Guidelines
for anti-epidemic measures meningococcal infection

The source of meningococcal infection is a sick person or a bacteriocarrier, infection occurs by drop (aerosol) way.

There are 3 groups of sources of infection:

1. Patients with generalized forms - GFMI (about 1% of the total number of infected persons).

2. Patients with acute meningococcal nasopharyngitis (10-20% of the total number of infected persons).

3. "Healthy" carriers - persons who secrete meningococci and do not have inflammatory changes in the nasopharynx.

The most dangerous source of infection is a sick generalized form - GMFI (meningitis, meningococcemia, meningoencephalitis, etc.) in the prodromal period, which averages 4-6 days.

A certain epidemiological significance belongs to patients with meningococcal nasopharyngitis, the duration of the infectious period is about two weeks.

A "healthy" carrier has a significantly lower infective capacity. At the same time, the number of carriers is hundreds of times greater than the number of patients: the epidemic process in meningococcal infection is supported by a consistent state of carriage. The duration of the carriage of meningococci averages 2-3 weeks, in 2-3% of persons the carriage can continue for 6 or more weeks. There are some reports of a longer carrier state, especially in the presence of a chronic inflammatory condition of the nasopharynx.

The focus of meningococcal infection is characterized by the appearance in the family, children's institution, school and other groups of the patient GFMI. The border of the focus is determined by the epidemiologist in each specific case, all those who communicated with the sick person are identified for a more complete diagnosis of patients with meningococcal nasopharyngitis and carriers.

In epidemiological practice, foci are divided into two categories: with a small number of people communicating with each other and clearly defined boundaries (family foci, foci in groups of children's groups, school classes) or foci where it is difficult to determine the boundaries due to a significant number of people in close proximity. communication (students of various kinds of schools, employees of enterprises and institutions, etc.).

Overconsolidation, increased humidity in the room, violation of the sanitary and hygienic regime contribute to the spread of infection and the emergence of group diseases of meningococcal infection. Outbreaks occur more often in organized groups of children and adolescents, as a rule, during the first weeks after their formation or during a seasonal rise in the incidence. At the same time, persons newly admitted to collectives, especially those who arrived from other settlements, are at the greatest risk of infection.

Anti-epidemic measures in the focus of meningococcal infection

Mandatory registration and submission of an emergency notification to the sanitary and epidemiological station are subject to cases of a generalized form of meningococcal infection (GFMI): meningococcal (epidemic cerebrospinal) meningitis, meningococcemia (sepsis, without damage meninges) and their combined forms, as well as bacteriologically confirmed meningococcal nasopharyngitis. In the presence of group diseases of the GFMI with a number of 5 or more cases, an extraordinary report is submitted to the Ministry of Health of the Union Republic in the prescribed manner.

Patients with a generalized form of meningococcal infection or if it is suspected are immediately hospitalized in specialized departments of infectious diseases hospitals, and in their absence - in boxes or semi-boxes.

Patients with bacteriologically confirmed meningococcal nasopharyngitis, identified in the foci of infection, depending on the severity of the clinical course, are placed in infectious disease hospitals or in special hospitals deployed. They can be isolated at home if there are no more children of preschool age and persons working in preschool institutions in the family or apartment, and also subject to regular medical supervision and treatment.

Contact with the patient left at home, children attending preschool institutions and persons working in these institutions are allowed into the team only after a medical examination and a single bacteriological examination with a negative result.

Discharge from the hospital of patients with HFMI and nasopharyngitis is made after a complete clinical recovery, without bacteriological examination for carriage of meningococci.

Reconvalescents of meningococcal infection are allowed in preschool institutions, schools, boarding schools, sanatoriums and educational institutions after one negative result of bacteriological examination, carried out no earlier than 5 days after discharge from the hospital or recovery of the patient with nasopharyngitis at home.

Various prophylactic vaccinations for convalescents who have undergone a generalized form of meningococcal infection are carried out 6 months after recovery, for those who have had meningococcal nasopharyngitis - after 2 months, for carriers - 1 month after release from the pathogen.

After hospitalization of the patient, the GFMI carries out the following activities:

the boundaries of the focus are determined, the persons in contact with patients are identified, taking into account the duration and proximity of communication;

in preschool institutions, orphanages, boarding schools, children's sanatoriums, schools (classes) quarantine is established for a period of 10 days from the moment of isolation of the last patient. During this period, the admission of new and temporarily absent children, as well as the transfer of children and staff from one group (class) to another, is prohibited;

all persons who communicated with the patient in a team, family (apartment) are subjected to a medical examination (in groups it is mandatory with the participation of an otolaryngologist). Particular attention is paid to identifying individuals with chronic inflammation in the nasopharynx and individuals with unclear "allergic" skin rashes. In the presence of pathological changes in the nasopharynx, patients are isolated from the team, and contacts in the family (apartment) are not allowed in children's groups and schools until a diagnosis is made. Persons with suspicious skin rashes are hospitalized to rule out meningococcemia.

In the outbreak, clinical observation is carried out with an examination of the nasopharynx, skin and daily thermometry for 10 days (quarantine period).

Children under the age of 1 year who had contact with patients with a generalized form of meningococcal infection, with preventive purpose normal immunoglobulin is administered at a dose of 1.5 ml, and at the age of 2 to 7 years inclusive - 3.0 ml. The drug is administered intramuscularly, once, no later than the seventh day after the registration of the first case of the disease.

Bacteriological examination is carried out:

a) in children's institutions - children who were in contact with the sick, and the attendants of the entire institution;

b) in schools - students and teachers of the class where the patient is registered;

c) in boarding schools (round-the-clock stay of children) - students who interacted with the patient in the classroom and in the bedroom, as well as teachers and educators of this class;

d) in families, apartments - all persons who communicated with patients;

e) in universities, secondary educational institutions, vocational schools, special schools in the event of a case of illness in the first year - teachers and students of the entire course; in senior years - only communicated with the patient in the study group and the hostel room;

f) in other organized groups - persons living in a hostel.

In preschool institutions, bacteriological examinations of contacts are carried out at least twice with an interval of 3-7 days, in other groups - once.

Carriers of meningococci identified during bacteriological examination in preschool groups, boarding schools and other children's institutions are removed from the group for the period of sanitation. Carriers are not isolated from a group of adults, including educational institutions.

Carriers of meningococci - children and adults identified in family centers, are not allowed in preschool institutions, schools, boarding schools, sanatoriums, pioneer camps and other children's institutions. Bacteriological examination of the groups that visited these carriers is not carried out.

If a carrier of meningococci is detected among patients in somatic hospitals, it should be isolated in a box or semi-box. The issue of sanitation is decided depending on the underlying disease. In the absence of the possibility of isolating the carrier, a sanitation course is mandatory. The staff of the department is subjected to a single bacteriological examination, the identified carriers are suspended from work for the duration of the sanitation.

