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Skrypnyk, K.S. Neporada, O.F. Hopko // Visnyk problem biolohii i medytsyny - 2017 - Vyp. 4, tom 1 (139). - c.70-73.
5. Snihyr N.V., Sabadash V.Ye. Rol helicobacter pylori v etiopatohenezi khvorob shlunkovo-kyshkovoho traktu / N.V. Snihyr, V.Ye. Sabadash // Liky Ukrainy. - Medicine of Ukraine. - 2019. - №2 (228).- s. 12-15.
6. Melinder C. Decreased stress resilience in young men significantly increases the of subsequent peptic ulcer disease - a prospective study of 233 093
men in Sweden / C. Melinder // Aliment. Pharmacol. Ther. - 2015. - Vol. 41 (10). - P. 1005-1015.
7. Bhatia V. Stress and the gastrointestinal tract / V. Bhatia, R.K. Tandon // J. of Gastroenterology and Hepatology. - 2005. - Vol. 20 (3). - P. 332-339.
8. Iskra Yu., Biliaiev A. Chastota stresovykh vyrazok i yikh zalezhnist vid kyslotnosti shlunkovoho vmistu v peryoperatsiinyi period u ditei /Iu. Iskra, A. Biliaiev // Ukrainskyi naukovo-medychnyi molodizhnyi zhurnal. - 2017. - №1(99). - S.31-36.
UDC:616.932-07:355.01(477)
Melenko Svitlana Romanivna
PhD, Associate Professor of the Department of Infectious Diseases and Epidemiology
Bukovinian State Medical University Klym Lidiia Olexandrivna student
Bukovinian State Medical University
Zapotochna Viktoria Olexandrivna
student
Bukovinian State Medical University DOI: 10.24412/2520-6990-2023-9168-55-58 CHOLERA AND THE ONGOING WAR
Abstract.
During military operations, for a number of reasons, such as deterioration in the quality of drinking water, inadequate compliance with sanitary standards due to the occupation of territories, etc. Among the acute intestinal infections, cholera outbreaks pose a great danger. The issue ofprevention of acute infectious diseases is urgent.
Keywords. Cholera, vibrion cholera, war, pandemic, seven cholera pandemics, Ukrainian cases of cholera
Introduction. According to the International Health Regulations (IHR) 2005, due to the ease of infection, high rate of spread, severe course, and high mortality, cholera is an infectious disease that significantly affects public health and can spread rapidly on an international scale.
Cholera has plagued humans for hundreds, if not thousands, of years, particularly in the areas around the Bay of Bengal, with some of the first records of cholera-like illness reported in ancient Sanskrit medical texts written around 500-400 BCE[1]. One of the first descriptions of cholera dates back to the campaigns of Alexander the Great, whose soldiers probably suffered from the disease during an Indian campaign. One source describes the patient's condition as follows: "The lips turn pale, the gaze becomes meaningless, the eyes roll back, the arms and legs shrivel as if by fire, and the disease affects many thousands of people."
Favorable conditions for the spread of the disease include a hot climate, high rainfall, the presence of water bodies contaminated with feces, and high population density. The peculiarities of India as the primary center of cholera "preserved" the disease without significant changes until the nineteenth century. However, since the 1800s, the spread of cholera has suddenly and tragically for humanity become a pandemic, which has been recorded since 1817. The reasons for this rapid spread of the disease are the explosive growth of international trade, numerous colonial wars, and significant migration.
Since then, cholera has become a pandemic. The first pandemic (1817-1824) began in India during the colonial war and spread to neighboring regions of India - China, Ceylon, and then to Japan. In 1820, the disease was discovered in East Africa. The following year, the British brought it to Arabia, then to Persia, Turkey, and the Transcaucasus[2].
