From Big Medical Encyclopedia

EPIDEMIOLOGY (Greek epidemos logos extended among the people + the doctrine) — the medical science studying patterns of epidemic process and developing measures of fight against infectious diseases of the person.

Public and medical importance E. is defined by the essential specific weight of infectious diseases in the general incidence of the population. Large epidemics, striking a considerable part of the working population, cause serious damage to the national economy. In this regard development of theoretical and applied aspects E., the fight against infectious diseases developing effective system, is one of essential growth factors of productive forces. Success achieved in our country in elimination of a number of infectious diseases or falloff of incidence and many infectious diseases mortality to-rye in a crust is well-known, time meets in the form of sporadic cases (malaria, poliomyelitis, diphtheria, tetanus, etc.).

High performance of evidence-based system of preventive and anti-epidemic actions caused wide use of a technique epidemiol. researches and for clarification of the reasons of spread of mass diseases of the noninfectious nature (so-called epidemiology of noninfectious diseases). Use epidemiol. a method for interpretation of the reasons and mechanisms of distribution of a number of noninfectious diseases (cardiovascular, oncological, mental, etc.) it was in some cases effective in studying and development of measures of their prevention.

The epidemiology arose from empirical overseeing by features of spread of various infectious diseases and assessment of efficiency of the practical actions applied by the person in fight against them since an extreme antiquity. From medical monuments of Ancient Egypt, works of the Greek and Roman historians and doctors, poetic works it is known that the mankind long since rendered heavy tribute to numerous infectious diseases — smallpox, to plague, a leprosy, etc., to-rye often became general disaster. Assume what in

14 century in Europe from plague died apprx. 25 million people, and in 17 century from smallpox — more than 60 million people. Already anti-epidemic measures for fight against a leprosy are entered into the Middle Ages: patients were expelled out of borders of settlements and on pain of death forced to wear distinctive clothes. Much earlier in Ancient China the first attempts of artificial immunization against smallpox were made — dressed children in the shirts which are taken off from patients by smallpox impregnated with contents of smallpox pustules or entered them into nostrils the dried-up crusts of smallpox pustules.

As main objective E. studying of so mass phenomenon in human about-ve as epidemic process (see), the expressed social essence of this science is obvious is. At all stages of development E. was the arena of fight between materialism and idealism.

Great value in clarification of character inf. diseases and formation of materialistic representations in epidemiology had J. Frakastoro's doctrine about a contagion, according to Krom activators inf. diseases were considered as the live germs of diseases capable to breed. In the subsequent the term «contagium vivum» (live catching) often occurs in compositions of a number of scientists of the Middle Ages.

The powerful contribution to development of epidemiology brought T. Sydenham, in detail and precisely described clinic of many inf. diseases, paid attention to the general patterns of their distribution.

The domestic epidemiology was characterized by original development for a long time. Peter I's reforms promoted that in

18 century Russia took a way of bystry economic development and wide international relations. In this regard cases of a drift to the country such especially dangerous inf even more often began to be registered. diseases, as plague, smallpox, cholera. Therefore it is logical that published in 1728. The collection of laws of the Russian Empire contained articles concerning anti-epidemic actions. Specific measures against a drift of an infection were stated in «The charter about quarantines». Works of the Russian doctor D. S. Samoylovich (1744 — 1805), in particular about the principles of the organization of antiplague actions, were transferred to the majority of the European languages. The compatriot and D. S. Samoylovich's contemporary Ivan Viyen in 1786 published work on epidemiology by Morava of an ulcer (plague). Actually this work was the first Russian leaders on epidemiology.