Patients with acute nasopharyngitis (not bacteriologically confirmed), identified in the focus of meningococcal infection, are subject to treatment as prescribed by the doctor who made the diagnosis. From children's preschool groups, these patients are isolated for the duration of treatment and are allowed into the team only after the disappearance of acute phenomena.

Identified carriers of meningococci are sanitized at home or in departments specially deployed for this purpose: adults - with ampicillin or chloramphenicol 0.5x4 times a day for 4 days. For children, these drugs are prescribed according to the same scheme in age dosages. For sanitation of carriers in closed groups of adults, rifampicin at a dose of 0.3 every 12 hours for 2 days is recommended.

3 days after the end of the sanitation course, carriers, regardless of the drug used, are subjected to a single bacteriological examination and, if there is one negative bacteriological analysis, they are allowed into the teams.

With a long-term carriage (over 1 month) and the absence of inflammatory changes in the nasopharynx, the carrier is admitted to the team where it was detected.

Final disinfection # is not carried out in outbreaks. Transport for transportation of patients is not subject to disinfection. The room is subjected to daily wet cleaning, maximum decompression in the sleeping quarters, frequent airing of the room, irradiation with ultraviolet and bactericidal lamps.

During the period of the seasonal rise in the incidence, large gatherings of children at entertainment events are prohibited, and the breaks between screenings in cinemas are lengthened.

Extensive explanatory work is constantly being carried out among the population about the need for early access to a doctor.

Specific prophylaxis

The meningococcal vaccine of serogroups A and C (manufactured by the G.N. Gabrichevsky Moscow NIIEM) is weakly reactogenic, harmless, immunologically active, causes an increase in antibodies from the 5th day after a single injection, and after 2 weeks the antibodies reach their maximum level. The vaccine is used for prophylactic purposes and for the purpose of emergency prophylaxis in the foci of meningococcal infection.

1. For prophylactic purposes, vaccination is carried out in territories during the period of epidemic trouble, with an incidence rate of more than 2.0 per 100,000 population.

Vaccinations are subject to:

children from 1 year to 7 years inclusive;

first-year students of institutes, technical schools, vocational schools, temporary workers and other persons who came from different localities in organized groups and united by living together in hostels (preferably during the formation of teams);

children admitted to orphanages, students of the first grades of boarding schools.

With a sharp rise in the incidence and an indicator of more than 20.0 per 100,000 of the population, mass vaccination of the entire population, under the age of 20 years, is carried out.

2. For the purpose of emergency prophylaxis (to prevent secondary diseases), the vaccine is administered in the focus of infection in the first 5 days after the first case of a generalized form of meningococcal infection is detected.

Vaccinations are subject to:

persons who were in contact with the patient in a children's institution, school class, family, apartment, dorm room and friendly contacts;

persons re-entering the team - the focus of infection (the vaccine is administered to them a week before admission);

students of the entire first year of secondary and higher educational institutions with the occurrence of diseases of the GFMI in the first year or in senior years;

senior students who interacted with the patient in a group or dorm room;

children living in rural areas, schoolchildren, students of vocational schools, etc., as well as all persons who were in any degree of contact with a patient in a settlement where no diseases were recorded over the past 3 years.

Immunization is carried out in accordance with the instructions for the use of the polysaccharide meningococcal vaccine, not earlier than 2 months after the introduction of other vaccines, and in the foci of infection - regardless of the period of their introduction.

Re-vaccination of the same persons is carried out no more than once every 3 years.

In immunized groups, quarantine is not established, bacteriological examination and immunoglobulin prophylaxis are not carried out for contacts older than 1 year.

Federal Service for Supervision of Consumer Rights Protection
and human well-being

3.1.2. PREVENTION OF INFECTIOUS DISEASES.
RESPIRATORY INFECTIONS

Prevention of meningococcal infection

Sanitary and epidemiological rules

SP 3.1.2.2156-06

1. Designed by: G.F. Lazikova, A.A. Melnikova, N.A. Koshkina, Z.S. Wednesday (consumer rights and human welfare); I.S. Koroleva, L.D. Spirikhin (FGUN "Central Research Institute of Epidemiology" of Rospotrebnadzor); T.F. Chernysheva (FGUN "Moscow Research Institute of Epidemiology and Microbiology named after G.N. Gabrichevsky); I.N. Lytkina (Department of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in Moscow).

3. Approved by the decision of the Chief State Sanitary Doctor Russian Federation G.G. Onishchenko dated December 29, 2006 No. 34

4. Registered with the Ministry of Justice of the Russian Federation on February 20, 2007, registration number 8974.

5. Introduced instead of the sanitary and epidemiological rules “Prevention of meningococcal infection. SP 3.1.2.1321-03 ", canceled by the Decree of the Chief State Sanitary Doctor of the Russian Federation dated December 29, 2006 No. 35 (registration number in the Ministry of Justice of the Russian Federation 8973 dated February 20, 2007 1 from January 1, 2007

the federal law
"On the sanitary and epidemiological well-being of the population"
No. 52-FZ of March 30, 1999

“State sanitary and epidemiological rules and regulations (hereinafter referred to as sanitary rules) - regulatory legal acts that establish sanitary and epidemiological requirements (including criteria for the safety and (or) harmlessness of environmental factors for humans, hygienic and other standards), non-compliance which poses a threat to human life or health, as well as the threat of the emergence and spread of diseases” (Article 1).

“Compliance with sanitary rules is mandatory for citizens, individual entrepreneurs and legal entities” (Article 39).

“For violation of sanitary legislation, disciplinary, administrative and criminal liability is established in accordance with the legislation of the Russian Federation” (Article 55).