II pandemic (1826-1851)
In 1826-1828, the disease spread east of India, to China, Indochina, and northwest to Afghanistan, Khiva, and Bukhara[3]. Meanwhile, in 1830, the disease made its way to the Middle East. Up to 150 thousand people died in Egypt. During the Russo-Polish War of 1830-1831, more than 12 thousand soldiers died of cholera in the Russian army alone. The following year, French colonial troops introduced cholera to Africa, and emigrants to North America and Australia[4]. In the Russian Empire, 534,000 people fell ill with cholera in two years, and 230,000 died. Cholera appeared in Central and Western Europe in 1831. The disease pandemic spread to all continents. In 1848, 60-100 soldiers died of cholera every day in the Russian army of Field Marshal Paskevich in Galicia[3].
III pandemic (1852-1860)
From India, the spread of cholera to Persia was associated (and later it happened often) with the Shiite pilgrimage to the sacred graves of Kerbala and Najaf. Cholera was brought to Arabia by pilgrims traveling to the Muslim shrines in Mecca and Medina[2]. In those years, there were problems with water stored in con-
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taminated cisterns, there were not enough public re-strooms, and crowds and swarms of flies had a negative impact. These sacred Muslim cities were an additional hotbed of cholera until the mid-20s of the 20th century, as pilgrims from North Africa, the Middle East, and the Middle East carried it from their native places after receiving it from Indian believers[3].
IV pandemic (1863-1875)
It is notable for the rapid spread of the disease by rail and ship after the opening of the Suez Canal, which "provided" courier transportation of the infection from India to Europe. Now cholera could reach Europe not in two or three years, but in a few weeks. The ships that sailed from Alexandria, Egypt, carried it to the ports of Italy, France, and Spain.
V pandemic (1881-1896)
For the first time, the pandemic started not in India but in Egypt. It was there, in Cairo, in 1883, that German scientist Robert Koch isolated a pure culture of cholera vibrio from the corpses of cholera victims and described the causative agent of the disease in detail[5]. According to various estimates, over 10 million people died of cholera in the nineteenth century[6].
Pandemic VI (1899-1923)
It emerged again from India and lasted longer than any other before it. It covered all continents except Antarctica. Until 1905, only the classical cholera vibrio was considered the causative agent of cholera. However, in 1905, German bacteriologist Felix Gottschlich isolated another vibrio from the intestines of pilgrims returning from Mecca who died of diarrhea at the El Tor quarantine station in the Sinai Peninsula, which got its name from the station itself [7].
The VII cholera pandemic began in 1961, but, unlike the previous ones, it was caused by the El Tor biotype, although in recent years an increase in morbidity caused by both the classical cholera vibrio and other serogroups has been recorded again. This pandemic continues to this day[4].
Cases of cholera in Ukraine have been detected during all pandemics. During the Second Pandemic, cholera was introduced to Ukraine in 1830. The spread of cholera was facilitated by the Russo-Ottoman war, when the army began to return from combat. Cholera reached its peak in Ukraine in 1831. In 1847, the Third Pandemic reached the shores of the Black and Azov Seas, first in Odesa, and then throughout Ukraine and Poland. In 1847, cholera reached Kyiv, where it claimed many lives. At that time, the Ukrainian pathologist Ivan Mykolaiovych Reypolskyi was engaged in the study of cholera. In 1853-1855, cholera was especially rampant in the Crimea during the Crimean War. During the Fourth Pandemic, cholera spread in August 1865 from Constantinople, first to Odesa, and from 1866 to almost all communities in Ukraine. An investigation organized by the military governor revealed that many citizens in the suburbs either secretly dumped corpses into the Dnipro or buried them in secluded places.
During the fifth pandemic in late 1885, cholera reached Galicia, central and eastern Ukraine.
The VI cholera pandemic - in Ukraine, there were initially isolated cases. With the outbreak of the First
World War (1914), cholera spread in the Russian army, mainly on the Southwestern Front. In the next two years, the epidemic decreased significantly, but in 1918, due to the intensive movement of refugees, demobilized and prisoners of war, and then because of the civil war, a new large outbreak of cholera occurred. It spread throughout Ukraine. The mortality rate from cholera was very high; for example, in Odesa in 1918 it was 55.8%, in 1919 - 47.2%, in 1920 - 65.0%, and in 1921 - 48.8%. The highest mortality rate was among the youngest and oldest groups of patients. After the end of the civil war, the authorities launched a vigorous fight against cholera, and as a result, cholera was finally eliminated throughout the USSR by 1926 [8].