The second half of 19 century was marked by emergence and rapid development of new science — bacteriology (see Microbiology). Opening of JI. Pasteur, R. Koch, I. I. Mechnikov and their followers allowed to find out in a short space of time an etiology of many inf. diseases, and further to establish sources of these diseases, to feature of the mechanism of transfer of their activators, to develop a technique of laboratory diagnosis inf. diseases and on this basis to formulate the principles of evidence-based system of preventive and anti-epidemic actions. It promoted bystry development of epidemiology in Russia that was followed by emergence of scientific institutions epidemiol. profile: during 1886 in Russia 5 pasterovsky stations were open (see Pasterovsky stations, points); in 1887 it was based Kharkiv bacteriological by in-t (nowadays Kharkiv scientific research institute of microbiology, vaccines and serums of I. I. Mechnikov); later in St. Petersburg Ying t of experimental medicine was organized; then in Moscow and Kiev were discovered bacterial. in-you, and in a number of provinces — sanitary and bacteriological in-you.

The first epidemiol. about-in in Russia it was organized by S. P. Botkin in 1866 generally for strengthening of efficiency of fight against cholera.

Domestic E. made a large contribution to world science. So, G. N. Minkh, O. O. Mochutkovsky respectively in 1874 and 1876 in experiences of autoinfection established a role of blood-sicking insects in spread of sypny and returnable typhus. P. N. Diatroptov carried out experimental studying of cholera, diphtheria, a malignant anthrax and plague. E. I. Martsinovsky developed measures of fight against malaria, a leushmaniosis and other diseases of the parasitic nature. JI. A. Tara-sevich studied questions of immunity to inf. to diseases and efficiency of vaccines against a typhoid and cholera. I. I. Swordsmen created the phagocytal theory — a basis of the doctrine about immunity (see), was the author of classical works on epidemiology of cholera, a typhinia, syphilis, dysentery, tuberculosis. To development E. basic researches of D. I. Ivanovsky who opened viruses, F. A. Lesh — the founder of medical parasitology, P. F promoted. Bohr — the founder of the doctrine about leysh-manioza, G. N. Gabrichevsky — one of pioneers of a serotherapy of diphtheria, V. K. Vysokovich who executed the largest researches on epidemiology of plague, I. G. Savchenko, investigating possibilities of immunization against cholera, etc.

D. K. Zabolotny possesses numerous works on epidemiology of plague, cholera, syphilis, sapropyra and some other inf. diseases. JI. V. Gromashevsky developed the doctrine about the mechanism of transmission of infection, generalized original positions of theoretical epidemiology and on essentially new basis created natural-historical classification inf. diseases.

Important for development E. there were works E. N. Pavlovsky and his pupils who developed the doctrine about a natural ochagovost of a number of infectious diseases, dangerous to the person, from group of zoonoz (see. Natural ochagovost). K. I. Scriabin created the doctrine

about helminths and the principles of fight against helminthoses. The big contribution to studying of patterns of epidemiology of malaria, a leushmaniosis, a toxoplasmosis, a tularemia, a brucellosis and other natural focal diseases of the parasitic and bacteritic nature were brought by V. N. Beklemishev, P. G. Sergiyev, N. G. Olsufyeva other. Researches of rickettsioses of P.F. Zdrodovsky and N. F. Gamalei's work, G. P. Rudneva, H became widely known. N. Zhukova-Verezhnikov and others, the expanded ideas of epidemiology, an epizootology and prevention of plague and cholera.

The general recognition got a job of JI. A. Ziljbera, A. A. Smorodin-tseva, M. P. Chumakova, V. M. Zhdanova, V. D. Solovyova and other Soviet scientists concerning studying of an etiology and epidemiology of viral infections, and also development of means and system of their specific prevention.

It should be noted works of modern domestic epidemiologists on creation of scientific fundamentals of quantitative epidemiology, and first of all the modern scientific and methodical principles of assessment of efficiency of means of specific prevention and diagnosis inf. diseases, epidemiological forecasting.

Achievements E. and influence them on medical practice was led to creation of highly specialized sanitary and epidemiologic service in our country. Activity of this service (see. The sanitary and epidemiologic service) is directed to consecutive improvement a dignity. - a gigabyte. working conditions and life of the population, decrease in incidence of infectious diseases up to their elimination. Current state E. is defined by high performance of the operating system of sanitary and preventive and anti-epidemic actions that it is confirmed with elimination in our country of a number of infectious and parasitic diseases.

