Инфекционные болезни

061UECTBEHHOE 3.llPABOOXPAHEHHE B EBPOnE 3 EBPOnERCKOE PEfHOHAJlbHOE 6IOPO BceMHpHaH OpraHHJaUHH 3.npaeooxpaHeHHH . KoneurareH 1974 illl<l>EKIIJ1OHHl,IE BOJIE3Hl1 B npoAaJKY He nocTynaeT PacnpocTpaHReTCR EBPOITEli!CKI1M PErl1OHAJibHhlM BlOPO BceM11pHOH opraH113an;1111 3ApaBooxpaHeH11R KOIIEHrAI'EH 1 ~7-1 IIp11Me'!au11e Jl:al:ll:lhle 11 Bh!AepJK1C11 113 "O6~ecTBe lllioro 3,n;paBooxpan euHR B EBpone" M0r)''I' Bocnpo113B0,ll;11'T'bCR np11 y c .JI0Bl1H yKa3aH11H 11cTo'Il!111Ka nepene'Ja'l'bIBaeMoro 'reKcTa . )I,JI.R D0JIY1leHll!R npaBa Ha IT0JIH0e B0CITp011!3Be,n;en11e IIIJil1 nepeBo,n; CTaTeH CJie- ,n;yeT o6pa~a 'I'bCR B EBponettcKoe per111oua.Jlbuoe 6ir.po BO3, K0Topoe np~rne •rc 'rayc •r TaKoro po,n;a 06pa~eH11R . T0J!hKO caMH a BT0phI 0'l'BeTC'l'BeHlll,l 3a B3rJU!,ll;bl, BhlpaJKemn,re B no,n;n11caH1IblX IIIM11 CTaTbRX. ii ISBN 978 92 890 7357 8 ISSN 0250-8672 © Всемирная организация здравоохранения 1974 г. CO)O::PJKAIDIE Bae.n;e1rne - X. 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Ilo3Tarman AHKBgn;agHR KOPH 3BOJill)D;l1R DOAHTHKH BaKD;HHaD;11H npoTHB KOpH B Jll/)60H CTpaHe 6yAeT 3aBH- ceTb OT ee ,mHAeMHOAOr~eCKHX, reorpacti~eCKHX H 3lCOHOMl'!'leClCHX ycAOBHH; B CTpaaax , rAe 3TH YCAOBHR pa3AH'llihl B pa3llI,IX paHoaax, 3Ta IlOAHTHKa MO*eT pa3Jlll'laTbCR B 3aBHC11MOCTH OT lCOHKpeTHOH o6cTaHOBICH H HMeID~XCR cpeACTB AAR npoBeAeHIIB BaKD;HHa~HH. B CTpaaax, rAe 11:MeeTCR MHO*eCTBO pa3pO3HeHHhlx ceJibC lCHX HaceAeHHhIX nyHlCTOB C BeAOCTaTO'IHO pa3BHTOH MeAHD;HHClCOH DOMO~~. BepORTHO, 6yAeT ~eAecoo6pa3HO nocpeACTBOM MaCCOBhlX KaMDaHHH Ba.1CD;HHaD;11H cctiopMHpoBaTb CB060AllI,le OT lCOpH 3OllI,l, a Ha CAeAYID~eH CT~HH nepeHTH lC AHlC- BHAaD;11H BaJKBefurmx oqaroB HHctieKD;l1H B ropOAClCHX H APyrHx DAOTHO Hace.,1eHllI,IX paHoHax. C AP)TT'OH cTopoBM, aa~HoHaJibHMe oprallI,l 3ApaBooxpaHeBIDI MOryT no- *eAaTb aaqaTb C H36HpaTeJibHOH BalCD;HHa~HH B OCHOBllI,IX ~eHTpax CKODAeHIDI Ha- ceAeHHR H pacnrnpnTb nporpaMMY, HaClCOJiblC< dTO DO3BOART cpeACTBa, BalCD;HHHpyn HaceAeHHe B ropOACKHX, a 3aTeM H B CeJibClCHX paHoHax. B He60JibIDHX no Tep- pHTOPHH H BhlCOlCOpa3BHThlX CTPaHax ~e aaqHHaTb C BBeAeHIDI BalC~HHaD;11H npo- THB lCOpH B o6M'IHhle nporpaMMM HMM)'HH3aD;HH AeTCKoro aaceAeBIDI H, lCOrAa 6yAeT AOCTHrHYT AOCTaTO'lllI,IH ycnex, DpHAO*HTb 3Hepr~e y e= AAR AHKBMAaD;11H aa- 6oAeBaHHR BO BCeH CTPaHe. IlpH Jill)6hlX o6CTORTeJibcTBax AAR o~eIDCH XOAa KaMDaHHH BalCII;HHaD;HH , BHe- ceHIDI Heo6XOAHMhIX H3MeHeHHH B DOAHTHKY BalCD;HHaD;HH II B MeponpIDITIIB no BalCD;HHa- ~HH BeCbMa Ba*HO opraHH3OBaTb IlOCTORHllI,IH HaA3Op 3a 6oAe3HbID H 3a 3$cI>eKTHB- HOCTbID BaKD;HHaD;HH, BlCJill)qan lCOHTpOJib 3a DPOAOA*HTeJibHOCTbID HMM)'HHTeTa, a TalC*e 3a ae6AaronpIDITHhIMH pealC~MH Ha BBeAeHHe BalC~HllI,l. BHBJil10rP A<!> IBl V Cumakov, M.P. et al. (1970) Epidemiological Review, 24, 118 Scott, D. (1971) Amer . J. Epidem., 94, 37 Sutherland, I. & Fayers, P . M. (1971) Brit. med. J ., !, 698 Warin, J.F. & Rodgers, J.S. (1971) Med. Offr, 125, 277 Warin, J.F. (1971) upublished document 7 BPO.JK,lij::JUlAfl KP ACHYXA l1 EE ,101AI'HOCTI1KA Ilpo$eeeop ~.A. ~a,n;*eH n e.n; Ha Tp ltf'I e e Ka.Ji 6 OJI.b H I1I1,a ' Jloll,ll OH BBet5eH11e B11pyeHa.Ji 3TH0Aor11J1 Kpaeeyx11, xoTn 11 npe.n;noAaraBmanen B TeqeH11e MHor11x AeT, 6hIJia OKOHqaTeJibHO yeTaHOBAeHa TOJI.bKO B 1938 r., KOr.n;a XHpo 11 TaeaKe y.n;aAOeb e TIOMO~ID oq~eHHhlX OT 6aKTepIDi $HJibTpaTOB HoeorAOTO'IHLIX e.MhIBOB, TIOJIY'leHHhlX BO BpeMR oeTpOH $a3hl 6oAe3HH, oe~eeTBHTb nepe.n;aqy HH$eKD;HH .n;e- TRM. B TO BpeMR 3TO eoo6~eHHe He npHBAeKAO oeo6oro BHHMaHl1JI, Y4HThIBaR Aer- Koe TeqeHHe 3a60AeBaHW1 y Jill),ll;eH . l1 TOJibKO TpH ro.n;a enyeTR HhlHe TIOKOHHhlH e3p HopMaH rperr yKa3aA Ha eepbe3Hhle naToreHHhle eBoHeTBa 3Toro B11pyea . rperr o6paTHA BHI1MaH11e Ha Heo6M'IHOe 3TIH,ll;eMHOAOr!14eeKoe RB~eHHe - B03HHKHO- BeHHe ~eAoro oqara e.JIY'laeB BPO*,ll;eHHOH KaTapaKTM B CH,ll;Hee 11 np11Aer8.lf)~HX K HeM)' paHoHax HoBoro IDJKHoro Y3Jibea . rperr TaK*e 3aMeTHA, qTo 6oJibHMe .n;eTH qaeTO 6MAH emmucoM MaAeHbKHMH, He.n;ocTaTO'IHO yn11TaHHhlMH 11 MHOrHe 113 HHX HMe- AH BpO*,ll;eHHMe 3a60AeBaHHR eep.n;~. CBR3b Me~ 3THMH .n;e$eKTaMl1 11 KpaeeyxoH 6MAa yeTaHOBAeHa, Kor.n;a rperr 06HapyJtU1A 3a60AeBaH11e KpaeeyxoH Ha paHHHX eTa- ,ll;l1JIX 6epeMeHHOe TH B aHaMHe3e y 60Jibllfl1HeTBa MaTepeH 3THX .n;eTeH (Gregg, 1941). 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Kor.n;a 3TIH,ll;eMIDI Kpaeeyx11 BeIIhixeyAa B HeeKOJibKl1X eTpaHax EBpOIIhI . .n;eHM ,ll;Ba Kpyrrm,rx npoeneKTHBHhlX 11eeAe.n;oBaHHR, O,ll;HO B IIIBewr11 11 .n;pyroe B BeA11- Ko6p11TaH1111. JlyH.n;eTp~M (1952) eoo6~11A, qTo B IIIBen;HH qaeTOTa e.JIY'laeB aHoMa- AHH pa3Bl1Tl1R rAa.a, opraHOB eAyxa 11 eep.n;~a, a TaK*e MepTBOpO*,ll;eHl1H eoeTaB- ~~a 11 %, 11 % 11 8 % Ha Ka.lt(,ll;LIH 113 nepBMX Tpex Meen~eB 6epeMeHHoeT11 11 10% 3a Beeb nepBMH TpHMeeTp . Ilo eoo6~eH111fl M3HeOH 11 ee KO~er B AHr~11 qaeTOTa TaKHX e.JIY'laeB eoeTaB~Aa 15,6%, 19,7% 11 13,0% Ha Ka.lt(,ll;LIH 113 nepBMX Tpex Meen~eB 6epeMeHHoeT11 11 15,6% 3a Beeb nepBMH TpHMeeTp ( Mans on et al., 1960). 3TH TIOKa3aTeAl1 oeHoBaHhl Ha K~11qeeKOM .n;11arH03e Kpaeeyx11 y MaTe- peH, y KOTOpMX BO BpeMR 6epeMeHHOeTl1 6MAa eMTib . Tenepb 113BeeTHO, qTo Bpe,lJ;Hoe B03,ll;eHeTBl1e Ha TIAO,ll; MO*eT BM3MBaTb eR ey6K~l14eeKOH Hll$eKD;HeH y Ma- TepeH, 11 TI03TOM)' 3TH .n;aHHhle, BepoRTHO, 3aHH*eHhl, B TO BpeMR KaK npe~e TIOKa3aTe~ 6MAH 3aBMmeHhl. B eHAy HeeKOJI.bKHX np11q11H TPY.n;HO TO'IHO onpe.n;e- AHTb eTeneHb onaeHOeTl1 .n;~ TIAO,ll;a; HO MOJKHO eKa3aTb, qTo XOTR pHeK 3apa*eHHR 8 TIAOAa oqem, BhlCOK, np11 Ha~q1111 Kpaceyx11 y MaTep11 Ha paHHeH CT~l111 6epeMeH- HOCTl1, eyY He COOTBeTCTByeT CTOJ[b *e BhlCOKaJI qacToTa Bpo~eHHhlX aHoMaA11Hpa3- B1'ITIU! ( Dudgeon, 1969) . MHor11e aBTOpl1TeThl B 3'1'011 o6AaCTl1 C'-IHT8.l'lT' '-I'l'O ua 1160Aee onacHhIM nep110AOM JIBJllilflTCJI nepBhle 16 HeAe.J[b 6epeMeHHOCTl1, XOTJI 6MAl1 c~a11 aapa*eH11JI nAoAa B nep110A Me*AY 16-H 11 20-11 HeAeAeH. B u;eAoM onacHoc'I'b r116eA11 IlAOAa, MepTBOpo~eHl1JI 11 BPO*AeHHhlX aHoMaAl1H pa3Bl1TIU! np11 HaAl,fq1111 icpaceyx11 B TeqeH11e nepBhlX 16 HeAe.J[b 6epeMeHHOCTl1 COCTaBAReT OT 20% AO 30% (Dudgeon, 1967). BTOphlM Ba*HMM cpaicTopoM, OT KOTOporo 3aBl1Cl1T 3apa*eH11e IlAOAa, JIBAReTcJI 11MMYHHhlH CTaryc Ma Tep11 B 3TO BpeMR. OnacHOCTb 11H<tJ11u;11po- BaHl1JI TIAOAa B03H111CaeT TOJ[bJCQ B c~ae nepBl1'IHOH 11H¢eicu;1111, np11 pe11H¢eK1J,Hl1 TaKaJI onacHoC'I'h He B03Bl1KaeT. l1ccAeA0BaH11R JlYH,ll;CTP~Ma, M3HCOH 11 ee KO~er TaK*e noicaaa.JUI, '-ITO B oc- HOBHOM o6HapyJKHB1Ul)TCJI aHoMaAl111 pa3Bl1Tl1JI rAa3,, opraHOB CAYXa 11 cepAu;a' KO- TOphle MOryT B03H11KaTb KaK OTAe.J[bHO, TaK 11 B coqeTaH11H , ~I 11HOrAa conpoBO*Aa- JflTCJI M11JCpou;ecjlaA11eH H YMC'l'BeHHOH OTCTaAOCTblfl. Bee 