Given the history of the spread of cholera across the globe, we can draw certain conclusions about the causes of its spread. After all, every pandemic coincides with armed conflicts, occupation of territories and a large number of refugees who were forced to live in poor sanitary conditions. During any armed conflict, especially one that escalates into a large-scale war, sanitary conditions deteriorate not only among the military but also among the local population.
More than 35,000 suspected cases of cholera have been reported across the Syria, according to the United Nations' children's agency. UNICEF said only approximately 2,500 have been tested, of which nearly half were confirmed positive[9].
For example, the Yemeni Civil War (2014-pre-sent) has led to widespread destruction that has triggered the world's largest cholera outbreak [10].
The large-scale Russian aggression against Ukraine is no exception.
Many cities and villages have suffered and continue to suffer from aerial bombardment and fighting on their territories. A humanitarian catastrophe is developing in many settlements in the eastern part of Ukraine. Due to the constant shelling and destroyed infrastructure, local residents are unable to receive water of adequate quality. Residents of the occupied territories have not had access to proper medical treatment for a long time, which significantly reduces the chances of a positive outcome in the event of an infection.
Water infrastructure is often indirectly damaged due to secondary reverberating effects of attacks on urban infrastructure. For example, the Alouk water station in the Al-Hasakeh governorate in Syria, which serves 460 000 people directly and another half a million indirectly via truck transport, has faced numerous deliberate disruptions as a result of Turkish occupation. In northwest Syria, substantial water infrastructure damage occurred in July, 2019, when eight facilities in the Al-Ma'ra district were attacked by Syrian Government forces, leaving a quarter of a million people without water[11].
Prolonged exposure to shelling and lack of access to drinking water forces people to use water from any source: puddles, pipes, open wells, filled open containers, etc. in the destroyed villages and cities of Ukraine, including Mariupol, is a well-known fact. All this can lead to the development of acute intestinal infections,
«coyyomum-joutmal» #9168), 2023 / MEDICAL sciences
including cholera. There is a suspicion of cholera outbreaks in this city, but reliable data is not available due to the occupation.
The mechanism of cholera transmission is fecal-oral. This mechanism can be realized in several ways, and depending on the predominance of one or another way, cholera epidemics are distinguished as waterborne, contact, foodborne, and mixed. Mixed epidemics occur more often. In the case of waterborne cholera, there is a rapid increase in the incidence within a few days. Infection occurs when people swim in open water or consume infected water for drinking and other household needs. The number of cases depends on the degree of contamination of water bodies, the number of people using this water, and the effectiveness of anti-epidemic measures [12].
The WHO does not recommend quarantine measures or a ban on the movement of people and goods in the prevention of cholera. The few cases of cholera linked to imported food have involved food that belonged to individuals who traveled.
The WHO's recommendations for the public to
prevent cholera (1992) have three basic rules:
• Heat food;
• Boil water;
• Wash your hands.
Preventive measures to prevent the further spread of cholera in the event of an outbreak in a particular area. Immediately after an outbreak is identified, the usual intervention strategy should aim to reduce mortality by providing rapid access to treatment and limiting the spread of the disease by disinfecting water, providing adequate sanitation, and conducting active health education to improve hygiene and safe food handling practices in individual communities, which are critical factors in reducing cholera.
Therefore, in order to minimize water loss in the body in case of lack of access to it and poisoning by substances contained in it (biological and toxic), the following rules should be followed:
- be sure to have and take a supply of water with you when moving to a bomb shelter, basement or other places;
- clothing should be adequate to the temperature and humidity conditions, it should not be too hot or too cold;
- if possible, reduce physical activity in the shelter or at home;
- boil water: in the absence of suspicion of infection with bacterial agents from the moment of boiling - 10 minutes, if such infection is suspected - 1 hour.