FEDERAL SERVICE FOR SUPERVISION IN THE FIELD OF PROTECTION

CHIEF STATE SANITARY PHYSICIAN
RUSSIAN FEDERATION

RESOLUTION

On the basis of Federal Law No. 52-FZ of March 30, 1999 “On the Sanitary and Epidemiological Welfare of the Population” (Collected Legislation of the Russian Federation, 1999, No. 14, Article 1650, as amended on December 30, 2001, January 10, June 30, 2003 ., August 22, 2004, May 9, December 31, 2005) and the Regulations on State Sanitary and Epidemiological Rationing, approved by Decree of the Government of the Russian Federation of July 24, 2000 No. 554 (Collected Legislation of the Russian Federation, 2000, No. 31, Art. 3295, 2005, No. 39, item 3953)

RESOLVE:

1. Approve the sanitary and epidemiological rules “Prevention of meningococcal infection. SP 3.1.2.2156-06 "().

2. Enact the sanitary and epidemiological rules “Prevention of meningococcal infection. SP 3.1.2.2156-06" from April 01, 2007

G. G. Onishchenko

FEDERAL SERVICE FOR SUPERVISION IN THE FIELD OF PROTECTION
CONSUMER RIGHTS AND HUMAN WELL-BEING

CHIEF STATE SANITARY PHYSICIAN
RUSSIAN FEDERATION

RESOLUTION

In connection with the approval by the Chief State Sanitary Doctor of the Russian Federation on December 29, 2006 and the entry into force on April 1, 2007 of the sanitary and epidemiological rules “Prevention of meningococcal infection. SP 3.1.2.2156-06"

RESOLVE:

From the moment of the entry into force of the said sanitary and epidemiological rules, the sanitary and epidemiological rules “Prevention of meningococcal infection. SP 3.1.2.1321-03”, approved by the Chief State Sanitary Doctor of the Russian Federation on April 28, 2003 and registered with the Ministry of Justice of the Russian Federation on May 29, 2003, registration number 4609.

3.1.2. PREVENTION OF INFECTIOUS DISEASES.
RESPIRATORY INFECTIONS

Prevention of meningococcal infection

Sanitary and epidemiological rules SP 3.1.2.2156-06

1 area of ​​use

1.1. These sanitary and epidemiological rules (hereinafter - sanitary rules) establish the basic requirements for a set of organizational, sanitary and anti-epidemic (preventive) measures, the implementation of which is aimed at preventing the spread of meningococcal disease.

1.2. Control over compliance with sanitary rules is carried out by the bodies exercising state sanitary and epidemiological supervision in the Russian Federation.

1.3. Compliance with sanitary rules is mandatory for citizens (individuals), legal entities and individual entrepreneurs.

2. General information about meningococcal infection

Meningococcal infection is an anthroponotic disease caused by meningococcus and occurring in various clinical forms.

The causative agent is Neisseria meningitidis (meningococci are Gram-negative cocci). Depending on the structure of the polysaccharide, 12 serogroups are distinguished: A, B, C, X, Y, Z, W-135, 29E, K, H, L, I.

Meningococci of serogroups A, B, C are the most dangerous and can often cause diseases, outbreaks and epidemics.

Intragroup genetic subgrouping of meningococci and determination of enzyme types makes it possible to identify hypervirulent strains of meningococci (serogroup A meningococci - genetic subgroup III-1, serogroup B meningococci - ET-5, ET-37 enzyme types), which is important in predicting epidemiological distress.

The pathogen is transmitted from person to person by airborne droplets. More often they become infected from asymptomatic carriers and less often through direct contact with a patient with a generalized form of meningococcal infection.

The risk of developing the disease in children is higher than in adults. All persons are susceptible to the disease, but the risk of infection is higher in people with a deficiency of terminal complement components and in people with splenectomy.

The incubation period is 1 to 10 days, usually less than 4 days.

3. Standard definition of the case of generalized
forms of meningococcal infection

A reliable record of diseases with generalized forms of meningococcal infection is based on objective indicators of a standard case definition with the following classification:

Suspected standard case of acute meningitis detected at the prehospital level. The main criteria: an unexpected rise in temperature to 38 - 39 ° C, an unbearable headache, tension (rigidity) of the neck muscles, a change in consciousness and other manifestations. In children under 1 year old, the rise in temperature is accompanied by a bulging of the fontanel.

Probable standard case of acute bacterial meningitis are detected, as a rule, immediately after hospitalization, taking into account one or more of the above criteria and: cloudy cerebrospinal fluid, leukocytosis of more than 100 cells per mm3 with a predominance of neutrophils (60-100%), leukocytosis in the range of 10-100 cells per mm3 with a predominance of neutrophils (60 - 100%) with a significant increase in protein (0.66 - 16.0 g / l) and a decrease in glucose.

Possible standard case of generalized form of meningococcal disease (meningococcal meningitis and/or meningococcemia) includes one or more of the above criteria and: detection of gram-negative diplococci in the cerebrospinal fluid and / or blood, the presence of specific hemorrhagic rashes on the skin, an epidemiological indication of a repeated case from the focus, or an unfavorable situation for meningococcal infection in the region.

A confirmed standard case of a generalized form of meningococcal infection (meningococcal meningitis and/or meningococcemia) includes one or more of the above criteria and: detection of a group-specific antigen to meningococcus in the cerebrospinal fluid and/or blood; .

The growth of a culture of meningococci from the nasopharynx and other non-sterile loci of the body is not a confirmation of the diagnosis of a generalized form of meningococcal infection.

4. Measures for patients with generalized
form of meningococcal infection

4.1. The generalized form of meningococcal infection is a serious infectious disease that requires immediate hospitalization of the patient in a hospital for diagnosis and treatment.

4.2. Identification of patients with a generalized form of meningococcal infection and persons with suspicion of it is carried out by doctors of all specialties, paramedical workers of medical and preventive, children's, adolescent, health and other organizations, regardless of departmental affiliation and legal form, medical workers engaged in private medical practice , for all types of rendering medical care, including:

When the population seeks medical help;

When providing medical care at home;

When receiving from doctors engaged in private medical practice;

During medical supervision of persons who communicated with patients with meningococcal infection in the outbreak.

4.3. Diagnosis should be confirmed upon admission to the hospital. clinical examination and laboratory analysis (clinical and microbiological) of blood and cerebrospinal fluid samples. Material for microbiological examination is taken before intensive antibiotic therapy. Microbiological examination of material from patients with a generalized form of meningococcal infection and persons suspected of having this disease is carried out in accordance with current regulations.

4.4. About each case of a generalized form of meningococcal infection, as well as suspicion of a disease, doctors of all specialties, paramedical workers of medical and preventive, children's, adolescent and health organizations, regardless of departmental affiliation and legal form, as well as medical workers involved in private medical activities, report by phone within 2 hours and then send an emergency notification in the prescribed form within 12 hours to the bodies exercising state sanitary and epidemiological surveillance at the place of registration of the disease (regardless of the patient's place of residence).

4.5. A medical organization that has changed or clarified the diagnosis of a generalized form of meningococcal infection shall, within 12 hours, submit a new emergency notification to the bodies exercising state sanitary and epidemiological supervision at the place where the disease was detected, indicating the initial diagnosis, the changed (clarified) diagnosis and the date of the clarified diagnosis .

4.6. The bodies exercising state sanitary and epidemiological supervision upon receipt of emergency notifications of a modified (specified) diagnosis of a generalized form of meningococcal infection inform the medical and preventive organizations at the place of detection of the patient that sent the initial emergency notification.

