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The flu, a parainfluenza

Parainfluenza

Etiology. It is known 4 types of viruses of a parainfluenza (PI-1, PI -2, PI -3, PI -4). Parainfluenza viruses contain the RNA, are unstable in an environment, are completely inactivated at warming up to 50°C during 30-60 mines, under effect of disinfectants.

Epidemiology. A source of an infection - the person. Disease is passed by airborne way and weeps as epidemic cases or is sporadic. The greatest rise of a case rate is observed in autumn-winter and spring months.

Pathogenesis. Infection atriums - mucosal of the respiratory of a tract, especially larynxes, a nose where the virus is reproduced, causing inflammatory changes. As a result of an edema and an inflammation of a mucosa of a larynx children can have false croup.

Clinic. An incubation interval - 2-7 days. Disease starts by degrees, with a moderate intoxication, sub febrile temperature then the catarral syndrome being mastered at parainfluenza develops is more often. Typical it is necessary to count occurrence of a laryngitis that is accompanied by the dry "barking" tussis hoarse by a voice, quite often an aphonic. Tussis is saved long time, sometimes up to 12-21-th day of disease. Rather often the parainfluenza laryngitis weeps without a fever and starts a hoarse of a voice or an aphonia.

At visual inspection find out a hyperemia of a fauces, a soft palate, a rear wall of a pharynx. For children the parainfluenza is complicated a croup. In these cases disease starts is acute from a heat, rasping tussis, a hoarse of a voice. The stenosis of a larynx develops suddenly, is more often at night, and some hours proceed. Other complications of a parainfluenza are the virus-bacterialed pneumonia, and also an otitis and a lesion of additional sinuses of a nose.

Preliminary treatment. It is similar those at all acute respiratories virus infections During epidemic flashes preliminary treatment of a flu does not present difficulties. Sporadic cases of disease demand laboratory confirmation which is spent the same as at a flu, - a method of an immunofluorescence.

Treatment. On virus PI-3 the deityforin (see "Flu") operates. Pathogenetic and symptomatic agents are usually used. Apply an antiflu, the thermal procedures desensitizing agents. At a stenosis of a larynx it is necessary to render first aid - distracting agents (hot foot baths), to assign desensitizing and spasmolytic preparations. Hospitalization is shown. Prophylaxis specific is not developed.

FLU

FLU (influenza) - a highly infectious virus infectious disease of respiratory paths. Viruses are usually passed from the person to the person at tussis and a sneeze. The incubation interval(delitescence) of disease lasts usually 1-4 days then for the person the first signs of disease including start to appear: a headache, rise in temperature, loss of appetite, delicacy, and also a febricula. Disease lasts about a week. To the majority of patients keeping of a confinement to bed and trick of Aspirinum helps to recover, however sometimes there are complications as a pneumonia (it can be a primary postinfluenzal virus pneumonia or a secondary bacterial pneumonia). Any kind of a pneumonia can be completed by mors sick as a result of a having place hemorrhage in mild. The main bacteria being a reason of development of a secondary infection for the person, bacteria of sorts Streptococcus pneumoniae, Haemophilus influcnzae and Staphylococcus aureus to which suppression the appropriate antibioticotherapia is applied are. The transferred flu frames in an organism of the person immunity only to the defined strain or one type of a virus; the same concerns and to immunization.

Etiology.

Originators of a flu concern to ortomixoviruses set, including 3 sorts of viruses of a flu: A, B, C. The viruses of a flu contain the RNA, the external shell in which 2 antigens - a hemagglutinin and a neuraminidase are placed, capable to change the properties, especially for a virus such as A. Change of a hemagglutinin and neuraminidases causes appearance of new subtypes of a virus which cause usually more serious and more mass diseases.

According to the International nomenclature, the denotation of virus strains includes the following data: a sort, a place of isolation, number of an isolat, year of isolation, a variety of a hemagglutinin (H) and neuraminidases (N). For example, A/Singapore/l/57/H2N2 designates a virus of a sort And, selected in 1957 in Singapore, having a variety of antigens H2N2.

To viruses of a sort A bind pandemics of a flu. Viruses of a flu In do not cause pandemics, but local "waves" of rise of a case rate can capture one or several countries. Viruses of a flu With cause sporadic cases of disease. Viruses of a flu are steady against low temperatures and freezing, but fast perish at warming.

