Socio-Epidemiological Aspects of Improving the Prevention of Tuberculosis Infection in the Armed Forces of the Russian Federation

The dissertation is devoted to the study of socio-epidemiological aspects of improving the prevention of tuberculosis infection in the Armed Forces of the Russian Federation. The current sanitary-epidemiological situation regarding tuberculosis among military personnel is investigated, existing methods of diagnosis and detection of tuberculosis of the respiratory organs are analyzed, as well as the features of the clinical course of the disease in various categories of military personnel. The necessity of updating the system of early and active detection of tuberculosis patients is substantiated, and a new approach to the organization of anti-epidemic measures in the troop level is proposed based on targeted questionnaire surveying of military personnel as an element of a screening system.

Relevance of the Research

Each year, up to 10 million people contract tuberculosis worldwide, of whom approximately 3 million die. By the present time, the total number of patients has reached 50–60 million, and if the situation with regard to the fight against tuberculosis is not radically revised, then within the next 30 years no fewer than 90 million people will contract tuberculosis, and more than 30 million will die from this disease. The tuberculosis epidemic is becoming increasingly dangerous, annually claiming more human lives than any other infectious disease [123, 105]. This centuries-old disease has not been eradicated in any country in the world [116, 163, 187].

A serious tuberculosis situation has developed in the Russian Federation, primarily due to morbidity in penal institutions, which is 30 times or more higher than among the civilian population.

The trend and level of tuberculosis morbidity in the Armed Forces are comparable to those in the country as a whole and exhibit similarly unfavorable indicators. Thus, according to morbidity data for military personnel in 2004, it increased compared to preceding years and reached 0.9‰.

Under the changed socio-economic conditions in the country, the epidemiological situation regarding tuberculosis has not improved, and adequate changes to the system of preventive and anti-epidemic measures have also not occurred. All of this indicates that, both in the country and in the Armed Forces of the Russian Federation, the system of prevention of the considered infection cannot be considered effective.

Despite the diversity of preventive and anti-epidemic measures conducted under modern conditions, the leading directions are the measures for early active detection of tuberculosis, carried out by the military medical service. However, today this is a rather limited arsenal. In particular, preventive measures within the system of socio-hygienic monitoring of tuberculosis infection mainly consist in conducting planned fluorographic examinations, tuberculin diagnostics, and vaccination of personnel. Fluorographic examination as a means of detecting tuberculosis can be considered early only conditionally, since the specific process has no correlation with the conduct of such planned measures [28]. Therefore, even with ideal organization of this measure in the troops, it is impossible to protect them from the penetration or emergence of a "fresh" focus.

With regard to preventive measures, tuberculin diagnostics in the troops is conducted once upon admission to military service by conscription. Accordingly, these tuberculin diagnostics also exert no influence on the detection of the tuberculosis process during further service.

The presence of complaints regarding the health status of military personnel, as a possible element for conducting screening measures, is practically not taken into account in the organization of anti-tuberculosis work. It would seem that such a dangerous ailment offers no alternative? This is not entirely so.

It is known that there exists a certain interrelation between the methods of tuberculosis detection and such indicators as the prevalence of the specific process and the epidemiological danger of the patient under conditions of service in the Armed Forces of the Russian Federation. However, this aspect of tuberculosis epidemiology is insufficiently addressed.

The system of preventive and anti-epidemic measures of anti-tuberculosis direction in the Armed Forces of the Russian Federation is carried out by specialized medical institutions (tuberculosis hospital, tuberculosis department), centers of state sanitary-epidemiological surveillance, and military medical officers of the troop level. However, the share of participation of each of these parties in anti-tuberculosis measures and the adequacy of the measures conducted have been insufficiently studied.

At the "front line" of the fight against tuberculosis stand troop medical officers. Having no specialized diagnostic methods in their arsenal, they become, in essence, hostages of a poorly controlled situation. Under these conditions, the search for methods accessible to the troop level that would allow excluding the possibility of penetration or suspecting a "leak" of a tuberculosis patient into a military collective becomes highly relevant.

Based on the above, the goal and objectives of the research were formulated.

Goal of the Research

To substantiate and develop recommendations for improving the system of early and active detection of patients with tuberculosis infection in the Armed Forces of the Russian Federation.

To achieve the stated goal, it is necessary to solve the following tasks:

1. Conduct an analysis of the sanitary-epidemiological situation regarding tuberculosis in the Armed Forces of the Russian Federation.

2. Identify the features of tuberculosis diagnostic methods among military personnel of various categories.

3. Clarify the patterns of clinical course of tuberculosis infection among military personnel at the present stage, influencing the organization and conduct of anti-tuberculosis measures in the troops.

4. Propose a convenient and accessible method for early detection of tuberculosis patients for troop-level medical officers.

Scientific Novelty

In the process of searching for methods accessible to the troop level for early and active detection of patients or suspected cases of tuberculosis infection among military personnel, the conduct of targeted questionnaire surveying of military personnel as an element of a screening system of anti-tuberculosis direction was proposed for the first time.

Criteria for the epidemiological danger of patients for military personnel depending on the method of detection and the degree of prevalence of the specific process were established, which provides for a fundamentally new approach to the organization of anti-epidemic measures in the troop level.

Practical Significance

The possibility of isolating 50% of tuberculosis patients one month earlier than could be done with existing approaches, using the proposed system of periodic surveys of military personnel, has been established.

The main provisions and conclusions of the dissertation may be used in the educational process at military-medical universities of the Armed Forces of the Russian Federation.

The organization of tuberculosis detection among military personnel for troop-level medical officers has been improved through a specially developed questionnaire method.

Main Propositions for Defense

1. The modern system of detecting tuberculosis of the respiratory organs in the troops does not allow adequately influencing the level of tuberculosis morbidity in the troops and requires improvement.

2. The level of morbidity and the structure of clinical forms of tuberculosis of the respiratory organs in the Armed Forces differ among categories of military personnel by conscription and contract.

3. Active detection of tuberculosis in the troops is at an extremely low level. The situation can be changed by expanding the circle of persons included in the group of dynamic dispensary observation, as well as by searching for new methods of early diagnosis of diseases suspected of tuberculosis infection among military personnel. One of the approaches proposed is the questionnaire method.

Implementation in Practice

The results of the research have been implemented in the methodological guidelines "Organization of Anti-Tuberculosis Measures and Fluorographic Examination in the Armed Forces of the Russian Federation" (Main Military Medical Administration, 2005), and are also used in teaching the department of military epidemiology and military (naval) hygiene at the State Institute for Advanced Training of Physicians of the Ministry of Defense of the Russian Federation, in the cycle of criminology at Police Academy No. 2 of the Main Department of Internal Affairs of Moscow, and in the department of criminal law disciplines at the Moscow Humanities-Economic Institute.

Presentation

The dissertation materials were reported at sessions of the department of military epidemiology and military (naval) hygiene at the State Institute for Advanced Training of Physicians of the Ministry of Defense of the Russian Federation, and at scientific-practical conferences.

The main results were reported at the scientific-practical conferences "Tuberculosis Today" (Moscow, 2003), "Problems of Prevention of Infections Relevant to the Troops and Ways of Their Resolution" (Moscow, 2003), "Actual Problems of Organization of Medical Support of Troops in Modern Conditions" (Moscow, 2005).

Publications

Nine printed works have been published on the topic of the dissertation.