4.7. On the results of microbiological examination of the material from the patient on the etiological interpretation of the disease and serogrouping of meningococci, the medical institution reports to the authorities exercising state sanitary and epidemiological supervision at the place of registration of the patient (regardless of his place of residence) no later than the 4th day after his hospitalization.

4.8. Discharge of a patient with a generalized form of meningococcal infection from the hospital is carried out after clinical recovery. Convalescents of the generalized form of meningococcal infection are allowed to preschool educational institutions, schools, boarding schools, health organizations, sanatoriums, hospitals, secondary and higher educational institutions after the completion of the course of treatment.

4.9. The completeness, reliability and timeliness of recording diseases of meningococcal infection, as well as the prompt and complete reporting of them to the bodies exercising state sanitary and epidemiological supervision, is ensured by the heads of medical, preventive, children's, adolescent, health and other organizations, regardless of departmental affiliation and organizational and legal forms.

4.10. Each case of meningococcal infection is subject to registration and registration in medical and preventive, children's, adolescent, health and other organizations, regardless of departmental affiliation and legal form.

4.11. Reports on diseases of meningococcal infection are compiled according to the established forms of state statistical observation.

5. Interventions for contact persons
with a patient with a generalized form of meningococcal
infection, persons suspected of having this disease
and carriers of meningococci

5.1. Persons who have been in contact with a patient with a generalized form of meningococcal infection in a family (apartment), a preschool educational institution, a school, a boarding school, a health institution, a sanatorium, a secondary and higher educational institution are subject to daily medical observation for 10 days with a mandatory examination of the nasopharynx, skin covers and thermometry. The first medical examination of persons who communicated with the patient is carried out with the obligatory participation of an otolaryngologist.

5.2. In pre-school educational institutions, schools, boarding schools, orphanages, orphanages and health-improving organizations, in secondary and higher educational institutions, medical supervision of those who communicated is provided by the medical personnel of these organizations. In the absence of medical workers in these organizations, this work is provided by the heads of medical and preventive organizations serving these organizations.

5.3. During medical observation, the doctor explains to those who had contact with the patient about the most important symptoms of the disease and indicates the need to immediately call the doctor if symptoms or signs of the disease appear. If persons with objective symptoms of the disease are identified, they are immediately hospitalized for further observation.

5.4. After identifying a case of the disease and hospitalizing the patient, all contact persons in the outbreak are given a course of chemoprophylaxis to prevent secondary cases (). In order to achieve the greatest effectiveness, chemoprophylaxis is carried out within the next 24 hours after the registration of a case of the disease. This measure is applied in foci during the period of sporadic non-epidemic morbidity and is limited. If a disease occurs, then chemoprophylaxis in the focus is carried out among: cohabiting family members; persons of institutions where there is cohabitation (students of boarding schools, roommates in a hostel); pupils and staff of preschool institutions (all persons who contacted in classrooms and dormitories); persons who had established contact with the nasopharyngeal secrets of the patient.

5.5. For the purpose of early detection of epidemiologically significant carriers of meningococci (possible sources of infection), a bacteriological examination of persons who communicated with the patient is carried out in foci with 2 or more cases of generalized forms of meningococcal infection and in those foci where the sequential occurrence of diseases is separated by a time interval exceeding the incubation period (more than 10 days). The sampling of material (nasopharyngeal mucus) is carried out among all those who were in close contact with the patient in the first 12 hours after the registration of the case of the disease before the start of chemo-prophylactic measures. Taking and transporting material for bacteriological examination of the nasopharynx for the presence of meningococci is carried out in the prescribed manner.

5.6. Bacteriological examination of persons who have been in contact with a patient with a generalized form of meningococcal infection in foci with 2 or more cases of the disease, as well as repeated examinations of identified carriers of meningococci, are carried out by bodies exercising state sanitary and epidemiological surveillance.

5.7. Patients with acute nasopharyngitis, identified in the focus of meningococcal infection, are examined bacteriologically and, depending on the severity of the clinical course, are hospitalized in an infectious diseases hospital for treatment. It is allowed to treat them at home, subject to regular medical supervision, as well as in the absence of preschool children and persons working in preschool educational institutions, orphanages, orphanages and children's hospitals in the family or apartment.

5.8. Carriers of meningococci identified in foci with 2 or more cases of a generalized form of meningococcal infection are subject to clinical observation and chemoprophylactic measures at home.

5.9. Convalescents of acute nasopharyngitis are allowed to institutions and organizations after the completion of the full course of treatment and with the disappearance of the clinical manifestations of the disease.

5.10. Carriers of meningococci undergo a single bacteriological examination 3 days after the course of chemoprophylaxis, and if there is a negative result, they are admitted to preschool educational institutions, schools, boarding schools, health organizations, sanatoriums and hospitals. With a positive result of bacteriological examination, the course of chemoprophylaxis is repeated until a negative result is obtained,

6. Activities in the focus of meningococcal infection

6.1. The purpose of carrying out anti-epidemic measures in the focus of meningococcal infection (the team where the disease arose with a generalized form of meningococcal infection) is the localization and elimination of the focus.

6.2. Upon receipt of an emergency notification, specialists of the bodies exercising state sanitary and epidemiological supervision, within the next 24 hours after the patient's hospitalization, conduct an epidemiological investigation of the focus of infection with filling out an epidemiological investigation card, determine the boundaries of the focus, persons who communicated with the patient, organize bacteriological examinations of contact persons and patients nasopharyngitis, carry out anti-epidemic measures.

6.3. In the focus of meningococcal infection, after hospitalization of a patient or suspected of this disease, the final disinfection is not carried out, and in the premises where the patient or suspected of the disease previously stayed, wet cleaning, ventilation and ultraviolet irradiation of the room are carried out.

6.4. In preschool educational institutions, orphanages, orphanages, schools, boarding schools, health organizations, children's sanatoriums and hospitals, a quarantine is established for a period of 10 days from the moment of isolation of the last sick person with a generalized form of meningococcal infection. During this period, admission to these organizations of new and temporarily absent children, as well as transfers of children and staff from the group (class, department) to other groups is not allowed.

6.5. In groups with a wide range of people communicating with each other (higher educational institutions, secondary specialized educational institutions, colleges, etc.), if several diseases occur simultaneously with a generalized form of meningococcal infection or sequentially 1-2 diseases per week, the educational process is interrupted for a period of at least for 10 days.

7. Epidemiological surveillance of meningococcal disease

7.1. Epidemiological surveillance of meningococcal infection is the activity of bodies exercising state sanitary and epidemiological surveillance aimed at identifying signs of epidemiological distress and taking preventive anti-epidemic measures to prevent the rise and spread of infectious disease. Identification of early signs of epidemiological trouble for meningococcal infection is carried out by constant dynamic assessment of the state and trends in the development of the epidemic process using methods of operational and retrospective epidemiological analysis.