3TH AecjleKThl BXOAJIT B no- HJITl1e " CHHAPOM icpaceyx11". BhrAo ycTaHOBAeHo, '-ITO np11 o6cAeAOBaHl111 qepe3 onpeAeAeHHMe npoMe*YTKH BpeMeH11 AeTeH, noABeprm11xcH BHYTPHYTpo6HoyY aapa*e- Hl1JI) icpacHyxo11, qacToTa Ae<PeKTOB opraHo :.... CAYXa B 6oAee C'l'apmeM BoapacTe aua- q11Te.J[buo BhlIDe, qeM y AeTeH B B03pacTe AO 2 AeT (Sheridan' 1964). CnycTJJ AeCJITb Ae'r BCilhlXHyAa HOBaH 3TittAeMIU! KpacHyx11, BnaqaAe B EBpone B 1962-1963 rr., a 3aTeM B TH*eAOH naUAeMH'-IeCKOH cjlopMe B CillA B 1964-1965 rr. EcTeCTBeHHo, '-ITO 3TittAeM11e11 6hlAO oxaaqeHO MHOr o MOAOAhlX *eH~lfil, 11 MHor11e AeTl1 POA11Al1Cb C auoMaAHHMl1 pa3Bl1TIU!, Bhl3BaHBhlMl1 icpacHyxoH. OAHaKO Ha 3'1'0T pa3 y AeTeH C Bpo~eHHhlM:11 HOBhle 11 He06MqHhle oco6eHilOCTl1. cnell,11a.J[bHhle Aa6opa'I'Opmre TecTM c aHOMaA11RMl1 pa3Bl1'1'HJI 6MAH OTMe'-IellhI ueJCO'l'OpLJ:e K 3TOMY BpeMeHl1 TaK*e 6MA11 pa3pa60Talihl o;e.J[blfl o6Hapy*eHIU! B11pyca icpacuyx11 11 onpe- np11MeHeH11e 3T11X MeTOAOB Il03BOAHAO ~e IlOHJITb na- ToreHe3 nopa*en11R ITAOAa, Bhl3hlBaeMoro B11pycoM icpaceyx11. Ilpe~e Bcero, q11c- AO 3aper11cTp11poBaHllhIX c~aeB 6hlAO oqeHb 6oAbIDl1M, '-ITO o~aCTl1 OTpa*aAo 06- m11pHOCTb 3TittAeMl111, HOB TO *e BpeMR RBARAOCb pe3YJ[bTaTOM 6oAee T~aTe.J[bHOro BhlHBAeHHR c~aeB Bpo~eHHOH icpaceyx11. Bo-BTOphlX, BCKope CTaAO oqeBwi;Ho, qTo, KPOMe KAaCCl,fqeCKOro Tl1Ila C11HAPOMa icpaceyx11, c ~eCTByeT MHoro HOBhlX npoJIBAeHnH' KOTOphle rrpe*Ae AH6o He OTMeqaAl1Cb' A116o ITpOCTO He accon,mrpoBa- A11Cb c BHYTPnyTpo6HhIM 3apa*eH11eM Kpaceyxo11. Y MHor11x rpyAHMx AeTeH ua6.JII{)- AaAMcb nypnypa, renaTOCITAeHoMeraAHR, renaTHT 11 rropa*eHHR KOCTeH; AAR 0603- HaqeHHR 3Tl1X naTOAOrl,fqeCK11X COC'l'OHHl1H 11CITOJ[b30BaAl1Cb pa3Jlll'lHh!e Ha3Ball11JI, Taic11e KaK "pacm11pelilWH CHHAPOM Kpaceyx11" 11Al1 "ocTpaH HeoHa'raAbHaR icpacey- xa". ~eTa.J[bHoe KA!1Hl,fqecicoe 11 B11pycoAorl1'-IecKoe 113yqeH11e 3T11X c~aeB noica- 3aAo, '-ITO BHyTpnyTp06HaR KpacHyxa qacTO rrp eAcTaBAReT co 6011 Cl1CTeMHoe aa60- AeBaH11e, KOTOpoe nopa*aeT c pa3y HeCKOJ[bKO opraHOB 60.J[bHOro. B HaCTOR~ee BpeMR o6~enpl1HJITblM TepM11HOM, onpeAe=~11M 3TO COCTOJIHHe, HBAReTCH "BpOJK- AeHllaJI icpacHyxa". IlocAeACTBHJI BeyTpnyTpa6HOH icpaceyx11 11MelflT MHO*eCTBeHHhIH xapaKTep (cM. pHC. 1). 9 MoJtWo 3aMeTHTb, qTo noTen~aJibHo JI1060H opraH qeAoBeqecxoro TeAa MO*eT 6MTb nopa*eH 6oAe3Hbm, H O~HM H3 BaH6oAee Ba=x BMBOAOB, OCHOBaHBMX Ha H3Y'IeHHH 3n~e:Ml1H B 1962- 1965 rr., 6MA BMBOA o TOM, qTo BHYTJ>J1YTp06Ha.R Kpaceyxa BM3MBaeT MHO*eCTBeHHMe aHoMa.JIHH pa3BHTHH. Ba=M MOMeHTOM RBJIJI- eTcR TO, qTo HeKOTOpMe npORBAeHHH 6oAe3HH npeypoqeHM K onpeAeAeBHOMJ" B03- pacry, a paaHMe coqeTaHHH anoMaAHH MoryT Ha6~aTbCR y AeTeH paBHero H 60- Aee cTapmero BoapacTa (cM. Ta6A. 1). OcHOBMBaRCb Ha eAHHH'llihIX WlH KOM6HHHpOBammx aHOMa.JIHRX pa3BHTHH, KAH- HHII;HCT MO*eT npeAilOAaraTb HaAHqHe Bpo~eHHOH xpacnyxH, KOTOpa.R 3aTeM MO*eT 6MTb IlOATBep~ena npH IlOMO~H Aa6opaTopHMX TeCTOB. B TeqenHe BeCKOJibKHX nocAe~HX AeT MM npoBOAWIH AeTa.libHOe o6cAeAOBaHHe B ~OH,ll;OBCKOH neAHaTpwqe- CKOH 60.IIbHH~e HeCKOJibKHX rpynn AeTeH, IlOABeprmHXCR BHYTJ>J1YTp06BOMJ" 3apa*e- HHIO xpaceyxoH. MHorHe H3 3THX 60.IIbHMX AeTeH nocTYUHJIH H3 paamzx paHoHOB CTpamz, a TaK*e H3yqaACR MaTepHaA, nocrynHBIDHH AJIJI Aa6opaTopHMX HCCAeAoBa- HHH. '-IHCAO CAyqaeB H HX KAHHHqeCKa.R KAaccH~HKa~ npeACTaBAeHM B Ta6A . 2 . OcHOBHa.R rpynna 60.IIbHMx c BpoJK,llieBHoH xpaceyxoH: MoJtWo aaMeTHTb, qTo y 60.IIbIDHHCTBa AeTeH 3TOH rpynnM HMeIDTCR MHO*eCTBeHBMe aHoMa.JIHH pa3BHTHH (255 H3 302). Tax xax B cne~aAH3HpoBaBHMe KAHHHKH HanpaBARIDT o6Mqno 60- Aee TR*eAMe CAyqaH TO, OCHOBMBa.RCb Ha 3THX AaHHMx, He.1Ib3R CAeAaTb BMBOA 0 cpaBHHTeJibHOH qacTOTe CAyqaeB eAHHHqHMX HJIH MHO*eCTBeHHMX aHoMaAHH pa3BH- THH. TeM He MeHee, qeM qa~e HCCAeAOBaTeJib CTaAKHBaeTCR co CAyqa.RMH BPO*- AeBHOH KpacHyxH, TeM qa~e OH o6Hapy*HBaeT coqeTaHHe HeCKOJibKHX aHOMaAHH. Pa3AHqHMe coqeTaHHH anoMa.JIHH y AeTeH 3TOH rpynnM noxa3aHM B Ta6A. 3. BpoJK,llieHHaR nep~enTHBHaR r;ryxoTa: 6MAO npoBeAeHo cne~aJibHoe o6cAeAo- BaHHe 160 AeTeH c Bpo~eHHOH nep~enTHBHoH HAH ceHcopHo- HeBporeBHoH rAYxo- ToH. Y AeTeH, c~'PMa.Jl)~Hx rAYXOToH, B Bo3pacTe AO 4 AeT aHTHTeAa K BHpycy KpaceyxH 06HapyJ01Ba.JIHcb qa~e (54%),no cpaBnenmo c rpynnoH cAyqaHHo oTo6pan- HMX AeTeH Toro *e B03pacTa (7 , 1%) . fuAa ycTaBOBAeHa oqeHb TeCHa.R KOppeJIJI- ~R Me~ o6napy*eHHeM aHTHTeA y AeTeH H Ha=HeM B aHaMHe3e CMilH HJll1 KOH- TaKTa c 6oJibHM:Ml1 y MaTepeH, o~axo, B rpynne AeTeH, cTpaAruo~Hx rAYXOTOH (71), ~H MaTepH, corAaHo AaHHMM anaMHe3a, He HMe.JIH CMilH WlH KOHTaKTa c 6oJlbHLIMl1, y 18 qeAoBeK (25 %) rAYxoTa 6MAa BM3BaHa BHYTPJ1YTpo6HoH xpaceyxoH . EcAH 3TO npeAilOAO*eHHe cnpaBeAAHBO, TO xpaceyxa qa~e BM3MBaeT nep~enTHBnyID rAYXOTY, qeM npeAnoAaraAH panee (Gumpel et al., 1971). 06Mqno npHBOART noxa3aTeJib 5%. ~eTH, no~Beprm11ecR BeyTpeyTpo6HoM}'" 3apa*eHH10 xpacHyxoH , Ho 6e3 KAHHH- qecKHX aHoMaAHH npH POJK,llieHHH : 3Ta ~aTeJibHo oTo6paBHa.R rpynna H3 228 AeTeH 6MAa o6cAeAoBaHa MOHM KOAAeroH A- POM KaTpHH IleKeM. JTO o6cAeAOBaHHe RB- JIJIAOCb qacTbID 6oAee AeTaJibHOro H3yqeHHR 3am,HTHoro AeHCTBHH HMMYHOrAo6yAHHa, npoBOAHBmerocH ~a6opaTopHOH CAY*6oH o6~eCTBeHHOro 3ApaBooxpaHeHHH B AHrAHH . MaTepH 3THX AeTeH IlOABepr.JIHCb 3apa*eHHm xpaceyxoH B nepHOA 6epeMeHHOCTH BO BpeMH 3n~e:Ml1H 1961-1962 rr.; Bee OHH IlOAyqWlH HMMYHOrAo6yAHH, HO HeCMOT- PH Ha 3TO, 3a60Ae.JIH KAHHHqeCKH BMpa*eHHOH KpaceyxoH. IlpH PO*AeHHH H B nepBMe MeCHilj,I *H3HH y 3THX AeTeH He 6MAO OTMeqeno RBHLIX anoMaAHH pa3BHTHH, 10 Bhl3"lBaeMhlX KpaceyxoH, HOK KOHIJY nepBoro roAa *H3HH 6UAO BhlHBAeHO HeKOTopoe 'll:lCAO CJIY'laeB rJIYXOTU. IlpH o6cieAOBaHHH B BoapacTe OT 1 AO 3 AeT 6MAO 06- Hapy*eao, qTo 22 % CTPaAaJOT rJIYXOToH, a y 48% npaKTHqecKHX 3AOPOBMX AeTeH 6w- AH o6aapy*eHLI aHTHTeAa K BHpyc y KpaceyxH, B OT~He OT O*HAaeMoro IlOKa3aTe- AH - 5,6% y AeTeH KOHTpoJibHOH rpynnM (Butler et al., 1965). ReAaBHo HeKo- Topue H3 3 THX AeTeH B B03pacTe 7...[3,· AeT 6MAH BHOBb o6cAeAOBaHLI, H cpeAH HHX o6Hapy*HAH AODOAHHTeJibHoe qHcAo AeTeH c qacTwmoH noTepeH CJIYXa. OAHaKo cpeAH HHX oKaaaAHCb TOJib KO Te AeTH, y KOTOphlX B B03pacTe OT 1 AO 3 AeT 6u- AH o6Hapy* eHLI aHTHTeAa K BHpyc y KpaceyxH . ~eTH c OTPHII,a.TeJibHLIM pe3YJibTa- TOM cepoAorHqeCKH.X HCCAeAOBaHHH OCTaBaAHCb HOpMaJibHLIMH . ~a6opaTopaan AHarHocTHICa B nepHOA IlOCAe 3IlffAeMHH 1962-1965 rr. 6MAO CAeAaHO TPH Ba*HL!X Ha6Jill')Ae- HHH, peayJibTaTM KOTOphlX BilOCAeACTBHH HCilOJib30BaAHCb npH AHarHOCTHKe BHYTPH- yTpo6HoH KpacHyxH. TaK, cHaqaAa IlAOTKHH HAP, (1963) noKa3aAH, qTo aHTH- TeAa K BHpycy KpaceyxH DpHCYTCTByYDT y 6oJibHLIX Ae TeH H nocAe mecToro MecH~a JKH3HH, T.e. B TO BpeMH, KOrAa naccHBHO nepeAaHHLie MaTe pHHCKHe aHTHTeAa He AOJIJKHLI o6Hapy*HBaTbCH. 