- if the supply of safe water is exhausted and there is no possibility of boiling, you can disinfect water with special tablets - Aquatabs, Aquacid, Pantocid and its variants, etc[13].
Some experts cite ways to purify water in extreme conditions using iodine drops, potassium permanganate, hydrogen peroxide, or hydroperite tablets, etc.
During a war, water is sometimes more important than food, any strategic actions, and ammunition, because it can be a source of much greater mass destruction than the military actions themselves, especially in the absence of access to medical care.
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The search for options to reduce the spread of the disease has been ongoing throughout the history of the disease. Ukrainian scientists also did not stand aside.
In 1888, the Ukrainian microbiologist Mykola Fe-dorovych Gamaleya tested the safety of an oral vaccine made from killed vibrios, which he proposed for the prevention of cholera, on himself and his wife. Vo-lodymyr Aronovych Khavkin, a bacteriologist and epidemiologist from Berdiansk and Odesa, a student of Ilya Ilyich Mechnikov, devoted much of his time to cholera research. The world owes him the introduction of the anti-cholera vaccine, which he tested on himself in 1892. Danylo Zabolotnyi, a Ukrainian microbiologist and epidemiologist, together with Ivan Savchenko, a pathologist and microbiologist, conducted a dangerous experiment in 1893. They drank a live culture of cholera vibrio after a preliminary test immunization to confirm the effectiveness of the oral vaccine.
According to WHO recommendations, in areas where cholera is endemic and where outbreaks are at risk, immunization with existing whole-cell killed oral cholera vaccines should only be used in combination with the usual recommended control measures. Vaccines provide only short-term protection while longer-term measures such as improved water and sanitation are being implemented.
Currently there are three WHO pre-qualified oral cholera vaccines (OCV): Dukoral®, Shanchol™, and Euvichol-Plus®. All three vaccines require two doses for full protection.
In October 2017, GTFCC partners launched a strategy for cholera control Ending Cholera: A global roadmap to 2030. The country led strategy aims to reduce cholera deaths by 90% and to eliminate cholera in as many as 20 countries by 2030. [14].
Conclusions. Cholera is a particularly dangerous infectious disease. It is characterized by rapid spread under appropriate conditions and in the absence of control of sanitary and epidemiological standards. Wars are accompanied by the destruction of critical infrastructure, which contributes to the use of unfit water for consumption. The inability to use safe water causes outbreaks of acute intestinal infections, including cholera. It is impossible to achieve a significant reduction in cholera outbreaks if armed conflicts continue on the planet.
References:
1. Cholera Suman Kanungo, Andrew S Azman, Thandavarayan Ramamurthy, Jaqueline Deen, Shanta Dutta Affiliations expand. PMID: 35397865 (https://doi.org/10.1016/s0140-6736(22)00330-0)
2. Hays, JN (2005). Epidemics and Pandemics: Their Impacts on Human History. ABC-CLIO. c. 193. ISBN 1-85109-658-2. (http://books.google.com/books?id=GyE8Qt-kS1kC&printsec=frontcover&source=gbs_sum-mary_r&cad=0#PPA193,M2 )
3. Charles E. Rosenberg (1987). The Cholera Years: The United States in 1832, 1849, and 1866. University of Chicago Press.( https://archive.org/details/cholerayearsunit0000rose)
4. Cholera's seven pandemics Disease has killed millions since 19th century May 9, 2008 | 4:58 PM ET/
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58
CBC News
(https://web.archive.org/web/20080513221429/http:// www.cbc.ca/health/story/2008/05/09/f-cholera-out-breaks.html)
5. Howard-Jones, N (1984). Robert Koch and the cholera vibrio: a centenary. BMJ 288 (6414): 379-81. PMC 1444283. PMID 6419937. (https://dx.doi.org/10.1136%2Fbmj.288.6414.379)
6. Pyle GF (2010). «The Diffusion of Cholera in the United States in the Nineteenth Century». Geographical Analysis 1: 59-75. doi:10.1111/j.1538-4632.1969.tb00605.x. PMID 11614509 (https://www.ncbi.nlm.nih.gov/pubmed/11614509?do pt=Abstract)
7. GOTSCHLICH F. — Über choiera — und choleraähnliche Vibrionen unter den aus Mekka zurückkeren — den Pilgern. Zeitschrift für Hygiene und Infektionen, 1906, 53, 281—304.