Viruses of a flu of a sort And are sectioned into many serotypes. Permanently there are new antigenic variants. The virus of a flu fast perishes at warming, drying and under the influence various disinfectant agents. The flu causes depression of an immunologic reactivity.

Antigenic variability of viruses of a flu.

Variability of a virus of a flu is well-known. This variability of antigenic and biological properties is fundamental feature of viruses of a flu of types A and B. Changes occur in surface antigens of a virus - a hemagglutinin and a neuraminidase. Most likely it is the evolutionary gear of an adaptability of a virus for support of survival rate. New strains of viruses, as against the precursors are not bound by specific antibodies which are stored in a population. There are two gears of antigenic variability: is relative little changes (antigenic drift) and strong changes (an antigenic shift).

Antigenic drift - occurs in period between pandemics for all types of viruses (A, B and C). These are minor alterations in structure of surface antigens (a hemagglutinin and a neuraminidase), called by dot mutations in genes which encode them. As a rule such changes occur every year. In result there are epidemics as protection against the previous contacts to a virus is saved though she and is insufficient. Antigenic shift - Through irregular time slices (10-40 years) there are viruses with strong differences from a main population. These changes seriously affect antigenic structure(frame) of a hemagglutinin, and less often and neuraminidases. Now the gear of education of new strains of viruses of a flu finally is not clear. One of existing theories is based on a recombination of genes of a virus of a flu animal (birds, pigs) and the person, not having to it(him) of ready factors of protection of cellular and humoral immunity. Many types of animals are birds, a pig, a horse, sea mammal, etc. (including the person), types of viruses of type can be infected with a virus of a flu of A. Some A can infect some types of animals. The virus of a flu contains 8 molecules of the RNA. In case in one organism (for example, pigs) meet two different viruses of a flu they can exchange fragments of a nucleic acid with each other. Other theory stands on positions of reciclycaled appearance of a virus in a human population.

As a result of an antigenic shift absolutely new strains of viruses against which the overwhelming majority of the population has no immunity will be derivated. Such unpredictable changes about one today were observed only for viruses of type A. In result pandemics in all age groups which the more hardly, than the virus has more strongly varied develop.

Pathogenesis.

The virus of a flu gets in upper respiratory paths, penetrates into a cylindrical vibrating epithelium where its active reproduction bringing in damage of cells starts. Infection atriums are upper departments of the respiratory of a tract. The virus of a flu electively amazes a cylindrical epithelium of respiratory paths, especially tracheas. Rising of permeability of a vascular wall leads to to disturbance of microcirculation and occurrence of a hemorrhagic syndrome (a pneumorrhagia, nasal bleedings, a hemorrhagic pneumonia, an encephalopathy). The most typical is the lesion of a mucosa of a trachea, but at serious forms of disease all departments of pneumatic paths are involved in process down to alveoluses. Cells of a vibrating epithelium are exposed to a destruction, are quite often exfoliated, filling in lumens of bronchuses.

Now it is known, that in a pathogenesis of a lesion of a trachaeobronchialed tree a doubtless role the immune answer of an organism, framing of interleikines, the factor of a necrosis of a tumour, immunoglobulins, and also a status of an adenoid tissue of bronchuses and plays tracheas. Special value(meaning,importance) add active forms of oxygen which is generated with neutrophils under effect of a virus of a flu. As a result of a series of chemical responses radicals of oxygen turn to highly toxic chemical compounds (a hypochloride, a sulfoxide, etc.), possessing potent cytotoxic effect. Under operation of oxidizers bellows of cells suffer, first of all. Loss of barrier functions by cellular bellows is the major condition of diffusion of viruses from a cell to a cell down to their damage and generalization of an infection.

The virusemia is a mandatory phase of pathological process. The virus renders injuring effect on an endothelium of bulbs (predominary zones of microcirculation) mild, hearts, nervous system and other organs.

There is a rising permeability of walls of bulbs, development of a perivascular edema, predilection to a thrombogenesis, disturbance of a hemostasis that carries on behind itself an edema and a plethora mild, a brain and other organs. Most often are amazed mild, thus suffers not only a trachaeobronchialed tree, but also alveoluses, first of all alveolocytes II of the order, the surfactant covering a surface of alveoluses is blasted and not giving to them to be fallen down. Alveoluses are deformed, fallen down, filled by a transudate that aggravates gravity of a lesion mild.