3TOT BhlBOA IlOATBepAHAH BeAAep HAP,, (1964), a TaK*e APyrHe HCCAeAOBaTeAH (Dudgeon et al. , 1964 , Coope r et al., 1965). Bo-BTOphlX , 6MAO o6Hapy*eHo, qTo y 6oJibHLIX c BPO*AeHHOH KpaceyxoH B TeqeHHe nepBMX HeCKOJibKHX Mecn~eB *H3HH B Moq e H HOCOrAOTKe npHCYTCTByeT BHpyc (Alford et al ., 1964, Coo per H Krugman, 1967), H, B TPeTbHX, aHTHTeAa K BH- pycy KpacHyXH 6MAH o6Hapy*eHLI B IgM HMMYHOrAo6yAHHe (Al ford, 1965), qTo YKaaMBaeT Ha llMM)'llHYlO peaKII;l1!0 IlAOAa. 06~HH ypoBeHb IgM, KOTopMH MOJKHo HCilOJib30BaTb B KaqecTBe AOilOAHHTeJibHOro npH3HaKa BHYTPHYTP06HoH HH~eKil,IDI, IlOBhlilleH y MHOrHX 6oJibHLIX AeTeH (Soothill et al., 1966). B aaBHCHMOCTH OT B03pacTa 6oJibHOro AAA nocTaHOBKH Aa6opaTopHoro AHarHo3a MOJKHO HCilOJib30BaTb CAeAyro~He TecTM: 1) y HOBOpOJll.llieHHLIX: BfilAeAeHHe B~~y ca H3 MOqH H HOCOrAOTKH; onpeAeAeHHe o6~ero ypOBHH IgM; BhlHBAeHHe aHTHTeA K BHpycy KpacayxH (npH IlOMO~H PTrA HAM PH); BWIBAeHHe cneD;11~HqeCKHX IgM aHTHTeA; 2) y AeTeH rpy,1Qior o B03pacTa: HaAHqHe aHTHreMarrJilf')THHHHOB HAH HeH- TPaAH3yYD~HX aHTHTeA K BHpycy KpaCHYXH y AeTeH B B03pacTe nocAe mecTH MeCH~eB; 3) y AeTeH B B03pacTe AO qe'Il>Ipex AeT: HaAHqHe aHTHreMarr.moTMH;HHOB. BcTPeq8JOTCH 6oJibHLie, y KOTOphlX OTCYTCTByYDT aHTHTeAa B onpeAeAHM:bIX THTPaX, HO KO~eCTBO TaKHX 60JibHhIX KpaHHe MaAo H He MO*eT npenHTCTBOBaTb HCilOJib- 30BaHHII) cepoAorHqeCKHX MeTOAOB npH peTpocneKTHBHOM aHaAH3e. HeAaBHO Kynep HAP-, ( 1971) OCHOBMBaHCb Ha CBOeM OllhlTe, coo6~wm, qTo 18,5% AeTeH, 6oJibHLIX BPO*AeHHOH KpaceyxoH, YTPaTHAH aHTHreMarr.moTHHHHhl K DHTOMY roAY JKH3HH. XapAH Hee KOAAerH paHee npeAilOAO*H.7IH, qTo 3TO MO*eT DpOHCXOAHTb H B 6oAee paHHeM B03pacTe. RaM He YAaAOCb IlOATBepAHTb 3TOT 11 BUBO~. MapmaJLJI (1971) ycTaHOBHA, qTo XOTH H OTMeqaeTCH HeKOTOpoe CHH*eHHe yPOBWI aHTHTeA y ~eTeH cTapme ro~a, no~o6uoe HBAeHHe KpaHHe pe~Ko c~aeTcR y 60JibHhIX C MRO*eCTBeHHUMH aHoMaAHHMH pa3BHTHH, a TaK*e y 6oJibHhIX, CTp~a- IDll{HX rAYXOTOH. YpoBem, aHTHreMarrJDOTHH11HOB K BHpycy KpacuyxH y rpynIIhl 6oJibHhIX (91 qeAOBeK) B B03pacTe ~o 17 AeT IlOKa3aH Ha PHC. 2. TaKHM o6pa- 30M, MhI cqHTaeM, qTo BUHBAeHHe BHYTpttyTp06Horo aapa*eHHH KpacuyxoH y ~eTeH B03MO*HO npH IlOMO~ cepOAOrttqeCKHX MeTO~OB. 12 Puc. I PHC . 2 ~ 2048 c'.l 102tl u ~ i2 512 >, u 256 >, ~ 1 28 ;o ;<: 64 ;o 32 g Q 5 16 ~ 8 r, i:: 4 ~ ~ <'.4 S? C :;;: ~ '"" =: =--< Iv\ TAPA !,TA Pt::T lll! lrr MHKpOtjJTaJIT,M f'.nayKoMa TIO,iy'l' IICIIHC poro1111u;u llHC BMOl01H IIPOJIBJIEHHE BPO)WHHOH KPACHY:iGI llt::.11,OCTATO' ll lhll~l UEC Y P0)01BIIIHXCH U CPOK .11,t::TEH IIB.11,0CTATO'll!OE PA3IMTHE 3AM E.lVIE JI! lhlH POCT MlfKPOfl,t::<l>AJIHH TIAPAJ!ll'-l llEHTPAJlb l!Of'O ITPOHCXO,W JIHH l:lbffyYK.llLJH 11/ 11.JIH yaeJiwic111111i1 nepe.11;111-111 po.n;- 1-mt10K l!apyuie1111e pe•rn UPO:itvn: Hllhlt:: TIOPOhll CtP Tiopa)l(emie MHoKap.n;a ' Tiyp11ypa ~~u f'EflATOCfl.' IEl!OMEf'A.}lllfl ~eJITyxa - f'enaTHT "'- Tiopa)l(CliHC KOCTeii Uu.n;cJic,m e B>tpyca 0 llmjJeKD;H03HOCTb f'JIYXOTA YPOUEIIL AJ!THf'EMAI'f'.'IK1f lU0{J(O8 I, BlrPYCY h:PACIIYXII Y EOJlblll,IX U ll03PACTE )I() 1 7 JIET C MJIOJKECTl3t::JlllhlMH Al!mLA..:IHilMH PA3BnTHH, llhl3BAl!llh!MH BPOJtill:Ell l!Cil h'.PAC JIYXOfl 0 - 2 Mec.f!n;eu 3 - 5 6 - 11 ~ecnn,ea 13 4 5 - 9 10 - 1 ·. Ta 6.llHn,a 1 OBIIWI B3AMMOeBH3b A HOMA.JI 1111 PA3BlITl1H e B03PAeTCM 1. HBP KAT B3e 2. llBP B3e TllJI re *eJITyxa 3. !IBP KAT B3e TllJI re *eJiryxa Y ,n;eTei1 6oJiee CTapmero BoapacTa 4 . lfBP HP KAT PeTHHMT B3C 3YP ?r JiyxoTa 5. HP PeTMHH1' B3e ?3YP ?rJiyXoTa 6. HP KAT B3C IIIijJ r .ilYXOTa 8. 3aMe,iµeHHoe paaB11T11e 11 rJIYXOTa 9. rJiyxoTa H/ H.llH p8THHHT 10. rJIYXOTa E.IJ;111111Y.llb!E AIIOMA.JI:1111, 3A MelOIH1-lEIMEM rJIYX<YTI,i, BeTPE4.A.lfil'e.H PE)Q{O 11PM BPO'JIQJ;Efil!OO Ia'AeHYXE I-IBP = He,n;ocTaTO'IHhl11 Bee npH poll(,ll;e1om re reMaTOCOJieHoMeraJIHR lfP = lle,n;ocTa-rotJHoe paaBHTHe KAT KaTapaKTa B3C Bpolt(,ll;emrne aa6oJieBa~e cep,n;n,a IT!lJI 11apaJIHtJ ~eBTpa.1ll,BOro IlpOHCXO.)l(,ll;eHHR Til,11 TpoM60D;HTOileHHR eOOTBF.TeTBY1ffii;ME JIAOOPATOPHh!E TEeTbl B 3ABMeMMOCTl1 OT B03PAeTA y HOBopolfYleHiih!X ,n;eTei1:- Y rpy,zi;mrx ,n;eTei1 :- Y ,n;eTei1 6oJiee cTapmero B03- pacTa:- 11oBh!meBHe o6ll\ero yPOBHR JgM HaJIMtJHe IgM -aHTHTe.11. IIaJI11tJHe aHTHreMarrJllm'MHHHOB K B11pycy Kpaceyxu ilaJIHtJHe aHTMreMarrJIJOTHHHBOB K BHpycy Kpaceyxu 14 HaJllf'IHe &HTHreMarrJllCIPHHHHOB K BHpycy .... U1 Ta6JU1~ 2 rpyrma 1 rpyrrna II I rpyrrna m IDJlbHl,IE C BPOJtUJ;EHHOO KPACHYXOH HccAeAOBaIDle rrpoBeAeHo B AoH,11;0HCKOH rre,11;HaTpW1eCKOH 6oAbHH~e , Great Ormond Street, London W.C.l OcHOBHaR rpyrrrra 6oAbHhIX c BpOJK,ll;eH- qHCAO o6cAeAOBaH- lJ:HCAO 60AbHhlX , HOH KpaceyxoH HhIX 60AbHhIX HCKJll!J'leHHh!X H3 o6cAeAOBaIDIH EoAbHhle , HarrpaBAeHHhle B neAHaTpH- qeciey10 6oAbIDIIzy , HJI.H HC CAeAOBaHHe 302 15* naTOAOrHtleCKOro MaTepHaAa I I I BEoMeHHaR neE~enTHBHaR HJI.H ceHCOpBO-BeBpaAbBaR rJIYXOTa EoAbHhle c YMepeHHoH HAH TRxeAoH ~opMoH nep~enTHBHOH rAyxoTI,I , 06cAeA0BaHE1J,1e B ~eBTpe no npo6Ae- I 160 I 20 I MaM CAYxa H pe= B Ha~H~e (Grays Inn Road) J!;eTH 2 noABeprnrnecR BBYTPHYTP06- ROMY aapaxeBH10 KpacffYXoH, HO I 228 I - I 6ea aHOMaJI.HH rrpH pO_Jll,1.\eIDIH * Ehulo npeACTaBAeHo HeAOCTaToqHo AaHHhIX lJ:HCAO 6oAbHhIX , OTO- 6paHHh!X AAR rrpoBeAe- HHR aHaJU13a 287 (32 c e)J;H~HoH aHOMaJI.HeH 255 c MHOXeCTBeHHhIMH aHOMaAHRMH) 140 228 .... Ol Ta6JIH1¥1- 3 )V.Hffi,fE O BO.Jlbf!l,IX C MOOJKECTBEHm,IMH AHCMAJIIDlM}[ PA3BHTIDI, 8113BAHf!l,IMH KPACHYXOH, B 3ABHCHMOCTH ar BO3PACTA H CEPQJJ.OrWIECI<Oro CTATYCA HaJI.H'IHe aHTHTe.Jl K BHpycy Kpacayx:u y ,n;eTeH XapaKTep aH0MaJIHH B B03paCTe OT 6 MeCfl~eB ,n;o 4 .JleT Bcero lIHC.Jlo ,n;eTeH c CepoaeraTHBHhle CepoTI03HTHBHhle HaJIHlIHeM aHTHTe.Jl ).(Be aHoMa.JlHH KAT + B3C B3C + Bill' 83C + peTHHHT 4 68 72 68/ 72 B3C + II,HC TpH aH0MaJIHH KAT : B3C : BTir 2 88 90 88 / 90 KAT : B3C : II,HC MaoxecTBemme aH0MaJIHH nepe'IHc.JleHHhle BLDlle + TIIJI : rA 2 91 93 91 / 93 HP Bcero 8 247 255 247/ 255 CoKpall\eHHfl : KAT KaTapaKTa B3C Bpoll(,ll;eHHoe aa60.J1eBaHHe cep,.11;1¥1- Bnr BpoJK,21;eHHafl nep~eTITHBHafl I'.JlYX0Ta II,HC IlopaxeHHe ~eHTpa.JlbHOH aepBHOH CHCTeMbl TIIJI TpoM60n;HTOTieBH1IeCKafl nypnypa rA reMOJlHTH1IeCKafl aBeMHfl HP He,n;ocTaToqaoe pa3BHTHe JUITEPATYPA Alford, C.A., Neva, F.A. & Weller, T .H. (1964) New Engl. J . Med., 271, 1275 Alford, C.A. (1965) Amer. J . Dis. Child ., 110, 455 Butler, N.R. et al. (1965) Brit. med. J. ' 3., 1027 Cooper, L.Z. et al. (1965) Amer. J. Dis. Child. , 110, 416 Cooper, L . Z. & Krugman, s. ( 1967) Arch. 0phthal., 77, 434 Cooper, L.Z. et al. (1971) Amer. J . Dis. Child., 122, 397 Dudgeon, J.A ., Butler, N.R. & Plotkin, S.A. (1964) Brit. med . J., ~. 165 Dudgeon, J .A. (1967) Arch . Dis. Chi ld. , 42, ll0 Dudgeon, J .A. (1969) Amer. J. Di s. Ch ild., 118, 35 Gregg, N. McA. (1941 ) Trans. 