8. Infectious Diseases (Textbook) (ed. O. A. Ho-lubovska) - Kyiv: VSV "Medicine" (2nd edition, supplemented and revised) - 2018. - 688 p. + 12 p. color in.
9. Poor Access to Safe Water Fuels Cholera Outbreak in Syria Reuters Health Information © November 11, 2022 (https://www.medscape.com/viewarticle/983845)
10. Dynamic mapping of cholera outbreak during the Yemeni Civil War, 2016-2019. Ryan B. Simpson, Sofia Babool, Maia C. Tarnas, Paulina M. Kaminski, Meghan A. Hartwick & Elena N. Naumova Journal of Public Health Policy volume 43, pages185-202 (2022) (https ://link. springer.com/article/10. 1057/s41271-022-00345-x)
11. Weaponisation of waterAula Abbara, Naser Almhawish, Ibrahim Aladhan, Redwan Alobaid, Nabil Karah. Published:December 03, 2022 (https://doi.org/10.1016/S0140-6736(22)02320-0)
12. Cholera. Infectious Diseases in Children (ed. S.O. Kramarev, 2003) (https://compendium.com.ua/uk/tutorials-uk/infektsiyi/holera/)
13. Expert's advice on water purification in times of war © 2000-2023, LLC "Publishing House "Zdo-rovye Ukrainy. Medical Publications" (https://health-ua.com/news/69672-poradi-eksperta-shodo-ochish-ennya-vodi-v-umovah-vj ni)
14. Cholera, WHO, 30 March 2022 (https://www.who.int/news-room/fact-sheets/detail/cholera)
UDC:616.98:579.86
Melenko Svitlana Romanivna
PhD, Associate Professor of the Department of Infectious Diseases and Epidemiology
Bukovinian State Medical University
Oleksandra Kotenko
student
Bukovinian State Medical University
Maria Basenko
student
Bukovinian State Medical University DOI: 10.24412/2520-6990-2023-9168-58-60 DESCRIPTION OF CASES OF GENERALIZED TETANUS AND THE ROLE OF PREVENTION OF
THIS DISEASE: A REVIEW.
Introduction:
Tetanus is a rare disease caused by anaerobic bacteria, Clostridium tetani causing painful muscle spasms and respiratory failure. This bacterium can enter the human body via a deep wound, burn injury or medical procedure. However, in addition to this, the following were described tetanus also originate from odontogenic infection.
Tetanus is an illness that mainly affects the central and peripheral nervous systems. The clinical features of tetanus and its relationship to wounds and injuries are well known, dating back to ancient times. Clostridium tetani is an obligate anaerobe that produces a toxin found in soil and mammalian intestines. C. tetani transforms into a vegetative bacterium which then travels to the spinal cord and brainstem via the motor neurons. It then produces neurotoxin tetanospasmin, which interferes with the nervous system inhibitory neurotransmit-ters. C. tetani also produce tetanolysin, which has he-molytic properties and causes membrane damage. It's role is currently unknown.
Tetanus is now rare in developed nations due to effective immunization programs, but it remains a threat to all unvaccinated people, especially in undevel-
oped nations. Most reported cases are attributed to un-vaccinated individuals and improper identification and treatment of wounds and traumatic injuries.
Tetanus has high morbidity and mortality worldwide before the development of tetanus toxoid. The first vaccine was not very effective and had significant adverse effects, but one of the next and safer options was used during World War II for soldiers, which led to a 95% reduction in tetanus rates. Nowadays, tetanus toxoid is considered the safest and most effective medicine in the world.
Tetanus prophylaxis includes understanding and knowing the current tetanus immunization guidelines, recommendations, and indications for prophylaxis.
The key to the prevention of tetanus is immunization, identification of those at risk, and proper identification and treatment of wounds and traumatic injuries.