The main subject of epidemiology, on JI. To V. Gromashevsky — the epidemic process and numerous factors influencing its emergence and a current. Studying of patterns of epidemic process allows to define the principles, methods and prophylactics of infectious diseases, measures of fight against their distribution, an ultimate goal to-rykh — their elimination.

The epidemiology historically develops in close connection with such sciences as microbiology, immunology (see), infectious diseases (see), parasitology (see), social hygiene (see), etc.

Allocate the general and private epidemiology. The general epidemiology is theoretical discipline; she considers the general laws of spread of infectious diseases and develops bases of measures of prevention and fight against them. There are six laws of emergence and development of epidemic process following one of another (see): 1) a source

of a contagium at antroponoza (see) is the infected person (the patient, the carrier), and at zoonoza (see) — the infected animal; 2) localization of the activator in an organism of the owner and the mechanism of transfer of the activator determined by it from one individual to another are interconnected and provide a continuity of epidemic process, being a basis of preservation of the causative agent of infectious diseases as look; 3) localization of the activator in an organism and the mechanism of transfer of the activator corresponding to it make a basis of the natural-historical classification of infectious diseases of the person including the following groups of diseases: intestinal infections, respiratory infections, blood infections, infections of outside covers; 4) epidemic process arises and is supported only at interaction of three direct motive powers (factors) — a source of an infection (see), the mechanism of transfer of the activator (see) and susceptibilities of the population; 5) the natural and social phenomena can cause quantitative and qualitative changes of epidemic process by impact on its direct motive powers; 6) the epidemiology of any infectious disease changes only owing to such social changes in life about-va, to-rye can stimulate direct motive powers of epidemic process or influence depressing them.

The private epidemiology has generally applied character since

on the basis of the general laws of epidemiology considers features of epidemic process at separate infectious diseases. Detection of these features forms a basis for creation of rational system of preventive and anti-epidemic actions for fight against infectious diseases. According to direct motive powers of epidemic process — a source of an infection, the mechanism of transfer of the activator and a susceptibility of the population — measures of fight against infectious diseases are carried out in three directions: neutralization, elimination or, more rare, destruction of a source of an infection; rupture of the mechanism of transfer of the activator; creation of immunity of the population to this infectious disease. However at various nosological forms efficiency of these or those measures of fight against infectious diseases is various; in a complex of actions one of them can gain the leading value, others — auxiliary. Therefore during the planning of measures of fight against a certain infectious disease the right choice of the leading link in a complex of actions is important. E.g., immunization of the population a smallpox vaccine was the leading link in fight against natural smallpox; in fight against a sapropyra — early identification and hospitalization of patients, prevention of pediculosis.

The epidemiology uses the complex method of a research consisting of observation and an experiment. The method of observation includes epidemio l. inspection of the epidemic center (single observation), statistical method (mass observation), complex studying of epidemics (observation descriptive method) and descriptive and historical method. Intensity of epidemic process in dynamics decides on identification of seasonal and cycle variations, age, sexual and professional structure of incidence, etc. by a statistical method. Statistical data are usually provided in absolute figures and relative indicators (intensive and extensive) and can be presented in the form of digital tables, schedules, charts, cartograms, etc. However studying of incidence by means of a statistical method at all its importance does not allow to consider a role of the numerous factors influencing the course of epidemic process in specific conditions. Therefore the description of epidemic process within the limited territory with attraction of materials of comprehensive inspection of the epidemic centers is carried out.

By means of a descriptive method characterize the social and natural factors influencing epidemic process, features of a household and production situation, observance of rules of personal hygiene, water handling, sewerages and sewage treatments in this settlement, a dignity. - a gigabyte. condition of the enterprises for preparation, processing, transportation and implementation of foodstuff, points of public catering, etc.

Sometimes resort to the historical descriptive method applied at such infectious diseases, historical data on conditions of distribution to-rykh in the past can have practical value.