7.2. The purpose of operational epidemiological analysis is to assess the current situation with meningococcal infection by registering emerging cases of diseases with fixing a block of personalized information (age, gender, address, date of illness, date of treatment, method and results of laboratory diagnostics with determination of the meningococcal serogroup, involvement in organized groups, outcome disease), allowing to identify the beginning of epidemiological trouble for the organization of timely preventive and anti-epidemic measures.

10. Organization of immunization against
meningococcal infection

10.1. Preventive vaccinations against meningococcal infection are included in the calendar of preventive vaccinations according to epidemic indications. Preventive vaccination is started when there is a threat of an epidemic rise: obvious signs of epidemiological trouble are identified according to clause 2, the incidence of urban residents doubles compared to the previous year, or with a sharp increase in the incidence of more than 20.0 per 100,000 population.

10.2. Planning, organizing, conducting, completeness of coverage and reliability of accounting for preventive vaccinations, as well as timely

The regular submission of reports to the bodies exercising state sanitary and epidemiological supervision is provided by the heads of medical institutions.

10.3. The plan of preventive vaccinations and the need of medical and preventive organizations for medical immunobiological preparations for their implementation is coordinated with the bodies exercising state sanitary and epidemiological supervision.

11. Immunization of the population

11.1. With the threat of an epidemic rise in meningococcal infection, vaccination, first of all, is subject to:

Children from 1.5 years old to 8 years old inclusive;

First-year students of secondary and higher educational institutions, as well as persons who arrived from different territories of the Russian Federation, countries of near and far abroad and united by cohabitation in hostels.

11.2. With a sharp rise in the incidence (over 20 per 100,000 population), mass vaccination of the entire population is carried out with a coverage of at least 85%.

11.3. Preventive vaccinations for children are carried out with the consent of the parents or other legal representatives of minors after receiving from medical workers complete and objective information about the need for preventive vaccinations, the consequences of refusing them, and possible post-vaccination complications.

11.4. Health workers inform adults and parents of children about the required preventive vaccinations, the time of their implementation, as well as the need for immunization and possible reactions body for drug administration. Vaccination is carried out only after obtaining their consent.

11.5. If a citizen or his legal representative refuses to be vaccinated, the possible consequences are explained in an accessible form.

11.6. Refusal to carry out prophylactic vaccination is recorded in medical documents and signed by an adult, a parent of a child or his legal representative.

11.7. Immunization is carried out by medical personnel trained in immunoprophylaxis.

11.8. To carry out preventive vaccinations in medical and preventive organizations, vaccination rooms are allocated and equipped with the necessary equipment.

11.9. In the absence of a vaccination room in a medical and preventive organization serving the adult population, preventive vaccinations can be carried out in medical offices that meet sanitary and hygienic requirements.

11.10. Children attending preschool educational institutions, schools and boarding schools, as well as children in closed institutions (orphanages, orphanages) are vaccinated in the vaccination rooms of these organizations, equipped with the necessary equipment and materials.

11.11. Vaccination at home is allowed when organizing mass immunization by vaccination teams provided with appropriate funds.

11.12. Medical staff with acute respiratory diseases, tonsillitis, having injuries on the hands, purulent lesions of the skin and mucous membranes, regardless of their location, are excluded from preventive vaccinations.

11.13. Storage and transportation of medical immunobiological preparations is carried out in accordance with the requirements of regulatory documents.

11.14. Prophylactic vaccination against meningococcal infection is carried out with medical immunobiological preparations registered in the territory of the Russian Federation in accordance with the established procedure in accordance with the instructions for their use.

11.15. The meningococcal polysaccharide vaccine can be administered simultaneously with other types of vaccines and toxoids, except for the BCG vaccine and the yellow fever vaccine, but in different syringes.

11.16. Immunization is carried out with disposable syringes.

12. Accounting for preventive vaccinations and reporting

12.1. Information about the vaccination performed (date of administration, name of the drug, batch number, dose, control number, expiration date, nature of the reaction to the administration) is recorded in medical documents of the established form:

For children and adolescents - in the card of preventive vaccinations, the history of the child's development, the child's medical card for schoolchildren, the loose sheet for the teenager to the outpatient medical record;

In adults - in the outpatient card of the patient, the register of preventive vaccinations;

In children, adolescents and adults - in the certificate of preventive vaccinations.

12.2. In a medical and preventive organization, registration forms of the established form are created for all children under the age of 15 years (14 years 11 months 29 days) living in the service area, as well as for all children attending preschool educational institutions and schools located in the service area.

12.3. Information about the preventive vaccinations carried out for children under 15 years old (14 years 11 months 29 days) and adolescents, regardless of the place of their implementation, is entered into the accounting forms of the established sample.

12.4. Accounting for local, general, strong, unusual reactions and post-vaccination complications to vaccinations against meningo-coccal infection in medical and preventive organizations and bodies and institutions of state sanitary and epidemiological supervision is carried out in the prescribed manner.

12.5. A report on preventive vaccinations carried out is carried out in accordance with the state forms of statistical observation.

Attachment 1

Chemoprophylaxis of meningococcal infection

Chemoprophylaxis of meningococcal infection is carried out with one of the following drugs:

1) rifampicin- form of administration through the mouth (adults - 600 mg every 12 hours for 2 days; children - 10 mg / kg of body weight every 12 hours for 2 days);

2) azithromycin- form of administration through the mouth (adults - 500 mg 1 time per day for 3 days; children - 5 mg / kg body weight 1 time per day for 3 days);

amoxicillin - a form of oral administration (adults - 250 mg every 8 hours for 3 days; children - children's suspensions in accordance with the instructions for use);

3) spiramycin- form of administration through the mouth (adults - 3 million IU in two doses of 1.5 million IU for 12 hours);

ciprofloxacin - a form of administration through the mouth (adults - 500 mg once);

ceftriaxone - a form of intramuscular injection (adults - 250 mg once).

Annex 2

(reference)

Clinical manifestations and differential diagnosis
meningococcal infection

Clinical manifestations of meningococcal infection are diverse. There are: localized form - nasopharyngitis and generalized forms - meningitis, meningococcemia, combined form (meningitis + meningococcemia). Possible: meningococcal pneumonia, endocarditis, arthritis, iridocyclitis.