Thus, at a flu the specific virus lesion mild, stipulated by injuring operation on cells of free radicals of oxygen, disturbances of microcirculation, a hemostasis, surfactanted system therefore the local or wide-spread edema of a pulmonary tissue develops, sometimes a respiratory - toxic distress - syndrome takes place.

The lesion of nervous system at a flu also has a difficult genesis: injuring operation of a virus, its reproduction in an ependyma and a choroidal epithelium of cerebral ventricles, a hypoxia and so forth.

Consequence of a massive virusemia, toxynemia can become the infectious - toxic shock, appearing statuses menacing for a life - acute intimately vascular failure, a fluid lungs, a brain, the IDCS, a renal failure. Gravity of pathological process is connected to robustness of a virus, a status of immune system of the patient. The influenzal infection causes an immunity-scarced status that promotes connection of secondary bacterial infections, quite often staphylococcal etiology. It leads to to an exacerbation of various chronic diseases - rheumatic disease, a chronic pneumonia, a pyelitis, a cholecystitis, a dysentery, a toxoplasmosis and so forth, and also to occurrence of secondary bacterial complications. The virus is saved in an organism of the patient usually within 3-5 days from the beginning of disease, and at complication by a pneumonia - till 10-14 days.

Epidemiology.

A source of an infection - the sick person, including with atypical forms without the expressed fever and an intoxication. Infection occurs in the airborne way. The flu weeps as epidemics (from small flashes up to pandemics). The leading part in epidemic process is played with antigenic variability of a virus, especially a virus A. To a new antigenic variant of the originator the population does not have immunity that is a reason of fast diffusion of an infection. In interepidemic period the virus is saved in an organism of the person, defining a sporadic case rate, and also in an organism of animals and birds.

Signs, current.

Main signs for a flu the following:

The incubation interval proceeds from 12 up to 48 h. The typical flu starts is acute, is frequent from a cold fit or a chilling, the body temperature fast raises, and already in the first day the fever reaches a maximum level (38-40 degrees. C). Tags of a common intoxication (delicacy, an adynamia, a sweating, a pain in muscles, a strong headache, a pain in eyes) and signs of a lesion of respiratory paths (dry tussis, burns behind a breast bone, a hoarse of a voice) are marked. At inspection the hyperemia of the face and a neck, an injection of bulbs of the scleras, the raised diaphoresis, a bradycardia, a hypotension is marked. The lesion of upper respiratory paths (a rhinitis, a pharyngitis, a laryngitis, a tracheitis) is taped. Especially often the trachea whereas the rhinitis sometimes is absent (the so-called aqataraled form of a flu) is amazed. The hyperemia and original granularity of a mucosa of fauces are characteristic. Tongue is impose, there can be a short-term disorder of a chair. Complications on the part of CNS appear as a meningism and an encephalopathy. The leukopenia, a neutropenia are characteristic; an ESR in uncomplicated cases it is not raised. Mild forms of a flu can sometimes weep without a fever (the afebrialed form of a flu). Complications: pneumonias (up to 10 % of all patients and up to 65 % of hospitalized patients with a flu), frontal sinusitises, genyantrites, otites, toxic damage of a myocardium.

During epidemic of a flu the diagnosis of difficulties does not represent. During interepidemic time on a flu this disease meets seldom (3-5 % of all cases the ARD) and weeps often as the mild and erased forms. In these cases the flu is difficult for distinguishing from the ARD of other etiology. For confirmation of the diagnosis of a flu detection of a virus in a material from a fauces and a nose, and also revealing of increase of a credit of specific antibodies is used at probe of didymous Serums: first Serum takes till 6-th day of disease, in 10-14 days; increase of antiserum capacities in 4 times and more is diagnostic.

Complications.

From complications of a flu by the most serious the infectious - toxic shock, clinically appearing the following main syndromes is: an acute cardiovascular failure, a fluid lungs, a wet brain disseminated by intravascular coagulation. These syndromes can arise separately or in a combination with each other. At an acute cardiovascular failure paleness and a cyanosis of integuments, a tachycardia, falling of arterial pressure are observed. It is necessary to mean, that for the patients, suffering an idiopathic hypertensia, falling of arterial pressure does not reach at once a critical level and its depression to normal amounts should be regarded as an alarm signal.

