In the Middle Ages, such terrible diseases as the plague or black, smallpox devastated entire cities in a short time - even wars did not take so many lives. Typhoid and cholera were the same terrible diseases, epidemics of which claimed millions of human lives. Only at the end of the 19th century the first vaccine appeared, created by Vladimir Khavkin, a student of Mechnikov.
Dangerous infections
There are diseases characterized by exceptional infectiousness and a high probability of death - especially dangerous quarantine infections. The general characteristic of quarantine infections defines them as a process of interaction of pathogenic microorganisms with the human body that can lead to the emergence of an infectious pathology. The presence of an infectious agent in the body does not have to lead to the development of an infectious process. He can be there for a long time without any signs of presence, until some factor provokes the onset of the infectious process.
At the beginning of the 19th century, the most dangerous quarantine infections were first identified. Their list at that time included four diseases.
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 areas of Bengal, where its occurrence was determined by such factors as a hot climate, high population density, and low living standards. However, with the expansion of economic ties with the countries of Southeast Asia, the spread of the disease around the world has become possible. Since the beginning of the 19th century, over the course of a hundred years, six cholera epidemics have occurred, and all of them arose 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, a noticeable decrease in the incidence rate was observed, but in the 60s a new type of cholera vibrio appeared - El Tor. Until now, outbreaks of cholera periodically occur in different regions, 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 the wars, since there were still no developed trade relations. In the 14th century, the epidemic of "black death", as the plague was then called, claimed one third of the population of Europe. Having penetrated from Asia, it quickly spread along already established trade routes. These years were scary for Europe. Another epidemic, nicknamed the Great Plague, erupted in Europe in the mid-17th century. No wonder people were so afraid of the plague, considering it the lord's anger. And now the plague remains a dangerous infection. Of those affected, half of the people die each year, often due to a misdiagnosis and inept treatment.
3. Smallpox is a dangerous disease that relates to quarantine infections, known to mankind since ancient times. In Europe, it first appeared in the sixth century, and since then the epidemic of this disease has not stopped. At the beginning of the 16th century, the disease was brought to America by the Spanish colonialists. Of those who died, up to forty percent died. Only at the end of the 18th century a vaccine against smallpox appeared, however, foci of smallpox remained in some regions and posed a threat of epidemics. Therefore, it was decided by the combined efforts of international organizations to eradicate smallpox as a disease. In 1980, victory was won thanks to mass vaccination of several human generations.
4. Yellow fever. Yellow fever is thought to have originated in Africa and then spread to Asia and America. In Europe, yellow fever epidemics have been associated with high mortality. A study of the disease revealed that the mosquito is the carrier of the infection. Subsequently, the role of monkeys in the spread of the disease was revealed. The natural foci of yellow fever, as a rule, are tropical forests with a hot climate and too high humidity - the equatorial regions of Africa and South America.
In Russia, anthrax and tularemia are also considered especially dangerous. The first of them was already known in ancient times - it was called the “sacred fire”, but in Russia it received a different name because of its greater distribution in this region. Tularemia was first registered in the 20s of the last century, although it is possible that it was before.
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 clears up. For the first time, quarantine infections began to be fought back in the 14th century, when ships were detained in Italy on a raid until it became clear that there were any dangerous diseases in the team. Later, in the 15th century, treatment rooms — hospitals — were placed on trade routes, in which patients who arrived from foci of plague were placed, and their clothes were burned. However, an effective fight against infections began only after the efforts of many countries were combined. For the first time a joint document - the International Convention for the Suppression of 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 were developed during the outbreak of epidemics, which periodically changed in accordance with new realities.
After defeating smallpox, it was excluded from the list of dangerous infections, however, at the beginning of the 21st century it was again included in the well-known list due to the assumption of the presence of smallpox virus as a biological weapon in the laboratories of any countries. The list of quarantine infections has also been expanded; some guidelines have been amended. The pace of development of modern civilization, the expansion of international contacts, the increase in the speed of communication facilities - all that contributes to its rapid spread throughout the world, were taken into account.
Current definition of quarantine infections
Today, the World Health Organization defines quarantine infections as diseases that can create a global public health emergency. Their list is expanded and represents two groups of diseases:
- diseases that pose a danger to human health, which include poliomyelitis, smallpox, new forms of influenza and others;
- diseases that can not only dangerously affect human health, but also spread rapidly over large spaces - 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 the carrier or the climatic conditions of the area. These include various types of fever, in particular, Dengue fever, characteristic of areas with a tropical climate. In Russia, anthrax and tularemia are quarantine infections. Their list contains precisely the pulmonary form of the plague, this is due to the high speed of its spread.
After defeating smallpox, the world was confident that it would be possible to eliminate all dangerous infections in the world over time. However, time has shown that, unfortunately, their number is only increasing. Microorganisms - pathogens 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 certain diseases, allowing the possibility of the appearance of new, still unknown.
Preventive Quarantine Activities
If a source 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 the period during which the disease does not manifest its symptoms, this time can be several days or several weeks, then the disease can be detected only through laboratory tests. Actions taken to eliminate the infection include both medical and sanitary measures to get rid of the infection, and administrative measures to prevent its further spread. The complex of such events is called quarantine. Quarantine events can be divided into two large groups.
1. The first group includes quarantine measures carried out to prevent the occurrence of foci of infection.
2. The second group includes radical measures to destroy the existing focus of infection.
All measures of a quarantine nature are regulated by the Rules for the sanitary protection of the country's territory, drawn up taking into account the requirements of the World Health Organization. This international organization includes 194 countries that weekly report on the state of the epidemiological situation in their countries and ongoing sanitary measures. WHO monitors compliance with the rules by member countries, summarizing the reports received. However, in 2005, she introduced amendments to the IHR, according to which she can draw conclusions about the sanitary-epidemiological situation in the country not only from reports, but also from press reports, which are sometimes much more objective.