0phthal. Soc. Aust., 1, 35 Gregg , N. McA. (1944) ibid., _±, ll9 Gumpel, Shi rl ey M., Hayes, Kathleen & Dudgeon, J.A . (1971) Brit. med. J ., ~. 300 Lundstrom, R. <1952) Acta Paediat . (Uppsala), i!_, 583 Manson, M.M. , Logan, W.P.D. & Loy , R.M. (1960) Rep. on Publ. Hlth Med. Sub., 101 Marshall, W.C. (1971) Personal communi cation and thesis presented to the University o f London Plotkin, S.A., Dudgeon, J.A . & Ramsay, A.M. ( 1 963) Brit. med. J., ~. 1296 Sheridan, M.D. (1964) Brit. med. J ., ~. 536 Soothill, J.F., Hayes, Kathleen & Dudgeon, J.A. ( 1966) Lancet,!, 1385 Swan, C. et al. (1943) Med . J. Au st . ,~. 201 Weller, T.H., Alford , C.A. & Neva, F .A. (1964) New Engl. J . Med., 270, 1039 lJ 3IlI1,1.l;EM110JIOrWIBCKIDI RM30P 3A BPOJtOJ;EHROi1 KP ACRYXOW ITpocpeccop .11,lK.A. ~*eH ITe.n;HaTp HqecKaJI 60.IIbHIHJ;a' JlOH,n;OH CocTaBHOH qacTblfl Jllfl6oi1 nporpaMMLI HMM)'HH3ar:i;m1 npoTHB HH<l>eKD;l10HHOH .6o- Jle3HH .n;oJVKHa 6bI'rb nporpaMMa 3 Il l1,ll;eMHOJIOrH'leCKOro lla,.!1;30pa' n;eJlb KOTOpOH - on- pe.n;eJIHTb, 06ecneqm3aeT JIH .n;aHHaJI cxeMa 11.MM)'HH3aD;11H *e;rae.Moe 3all\HTHOe .n;ei1- CTBHe . Reo6xo,n;HMOCTb 3Toro .n;oKa3aHa B OTHOIDeHHH ,n;H<l>TepHH, KOKJllflIDa, IlOJIHO- MHeJIHTa l1 KOpH. 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B 60.IIbIDHHCTBe c;ryqaeB BpOJtVJ; eHUaJI Kpacuyxa MO*e~' 6h1Tb .n;11arHOCTH- poBaHa .n;ocTaTO'IHO TO'Il.l.0 Ha OCllOBallHH KJIHHH'{eCKHX npH3liaKOB. 2. MeTOAhl J1a6opaTopHOH .n;11arHOCTHKH .n;ainT B03M0*1IOCTb B 6oJlbIDHHCTBe c;ryqaeB TIO,ll;TBep,n;HTb .n;11arH03. 3. OpraHH3aD;HH nporpaMMhl 3nw,n;eMHoJ1or11qecxoro Ha,.!1;3opa o6Jlerqeaa B cTpanax, pacno;rara.Jflll\HX 11an;110Ha.lih1lhlMII c;ry*6aM 11 3,n;paBooxpaHe H11JI 11 mKoJib- Hoi:i Me.n;un;i-llihl. 1 p. 251 Dudgeon, J.A. (1971) Pan A mer. 111th Org . , Scientific P ub. No . 226, 18 Haq aJio rrporpa= HaA3opa B BeJim<:o6pHTaHHll 6hl.JIO TIOJIO*eHo B 1971 r.; llMeJl)TCR ABa ~eHTpa perHCTpa~Hll: Ha ceBepe Alir.JIHH, B .Jrn,.zi;ce, H B neAHaTpHqe- CICOH 6oJibHH~e B JlofiAOHe - OH o6c.rry*HBaeT lf)JKH)'lll qacTb CTpaHhl . 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JTO eAe,n;y1r:11111e eTpallbl: BeJibrH.fl, BoArapH.fl , B eurpH.fl , ~1:111.fl, JIJn:iceeM6ypr, HHAepAaHAhl, HopaerHH, IloJibma , IlopTYI'aAHH, CoeA11He1:1noe KopoAeB- eTBo, <t>HH=H,.11;11.fl, <t>paHII,l1JI, IllBe~.fl H IDroeAaBHH. B ee 3TH eTpaHhl eoo611111AH O ua- Al1'-11111 ~eHTpaJib1:1oro yqpeJK,ZJ;eH11.fl, 3a1:1HMa10111eroeH TaKoH pa6oToH. 27 3.2 IlOCTYflHBIDHe yBe~oM.JieHID! l!HCAO y:aeAOM.JieHHH, IlOJIY'IeHHhIX pa3JIH'IHh[Ml1 CTpaHaMH, rAe HaXOAHAHCb KOH- TaKTbl 6oJibl:WX nepBJ.f1lllhIM H BTOpH'llihIM Cli~HJll!COM H roHopeeH B 1970 r., yKaaa- HO B Ta6A. 1. Ta6AHn;a 1 IIPOCJIEJKHBAIDIE KOHTAKTOB B EBPOilE : YBE,1.IPMJIEHIDI, IlOCTYilHBIIIME B 1970 r. IlepBH'IHhIH H BTOpH1mLIH CTpaaa CH~HJIHC I'oHopeH BeJibrIDI 18 1 Bo~apIDI 2 4 BeHrpIDI 3 40 ~HID! 15 64 JhoKceM6ypr 0 4 HHAepAallALI 2 8 IloJibma 6 10 P)'MhIBHH 14 5 CoeAHBeHHoe KopoAeBCTBO 24 36 'PHHAHHAIDI 6 115 'PpaHD;IDI 27 35 <PPr 9 41 IOrocAaBIDI 10 35 136 398 llIBen;HH coo6J1111Aa o6~ee qHcAo yBeAoM.JieHHH no ABYM 6oAe3HHM - 35; Hop- BerIDI H IlopryraAIDI n;H~p He yKaaaJIH. KoAH4eCTBO yBeAOMAeHHH O KOHTaKTax 60JibmIX nepBlf'IH.bIM H BTOPH4mIM CH~H- AHCOM H roHopeeH B 1970 r., HanpaBAeHmrx B ApyrHe CTpal:W li3 cTpaH, npHc~aB- IDHX COOTBeTCTBYJOJIIHe AaHmre, YKa3aJ:W B Ta6A. 2. 28 llIBeD;YIJI coo 6~11Aa o6~ee q11cA0 HanpaBAeHHhIX yBeAOMAeH11H no AByM 6oAe3HJIM 434; 11opryraAl1Jl He npeACTaBl:fAa 0TAeJlbHbIX AaHHbIX 0 BH:-rrpeHH11X 11 BHeIJTH11X yBeA0MAeHl1JlX . Ta6A11a,a 11 11POCJIEJKHBAHl1E KOHTAKTOB B EBPOTIE: YBE.lI;OM.7IEH.11J!, OTTIPABJIEHHh!E B 1970 r. 11epB11'1HhIH 11 BTOpl1'lHh!H CTpaHa Cl1(j)l1Al1C roHop en BeJibr11n 2 0 B0Arap11JI 3 2 BeHrp11n 5 21 .lI;aHl1Jl 3 39 .7hmi:ceM6ypr 0 2 H 11A e p Aa H,.lJ;hl 33 78 !1oJlbma 18 19 PyMhlHl1H 8 4 CoeAl1llenuoe KopoAeBCTBO 7 41 <I> J,IliJIJ!ll,ll; 11Jl 0 18 <I> p aH IJ,lli! 109 54 HlrocAaB l1R 9 0 197 278 3. 4 ncno.lI.b3yeMMe Kap'l'bI 3. 4 . 1 Kap'l'bl _n;JIR Meltl,ll)YHapoAHOH nepeAaq11 11HcJlOpMaa,1rn B EB pone A0C'1'11rHy'ra HeK0T0paR C'l'eneHb CTall,ll;ap'l'l13aIJ,1111 . lli!'T'b CTpaH (.lI;aHl11!, Hl,fAepAaH,llpI, CoeAHHeHHOe KopoAeBC TB0, <!>Pr 11 HlrocAaBl1Jl ) yJKe HCIT0Jlb- 3yY)T 0A11HaK0Bhie npoc'l'ble Kap'Thl, C0CTaBAeHJ.lhle Ha aHrA11HCKOM Jl3hIKe (.lI;onoJU.1e- H11e 2). B IDBeD;l111 TaKJKe 11CIT0.JTh3yeTCJl npocTaR KapTa 3an11c11 Ha mBeACK0M 1!3hIKe. Qua np11MeHJieTcJI AJIR MHor11x 11H(j)eKD;YIOHHhIX 6oAe3HeH; c11(j)11A11c (paHH~IH 11 no3AHWH), rouopeJI, MJirK11H manKp 11 Benepwiec K11H rpanyAeMaTo3 - 3T0 Al1illh ITJI'l'J, 113 5 2 6oAe3HeH' AJIR K0'l'0PhIX 11CIT0Jlb 3yeTCJl Kap Ta (.lI;onoAHeH11e 3) . 29 OcTaJil,HLie CTpaHLI, KOTOphle 3aHHMaIDTCR Me~apo~M IIpOCAe*HBaHHeM KOH- Ta.lCTOB (BeJlhrHR, BearpHR, .Jl!m;:ceM6ypr, HopaerHR, IloJlbma, IlopT)TaAHR, ~HH=H- AHR, ~paHD;IDI), coo6~HAH, qTo y HHX HeT yc TaHOBAeHHOH xapTLI, a BeAeTCR o6MeH OTAeJil,HhIMl:I nHCbMaMH Me*AY COOTBeTCTB}'ID~HMH MHHHCTepcTBaMH 3Apaaoo:xpaueHHR HAH 3KBHBaAeHTHhIMH BeAOMCTBaMH. CTpaHhl, OTBeTHBIIl1fe Ha BOIIpOCHHK, He HarrpaBHA11 (KpoMe Bo~apHH) o6paa- Il0B xapT, ICOTOphle 11cnOJil,3)'ll)TCR AJUi npocAe*HBaHHR KOHTaKTOB BHYTPH CTpaHLI, XOTR TaKHe xapTLI llYlKHhI B x==ax A= perHCTpan;Hl1 HH~OpMan;H11, nepeAaBaeMOH IleHTpaAbHOMY yqpe*AeHHII). TaKaR Kap Ta HCnOJil, 3yeTCR B CoeAHHeHHOM KopoAeB- CTBe A= 3TOH IleAH, a TaK*e A= o6hl'lllOro BHyTpeHHero npocAe=aaHHR KOHTaK- TOB Me*AY ICAHH11KaMH (CM. ~onoAHeHHe 4). HHorAa, ecAH AaHHLie BalKHLI , 3Ta KapTa MO*eT 6hlTb TaK*e nepeAaHa Ha APyrHe CTpaHLI. He 6hlAH npeACTaBAeHLI TaK*e H o6pa3Jll,l BH'JTpeHHHX pa6oqHx KapT. B )l;onoAHeHHH 5 AaeTCR o6pa3eil xapTLI, Ha ICOTOP)'ll) MeCTHOe yrrpaaAeHHe 3Apaaoo:xpaHeUHR ~OHAOHa (ropoA Bec-r- MHHCTep) 3aHOCHT HY~ HH~OpMaI:lHII) c noCTYU8l()~HX xapT H ICOTopaa 3aTeM Hc- IlOJil,3yeTCH B IC=HKax Ka!C pa6o'JHH AOxyMeHT . IlocAe 3Toro MeCTHhlH oprau 3Apaaoo:xpaHeHl1R Hanpaa=eT ee A= xpaHeHHR B Kap ToTexy. 4. Pe3yJil,TaTLI Me)t(,llyHapo.n;Horo npocAe=aaHHR KOH'l'aKTOB B Ta6A. 3 npHBeAeHLI pe3YJil,TaTLI, no~eHHLie B OAHOH eaponeHCKOH cTpaHe (AlrrAWi H Y3Jll,C), rAe MHHl1CTepcTBO 3Apaaoo:xpaHeu11R 11 COilHaJil,Horo o6ecneqe- HM 1 o6pa6aTMBaeT nocTYUruc,~He H oTDpaaJUieMhle xapTLI. B 1970 r. B ~OHAOHe MHHl1CTepc'f'BO 3Apaaoo:xpaueH11R H COD;HaJil,HOro o6ecne- qeHHR nepeAaAo B OTAeA 3ApaaooxpaHeHHR ropoAa Bec'l'MHHcTepa 20 ~opM. r..u r. IlHTepc, KOTOPhlH BeAeT 3TY pa6oTY, coo6nrnA, qTo 4 ICOHTaKTa He MOrAH 6hlTb npocAe*eHLI no rrp~HHe HeAOCTaTO'lllOH HH~OpMau;H11, COAep*a~eHCR Ha 3a- noAHeHHLix xapTax yaeAOMAeHHH, 4 nepeMeH11AH aApeca, 11 6hlAH npocAe*eHLI H AeqeHLI' 1 •. 