At a starting fluid lungs patients complain of labored respiration, accept the forced position. Terrible prognostic tag - a foamy sputum with streaks of a blood. For such patients macrovesiculous rhonchuses in lower departments mild, a shorting of a percutory sound are auskultatie defined. The wet brain develops for children and faces of elderly and senile age is more often and appears disturbance of consciousness, a meningism.

The degree of an infectious - toxic shock defines gravity of an infection. The fulminant (hypertoxical) form of a flu is stipulated by rapid development of infectious toxic shock II-III of a degree in the first day of disease. The slightest suspicion on tags of a cardiovascular failure, a fluid lungs, a brain, a hemorrhagic syndrome are the grounding for immediate hospitalization by first aid.

Gravity of an infection is connected also to a lesion mild a virus of a flu which arises for 1-2 day of disease. For it the clinicoradiological picture of a various degree of an expression of a fluid lungs, less often than a respiratory - toxic distress - syndrome is characteristic. By x-ray changes which were regarded as interstitial pneumonias earlier are typical for a virus lesion mild. However any tags of a pneumonia at these changes are not present, and the available symptomatology is connected predominary to a vascular plethora, a perivascular edema. If not the bacterial infection the above described disturbances are stoped within 7-10 days is joined.

The most often complication of a flu is the pneumonia. Frequency of pneumonias changes from 15 % at a flu A (HINI) up to 26-30 % at a flu A (H3N2) and B. Most often etiological factor causing an acute pneumonia, complicating a flu, especially during epidemics, the staphilococcus is. Much less often the flu is complicated hardly weeping acute pneumonia called esherihyas, a pyocyanic rod, clebsiellas and other bacteria. The acute staphylococcal pneumonia complicating a flu, gravity of the common status, the expressed cardiovascular and respiratory failure, rather scanty firstly distinguish physical finds in mild, not appropriate to a grave condition of patients, fast advance, multiplicity and massiveness of the centers of a lesion of a pulmonary tissue with bent to abscessing, hemorrhagic character of an inflammation, often involving in pathological process of a pleura. By x-ray on a background of a various expression and extent of inflammatory infiltration, an edema of an interstitial tissue mild and concerning small response of radical lymphonoduses the plural bullas imitating caverns or abscesses, and this or that interest of a pleura often are taped.

The acute staphylococcal pneumonia can complicate current of a flu at any time. In the first days to catch the beginning of a staphylococcal pneumonia it is difficult, as over this period in a clinical picture is dominated with signs of a serious flu: a strong headache, weakness, a multiple vomiting, nasal and other bleedings, excruciating tussis, a pain behind a breast bone, a hoarse of a voice, etc. Physical manifestations of a pneumonia are poor, but the short wind, a cyanosis, a tachycardia, cold fits, a purulent sputum can speak about its connection with impurity of a blood, a pain in a side at respiration and tussis. In later periods (after the third day of disease) about occurrence of this complication testify fast deterioration of a common status on a background of a cease of manifestations of the influenzal infection, a new feverish wave (less often the paradoxical depression of a body temperature not appropriate to a grave condition of patients), intensifying of tussis, appearance of a blood in a sputum, pleural pains, a short wind, a cyanosis, etc.

Extremely hardly weeping acute staphylococcal pneumonias complicate a flu during increase and at height of epidemic is more often. If during epidemic meets the serious pneumonia combined to signs of a flu (on last often do not pay attention and do not take into account in preliminary treatment!) he, first of all, should think of the staphylococcal nature of a lesion mild and assign appropriate treatment, not waiting results of bacteriological probe of a sputum. At various variants of a "fulminant" flu always there are conditions for occurrence of bacterial complications and often on the grounding of the clinical data it is impossible to eliminate presence last.

From other complications meeting enough often (2-8 %) it is necessary to mark a mastoiditis of the bacterial nature, sinusitises, an otitis. The encephalitis, a meningitis, neuritises, a myocardial dystrophy are seldom observed. After the transferred flu, as a result of depression of an immunologic reactivity, chronic diseases - a bronchitis, a tonsillitis, a pyelitis, a tuberculosis, rheumatic disease become aggravated. Besides owing to a lesion at a flu of an endothelium of bulbs current of all intimately vascular diseases, especially for people of elderly and senile age worsens. Therefore in period and after epidemic of a flu so often there are myocardial infarctions, insults and other serious complications of a vascular pathology.

