitis, measles, and viral hepatitis B registered. Cases of scarlet fever in the reporting period were limited to some isolated cases (see Table 1 given herein).

Table 1

Infectious morbidity in children observed by medical institution DGP No. 2 for period 2021-2022

Disease	Recorded case(s)
	2021	2022
Dysentery	-	-
Viral hepatitis	-	-
Measles
Rubella	-	-
Meningitis	-	-
Acute bowel intestinal infections	38	11
Epidemic parotitis	-	-
Varicella	19	15
Pertussis	1	-
Diphtheria	-	-
Pediculosis	3	1
Scabies	-	-
Salmonellosis
Infectious mononucleosis	-	-
Poliomyelitis	-	-

Preventive immunization of children is the main measure that can significantly reduce infectious morbidity in childhood and build up immunity. Vaccination of children is carried out as a part of the implementation of the Federal Law U157-FZ “Immunoprophylaxis of Infectious Diseases” dd. September 17, 1998 (as amended on July 2, 2021), in accordance with Order No. 1122 “Approval of the national calendar of preventive vaccinations, the calendar of preventive vaccinations according to epidemic indications and the procedure for conducting preventive vaccinations” dd. December 6, 2021, issued by the Ministry of Health of the Russian Federation.

Great attention is paid to the issues of children’s immunoprophylaxis by DGP No. 2 (see Table 2 herein). For children at risk, the polyclinic institution prepares their own individual vaccination schedules.

Table 2

Coverage by preventive vaccinations of the pediatric population during the reporting period

Infection to be prevented by vaccination	2021	2022
Diphtheria	96,3	95,2
Pertussis	95,3	96,2
Poliomyelitis	92,3	97,5
Measles	97,6	96,2
Epidemic parotitis	92,6	96,2
Rubella	97,2	95,7
Viral hepatitis В	94,6	97,4
Tuberculosis	96,5	97,6

During 2022, within Area No. 7 of the 2nd Branch of the Pediatrics Policlinic DGP No. 2, 98.3% of the children from risk groups completed their recovery and rehabilitation and were allowed to be vaccinated. There are no permanent exempts for medical reasons reported for the period under consideration within the area of the responsibility of the above medical institution. As to the provisional exempts for medical reasons, their structure included diseases of the central nervous system – 78.2%; allergic diseases – 11.8%; blood diseases – 10%.

The refusal of parents from preventive vaccinations for 2022 was recorded in 2% of the cases. Thus, the formation of immune layers during the reporting period was slightly reduced due to the fact that the coverage with preventive vaccinations was less than 98% (see Table 3 herein).

Table 3

Preventive vaccinations in percentage for 2021-2022

Age	Infection to be prevented by vaccination and vaccination in progress	2021	2022
	Diphtheria
12 moths.	Vaccination completed	97,9	96,7
24 months	Ist revaccination	98,5	98,3
	Pertussis
12 months	Vaccination completed	98,9	98,7
24 months	Ist revaccination	98,6	98,5
	Poliomyelitis
12 months	Vaccination completed	97,9	97,3
24 months	Ist revaccination	96,2	97,1
36 months	IInd revaccination	97,2	97,1
	Measles
12 months	Vaccination	97,8	96,3
	Parotitis
12 months	Vaccination	97,8	96,3
	Rubella
	Vaccination	97	96,2

Conclusions

Over the past two years, there has been a decrease in the incidence rate of the infection diseases in children in the first year of life. At the same time, the level of spread of acute infections of the upper respiratory tract of multiple and unspecified localization remains high that can be explained by the complexity of their diagnostics at the early stages of infection, and as a result, the effectiveness of treatment of which remains at a low level that is accompanied by high mortality.

Thus, the observed dynamics of an increase in the share of the pediatric patients diagnosed with infectious and parasitic diseases requires closer attention to the problem of infectious and especially associated infections in the pediatric patients, optimization of the follow-up of such patients at the early stages of infections of the upper and lower respiratory tract, and timely diagnosis of new combinations of associated infectious diseases.

As a part of the prevention of infectious diseases in children in 2021, Resolution “Additional measures to prevent the formation of foci of acute intestinal infections, including viral etiology, in children’s educational organizations of the Krasnodar Region Territory in 2021” was adopted. In order to ensure the sanitary and epidemiological well-being of the population of the Krasnodar Region Territory and prevent spreading of infectious diseases, Resolution “Organization of serological monitoring of the state of herd immunity of the population of the Krasnodar Region Territory in 2021” was adopted, too.