6hlA npocAe*eH' HO OTICa3aACR OT AeqeHHR . BOJil,filHHCTBO yBeAOMAeHHH 113-3a rpaH11Jll,l noc'rynaeT 113 )l,au1111, KaHaAM, H11- AepAaHAOB, Cl[A 11 illBen;HH, npHqeM qacTO pe~ HAeT O MOPRKax 11A11 0 AHJ:laX, co- IlPOBO*Aa.Jfl~HX "non"-rpynilhl, coaepmruc,~He T)'PHe no Eapone. vi Tex, H APyrHx TI>YAHO npocAeAl1Tb BBH,Z.J;y 11X M0611Jll,HOCTl1. BoJlhIIIylf) noMO~ OICa3hlBaJOT napoXOA- Hhle ICOMilaHHH, npeAOCTaB=R HH~OpMan;HIO O nopTax Ha3HaqeHHR 11X CYAOB . HH~op- Man;HIO O TOM, rAe BhlCTYU8l()T "non"-rpynnhl B AllrAH11, A8l()T peAalCTOphl JtCYPHaAoB, ocae~run~HX Bonpochl "non"-MY3hlKl1. KoAHqeCTBO HHOCTpaHHhIX KOHTaKTOB Ka*eTCR ue60Jil,IDHM, HO cAeAYeT noM- HHTb' qTo ICAHHHIC11 He yBeAOMJIJilflT J:leHTphl O 60Jil,IIl1fHCTBe CJP,rqaeB' TaK KaK qacTo cqHTaJf)T, qTo Aa*e IlhITaTbCR npocAe*HBaTb HX, 11CXOAR 113 TOH He3uaqHTeJil,HOH 1 11,H~phl JII{)6e3HO npeAOCTaBAeHhl A-POM ~.X. Bepp11 30 Ta6.JJ.111J,a 3 MEJK,llYHAPO.n;HO E IIPOC.JIEJIG1BAIU1E KOH TAKTOB B AHf.JIJ,rn:. 11 Y3JibCE (~Jlh-,D;e Ka6pL 1970 r . ) I Bxo,n;. a HHipopMaII;l1Ji no.JI}r'leHa -16 ,ll;oc•ra'l'O'll!0 ,ll;.!lli nepe,n;a•rn ,n;a.JJ.ee 41 OTIJe'l' B ,n;aJibuewmeM no.1-ry• rc11 23 Mec'l'oHaXOJtl,llCIUIC ye ·raH0B 11'l'b ue y,n;aJI0Cb 1 2 \' Onrn6o,rno :',"Ka3aumre .'ll!1J,a 1 Ilpot:JJeJKelihI, 0 'PP 1111a 'l'C JIT, lJLI e pe3yJU,Ta'l'L! I 3 IlpocJie ll\eHhI , C0<''l'0lill l!e 11 e113Bec'l'H0 " Y i1:e HaX0,ll;R 'l' CR lHl H 3Jie•1c111u1 2 m .111J11m1poaaID,I H Jie'la'l'cli J I a l !cxo,n;. Bcero H 100 6 28 G9 10 03 3 1:) - 1 3 G - :~ " 4 2 ::i CIIIA - 13, IllBeI.J,vlli - 12, R1i,n;ep.Jiau,n;LI - 10, Ka11a,n;a - 5, ,lI,aBHR - 3, ,.'l;pyr11e - 3 I 6 CIITA 8, MaJiaHR, <!>Pf, Ilo..llhma H llcnauun - no 2 H K,1.;r~'loiii, l '.! oc'l a.U, LLLI X C'l'JlaH - no 1 B 1<:a)l(,ll;o11 :.n W:I(J>opYa~, ICOTopa.JI m,:eeTcR, - 6eaua,.z,;elKlla.JI aa,.z,;aqa. B ~pyrHX C~a.JIX Ha- ~elK,ll;a B03AaraeTCR Ha ~yaeH 60Jil>HOro, H TOr~a ~eAiU()TCR IlOIIbITICH no TeAe~ouy HJW IlHCblLOlL y6e~HTb 6oJil>Horo YJCa3aTb lCOHTaICT. 06~ ee qHCAO HH~eICrr;w1, ICOTO- p~e, ICaIC npe~oAaraeTcR, 6MAH aaBe3eHM B AHrJll1!0 B 1969 r., noICaaauo B Ta6A. 4. Ta6JWga 4 3AB03 BEHEPWIBCKl1X BOJIE3HEH B AHr Jll1lO, 1969 r . IlepBH'llll>lH H BTOPH'lllhlH CH~HJWC 11H~eICil;l1R IC-Bo npon;eHT IC-Bo 06~ee qHCAO aaperHcTp11- poBaHllhl:x c~aeB 1 265 - 50 037 C~aH, 0 lCOTOphlX HlLE!lOTCR ~aHHMe 1 199 100,0 49 910 3apaJKeHHe IlpOH30filAO B AHrJWH 939 78, 3 47 013 3apaJKeHHe npOH30filAO aa py6eJKoY 205 17, 1 1 858 HeH3BecTHO 55 4,6 1 039 rouopeR npon;eHT - 100,0 94,2 3,7 2,1 (Ha oTqeTa rAaBHoro Me~Hn;HHcICoro cnen;HaJWcTa MHHHCTepcTBa a,iwaBooxpaue- HHR H con;HaAbHoro o6ecneqeuHR aa 1969 r.) 32 ,ll;OIIOJilIEHl1E 1 l.lOIIPOCHl1K .1I,lliI IIOJIYl!EIDIB HH<!>OPMAI.IJ1H OB YBE,ll;OMJIEHHl1 0 PACIIPOCTPAHEHl1H BEHEPl1l!ECKl1X BOJIE3HE11 MEW CTPAHAMl1 0.n;HnM 11 3 nyHKTOB noaeeTK11 .n;HR Pa6oqei1 rpynnhl no aonpo ey o paenpoe 'rpa- 11 ,~ 111111 aeuep11qee101x 6o.Jie3Hei1 MeJK,.ZJ;y eTpaHaMM, eoae111aH11e KOTopoii 6y,n;eT npoxo- ,;1,11 ·1'6 B K oneurareue B ,n;eJCa6pe 1971 r., 6y,n;eT paeeM0TpeH11e 11enoJib3yeMhIX B Ha- C'l'O>IJJ\C e Bpew1 MeTO,ll;OB Me;J(,ll;YHapo,n;Horo npoe.JieJK11BaHJ,(R ICOUTa!C 'PO B 60.JibHblX e11cp11- J[lleOM H roHop eeii . ,ll;JIB Toro 'ITo6u y yqaeTHl1KOB eoae111aH11H 6h!.JI11 Bee Heo6xo,n;111,n,re ,n;aHHh!e, npo- e1 1M J[ll')6e 3UO O'PBe'l'HTb Ha eJ1e,11;}'101lll1e npoeThle Bonpoebl ('t'aM, r,n;e H}'JKHO, npoe nM npue ·1•aBJIH'I'L KpeeTHJC11) . 1 . Oprau113oBaua .Jil1 B Barnett eTpaHe pa6oTa no yae,n;oM.JieHl11"' .n;pyr~1x eTpau o 60.Jll,Hb!X: a) 6) m1<PeKill10HHh!M e mfJH.JIHeOM roHopeeii o6eHMH 6o.Jie3HHMH? f1poao.n;11TeH JIH 3 't'a pa6oTa •repe3 npaawreJ1bC'l'B e111rui1 opra11 ·> H e T :J. Ec JUI Ha BOnpoe 2 .n;aH no.JIOJKWr eJlhHblH O'rBe 'l' , TO e K OJlh KO np11MepHO KapT 6hlJIO ITOJI}nreHo B 1970 r. 113 .n;pyrnx e'rpall II e KOJILKO 6hlJIO HM HanpaB.JieHo? K o.Jil1'Iee·rBo no.ny•i:eHHblX yBe,ll;oMJieH11H K o.Jil•!"IeC'rBo HanpaB JieHHh!X y B e,ll;OM.JieHHH !l. l1MeeTeH JIH )' Bae eTal!AapTHaH Kap Ta, KOTOpaH 11enoJlh3yeTeH ,ll;JIJI u:eJieH MeJK)~yHapo.n;uoro npoeJieJKl1BaHHH KOHTaK'l'OB? ..n;a He •r (IlpoeHM npne.Jia'l'h o6pa3ell 11.JIH o6pa3Ilpl 11en0Jlh3~7eMh!X ic a pT ) 33 .ll;OTIOJUIEHl1E 2 . ' ICAPTA, COCTAWIEIIRAR B ·toE;.U.11HEliROM ' ICOPOOBCTBE Ii llPHJUITAR B IUITH EBPOllEHCKHX CTPARAX MHHHCTepcTBo a,a;pasoo,xpaueuHfl H coIJ,HaJ!buoro o6ecneqeuHJI A.JteIC c &.H)lp 4>J1eM>111r xayc , 3Jie<l>&.HT 3H.ll KacJt, .JlOH,llOH, C .E .1 CTporo ICOH!J!¥.eHlljHIU!bHO Ysa><&e>ihtli· roc nOAIW, OruocHTeJibHO KOH TRKTO B aeuep1A0CKHX 6oJlbllhlX Ranpas..vnr. >111<1>opw&.m-M O ICOHT&.IC Te 88HE>PH'l8C ICOr o 60.JlbHOrO ;f 6yAY 6JiaroAap ee 39. 803Bp&.J118Hl-18 3&.- IlOJOieHHoro axae~JU1pa 3ToA xap'Thl . . .ll.><.P .X . BeppH CT&.pm~ weAHIJ;HHCIClffl c nemt&.JIHCT . . . . . . . ' --- ---- ------------ -~ ----- -------------- ----- - - ICoHT&KT e esep1-r1ecKoro 60.llhuoro 4>aM.11JIHR : Boapac T: Mpec: MecTO BCTpeqH: ,llpyr11e B&.llWWe A&.HHWe : 0 KOHTB.JCTe coo6~euo 6oJihHhlW □ GH(IJHJU1.CO M , CT8.,.!J;H..R: D · HHolt seHep l!"lecJColi 6oJieaw.o a ID1e1Wo EcJU1 aapa~ea, yxaaaTb aa6o~eB&HHe: D ue aapa•eu IloJt : □ rouopeeH n1, 3apa•euj U&XOAHTCH .ua Ae~e~~ ( p~uee no IlOBO)O" 3 TOA HJitl)eKil,HH ue __ Jl"'1HJICII) □ aapa~eu, e oaepa~ea AJtH JieqeulUI 3ToH Wl~eKll,HH □ p&.Hee Jte'IHJICII no nosoAY 3Toli iw<1>e1rn;1m □ aapa~eu, ue Jieqeu LJ o6uapylltHTb ue y.n;aJIOCb □ o6uapy~eu, OTK&3&JICff OT o6CJI8.ll;OB&HWI □ HCAOCT&TO'lllO HH~op wan;HH, qTo6w aaqaTb pacCA8AOBaHHe 34 C,.J C.Jl :e 0 0 :.: ::::, .., "' :e <( "' ... ... i "' > <( _, _, <( ... :e 0 z < _, jct ~ I z < Mottogorens onteckn ingor lnsjuknad den 11 Ian I kommun (onges oven for ,m;ttborare) lnfektionsort Arbetsplots, skola, bornhem el dyl for den onmOlde VCrdas i I Sjukhusets namn 0 1 oppen 02 sluten v6rd vClrd Remitteronde ICk are (anges av anmOlonde sjukhuslOkare) Ovrigo uppgifter av epidemiologisk betydelse : Sm ittkOllo , sm ittvcigor, on dro onmOrkningsvOrdo omslOndigheter (I ex livsmedelshanteringJ vidtagno smitt- skydds6tgcirder m m :~"T~~;l dog I nr I ~ M I Nomn (Ej vid vene riska sjukdomar) Yrke / tilel Adress Tel Nationol i tel (om ej svensk) Allmanfarliga sjukdomar 1 2 0 Sjukdomsfoll O Smittbbrore Grupp I (se boksidon ) 2 □ Kv t1vriga Bokteriesjukdomar D 41. Botulism BetrOffande venerisk s jukdom uppges dels smittkOllo , dels ev kontokter , i I □ b6do fallen med nomn, odress, telefon och ungeforlig Older . Grupp II D 7. Tyfo;d Grupp V D 18. o;fter; D 42. Gostroenterit, elokartod , hos born i Oldern under tv6 Or• D 43. l isterios Ort, d a tum lb.kOre;..s·. ·under~·kr·i-f( . 1·eIeton 5oc sfvr I 280 FoshtOltd den 3 ,-4,..