Quarantine events are held at stations, at airports, at border checkpoints. They consist in the inspection of transport, cargo, passengers, international sanitary documents, the identification of persons who arrived from unsafe sanitary and epidemiological areas. They are subject to incubation, that is, to be in hospitals during the incubation period of the disease for which there is a suspicion.
Quarantine measures at the source of infection
If especially dangerous and quarantine infections have arisen, emergency antiepidemic commissions - NPKs are organizing and conducting quarantine measures in the epidemic outbreak, their decisions are binding on the entire population and institutions located in this territory. Quarantine measures at the source of infection include the following:
- a ban on the movement of people and the transport of goods through the focus of infection, as well as beyond;
- 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 examination of the source of infection;
- public health education ;
- ban on mass events ;
- Establishment of a system of entry and exit passes.
A cordon is set up around 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 representatives of internal affairs bodies carry internal security. The decision to terminate quarantine is made only after the end of the incubation period of the last identified patient. Quarantine measures at the site 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 vary.
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.
Infectious diseases for children
There are childhood infectious diseases that occur mainly in childhood and have a high degree of infectivity. As a result, in institutions they cause epidemics. Such diseases include diphtheria, whooping cough, measles, scarlet fever, chickenpox and others. They are called children's, because ill children get immunity and do not get these diseases in the future. Quarantine isolation measures for childhood infections include the following:
- isolation of the patient to prevent the spread of the disease;
- prohibition of admission of children to quarantined institution;
- disconnection - a ban on transferring children from one group to another until the end of quarantine;
- immunization of children.
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 infection, which should accelerate the end of the epidemic.
Airborne infections
Most infections caused by viruses or bacteria have an airborne spread. 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, flu, salmonella and others. In these cases, the isolation of patients and the cessation 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, airing, disinfection of the room with a solution of a half-percent solution of chloramine, it is possible with bleach;
- disinfection of dishes, linen and household items;
- strict restriction of contacts;
- in a children's institution, careful medical supervision of the group in which the patient was identified.
Intestinal infections
Among many infectious diseases, intestinal quarantine infections, which still represent a serious problem, occupy a significant place. Quarantine intestinal infections include diseases that combine the mechanism of localization of the pathogen in the intestine. Pathogens can also persist for a long time in the external environment, again entering the body with food or water. Diarrhea is an important symptom of such infections, which is why they are sometimes called diarrhea infections. They can occur in any age groups, but more often they are affected by small children, whose metabolic processes are still unstable. By origin, intestinal infections are divided into four types.
1. Viral, which include polio, 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 old get sick. But there are viruses that cause gastroenteritis with less severe diarrhea. An example is rotavirus infection, this is the most common of them, and often happens in young children.
2. Bacterial intestinal infections include diseases such as cholera, dysentery, typhoid fever and many others. When bacteria enter the body, their reproduction immediately begins with the release of toxins, on which the mechanism of intestinal infection development depends:
- Typhoid fever is an acute infectious disease caused by bacteria from the Salmonella genus, 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 infectiousness, the causative agent of which can for a long time maintain its viability in the external environment, transmitted by food or water. Vibrio cholerae also persists for a long time in marine and fresh water bodies. Infection can occur even with unprocessed seafood.
- Dysentery belongs to the group of quarantine infections - its causative agent is dysentery bacilli, which survive for a long time in dairy products. With self-medication, dysentery can turn into a chronic form.
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 in the body do not multiply, 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:
- neutralization of the source of infection, that is, isolation of the patient in a separate room or hospital;
- measures for disinfection of the focus of infection;
- immunization of persons in the focus of infection.
Nursing staff work order
The complex of quarantine measures necessary for carrying out in the epidemic outbreak regulates not only the list of measures applied, but the scope and timing of their implementation, responsibilities of various services - medical, veterinary and others. The organizer and coordinator of all the work is an epidemiologist. Other doctors, laboratory assistants, paramedics are subordinate to him. The action of the nursing staff in quarantine infections is determined by the plan of anti-epidemic measures and are as follows:
- ongoing disinfection of discharge of patients;
- disinfection of all rooms in which the patient was kept;
- disinfection of medical rooms;
- disinfection 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 a senior nurse and always in protective workwear, consisting of:
- special replaceable shoes on which rubber boots are put on;
- anti-plague bathrobe complemented by oilcloth apron;
- medical respirator;
- rubber gloves;
- towels that changes daily.
All protective clothing must be decontaminated after work. Hands are disinfected with a half-percent solution of chlorhexidine or chloramine.
Doctor's actions when a quarantine infection is detected
If quarantine infections are detected, the doctor’s tactics is determined by the plan of anti-epidemic measures:
- immediate notification of the epidemiological station about the likely occurrence of a dangerous infection;
- isolation of the patient with a quarantine infection and the provision of emergency care;
- material sampling and referral to the baclaboratory to clarify the diagnosis;
- disinfection of the room where the patient was;
- compilation of lists of persons in contact with the patient;
- isolation of contact persons before the end of the incubation period and the establishment of medical supervision for them;
- restrictive measures, establishment of observation posts, cessation of admission and discharge of patients;
- conducting explanatory work with contact persons;
- providing the quarantine team with the necessary materials and medicines.
Diseases of quarantine infections require the most urgent control measures because of 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. Currently, thanks to the joint efforts of many countries, such diseases are quickly localized and eliminated, and preventive measures can protect the population from the appearance of foci of epidemics.