Treat methods of an epidemiological experiment microbiological (see. Bacteriological techniques), virologic (see. Virologic researches), serological (see. Serological researches), entomological, parasitological and sanitarnokhimichesky researches (see San and that rno-gigiyen ichesky issled an ova of N iya); an experiment on animals; studying of efficiency of immunization, chemoprophylaxis on volunteers (volunteers). The experimental methods used in E., allow to reveal elements of epidemic process. So, mikrobiol. and virus of l. researches allow to decipher etiol. nature inf. diseases, quantitatively and qualitatively to characterize properties of its activator, to reveal a source of an infection, a way and factors of transfer of the activator etc. At the same time more detailed studying of the allocated strains of the activator — «establishment of its serotype and fago-type is of great importance. For this purpose apply methods of the serologic typing of strains, and also a lysotypy (see).

In a complex with mikrobiol. or virusol. methods widely use a method of a serological blood analysis, received from patients, specific antibodies, had or clinically healthy on existence, to an estimated disease-producing factor. These researches use also during the determination of specific weight of an immune layer among the population, at assessment of antigenic and immune activity of again offered vaccines, etc.

Along with the listed laboratory methods of a research in the epidemic centers of a row inf. diseases (tuberculosis, a brucellosis, a tularemia, plague) for identification of sources of an infection use allergy diagnostic tests (see).

For the purpose of studying of biology of the arthropods which are carriers of activators of big group transmissible boleeyy, and also

estimates of efficiency of means and me->tod of fight against them, apply entomological researches. They are used in a complex with parasitological and microbiological researches for studying of development of a contagium (invasion) in an organism of a carrier.

Widely use in E. dignity. - chemical researches of water, the soil, foodstuff and other objects, and also carrying out an experiment on animals, to-ry allows to make the diagnosis by method of a biological test, to study a pathogeny and the mechanism of transmission of infection, to estimate harmlessness and potential efficiency of vaccinal and serumal drugs.

Epidemio of l. researches on limited number of volunteers (volunteers) are conducted in cases when check of new vaccinal and serumal drug on animals does not give complete idea of its antigenic and immunogene activity and possible reactogenicity.

Teaching epidemiology is carried out at departments of epidemiology and infectious diseases in medical in-ta, and also in medical schools during the studying of infectious diseases.

The first department of epidemiology opened in 1920 at Odessa un-those was created by D. K. Zabolotny — the founder of domestic epidemiology. In 1923 teaching epidemiology in Kharkiv medical in-those under the leadership of M. N. Solovyov, and in 1928 — in Dnipropetrovsk medical in-those under the direction of JI began. V. Groma-shevsky. In 1932 in a number of medical in-t were organized a dignity. - a gigabyte. f-you with departments of epidemiology, and on medical and pediatric f-takh courses of epidemiology were given. In in-ta of improvement of doctors departments of epidemiology were also open.

Professional development of epidemiologists is carried out at departments of epidemiology central and republican in-t of improvement of doctors, in a number of medical in-t (Leningrad, Kharkiv, etc.). Works of the Soviet scientists were of great importance for improvement of knowledge of epidemiology. So, in 1927 D. K. Zabolotny published the management of «Fundamentals of epidemiology», in 1934 there was «A doctrine about epidemic diseases» of G. F. Vograli, then the textbook «General Epidemiology» of M. N. Solovyov (1935), «Private epidemiology» of V. M. Berman and soavt were published. (1936), «Course of the general epidemiology»

of V. A. Bashenin (1936). In 1941 L. V. Gromashevsky wrote the fundamental, become classical textbook «General Epidemiology» (republished in 1942, 1949 and 1965) and in 1947. «A course of private epidemiology» (together with G. M. Vayndra-h). In 1958 under the editorship of I. I. Elkin «The course of epidemiology», and in

1968 — the multivolume guide to microbiology, clinic and epidemiology of infectious diseases is published. In 1957 there was a textbook «Military Epidemiology» under I. I. Rogozin and V. D. Belyakov's edition, and in 1976 — a course of «Military epidemiology» of V. D. Belyakov.