<: 1968 0 8. Paroty foid• D 9. So1monellodiorre• 0 10. BocillOr dysenten• n 11. AmObodysenteri Grupp 111 D i2. Menmgokocksjukdom D 13. Po l;o • D 14. Prtmcir, 1cke varig h jCJrn- och hjCrn- hinneinflommation" Grupp IV (se bok,;don) D 15. Weils sjukdom och andro leptosp iroser• 0 16. Epidem isk gulsot D 17. lnokulationsgulsot Ev typ D 19. Mjoltbrond D 20. Papegojsjuko och andra ornithoser• Grupp VI (se baksidan) 11 21. Tuberkulos □ 22. lepro D 44. Schorlokansfcber D 45. Tuloremi D 46. Und ul ontfeber D 47. Stelkromp Maslcsjukdomar D 48. Filorios• Veneriska sjukdomar D 49• Sch;,iosom;o,;,• D 31 . Syfilis o) medfodd D SO. Trik inos D 32. b ) forvorvod D 33. Gonorre D 34 . Mjuk schanker D 35. Veneriskl lymfo- granulom Protozosjukdomor D 51. Malaria" D 52. Toxoplosmos D ·· I Mott_o_g_or_e_n_s_o_n_tec~k-n~;n_g _ _____________________ _ UC 0-4129 ~ ..., ;i. s: g ~ ~ trj ~ t:0 Eil trj §l s: ~ :=l ~ I C,.J ,ll;OilOJillEH11E 4 KAPTA, ~CilOJib3YEMAfl B CO~EHHOM KOPO.JIEBCTBE N CONFIDENCE Special Clinic Contact Report (Re.-. 9/70) ref. No. To: The Medical Officer of Hcallh/ Director of Special Clinic . (delete as appl,c..nlc) A patient at this clinic under trlt!:Hrncnt for of approximately days/weeks/months duration has disclosed IN STRICT CONFIDENCE the information overleaf about an alleged contact. Signed Designation for Director . Address .Special Clinic date Note : To fill in thi s form put tic~s in the boxes a~ain st th e relevant foaturcs , and comments in the spaces . For example, in the item for hai r "blonde" might be wri1ten in the space lo the right of "co lour" a tick put against "dycJ" and "pony1ail" written in the space 10 the right o f " st} le". 36 19 Name and Nickname MARITAL STATE DESCRIPTION APPEARANCE HAlR Colour HEIGHT Tall Single European Ycar1i: IN CONFIDENCE PART I O.:c\1pation : .ll:ono.meH11e 4 THIS FORM SHOULD BE DESTROYED AS 9GON Jul Male/Female . - --- - - i---··-----1 \ Married ~cpara1cd j __ w,d~ __ c_h,_IJ_r_cn __ ~ \'\ «.st 11,dian lnd,an or Pakistani Mn..,::Jnor ------- I Wig Dyed Medium Approx. ht. Orher--describe _=1 Style f<. ins. BUILD Thin Slirn Medium Plump Stout DRESS _w_._"_ur_e_=_· -d----~I ~I _o_,ru_·n_•_ry_D_,_"_,ed _____ l, -1 _u_n•_e_m_,_" ______ ~ Accent and Speech Type of Contact - · PART UA To be ..:omplctcd when addrcs5 of contact is known Address House _F_·1_a_, ________ _ _ R_oo_n_, ________ J _F_lo_o_, ___________ B_a_c_•-----~-F_ro_n_, ==_j_M_,d_J_lc _________ ~ Time of arrival home .... _, ____ _ Living alone ADDmONAL DESCRIPTION Colour of Eyes ·--- Teeth ··-·· . MARKS Physical Defects ___ _ Habits Head Gear Ores.~ Coar Tootwc,u Acc-.orics v.ith fanuly ¥.1th frn:nJ l'ART IJB To be completed only Vi-hen address or contact 1s not known Noiib 37 ,ll;onoJIHeH11e 4 PARl Ill HAS BEEN DETACHED AND DESPATCHED Other Details Places frequented by contact Most i,kei) rlJce to find cont , cl Mo:.. t likely t111H.:s Po~siblc district of rcs11Jcncc Other infonnatiun r---------------------------------------------------------- 1 I I I I S1 RICTL Y CONFIDE:' 1 IAL CONTACT TRACING REPORT To the Phys,c,an-in-Charge. Address of Special Clinic i'auent's Ref. No irom Date The person (contact) described 111 Part I was: (a) Located ·01 located (b) l ,an11ncd JI Not c,anunct.l (c) Already under treatment Brought unJer treatment (d) In fected with 1'<01 infected •delete •• appl1cable. Signed 38 PART III /•C.I. Form No. • Med,eal Officer of Health/ Director of Special Cl101c. date 19 Name Address • KAP TA, I1CII0.7Ib 3YEMAH MECTHLIM YIIP ABJIEHHEM 3,.ll;P ABOOXP AHEIDIB , JIOH.11:0H CITY OF WESTMINSTER HEALTH Department D·escri pt ion Nationality Age Height Eyes Hair Coloured Yes / No Other features Disease D of E Place Frequents .11:0IIOJilIEHME 5 No. Build Received from Date Returned Report CDlltJnued on reverse 39 IIPOBJIEMbI 11 3HAl!EHl1E .METQA@ OJ.31l(J:CTBEHHoro WABOOXPAHEHHH, IIP11MEIDIEMbIX B IIPOI'P_Af,/MAX BOPbBb_l C TPAXOMOH ,11;-p B. H113eTH"I Per110HaJibllhIH eneil,l1aAHeT no O$TaJU,MOAOrHH B o6~eeTBeHHOM 3ApaBooxpaneHHH, EBponeHexoe per110HaJibHoe 6~po BD3, KoneHraren, ,ll;aHWl Bo3MOJIWLI ABa pa3Jill'IHLIX noAXOAa K o6eeneqeBH!fl naeeAeHWl O$TaJibMOAOrltl"le- exoH noMOID;blfl. 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H e!COTOpb!e nporpaMMhI 3ITl1Alla,ll;3Opa, I1a- np11Mep , MHICJ)O CICOITH'JeCICl1e MC CJ1e,n;oBaH11.H opraH113MOB, Bhl3b!BaJ."II(HX MaJ1Hpl1Y' H JKe- JIY,D;OqJIO-ICHJileqHb!e HHct>e1Cu;1111, MOJKHO BhIITOJlHH'I'b ,n;aJKe np 11 HaJil1'J11H orpaHl1'JellHh!x pecypcon. 45 1. l1H$eK~HOHHhle OOAe 3HH RBHO perpeccHpyr,T, HO qTo6M A06HTbCR MaKCHMaJU,HO 3cfxpeKTHBHoro KOHTpOAR HaA HHMH, Heo6XOAHMa IDHpOKaR ceTb 3$$eKTHBHO AeHCT- ByYl~HX Aa6opaTopHH o6~eC TBeHHoro 3ApaBooxpaHeHHR B ITOMO~ aa~oHaJU,HhIM H MeJK,.ZzyHapO,ll,HhIM nporpaMMaM 3ITHAeMHOAOrHqecKoro HaA30pa. 3TH nporpaMMM ITOMO- l!yT Ha~oHaJibHhIM o praHaM 3ApaBooxpaaeHHR npHHHMaTb pa~HOHaJU,Hhie pemeHHR B OTHOIDeHID1 ITOAHTHKH npoBeAeHHR AaJU,HeliIDHX MeponpHRTHli. 2. IlporpaMMM 3ITl1,ll;eMHOAOrHqecKoro HaA3opa - 3TO peaJU,HOe Bhlpa*eHHe eAHHCT- Ba MeponpHRTHli o6~eCTBeHHoro 3ApaBooxpaHeHHR H aay,nn.rx HCCAeAOBaHHli. OHH COAeHCTBYY:T CTafiAapTH3a~HH MeTOAOAOrHH H TeM caMMM yJiyqmlil"T AeRTeJibHOCTb Aa6opaTopHli o6~eCTBeHHOro 3ApaBooxpaaeHHR, KOTOphle Y*e AO= AOCTHreyTb BhlCOKOro ypoBHR p a 6oTM. 3. B Aa6opaTOpHRX o6~eCTBeHHoro 3ApaBooxpaHeHHR PerHoHa CAeAYeT o6ecneqHTb 6oAee 3cfxpeKTHBHOe HCITOJib30BaHHe H BHeApeHHe COBpeMeHHhIX TeXHHtieCKHX AOCTH- 3THOAOrHtleCKHX areHTOB HAAR npocAe*HBaHHR HX pacnpocTpaHeHHJi B opraHH3Me qeAOBeKa, *HBOTHMX H nepeaocqHKOB, a TaK*e B OKPY*ain~eli cpeAe. 4. BoAbIITyll) ~eHHOCTb 6yAeT HMeTb ITPOAOA*eHHe TaKHX BHAOB AeRTeJU,HOCTH B03, KaK o6ecneqeHHe TeXUHtleCKHMH KOHCYJibTa~MH, cnpaBO'IHhIMH ~eHTpaMH H B03MO*- HOCTRMH AAR ITOAro·roBKH KaAPOB, qTo ITOMO*eT CTaUAapTH3HpoaaTb MeTOAOAOrl1l'l H npeAOCTaBHTb cnpaBO'-lllhili MaTepHaA, Heo6XOAHMhlli AAR HH$OpMHpOBaHHR COOTBeTCT- BYJn~HX yqpe*AeHHli HAAR OCY!lleCTBAeHHR nporpaMM 3ITHAeMHOAOrHqecKoro HaA30pa . BHBJil10rPA~l1ll Langmuir, A.D. (19 63 ) The surveillance of communicable diseases of national importance , New Engl. J. Med., 268, 182 Raska, K. (1 964) The e pidemiological surveillance programme, J . Hyg. Epidem. (Praha ) , VIII, 13 7 BceMHPHaJI opraHH3a~ 3ApaBooxpaHeHHJi, EBponeHcKoe perHoHaJibHoe 6~po (1969) MeTO@>I 3ITl1,lQ!¥;3opa 3a HHWeK~HOHHhIMH 6oAe3HRMH, OT'JeT o pa6oTe ceMHHapa, raara, 21-30 Ma.JI 1969, KoneHrareH World Health Or ganiza t ion, Regional Office for the Western Pacific (1971) First Regional Semi nar o n Methods of Epidemiological Surveillance and Geographic Pa t ho l ogy , Manila, 1-10 December 1971, Manila 46 1. MA.llilPl1fl B E BPOIIE ~-PM. IlocTHJil,0He P e rttoHaJil,1:lh!H cne~ttahHCT 0CH0BHhIX CJIY*6 3ApaBooxpaHeHHH, EBponeHCKO e perH0HaJil,H0e 6IDpO 8 03, KoneHrar e H, ,.l.viHIDI 1.1 O6sue B0ilp0 Chl B EBponeHCKHH perttoH BceMttpHOH opraHtt3a~HH 3ApaBooxpaneHHH BX0AMT 40 CTpaH tt TeppHTOpttli c 06111e11 'UIChellli0CTblfl HaCeheHHR 0K0h0 789 MHJWIH0H0B qeh0BeK (no AaHHhlM Ha 1972 r . ) . 