Acute purulent meningitis is the most common form of generalized meningococcal infection. Diagnosis of the disease is based on an assessment of the cerebrospinal fluid, so a lumbar puncture is performed in all cases with suspected purulent meningitis. Meningococcemia, sometimes its fulminant form, can occur alone or in combination with purulent meningitis. The first clinical manifestations of purulent meningitis are: a sudden unbearable headache, a rise in temperature above 38 ° C, nausea, vomiting, photophobia and tension (rigidity) of the neck muscles. Neurological symptoms may manifest as stupor, delirium, coma, and seizures. In infants, the first manifestations are not so pronounced, muscle rigidity, as a rule, is not pronounced, while the children are excited, cry inconsolably piercingly, refuse to eat, have a tendency to gag reflex and convulsions, the skin is pale, there is a bulging fontanel.

Meningococcemia, unlike meningitis, is difficult to diagnose, especially during the period of sporadic non-epidemic morbidity, since the suddenness and severity of clinical manifestations, heat, the state of shock is not always clearly expressed. Meningeal symptoms are usually absent. The most characteristic sign of meningococcemia is a hemorrhagic rash.

Lumbar puncture confirms the clinical diagnosis of purulent meningitis and makes it possible to identify meningococci, excluding other possible etiological agents of purulent meningitis, such as pneumococci, Haemophilus influenzae type "b" and other pathogens. A puncture is performed if meningitis is suspected in a hospital before antibiotic therapy is started. The cerebrospinal fluid in purulent meningitis is usually cloudy or purulent, but may be clear or bloody. Primary laboratory diagnosis of cerebrospinal fluid in purulent meningitis indicates: leukocytosis of more than 100 cells per mm3 (the norm is less than 3 cells per mm3) with a predominance of neutrophils (more than 60%); an increase in protein levels from 0.8 g / l or more (the norm is less than 0.3 g / l); detection of extracellular and intracellular diplococci. Additional important laboratory criteria are: decrease in glucose; isolation, identification and serogrouping of the culture of meningococci; detection of specific meningococcal antigens or their genetic fragments.

The hemogram is characterized by a pronounced leukocytosis. With meningococcemia, blood cultures are often accompanied by the isolation of a culture of meningococci, serological reactions reveal specific antigens, and direct blood microscopy reveals extracellular and intracellular diplococci. The possibility of sowing meningococci directly from the elements of a hemorrhagic rash is not excluded.

Symptoms of meningococcal nasopharyngitis are similar to clinical manifestations acute respiratory disease. Observed - general weakness, headache, sore throat when swallowing, dry cough, nasal congestion, poor mucopurulent discharge. The back wall of the pharynx is edematous, hyperemic, covered with mucous discharge, from 2 to 3 days hyperplasia of the lymphoid follicles is observed. The temperature is often subfebrile, rarely normal or reaches 38 - 39 ° C. Inclusion of the disease in the registration reports requires laboratory isolation of meningococci from the nasopharynx. Conducting laboratory tests to identify isolated meningococci and determine their serogroup affiliation is a mandatory component of laboratory confirmation of patients with meningococcal nasopharyngitis.

Bibliographic data

1. Federal Law "On the sanitary and epidemiological well-being of the population" dated March 30, 1999 No. 52-FZ.

2. Federal Law "On Immunoprophylaxis of Infectious Diseases" dated September 17, 1998 No. 157-FZ.

3. Fundamentals of the legislation of the Russian Federation "On the protection of the health of citizens" of July 22, 1993

4. Regulations on the implementation of state sanitary and epidemiological surveillance in the Russian Federation, approved by the Decree of the Government of the Russian Federation of September 15, 2005 No. 569.

5. Regulations on the Federal Service for Supervision of Consumer Rights Protection and Human Welfare, approved by Decree of the Government of the Russian Federation of June 30, 2004 No. 322.

7. Orders in force as of January 1, 2006, guidelines, recommendations, instructions and guidelines for the use of vaccines and toxoids, approved by the Ministry of Health and Social Development of the Russian Federation, the Federal Service for Supervision of Consumer Rights Protection and Human Welfare.

8. Order of the Ministry of Health of the Russian Federation No. 229 dated June 27, 2001 "On the national calendar of preventive vaccinations and the calendar of preventive vaccinations according to epidemic indications."

9. MUK 4.2.1887-04 "Laboratory diagnosis of meningococcal infection and purulent bacterial meningitis" - M., 2005.

10. Savilov E.D., Mamontova L.M., Astafiev V.A., Zhdanova S.N. Application of statistical methods in epidemiological analysis. -M., 2004.

11. L.P. Zueva, R.X. Yafaev. Epidemiology. - S.-Pb., 2006.

The document is no longer valid or canceled

Decree of the Chief State Sanitary Doctor of the Russian Federation of May 18, 2009 N 33 "On approval of the sanitary and epidemiological rules SP 3.1.2.2512-09" (together with "SP 3.1.2.2512-09. Prevention of meningococcal infection. Sanitary and epidemiological ...

IV. Events in the focus of a generalized form

meningococcal infection in the inter-epidemic period

4.1. The inter-epidemic period is characterized by sporadic incidence of generalized forms caused by various serogroups of meningococcus. The overwhelming number of foci (up to 100%) is limited to one case of the disease.

4.2. After receiving an emergency notification in the event of a generalized form of infection or suspicion of this disease, specialists from the territorial bodies of Rospotrebnadzor conduct an epidemiological investigation within 24 hours to determine the boundaries of the outbreak and the circle of people who contacted the patient, and organize anti-epidemic and preventive measures to localize and eliminate the outbreak .

4.3 Anti-epidemic measures in the outbreaks are aimed at eliminating possible secondary diseases and preventing the spread of infection outside the outbreak. They are limited to a circle of persons from the immediate environment of the patient with a generalized form. These include relatives living in the same apartment with the sick person, close friends (with whom they communicate constantly), pupils and staff of the children's organization group, roommates and dormitory roommates.

The list of close contacts can be expanded by the epidemiologist depending on the specific situation in the outbreak.

4.4. In the outbreak, after hospitalization of a patient with a generalized form or suspicion of it, quarantine is imposed for a period of 10 days. During the first 24 hours, the otolaryngologist examines the persons who communicated with the patient in order to identify patients with acute nasopharyngitis. Identified patients with acute nasopharyngitis are subject to bacteriological examination prior to the appointment of appropriate treatment. After a bacteriological examination of persons with symptoms of acute nasopharyngitis, they are hospitalized in a hospital (according to clinical indications) or left at home for appropriate treatment in the absence of children under the age of 3 in the immediate environment. All persons without inflammatory changes in the nasopharynx undergo chemoprophylaxis with one of the antibiotics (Appendix), taking into account contraindications. Refusal from chemoprophylaxis is registered in the medical records and signed by the responsible person and medical worker.

4.5. During the quarantine period, the outbreak is under medical supervision with daily thermometry, examination of the nasopharynx and skin. Children's preschool organizations, orphanages, orphanages, schools, boarding schools, children's health organizations are not allowed to accept new and temporarily absent children, transfer personnel from groups (class, department) to other groups.