Diagnostics.

The diagnosis during epidemic does not represent difficulty and is based on the clinico - epidemiological data.

During the interepidemic period the diagnosis "flu" should be confirmed laboratory. Early diagnostics - research of smears mucous from a fauces and a nose a method of fluorescent antibodies. Apply also serologycal method of research being retrospective, as an antibody to a virus of a flu for confirmation of the diagnosis it is necessary to find out in the didymous Serums taken in the first days of disease, and then in 5-7 days. Increase of a credit in 4 times and more is diagnostic. At research of a peripheric blood the leukopenia, moderate band shift, a normal ESR is usually defined.

Treatment.

Patients with a flu treat domiciliary. To a hospital refer patients with serious forms of a flu, with complications, with serious accompanying diseases, and also under epidemic indications (from a hostel, boarding schools, etc.). Left for treatment of a house place in a separate room or isolate from enclosing by means of a screen. Allocate separate utensils which is disinfected by abrupt boiled water. The faces which are looking after the patient, should wear a four-layer mask from a gauze. During feverish period it is necessary for patient to keep a confinement to bed. It is recommended warmly (heaters to legs, plentiful hot drink). For prophylaxis of hemorrhagic complications, especially with the raised BP, it is necessary to recommend older persons green tea, jam or juice of a black - fetal mountain ash, grapefruits, and also vitamins of group R (Rutinum, Quercetinum) in a combination to 300 mg of Acidum ascorbinicum day.

Effective agent is the antiflued donor gamma-globulin which assign at serious forms of a flu whenever possible in earlier periods (the adult on 6 ml, to children on 0,15-0,2 ml / kg). It is possible to use a normal human immunoglobulin which enter intramusculary in the same doses.

Antibiotics and Sulfanilamidums do not warn complications, in particular pneumonias. They are shown only at complications. Use antibiotics of penicillinic group, Tetracyclinums, gentamycin is more often. Widely use pathogenetic and symptomatic preparations. To decrease head and muscular pains apply Amidopyrinum, an ascofen, etc. Therapeutic operation antihistamine preparations (render Pipolphenum, Suprastinum, Dimedrolum). To improvement of drainage function of bronchuses apply the alkaline inhalations expectorating, bronchodilatators. At the expressed rhinitis locally apply 2-5 % a solution of ephedrine, Naphthyzinum, Halazolinum, Sanorinum, etc. Sometimes use admixtures of preparations. The so-called antiflu contains 0,5 G Acidum acetylsalicylicum, 0,3 G Acidum ascorbinicum, 0,02 G Rutinum, 0,02 gdimedrols and 0,1 Sodium lactatums of a calcium. To convalescents assign banks, Sinapismuses.

At the extremely serious hypertoxical forms of a flu (the temperature is higher 40°C, the short wind, a cyanosis, a sharp tachycardia, depression of a BP) treat patients in chambers of an intensive care. This patient intramusculary enter an antiflued immunoglobulin (6-12 ml), assign antibiotics of antistaphylococcal operation (Oxacillinum, Methicillinum, a zeporine on 1 gramm 4 once a day). Two times day intravenously enter an admixture containing 200-300 ml of Haemodesum or 40 % of a solution of a glucose, 0,25-0,5 ml 0,05 % of a solution of a strophanthin (or 1 ml 0,06 % of a solution of Korglykonum), 2 ml 1 % of a solution of Lasixum, 250-300 mg of Hidrocortizonum or Prednisolonum, 10 ml 2,4 % of a solution of an eufiline, 10 ml 5 % of a solution of Acidum ascorbinicum, 10 ml 10 % of a solution of Sodium chloridum of a calcium, 400 ml a reopolyglucine, 10000-20000 UNIT of a contrical. Spend an oxygenotherapy. At an acceleration of respiration from above 40 in 1 mines, at disturbances of a rhythm of respiration of the patient translate on artificial ventilation of the lungs.

