An integrated approach to the treatment of acute respiratory viral infections
Acute respiratory viral infections (ARVI) remain the most common diseases in the world, including among the children’s population. In the Russian Federation, acute respiratory viral infections occupy a leading place in the structure of the general incidence rate and account for more than 90% of all infectious diseases. They represent a large group of clinically and morphologically similar acute inflammatory diseases of the respiratory system caused by more than 350 pneumotropic viruses. According to the WHO, every third person suffers at least one case of acute respiratory viral infections during the year. The mortality rate from acute respiratory viral infections and their complications is also high. According to WHO statistics, every year respiratory diseases associated with seasonal flu cause the death of about 650 thousand people. Flu is especially dangerous for people at risk for increased morbidity. These include children under 3 years old, elderly people, pregnant women, and debilitated patients with chronic diseases of the lungs and cardiovascular system.
The situation of the incidence of ARVI and influenza
According to the WHO Regional Office for Europe, for 10 weeks. 2019 in the countries of the European region there was an intensive increase in the incidence of influenza and SARS. The structure of circulating influenza viruses was dominated by influenza viruses of subtype A (H1N1) 09. In 20 countries of the European Region, a wide spread of influenza viruses was recorded, in 13 countries – regional, in 5 countries – local. Also, sporadic cases of influenza-like diseases have been reported in 5 European countries. In the same period, on the whole, in the territory of the Russian Federation, there was a decrease in the number of regions with exceeding the epidemic threshold for the incidence of influenza and SARS. As in previous years, the most actively involved in the epidemic process were children of age groups 3–6 and 7–14 years from organized groups, as well as the adult population, mainly of older age groups.
A feature of the epidemic situation of recent years during the rise in the incidence of acute respiratory viral infections and influenza is the simultaneous circulation of several respiratory viruses in the human population. In the 2016–2017 season Among non-influenza etiology viruses, respiratory syncytial viruses predominated – 36.9%, parainfluenza viruses – 16.6%, adenoviruses – 16.5%, other non-influenza etiology viruses – 30%. In the present (2018–2019) epidemic season, the share of non-influenza etiology respiratory viruses (parainfluenza viruses, adenoviruses, respiratory syncytial viruses, etc.) in the structure of positive findings was insignificant.
The leading role in the group of respiratory viruses in the severity and development of complications belongs to influenza viruses. Influenza occupies a special place in epidemiological and social significance among all respiratory viruses, as well as in the significant economic losses associated with it, and is characterized by the highest rates of morbidity and mortality.
Problems of prevention and treatment of acute respiratory viral infections and influenza
Preventive measures for any infectious disease should be aimed at all three links in the epidemic chain: 1) the source of infection; 2) mechanisms and ways of transmission; 3) a susceptible organism. A specific immunization against influenza is the most effective means of protecting a susceptible organism, helping to reduce the circulation of influenza viruses in a population, which allows it to be recommended for the general population. In strictly controlled epidemiological observations, it was shown that immunization with modern influenza vaccines is the most effective scientifically based method of mass prophylaxis against influenza. It has been established that with timely vaccination, influenza can be prevented in 80–90% of children and adults. In this case, the disease in vaccinated proceeds in a milder form.
In Russia, there is an annual increase in the number of vaccinated against influenza. In the season 2016-2017. 36.6% of the country’s population were vaccinated (for comparison, 31.3% in 2015–2016). According to monitoring by the NGO Zashchita of the Ministry of Health of Russia, the incidence of acute respiratory viral infections in the unvaccinated population is 13.3 times higher, and the flu is 15.3 times higher than in the group of vaccinated against influenza within the framework of the National Calendar of Preventive Vaccinations. These data indicate a positive effect of vaccination on the incidence not only of influenza, but also of all acute respiratory viral infections.
Despite great successes in the development of new vaccines and chemotherapy drugs, including antiviral ones, influenza continues to be a difficult to control infection. Influenza viruses have a unique property – high genetic variability, which affects the instability of the emerging immunity of the macroorganism. This ability of influenza viruses allows them to quickly change their structure, acquire new properties and escape from the protection of the human immune system, which leads to the rapid spread of infection and causes the development of epidemics or pandemics in a short time.