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B03 Be ITOAY'JaAa H111Ca1CoH 11H$opMa~1111 o MaJIJipl1HBoH o6cTaHOBKe B CCCP. 06~aR '111CAeBHocTb HaceAeH11R fpeD;1111 11 CCCP (aa 11c1CJI10'1eH11eM YKpa11Hc1CoH CCP 11 BeAopyccJCoH CCP) cocTaBJIJieT np11MepHo 200 Ml1.JI.JlHOHOB. B ocTaJiblihlX 35 cTpauax (c o6~eH '111CAeHHocTbID HaceAeH11R np11MepHo 521 Ml1.JI.JlHOH), nepe,11;a'la MaJIJipl111 $alCT11'10ClCl1 Be npol1CX0,11;11T; ~110 TPl1 rpynl1hl: 3Tl1 CTpalihl MOJKHO no,11;paa,11;eAHTb Ha CA0,.!l;yfil- 1) cTpalThI, B lCOTOPhlX MaJIJipl1R A111CBl1,ll;l1poBaHa, HO 3TO 0$11D;11aJibHO He aa- CBl1,ll;0T0JibCTBOBaHO B03 (cTpalihl B $aae IlOM0pJKaH11R); 2) CTpalihl, B lCOTOphlX MaJIJipl1R Al1lCBl1,ll;l1pOBaHa, 11 3TO aacBl1,ll;0T0JibCTBOBa- BO B03 (cn11co1C "aTT0CTOBaHHhlx" CTpaH B03); 3) CTpaBhl, B lCOTOphlX MaJIJipl111 H111Cor,11;a Be 6hlAO 11Al1 )1(0 Olia 11C'l03Aa ,11;0 1957 r. (",D;OilOAHl1T0JiblihlH Cil11COlC" B03). XoTR B 3Tl1X 35 cTpauax nepe,11;a'111 MaJIJip1111 He npo11cxo,11;11T, cAY'3:a11 aa60Ae- BaH11R MaJIJip11eH Bee e~e BCTpeqa.ioTcR, a B H0lCOTOphlX paHoHax B03MOJKHO np11cyT- CTB11e nepeuocq111Ca 11Al1 nepeBoC'IJUCOB. TalCl1M o6pa3oM, JUUCBl1,ll;a~ MaJIJipl111 npalCT11'10ClCl1 ,lJ;OCTHreyTa B nepBOHaqaJib- HO MaJIJipl1HHhlX paHOHax lCOHTl1li0HTaJibBOH EBpOUhl, r ,11;0 3Ta 6oA0.3Bl> yJKe He RBJIJI0T- CR 0,ll;HOH 113 B0~11X ITp11'111li aa6oAeBaeMOCTl1, CMepTHOCTl1 11 11HBaAl1,ll;BOCTl1 11 npalC- T11'10ClCl1 He 11M00T COD;l1aJiblihlX 11 3lCOBOM11'10ClCHX IlOCA0,ll;CTBl1H. TalCOH ycnex o6y- CAOBA0H B OCHOBBOM Y.JIY'IIlleU11eM COCTORHl1R 3,D;paBooxpaueHl1R co Bp0M0Hl1 BOCeM- Ha,D;~aToro B0Ka, np11MeBeH11eM Cil0D;11$11'10ClCHX npoTl1BOMaJIJipl1HlihlX Mep C lCOH~a npomAoro BelCa 11 11CilOJib30BaHl10M 11HC0lCTl1~0B OCTaTOqHOro ,11;0HCTBl1R C lCOH~ 48 BTopoi:i MHpoBoH BOHHhl. TeM He MeHee, Ma.JUipi,rn Bee em;e HBJUieTeJI rrpwn1HoH Ha- npaellblx eTpa,zi;aHHH 11 eMepn1, icoTopyio MO)l(HO 1136eJKaTb; B noeJie,11;1111e ro,21,M yBe- JIH'!l1JIOeb q11e.JIO 3aBe3eHHhlX e.rryqaeB. 3TO - eJieAeTBl1e ~aeT11Bm11xeR noe3AOlC, B TOM q11eJie MHrp11pyiom;ei:i pa6oqeu eWll>I, eoBepmeHeTBOBaHl1Jl Al1arHoeTHqeeic11x B03MO)l(HOeTeH, 11, BepOJITHO, TalCJKe OJKHBJieHl1Jl Ma.JUipl111 B Tpon11qeeic11x pai:ioHax . 1.3.1 3aBe3eHHaJ1 Ma.JUipl1R B lCOHTHHeHTa.JlbHOH EBpone B HaeToRm;ei:i eTaTbe npoaHaJIH311poBaHhl Te e.rryqa11, 0 lCOTOphlX eTpaHhl lCOHTl1- HeHTa.JlbHOH EBpOIThl eoo6m;aJIH EBponeHeKOMY 6ropo B03 (B03/EPB) e 1967 no 1972 1'0,21,hl. 0AHaico HHOr Aa D;HC1>Phl 3a HelCOTOphle ro,21,hl OTeyTe TB)'lO'l'. B o6m;eM eoo6- m;eHHhle AaHHhle O q11eJie e.rryqaeB Ma.JUipl111 JIBJIJllOTeJI 3aa11JKeHHhlMH no eJieAyiom;l1M rrp11- q11IHaM: 1) HelCOTOphle Jierico 60.JlbHhle Bhl3AopaBJIHBaJOT eaMoeTOJITe.JlbHO 6e3 yeTa- HOBJieHl1Jl Al1arHo3a; 3) HelCOTOphle 60.JlbHhle A8lflT OTpl1JJ,a.TeJihH)'lll peaicD;l1!0 Ha HaJIHql1e napa311TOB np11 11eeJieAOBaH1111 Ma3lCOB lCpOB11; 4) HelCOTOphle.60.JlbHhle 1136eralflT o6eJieAOBaHHR; 5) B HelCOTOphlX eTpaHax HeeoBepmeHllbl A11arHoeTHqeeic11e epeAeTBa; 6) HelCOTOphle eTpaHhl pery.JUipHO He HanpaBJUlll)T eoo6m;eH11JI O e.rryqaJIX Ma- JUI p 1111 . B Ta6JI. 1 yica3auo q11e.JI0 e.rryqaeB Ma.JUip1111 (e paenpeAeJieH11eM no npo11exoJK- AeHHID HHcpeicrorn:), 0 lCOTOphlX eTpaHhl lCOHTHHeHTa.Jlb HOH EBpOIThl eoo6m;11JIH B B03/EPB e 1969 no 1972 rr. B 1972 r. eoo6m;aJioeb o 5685 e.rryqaRx, 113 icoTo- phlx 5640 6hl.Jil1 3aBe3eHHhle, 4 noBTOpHhle, 19 HHAYD;HPOBaHHhle, a 22 MeeTHhle. C 1969 no 1972 rr. q11e.JI0 3aBe3eHlfh!x e.rryqaeB HeyicJIOllliO B03paeTaJio. 3Tl1 D;Hcpphl BlCJIIOqa.JOT TalCJKe AaHHhle 113 Ilopryra.JI1111, 06~JieHeH11e lCOTOphlM Aa- eTeJI Hl1JKe. B Ta6JI. 2 yica3aHo q11e.JI0 3aBe3eHHhlx e.rryqaeB MaJUip1111 e paenpeAeJiea11eM no BHAaM napa311Ta, o lCOTOphlX B B03 ITOeTYTil1Jil1 eoo6m;eHHR e 1967 no 1972 rr. M3 Ta6JIHIIJ>! Bi1AHO, qTo B oeHOBHOM napa311'J1,1 npeAeTaBJieHhl BHAOM Plasmodium vivax, 3aTeM P . faleiparum 11 B He6o.Jlbmoi:i eTeneH11 P . malariae 11 P. ovale. 3HaqttTe.JlbHoe q11e.JI0 eJIYqaeB He icJiaee11cp11D;HpoBaHo. B 1972 r. B 3838 113 5640 e.rryqaeB napa311TaMH 6hl.JIH P.vivax, B 1610 e.rryqaJix - P.faleiparum, B 42 - !'__:_ malariae, B 53 - P.ovale; 20 e.rryqaeB 6hlJIH eMeilla.HHhlMH, a 77 - HeicJiaee11cp11- D;HpoBaHllb!Ml1. 3Tl1 Aa.HHhle AaJOT oeH0BaH11e ITOJiaraTb, qTo 60.JlbmHHeTBO e.rryqaeB RBJifilOTeJI Ao6poicaqeeTBeHHhlMH (P.vivax), Ho B 1972 r. Bee em;e 6hl.JIO 60.Jlbmoe q11e.JIO e.rryqaeB (oAHa TpeTb o6m;ero lCOJIHqeeTBa), lCOTOphle MOl'JIH 11MeTb JieTa.JlbHhlH 49 Ta6JU1Ilja 1 llliCJIO CJIYl-IAEB MA.7ll1PIB1, l KJIACCH<l>HII,l1POBAHHl,IX no IlPOHCXOJtCll;EHl1ID l11I<l>EKIUIH, 0 KOTOPb!X CTPAHbl KOHTl1HEHTA.7IbHOH EBPOIIbl COOBllIWil1 B B03/EPB c 1969 no 1912 rr. Bcero 2 3aae- 2 noBTOpHhie l1B.Tpo.n;yHpo- IifH,ll;yII;11po- MeCTHhie CJiy'laeB 3eHl!hie aaHHbie BaHHbie 1969 2 980 2 950 0 0 30 0 1970 3 451 3 420 4 0 27 0 1971 5 073 4 993 3 1 76 0 1972 5 685 5 640 4 0 19 22 17 189 17 003 11 1 152 22 1 Il0~TBeplfl,ll;eB0 MHICp0CK0TIHqecKH 2 BKJJIOqaH CAe,ll;)'lf)~He CJiy'laH Ha 3aM0PCKHX TeppHT0PHHX nopryraAHH , ~aBIDHe 0TpHD;aTeJibHhie pe3yJibTa'fi>I B caMOH nopTYJ'aAHH: 1969 2063 1970 2561 1971 3934 1972 4400 12958 50 Ta6Jll!Wt 2 1 lfilCJIO 3ABE 3EHHbIX CJD'l!AEB MA.JIBPIDI, K.JIACC11<t> illij1POBAIIlThIX no BM,1.¼M IIAP A311TA, COOBIIUJ{BLIX B B03 C 1967 no 1972 rr. CMemaH- HeICJiaccmtrn:- JleTa.Jllil:lhle P.v. P.f. P. rn. P.o. Hhle n;i,ipoBaHl:lhle B cero 11CXO,.ll;i,I c.rryqa11 c.rryqa11 1967 446 238 31 37 2 85 839 HeT c B e,.11;emrn. 1968 455 251 25 18 4 67 820 HeT cBe,.11;emrn. 1969 680 532 31 30 9 1 668 2 950 25 1970 2 427 648 39 31 31 244 3 420 11 1971 3 684 1 008 49 45 34 173 4 993 11 1972 3 838 1 610 42 53 20 77 5 640 15 B cero 11 530 4 28 7 217 214 100 2 314 18 662 62 1 BlCJlll)'laJI 6oJibmoe 'lHCJIO c.rryqaeB' 3aBe3eHHhIX 113 3aMOpCIC l1X TeppHTOpHH IlopTYJ'aJlll11, ICaIC yica3aHo B Ta6.JI. 1 51 Hcxo,.n; (P. falciparum). Ilapa3H'11,1 BHAa P.malariae cTaBRT oco6yir, npo6AeMY, TaK xax OHH o6yc~OBAHB3IDT 6oJibmoe qHCAO HH,lly:a;HPOBalil:llilX CJIY'IaeB; npe,.n;cTaBAH- eT TFYAHOCTb cneD;H$HKa ,ll;HarHOCTHKH CJIY'IaeB, BM3LIBaeMLIX P.ovale· HeKOTOpMe CJIY'IaH ,.n;amr xax II HeKAaCCH$HIJ;HpOBaHmre", nocKOJibKY 6oJibmie He 6MAH no,.n;Bepr- ey'll,I ,.n;aJibHeHllleMY o6cAe,.n;oBaHHIO . B 1972 r. 6MAO 15 AeTaJihmIX CJIY'IaeB. HM:e- IDJD.HeCR coo6~eHHR TaK*e HenoAmre no cAe,n;yJOJD.HM npwqHHaM: 1) OTCYTCTBYIDT ,.n;aHHhle O BHAaX napa3HTOB, o B03pacTe, ITpO$eCCHOHaJih- mIX rpynnax, a,n;eKBaTHOCTH AeqeHHR HO ,.n;pyrHx xapaxTepHCTHKaX CJIY'IaeB C AeTaJihmrM HCXO,ll;OM; 2) HeT HH$0pMa~HH O 3aBe3elil:llilX B EBpony IDTaMMaX BHAOB UAa3MO,ll;HR H 06 HMMYHOAorwqecKOM COCTORHHH 