The forecast. At a uncomplicated flu the working capacity is restored in 7-10 days, at "connection of a pneumonia - not earlier than 3-4 weeks. The forecast concerning a life favorable, serious forms with an encephalopathy or a fluid lungs (it is usual during epidemics) can represent threat for a life.

Prophylaxis.

Bacterination alive intranasal or inactivated (it is intradermal and under a skin) is used by vaccines. For prophylaxis of a flu And it is possible to use Remantadinum (for 0,1 grammes / day) which give during all epidemic flash. In the center spend the current and final disinfection (utensils pour with abrupt boiled water, linen boil).

Rising of a common nonspecific resistance is promoted by an eleuterocock and other vegetable adaptogenes, and also vitamins which it is necessary to apply courses 3-4 weeks. During seasonal upswings a case rate by a flu and other ARVI. For emergency prophylaxis use:

Alive influenzal vaccines

The alive influenzal vaccines for the first time suggested by A.A.Smorodintsevym in 1938, represented by three preparations: the vaccine influenzal alive allantoyse for intranasal application to children is made the NIIVS in Saint Petersburg, and also in Irkutsk. It is allowed for application for children with 3 till 14 years. The vaccine influenzal alive allantoyse, earlier used only for adults, is issued by firm on production of immunopreparates in Irkutsk and allowed now and for immunization of children, since 7-years age. Probes on learning possibility of its application to children from 3 years and unitary are carried on. The cleared alive influenzal vaccine is issued the NIIVS and recommended for application for adults and teenagers from 14 years.

The LIV apply to prophylaxis of a flu as an aerosol which enter in a nose with the help of a sprayer - batcher. To children of the LIV enter it is double with an interval in 3-4 weeks, the adult - unitary.

Inactivated influenzal vaccines

Now abroad and in our country inactivated influenzal vaccines are widely applied: integralvirion, sub virus or split , and also subindividual trivalent influenzal vaccines.

The inactivated integralvirion influenzal vaccine in Russia is made scientific research institute EM by it. L.Pasteur in Saint Petersburg and in Ufa also it is applied for children from 7 years and adults. The group of the inactivated split influenzal vaccines includes 3 vaccines: Begrivak Kyron-Bering GmbH in Germany is made by the corporation. Vaxyflu Aventis Pasteur in France is made by the corporation. Both vaccines are allowed for application for adults and for children from 6 monthly age. Vaccine fluarixe is made by SmithKlaynBeach corporation in Germany and allowed to application of children from 1 year and for adults. The group of inactivated subindividual influenzal vaccines includes: Influvac - it is made Pharmaceutikals B.V.'s by Solvey corporation, Veesp. In Netherlands, the Agryppal of Zhairon S.P.A. corporation, made in Italy and trivalent polymer - subindividual vaccine grippol which, besides surface protective antigens of viruses of a flu, contains also high-molecular immunostimular as polyoxide. All 3 vaccines are allowed to application for children, since 6-monthly age and for adults.

Bacterination against a flu first of all is recommended to faces of group" raised risk of a becoming infected ": children, medical staff, military men, workers of sphere of consumer services, transport, educational institutions and so forth, and also to groups " raised risk of development of unfavorable consequences of the transferred influenzal infection ". Faces 60-65 years, suffering chronic diseases of cardiovascular and respiratory systems, genitourinary system, Diabetum and other diseases of a metabolism, the temporary and got immunodeficiencies(immunity-scarced), often were ill children of preschool age and school age concern to this group is higher. However take root against a flu can and should any person, wishing to reduce risk of disease and probable complications at absence for it the medical contraindications indicated in instructions on preparations.

Main contraindications for bacterination as the LIV, and IGV are acute infectious diseases and an allergy to an egg white as vaccines are made from the viruses of a flu multiplied in chicken embryoses.

Efficiency of various vaccines

Probes on learning protective properties of antiflued vaccines were spent by many scientific institutes: scientific research institute of virology it. D.I.Ivanovo (Moscow), scientific research institute of a flu (Saint Petersburg), Institute of an epidemiology and a microbiology it. Lui Pasteur (Saint Petersburg), the State institute of standardization and the control of biological preparations it. L.A.Tarasevich (Moscow), etc. In connection with that, that during epidemics of one of the most unprotected groups children and teenagers are, the huge amount of observations has been lead on these contingents

So, in durable probe on learning efficiency of bacterination of the LIV and IGV for schoolboys low and advanced age it has been shown, that during epidemic rise of a case rate the number of viruses infected with actual strains in group placebo more than in 2 times was higher, than among schoolboys, vaccinated IGV or the LIV in one year prior to this season. And the next year the effect from inoculations was high, however there was its some depression. In a case of scheduled annual mass inoculations of the most effective bacterination of the second and third year [5, 6] is.