4.6. The occurrence of foci with secondary diseases with generalized forms of meningococcal infection within one month during the inter-epidemic period is an alarming sign of a possible increase in the incidence. In such foci, with the established serogroup of meningococcus that formed the foci, emergency vaccination is carried out with a meningococcal vaccine, which contains an antigen corresponding to the serogroup detected in patients.

Vaccination is carried out in accordance with the instructions for use of the vaccine.

Vaccinations are subject to children older than 1 - 2 years, adolescents and adults:

In a children's preschool educational organization, orphanage, orphanage, school, boarding school, family, apartment - all persons who communicated with the patient;

Persons who communicated with the patient in hostels, in the event of a disease in teams staffed by foreign citizens.

The presence of a vaccinated disease with nasopharyngitis without a temperature reaction is not a contraindication for vaccination.

Meningococcal infection is an anthroponotic disease caused by meningococcus and occurring in various clinical forms. The causative agent is Neisseria meningitidis (meningococci are gram-negative cocci). Depending on the structure of the polysaccharide, 12 serogroups are distinguished: A, B, C, X, Y, Z, W-135, 29E, K, H, L, I. Meningococci of serogroups A, B, C are the most dangerous and can often cause diseases , outbreaks and epidemics. Intragroup genetic subgrouping of meningococci and determination of enzyme types makes it possible to identify hypervirulent strains of meningococci (serogroup A meningococci - genetic subgroup III-1, serogroup B meningococci - enzyme types ET-5, ET-37), which is important in predicting epidemiological distress.

There are three categories of sources of infection: patients with a generalized form of meningococcal infection, patients with meningococcal nasopharyngitis, carriers of meningococci. The pathogen is transmitted from person to person by airborne droplets. More often they become infected from asymptomatic carriers and less often through direct contact with a patient with a generalized form of meningococcal infection. The risk of developing the disease in children is higher than in adults. All persons are susceptible to the disease, but the risk of infection is higher in people with a deficiency of terminal complement components and in people with splenectomy.

The incubation period is 1 to 10 days, usually less than 4 days.

Activities in the focus of meningococcal infection.

In the focus of meningococcal infection, after hospitalization of a patient or suspected of this disease, the final disinfection is not carried out, and in the premises where the patient or suspected of the disease previously stayed, wet cleaning, ventilation and ultraviolet irradiation of the room are carried out.

In preschool educational institutions, orphanages, orphanages, schools, boarding schools, health organizations, children's sanatoriums and hospitals, a quarantine is established for a period of 10 days from the moment of isolation of the last sick person with a generalized form of meningococcal infection. During this period, admission to these organizations of new and temporarily absent children, as well as transfers of children and staff from the group (class, department) to other groups is not allowed.

In collectives with a wide range of people communicating with each other (higher educational institutions, secondary specialized educational institutions, colleges, etc.), if several diseases occur simultaneously with a generalized form of meningococcal infection or sequentially 1-2 diseases per week, the educational process is interrupted for a period of at least than 10 days.

Specific prevention of meningococcal infection.

The airborne mechanism of transmission in meningococcal infection and the widespread nasopharyngeal carriage of meningococci (4-8%) in the population hinder the effectiveness of anti-epidemic measures against the source of infection and the causative agent of the disease. A radical measure that prevents the spread of the disease is specific vaccination.

The procedure for conducting prophylactic vaccinations against meningococcal infection, the definition of population groups and the timing of prophylactic vaccinations are determined by the bodies exercising state sanitary and epidemiological supervision. I

Organization of immunoprophylaxis against meningococcal infection.

Preventive vaccinations against meningococcal infection are included in the calendar of preventive vaccinations according to epidemic indications. Preventive vaccination is started when there is a threat of an epidemic rise: obvious signs of epidemiological trouble are identified according to paragraph 7.3, an increase in the incidence of urban residents by a factor of two compared to the previous year, or with a sharp increase in the incidence of more than 20.0 per 100,000 population.

Planning, organization, conduct, completeness of coverage and reliability of accounting for preventive vaccinations, as well as timely submission of reports to the bodies exercising state sanitary and epidemiological supervision, are provided by the heads of medical institutions.

The plan of preventive vaccinations and the need of medical and preventive organizations for medical immunobiological preparations for their implementation is coordinated with the bodies exercising state sanitary and epidemiological supervision.

Immunization of the population.

With the threat of an epidemic rise in meningococcal infection, vaccination, first of all, is subject to:

Children from 1.5 years old to 8 years old inclusive;

First-year students of secondary and higher educational institutions, as well as persons who arrived from different territories of the Russian Federation, countries of near and far abroad and united by cohabitation in hostels.

With a sharp rise in the incidence (over 20 per 100,000 population), mass vaccination of the entire population is carried out with a coverage of at least 85%.

Preventive vaccinations for children are carried out with the consent of the parents or other legal representatives of minors after receiving from medical workers complete and objective information about the need for preventive vaccinations, the consequences of refusing them, and possible post-vaccination complications.

Health workers inform adults and parents of children about the required preventive vaccinations, the time of their implementation, as well as the need for immunization and possible reactions of the body to the administration of drugs. Vaccination is carried out only after obtaining their consent.

If a citizen or his legal representative refuses to be vaccinated, the possible consequences are explained in an accessible form.

Refusal to carry out preventive vaccination is documented in the medical records and signed by the parent or his legal representative.

Immunization is carried out by medical personnel trained in immunoprophylaxis.

To carry out preventive vaccinations in medical and preventive organizations, vaccination rooms are allocated and equipped with the necessary equipment.

In the absence of a vaccination room in a medical and preventive organization serving the adult population, preventive vaccinations can be carried out in medical rooms that meet sanitary and hygienic requirements.

Children attending preschool educational institutions, schools and boarding schools, as well as children in closed institutions (orphanages, orphanages) are vaccinated in the vaccination rooms of these organizations, equipped with the necessary equipment and materials.

Vaccination at home is allowed when organizing mass immunization by vaccination teams provided with appropriate funds.

Medical personnel with acute respiratory diseases, tonsillitis, injuries on the hands, purulent lesions of the skin and mucous membranes, regardless of their location, are excluded from preventive vaccinations.

Storage and transportation of medical immunobiological preparations is carried out in accordance with the requirements of regulatory documents.

Prophylactic vaccination against meningococcal infection is carried out with medical immunobiological preparations registered in the territory of the Russian Federation in accordance with the established procedure in accordance with the instructions for their use.

The meningococcal polysaccharide vaccine can be administered simultaneously in different syringes with other types of vaccines and toxoids, except for the BCG vaccine and the yellow fever vaccine.

