Vol 16, No 6 (2011)

This paper analyzes the state-of-the-art of infectious diseases in Mongolia over 90 years of public health in Mongolia. The situation related to infectious diseases has undergone substantial changes over 90 years. Smallpox and plague occurred frequently in pre-revolutionary Mongolia. Due to mass vaccination against smallpox, the latter was eradicated in Mongolia in 1940. Systematic health-promotion and prophylactic work against plague has resulted in stable epidemic well-being over the past many past years. The high preventive vaccination coverage rates have been achieved by widely immunizing the population in the country, which could considerably reduce the incidence of infections controlled by specific preventive means. In the past 10 years, the country has not notified diphtheria and whooping cough and the incidence of measles has stabilized at a level of 0.9-1.0 per 100,000 population. At that stage, out of the infectious diseases, viral hepatitis and HIV infection have engaged special attention. Although the incidence of hepatitis B has recently stabilized owing to vaccination; that of hepatitis A has remained high as compared to that in European and North American countries and, in the past 10 years, this rate has been 162.0-391.0 per 100,000. The first case of HIV infection in Mongolia was registered in 1992; as of 2010, the country notified not more than 83 cases, of which 21 (25.3%) cases were registered in 2010, which shows a considerable deterioration in the country's epidemiological situation. The immediate task at that stage is to build on earlier successes and to prevent the emergence and spread of infectious diseases that are absent in Mongolia.

The high incidence of herpesvirus infections is one of the topical problems of modern medicine. Herpesviruses are widely spread in the human population; they are able to affect virtually all organs and systems of the host, by causing latent Differentiation antigens (sCD95, sCD18, sCD50, sHLAI, sCD54) was studied by enzyme immunoassay using monoclonal antibodies (Ab) ICO-20 and polyclonal Abs to antigens of human peripheral blood mononuclear cells. A control group included 60 health donors matched with the study group for age and gender. Age over 60 years, moderate herpes zoster, eruptions on the torso, no comorbidities, and a 1.5-2-fold increase in sHLAI as compared with the reference values were found to be factors that contribute to the uncomplicated course of the disease. The cofactors of postherpetic neuralgia were elderly age (more than 60 years), the severe course of the disease, eruptions on the head, comorbidities, elevated blood urea levels, a 1.5-2-fold decrease in sCD95 and sCD54 as compared to the reference values.

The researchers of the State Research Center of Applied Microbiology and Biotechnology conducted a comprehensive laboratory study of clinical materials and the samples of foodstuffs and organs from wild rodents in order to isolate and identify a pathogen that had caused the outbreak of food infection in the Krasnoyarsk Territory in June-July 2008. Yersinia pseudotuberculosis strains were isolated from the clinical materials. Biochemical and serological typing, molecular genetic analysis, phagodiagnosis, and drug resistance determination showed that all the clinical isolates were genetically related.

Enterovirus type 71 (EV71) (Picornaviridae family, Enterovirus genus, HEV-A species) belongs to the most neuropathogenic non-polio human enteroviruses. CNS damages caused by EV71 in children were very similar in their clinical and pathomorphological pattern and frequently indistinguishable from those induced by virulent strains of poliomyelitis virus. During the past 30-40 years, EV71 has caused large outbreaks of hand, foot, and mouth disease (HFMD) in the countries of Europe (Bulgaria, Hungary) and Southeastern Asia (Malaysia, Taiwan, Singapore, China and others). HFMD (rash on the hand and foot skin and oral mucosa) affects children aged 1 month to 12-14 years, mostly with favorable outcomes in 3-7 days. On 2-5 days of HFMD, ≈ 1% of less than 2-3-year-old children were found to have neurological syndromes, such serous meningitis, poliomyelitis-like signs (pareses and paralyses of the extremities), brainstem encephalitis (tremor, myoclonic jerks, lethargy, bulbar palsy, acute heart and pulmonary failure, neurogenic pulmonary edema, shock, coma, death). In severe cases, mortality rates were as high as 92-94%. Motor, respiratory, and psychoemotional disorders remained long in a small portion of the patients. Pathomorphologic studies revealed damages to the neurons located in the respiratory and cardiovascular centers of the reticular formation of the medulla oblongata, to the nuclei in the n. vagus, and to the anterior nuclei of the spinal cord. The changes in myocardial and lung tissues were minor or absent. The main causes of pulmonary edema were damages to the nerve centers of the brainstem brain and dysregulation of the autonomic nervous system. Drugs and vaccines against EV71 infection are currently unavailable. Immediate (during the first days of EV71 infection) hospitalization of children with the earliest prognostic signs (temperature 38.5-39°C within ≥ 3 days, lethargy) of CNS involvement, early intravenous administration of human immunoglobulin, and active cardiovascular therapy (administration of milrinone) are recommended to reduce the incidence of severe and fatal cases of EV71 infections.