The wide spectrum of inactivated influenzal vaccines represented in Russia, frames possibility of a choice of a preparation for the defined national groups with allowance for states of health, age, etc. Probes of efficiency IGV spent among children and faces of 65 years and is higher (group of the raised risk of unfavorable consequences of the transferred influenzal infection). In probe of a season of 1999-2000 applied vaccine preparations: the Begrivak, Vaxygripp, Grippol, Influvac, Fluarix. Scope by inoculations has made 71 % [7].

The analysis reactogenesys after application IGV has shown a good acceptability of the above-named preparations. Inoculations have not affected common state of health vaccinated. On the data of other contributors, common responses at application IGV arise seldom, record the local responses passing independently within first 2 day [8] is more often.

Probes have shown, that for 70 % vaccinated the credit virus- specific antibodies has increased in 4 times and more (see fig. 1). The adjuvanticity of researched vaccines authentically did not differ. In opinion of some contributors, immunogene activity IGV not always happens comparable and depends on age and accompanying diseases which can be responsible for the low immune answer [9].

We estimated preventive efficiency of compared vaccines on a level infect during observation (number of laboratory confirmed cases of a flu A and B). The Index of epidemiological efficiency (the ratio of a case rate in check and experienced groups) was maximum after application of vaccine Vaxygripp and was equaled 2,7. In other our probe in an epidemic season of 2000-2001 where observations spent among children of school age, the index of epidemiological efficiency in group vaccinated Influvac has made 2,8.

Probes have shown, that all compared vaccines were a little reactogene, highly-immunogene and provided creation of protective levels of immunity to all vaccine viruses of a flu. In our opinion, vaccine Influvac, the most safe by way of side effects, is especially shown (along with healthy people) to small children and faces with a secondary immunodeficiency(immunity-scarced) and chronic diseases.

Other preventive preparations

And the ARVI are applied to nonspecific prophylaxis of a flu the preparations promoting framing of an endogenic interferon and raising immunity, and also the agents directly influential on the originator. Preparations of an interferon now widely are not applied to prophylaxis of a flu, though it is possible to use with success leukenferon ointment which 2 times day rub all epidemic period in nasal courses.

Specific antiflued preparation is Rimantadinum which possesses the expressed medical and preventive operation concerning all variants of a virus of a flu And. In connection with collateral toxic operation he is recommended for application to children from seven-year age and the adult. For prophylaxis during epidemic accept on 1-2 tablets of Rimantadinum in day till 20 days, and in the center of disease of 5-7 days before convalescence of the patient.

Other agent of specific prophylaxis of a flu is the domestic antiviral preparation an arbidol. He inhibits adsorption and penetration of viruses of a flu into a cell, being except for it immunomodulator, an inductor of an interferon and an antioxidant [13]. The arbidol is effective both at a flu A, and at a flu B, and also at some ARVI. To prophylaxis a preparation apply to children till 7 years on one, and high children and adults on 2 tablets (0,1 g) in the center of a flu daily, and during epidemic - in day 3 days in a week, 3-4 weeks. As against Rimantadinum the arbidol concerns to low-toxic to preparations and has no contraindications for application for adults and children.

Alongside with the indicated methods of prophylaxis it is possible to apply and other agents on rising a resistance of an organism - daily occupations by physical culture, reflexotherapy and a reflex - prophylaxis, a ultra-violet irradiation. (Hexavitum, Undevitum, Dekamevit) and fortifying agents (an extract of eleuterocock, a ginseng, etc.) it is necessary to assign vitaminization with allowance for age, a trade, a climatic zone of residing.

The problem of a flu and other ARVI is complex and difficult on the solution. Prophylaxis of these diseases should be well-timed, and behind bacterination against a flu in preepidemic period emergency chemoprophylaxis, especially for faces, not vaccinated against a flu up to epidemic can be undertaken.