The first congresses of epidemiologists, microbiologists and hygienists were convened even in the years of civil war. During the period from 1918 to 1922 there were six congresses. At these congresses the main attention was paid to discussion of various questions of fight against parasitic typhus, cholera, plague, malaria, flu, vaccinal and serumal business and the organization a dignity. - epid. service and scientific research in the country.

VII, VIII and IX All-Russian congresses, and in 1926 and 1928 respectively X and XI All-Union congresses were held to the period from 1923 to 1925. The XI All-Union congress made the decision on expediency of creation complex a dignity. - epid. institutions in all city and rural districts of the country. In the subsequent six more all-Union congresses of microbiologists and epidemiologists were held. The XVII All-Union congress worked in 1983 in Baku. On it various questions of the theory of epidemiology, the organization and a technique of anti-epidemic service of the population, prevention of the most mass infections of a bacterial and virus etiology were discussed; the considerable attention was paid to discussion of topical issues of biology and genetics of microorganisms, improvement of means and methods of laboratory diagnosis, drugs for antibacterial therapy, etc.

During the period between congresses various questions of epidemiology are discussed at regional, city, republican meetings of the relevant branches All-Union

about-va microbiologists, epidemiologists and parasitologists, at republican congresses. The Soviet scientists took part in work of the international congresses and symposiums.

Research in the field of epidemiology is carried out in our country in research in-ta and at the relevant departments of medical in-t, in-t of improvement of doctors, medical f-tov high fur boots, in republican and regional (regional) SES. In 1918 Ying t of experimental therapy and control of serums and vaccines Narkomzdrava is created by RSFSR (nowadays State scientific research institute of standardization and control of medicine -

sky biological drugs of JI. A. Tarasevich), in 1919 in Moscow — scientific research institute of vaccines and serums of I. I. Mechnikov and scientific research institute of epidemiology and microbiology of G. N. Gabrichevsky, and in 1920 — Central smallpox in-t, State in-t of national health care (GINZ) and scientific research institute of medical parasitology and tropical medicine of E. I. Martsinoveky; in 1923 in Leningrad — scientific research institute of epidemiology and microbiology of L. Pasteur, then in Moscow in

1931 — Ying t of epidemiology and microbiology of the honorary

academician N. F. Gamalei, in 1932 — All-Union scientific research institute of disinfection and sterilization, in 1944 — scientific research institute of virology of D. I. Ivanovsky, in 1955 — scientific research institute of poliomyelitis and viral encephalitis, in 1957 — the Moscow scientific research institute of virus drugs, in

1963 — the Central scientific research institute of epidemiology. In other cities of our country a number of scientific research institute is also created, work to-rykh is connected with studying of various aspects of epidemiology, microbiology and hygiene.

In the USSR it is created All-Union about-in epidemiologists, microbiologists and parasitologists.

Considerable work in the area E. conducts WHO, edges generalizes the given

0 global incidences of infectious diseases, coordinates the scientific research conducted in various countries in the area E., develops and enters international a dignity. governed, heads programs of elimination separate inf. diseases, etc., develops the international classification of diseases and causes of death.

In our country questions of epidemiology are taken up in the following editions: «Magazine of microbiology,

epidemiology and immunobiology», «Hygiene and sanitation», «The Soviet health care», «Questions of virology», «Medical parasitology», «The military-medical magazine», etc. Abroad treat such editions: «Epidemiologiya, microbiology and infektsiozn of a bolesta» (Bulgaria), «Acta microbiologica» (Hungary), «Deutsche Gesundheits-wesen» (GDR), «Acta microbiologica Polonica»,

«Archiwum Immunologii 1 Terapii Doswiadczalnej», «Przeg-lad epidemiologiczny» (Poland), «Archives roumaines de pathologie experimentale et de microbiologie» (Romania), «The magazine of hygiene, epidemiology and immunology» (in

4 languages), «Ceskoslovenska epide-miologie, microbiologie, immuno-logie» (ChSSR), «Journal of Infectious Diseases», «American Journal of Public Health», «American Journal of Tropical Medicine and Hygiene» (USA), «Annals de l’lnstitut Pasteur» (France), etc.