Immunization is carried out with disposable syringes.

Vaccines:

· Meningo A+C vaccine (Sanofi-Pasteur, France) for the prevention of meningococcal infection.

3009 0

Acute infectious disease with a probability of developing generalized forms of 0.5%. It is caused by Neisseria, mainly N. meningitis of serogroups A, B and C (less often by others - W13i, X, Y, etc.).

Typical clinical forms: nasopharyngitis, meningitis, meningococcemia, mixed form (meningitis and meningococcemia).

Nasopharyngitis is the most common form of the disease, it does not differ from other acute respiratory infections of other etiologies. Characteristic - moderately severe cough, runny nose or nasal congestion, half of the patients - fever, usually subfebrile. Recovery spontaneous in 3-7 days. A small proportion of patients with nasopharyngitis (1 out of 30-40) develop generalized forms.

Establishing a diagnosis is possible only when examining contacts in the focus of infection. Patients with nasopharyngitis can receive therapy at home: within 4 days, a course of antibiotic therapy with ampicillin, levomycetin, erythromycin, cefuroxime, rifampicin in medium therapeutic doses is carried out, in combination with irrigation and rinsing of the throat with antiseptic solutions (1: 5000 solution of furacillin, etc.) .

Meningitis, meningoencephalitis are manifested by a sudden (usually exactly the hour is indicated) onset of the disease, accompanied by a sharp increase in temperature to high numbers, anxiety of the child, the appearance of complaints of a strong (sometimes unbearable) headache, vomiting. By the end of the first day, most patients show positive meningeal signs - symptoms of Kernig, Brudzinsky, neck stiffness.

In infants, swelling and pulsation of the large fontanel is important. At a later date, a characteristic posture arises - a "pointing dog" or a "cocked trigger": the children lie on their side, their heads are thrown back, their legs and arms are bent, their stomach is pulled in. Consciousness is usually significantly impaired, generalized tonic-clonic convulsions are not uncommon. With primary diagnosis after the 3rd day from the onset of the disease, the prognosis of the disease deteriorates sharply.

Meningococcemia in the absence of concomitant meningitis is manifested by a rapid onset, high fever, anxiety of the child, the appearance during the first 6 hours of a rash with predominant localization on the buttocks, legs, lateral surface of the body. Initially, it may be morbilliform (maculopapular), but primary or secondary hemorrhagic rashes of an irregular (star-shaped) shape, located in the same places and with necrosis in the center, are of primary importance.

This form is often accompanied by the development of infectious-toxic (septic) shock, the diagnosis of which is to identify cold extremities, the appearance of blue spots on the skin or diffuse cyanosis, the appearance of tachycardia and low blood pressure.

Only early diagnosis meningitis and meningococcemia is the key to successful therapy of patients. Immediate hospitalization of children with anti-shock therapy is necessary for them already at prehospital stage(oxygen, prednisolone, sometimes with the introduction of anti-shock liquids into the vein). If meningitis is detected (without a rash), it is possible to administer penicillin at the prehospital stage.

Site surveillance

Children are discharged after clinical recovery. In the children's team are allowed no earlier than 10 days after discharge from the hospital. Those who have had meningitis are observed together with a neuropathologist for 12 months, meningoencephalitis - 2 years.

After a "clean" meningococcemia, which ended in complete recovery, the observation is terminated 1 month after discharge from the hospital. Vaccination is possible one month after clinical recovery. Children who have had a meningococcal infection (meningitis, meningococcemia, a mixed form of a generalized infection and nasopharyngitis) are discharged after the end of therapy without a bacteriological examination for meningococcus.

Convalescents are allowed in an organized children's team, secondary specialized and higher educational institutions in the presence of the 1st negative bacteriological test carried out no earlier than 5 days after the end of the course of treatment, bacteria excretors - 3 days after the end of sanitation (San.-epidemiological rules SP 3.1.2.1321- 03).

Activities in the focus of infection

For persons who communicated with a patient with a generalized form of meningococcal infection in the family (apartment), as well as in closed children's groups, daily medical supervision is established for 10 days with a mandatory examination of the nasopharynx, skin and thermometry. The first medical examination of persons who have been in contact with a patient or a carrier is carried out with the obligatory participation of an otolaryngologist.

Children attending preschool educational institutions, and personnel working in these institutions who have had contact with a patient with meningococcal nasopharyngitis, undergo a medical examination and a single bacteriological examination of the nasopharynx.

A bacteriological examination is carried out for all persons from the environment of a patient with a generalized form of meningococcal infection or a suspected disease:
- in preschool educational institutions, orphanages, orphanages, sanatoriums for children, hospitals and health organizations: for children in a group or department, as well as for service personnel of the entire organization;
- at school: to students and teachers of the class where the patient is registered or with suspected illness;
- in boarding schools: students who communicated in the classroom and in the dormitory, as well as teachers and educators of this class;
- in families (apartments): to all persons who communicated with the patient;
- in secondary and higher educational institutions: when registering a case of a disease in the first year - to teachers and students of the entire course, in senior courses - who communicated with the patient in a group and a hostel room;
- in other organized groups - to persons living in hostels.

The frequency of bacteriological examination in the foci of meningococcal infection is determined as follows:
- 2-fold examination of contacts with an interval of 7 days is carried out in preschool educational institutions, orphanages, orphanages, sanatoriums, hospitals for children;
- 1-fold bacteriological examination of contacts is carried out in all other groups.

Taking and transporting material for bacteriological examination for the presence of the causative agent of meningococcal infection is carried out in the prescribed manner.

Bacteriological studies of material from patients with meningococcal infection and persons suspected of having this disease, as well as those who communicated with them, are carried out in accordance with regulatory documents.

Teams with a wide range of people communicating with each other (students living in a hostel, boarding schools, etc.) in the event of the occurrence of several diseases at the same time with generalized forms of meningococcal infection or sequentially 1-2 diseases per week are dismissed for a period of at least 30 days.

Post-exposure specific prophylaxis (polysaccharide meningococcal vaccine A or A + C) is carried out for children aged 1 to 7 years with an incidence of more than 2.0 per 100 thousand of the population, up to 20 years of age - with an incidence of 20.0 per 100 thousand of the population and above. Children should be vaccinated in the first 7 days after contact, again - every 3 years with a high incidence in the territory. Vaccinations are carried out in the first 5-10 days after the first contact with the patient.

The presence of nasopharyngitis or carriage is not a contraindication for vaccination. If other causative agents of meningococcal infection are detected for prophylactic purposes, human immunoglobulin is administered to contact children aged 7 months to 7 years in accordance with the instructions for its use, intramuscularly, once, no later than 7 days after the source is established.

V.P. Dairy, M.F. Rzyankina, N.G. Lived