See also Infectious diseases, the Mechanism of transmission of infection, Anti-epidemic actions, Sa-nitarno-profilakticheskiye actions, Epidemic process.

Bibliography: History — Bashenin V. A. Kurs of the general epidemiology, M. — L., 1936, bibliogr.; Berman V. M., Levits A. M. and Rogozin of I. I. Kurs of private epidemiology, D., 1936; In i-e of N of I. Lshmolop or the description Morava of an ulcer, eya beings, proizshestv1ya, the reasons, porazheshya and productions of attacks,

with pokazashy an image predokhraneshya and doctoring sowing griefs, SPb., 1786; In about r it is scarlet also to G. F. The doctrine about epidemic diseases, t. 1, p. 1-2, Tomsk, 1935; Zhdanov V. M. Evolution of infectious diseases of the person, M., 1964; it, Evolution of causative agents of infectious diseases, M., 1984; Zabolotny D. K. Fundamentals of epidemiology, M. — JI., 1927;

Stallibrass To. Fundamentals of epidemiology, the lane with English, M. — L., 1936.

Textbooks, the guides, the main works — B and r about I O. V. N and L e p and N of the Item. Epidemiological aspects of modern immunology, M., 1972; Bleaching

V. D's k. Epidemic process. (Theory and method of studying), L., 1964;

it, Military epidemiology, L., 1976; it, Environment and epidemic process, Vestn. USSR Academy of Medical Sciences, No. 3, page 80, 1981; Bleaching

k V. D., Degtyarev A. A. both Ivannikov of Yu. G. Kachestvo and efficiency of anti-epidemic actions, L., 1981; Burgasov P. N. and Impecunious I. S. Scientific bases of the organization of prevention of infectious diseases, M., 1977; Groma-shevsky L. V. General epidemiology, M., 1965; Gromashev-

sky L. V. and Vayndrakh G. M. Private epidemiology, M., 1947; Elkin I. I. and d river. Epidemiology, M., 1979; Kurs of infectious diseases, under the editorship of S. N. Zlatogorov, t. 1 — 2, M., 1932 — 1935; The multivolume guide to microbiology, clinic and epidemiology of infectious diseases, under the editorship of

H. N. Shukova-Verezhnikova, t. 5, M.,

1965; The Guide to vaccinal and serumal business, under the editorship of P. N. Burgaso-va, M., 1978; Smirnov S. M. and Ter-Karapetyan A. 3. Epidemiology and prevention of zoonotic infections, M., 1975.

Periodicals — the Magazine of microbiology, epidemiology and immunobiology, M., since 1935 (1930 — 1934 — the Magazine of microbiology and mmunobiologiya, 1932 — 1934 — the Magazine of epidemiology and microbiology); The medical abstract magazine, Section 3 — Medical microbiology, medical virology, medical parasitology, epidemiology, infectious diseases. Antibiotics and chemotherapy, M., since 1957; Epidemiologiya, microbiology and infektsiozn of a bolesta, Sofia, since 1964; The Magazine of hygiene, epidemiology, microbiology and immunology, Prague, since 1957; American Journal of Epidemiology, Baltimore, since 1965 (1921 — 1964 — The American Journal of Hygiene); CeskoslovensM epidemiologie, microbiologie, immunologie, Praha, since 1952; International Journal of Epidemiology, Oxford, since 1972; Journal of Infectious Diseases, Chicago, since 1904; Przeglad epidemiologiczny, Warszawa, since 1920; Revue d' £pid6miologie et de of sant£ publique, P., since 1976 (1924 — 1970 — Revue d’hygifcne et de to a tyoyesta of sociales, 1971 — 1975 — Revue d’ of £pid6mio-logie, medecine sociale et sant6 publique).

P.N. Burgasov, A. A. Sumarokov.