6oJibmIX, KOTOpaR MO*eT ~aTb yxaaaHHR Ope- 3YJibTaTax AeqeHHJI HO B03M0Jt(ll0CTH nepe,.n;aqH; 3) He,.n;ocTaTO'lllO cBe,.n;eHmi o B03pacTe, noAe H rpynnax HaceAeHHR (TY- pHcTM, pa6oqHe-MHrpaHTM H T.,.n;.). B Ta6A. 3 yxaaaao qHCAO 3aBe3eHmIX CJIY'IaeB MaAHpHH C pacnpe,.n;eAeHHeM no KOHTHHeHTY npoHCXOiK,lJ;eHHJI, 0 KOTOpMX CTpamI KOHTHHeHTaJibHOH EBpOIIbI coo6- JD.HAH B03/ EPB c 1967 no 1971 rr. B 1971 r. H3 4993 3aBe3eHHJ,IX CJIY'IaeB 4739 6MAH 3aBe3eHJ,I H3 A4>pHKH. B Ta6A. 4 yxaaaHo qHcAo aaBeaeHmix CJIY'IaeB MaARpHH c pacnpe,.n;eAeHHeM no cTpaHaM KOHTHHeHTaJibHOH EBpOIIbI, HanpaBHBIDHM coo6~eHHJI B B03/EPB c 1967 no 1972 rr. 3a nocAe,.n;HHe mecTb AeT qHcAo aaBeaeHmrx CJIY'laeB Bea,.n;e coxpaHR- AOCb ITpHMepHO Ha o,.n;HHaKOBOM ypOBHe 3a HCKJDOqeHHeM Coe,.n;HHeHHoro KopoAeBCTBa H IlopTyraAHH, r,.n;e HX qHCAO yBeAHqHBaAOCb. C 1969 r. B IlopTyraAHH Ha6AID- ,.n;aeTCR oqeHb 6oJibmoe yBeAHqeHHe qHcAa aaBeaelil:llilx CJIY'IaeB; o,.n;Haxo cAe,.n;yeT 3aMeTHTb, qTQ ,.n;o HaCTOR~ero BpeMeHH B coo6~eHHJiX O 3aBe3eHHOH B EBpony Ma- AHpHH B qHcAO 3aBe3eHm.IX B IlopTyraAHIO CJIY'IaeB BXO,ll;RT xax CJIY'IaH HCTHHHO 3aBe3eHmie, Tax H Te, KOTOpMe 6MAH "nepe,.n;aHM" H3 3aMopCKHX TeppHTOpHli,HO ,ll;aAH OTPH~aTeJibmie pe3yJibTaTM B IIopTyraAHH . TeM He MeHee' B coo6~eHHRX, nocTynaBIDHX B Blnpo, 3TH CJIY'IaH cqHTaAHCb 3aBe3eHmIMH, XOTR OHH CTporo H He COOTBeTCTBOBaAH onpe,.n;eAeHHJD Tepwraa "3aBe3eHmre CJIY'IaH", C$0PMYAHPOBaHHOMY B03. 3TO noxaaaHO B Ta6A. 1. O Bcex cAYqaRx MecTHoro npoHcxoiK,lJ;eHHJI B 1972 r. coo6~eHHJI nocTynaAH H3 rpeD;HH (20 CJIY'IaeB) H KopCHKH (2 CJIY'IaR). (CM. Ta6A. 1). B IDJt(HOH EBpone peaJibHa onacHOCTb peHHTpO,ll;yKD;liH 6oAe3HH B peayJibTaTe nepe,n;BH*eHmi HaceAeHHJI. He6oJibIDaR BCIILilIIKa MaARpHH Ha KopCHKe B 1972 r . , oTHocHMaR aa cqeT aapa*emwx pa6oqHX-a$pHKaH~eB, ncHo noxa3bIBaeT, qTo Ha cpe,n;H3eMHOMOpCKHX TeppHTOpHJIX peHHTpO,ll;yKD;liR MaARpHH 6oAee qeM B03MOJl(lla. TeM He MeHee B HaCTOR~ee BpeMR CTeneHb BocnpHHMqHBOCTH m*HOH EBpOITM K MaAH- pHH TO'IHO He H3BecTHa. Olia o6R3aTeJibHO 3aBHCHT OT TaKHX $aKTOpOB, xax nAOTHOCTb nepeHocqHKoB, KOHTaKT nepeHocqHKa C qeAOBeKoM, a TaK*e ,ll;OArOBeq- 52 Ta6Jiu11,a 3 YJICJIO 3ABE3EFillh!X CJIYY.AEB MAJIHPlfil, C PAITPE.ll;EJIEHHEM TIO KORTlffiEHTAM TIPOHCXOJtCll,EHl1l1, 0 KOTOPh!X CTPAHhl KOHUffiEHTAJlbHOH EBPOIIl,l COOBill,11.iil1 B B03/EPB C 1967 TIO 1971 rr. KoHT11HeH 'I' ro,ll; 1 A(!)pmca A3UJI EBpona AMepmca HeH3BeCTHO Bcero 1967 525 168 2 rpeII;l'IJl 9 135 839 1968 562 139 1 " 6 112 820 1969 2 770 78 0 8 94 2 950 1970 3 :269 50 1 Kopcmca 7 93 3 ·1:20 (<!>paUD;l!Jl) 1971 4 739 84 1 II 9 160 4 993 I Tip HMCY:a1nie: m1¢opMaD,HR H3 CCCP uenoJIHaJI 1 BICJil{)1-{aR CJIY'lal!, 0 IC O'l'OPbIX coo6~aJIOCb B TiopTyraJilH! (CM . Ta6JI. 1) . 53 l'a6.111na I C-rpaua A-16au11R ABc111 n..R BCJlbI'l!J! Bo.:1rapu11 Beurp1U! rpeW!J! .11,am!J! llpJtall,llll1l licnauun 11TaJU1Jl JboKcew6ypr ll11.11epJiall,.11;hl Hopucr1u, 11oJlbma l1op'I-yl'aJU111 B P)'lll,IUl!J! CoCAlWCHHOe CCCP 4'UUJUlUAU 11 4>pQ.llWtK 4>Pf llexoc- .1oaaxu11 mnei!uap11n meewm Xlroc.,1anu>1 Beere a 6 " CM. rn6JI . YJIC.,10 3ABE31:.IOll,IX CJIY'IAEB MAJUIPIU!, COQl]ll):Jffil,LX U B03/ EPB ITT,l0::.,1LllhLl!I I CTPAHA.IUI ,· l'A3GIIU1Wfl no C:11'AH AM Ka!TID!EH1AJD,HOH EBPOllhl C 1967 no 19n rr. ro)I 19(;7 1968 1969 1970 1971 2 2 2 7 6 6 12 10 10 10 12 3 7 6 7 9 5 2 3 8 4 4 17 17 10 25 16 14 13 16 13 2 4 2 0 0 20 21 25 23 23 6 32 12 32 33 37 0 0 0 1 0 26 24 29 16 26 HI 3 4 0 2 7 4 4 3 2 236 311 2426 3041 4407 3 2 0 3 1 Kopo.11eacTeo 196 151 152 105 269 172 1,11 216 a 110 - 0 2 2 3 8 a a a a - - - - 10 47 54 55 52 85 4 6 3 4 10 3 I 7 12 4 17 24 31 33 25 1-1 8 12 13 13 839 820 2950 3420 4993 54 1972 I 12 3 8 4 37 28 1 19 31 6 0 12 6 a - 3 4984 8 328 a - 4 3 101 7 5 27 14 5640 B cTpauax- pen;1,mHeHTax MoryT c~ecTBoBaTb cJie.n;yIDJI\11e cwryan;H11: C11ryan;m1 IIepeHocq11K IIepe,11;aqa Pe 3Y Jib Ta 'I' 11 napa3l1T 1 n ep eHocq11K 11 napa3l1T HeB03MOJKHa B03MOJKHa onacuoc'I'b AJLJ! O'I'CYTC 'I'B)'lfl'I' Jt(l13Hl1 60Jlb11oro; onacHOC'l' ll AJLJ! uaceJieH11H He'!' (3a H C- KJIIl)'-!ern1 e M Hl.lAYII;H p OB amru X CJIY'Iaea) 2 np 11cyTc TBye T n e p e - B03MOJfQia onacuocTb AJIH Jt(H3liH 6oJib- 11ocq11K; O'I'CYTCTByeT uoro; onacuoc 'I'b AJIH Hace- pe3epayap n apa3HTa; JieliHH (B03MOJtill.bI 3I!ll,.ll;eMllll ) , MaJLJ!pHJI J111.lCBH,n;HpOBaHa B cpe.n;j KOTOporo 6oJibHhle BHOCHT napa3HTOB 3 np11cyTcTByeT n epe- ITp 011CX0,11;11T onacuoc'I'b AJIH )t( ll3llll 60.JlhlJO- uocq11K; np11cyTCTByeT ro; o n acHOCTb ,11;06aBJie!HIR pe3epayap napa311Ta nepeuocqHKa K Mee TI.IOMJ" re- 3epayapy napa3IITOB B03hl0 )t(Hbl 3ITll,.ll;eMHH llOCTb nepe11ocq11Ka B cyJI\eCTB)'lflll\HX ycJIOBHHX. Celiqac B pa3Jii1'Ulh!X CTpa11ax lfl)t(- HOH EBpOIThl ITpH ITO,l!AepJKKe BO3 ae.n;yTc JI 11CCJie.n;oBalll1Jl. 1 . 3. 2 JITH,lljeMMOJIOrl-flJ eC Koe 3HaqeHHe 3aBe3eHHhIX C.JIY'-IaeB 3Ha'leHlie 3aBe3ellHhIX CJIY'IaeB .D;OJlJKHO paccMaTp11BaTbCJI B paMICax TOH an11.n;e - MHOJIOrw1ecKOH o6cTaHOBKl1, B KOTOpOH 3TH CJIY'Ial1 11a6JDO,n;rur:TCH. B JIHHHHe 3aae3eHHoro CJIY'IaR (c.JIY'Iaea) Ha BhIIlleHa3BaHllhle cnryan;m1 3aBHCIIT oT cJie.zzyIDII\ero: 1) HMMy-HoJior1-1qecK11X ycJioBHH: yPOBHJI 11MMYHHTeTa uaceJie1111n - peJJ;11n11e11'1'a (c11ryan;1111 2 11 3), a TaK)t(e 3aBe3eHHhlx CJIY'IaeB B CBH3H co c •ra.n;11e11 pa3B11- THJI 6oJie3Hl1 (cTeITeHb 111I{fJeKJJ;1103HOC'l'l1 AJIH K OMapoB); 2) IDTaMMOB napa3HTa: 6oJiblihie Mory'!' 3aB0311Tb IDTaMMhl C onpeACJ!Clllllil~m 3 ITH,n; eMl10JIOrH'leCKHMM, KJ111lll-f'leCKHMH, Tepane BT11'IeCKHMl1 II llM1,fYl!OJIOI'll'WCIOI- Ml1 oco6ellHOCT.f!Ml1, KOTOpLie OTCYTCTBYJOT B CTpa11ax -p eu;1mueuTax. )'l'O MO- Jt(eT noBJIID!Tb ua n epe,11;aqy 111I{fJeKn;1111, npH,n;aTb Teqeurnn 6oJie3liH oco6hli1 xa- paKTep 11 OO'l' pe6oBaTb oco6oro Jieqeu11JI; 3) q11cJieHHOCTl1 napa3l1'l' OB: C l1T OT BOCITpl1HMql1BOCTH 11 YH3Bl1MOCTl1 ITOCJie.n;uero B OTliOIDe1nrn MaJlHpl1ll B 3aBHCl1MOCTl1 OT quc Jia 3aBe3eHHhIX CJIY'Iaea. ,ll;ocTaTOqHO 6oJibIDOC qHCJIO 55 e.7fY'IaeB enoeo6Ho yBeJ11,1q.11TI, pe3epByap napa3HTOB HaeTOJibKO, qTo np.11 ua- .711,1q.11.11 AP)'T'HX ITOAXOAR~X 3ITHAeMHOJ1or.11qeeKHX yeJIOBl'IH MOJt\eT B0306HOB.11TbeR nepeAaqa .11 pa3BHTbeR 3ITHAeMIIIR . Ilo3TOMY oeo6oe BHHMaH.11e eJ1e,n;yeT YAeJUITI, nepeABUJt\eHIIIRM HaeeJ1eHHR, BKJJID- qaR .113yqeH.11e KoqeBoro 06pa3a Jt\H3HH, ee30HHhIX neperoHOB eKOTa, oeo6LIX BHAOB l1HJt\eHepuo-TeX1I.11qeeKOH AeRTeJibHOeT.11, nepeABHJt\eHHH ee30llHhIX pa6oq.11x, BOeHHo- e~Jt\a~.11x, TYPHeTOB, 3KHnaJt\eH MopeKHX eyAoB .11 eaMOJ1eTOB .11 T.A. :JnHAemioJ1or1,1qeeK.11e npo6J1eMLI MoryT 6LITb pa3.JU!qHhillfil B pa3HLIX rpynnax Ra- eeJ1eH111R, Oeo6eHHOeTH MaARp.11.11 y MOPRKOB paeeMaTp.11BaJ1Heb IloeTHJibOHe (1971) (1). CJ1eAYeT npHHRTb Bee MepLI K eBoeBpeMeHHOMY BLIRBJ1eHH1D 3aBe3eHHLIX e.7fY'IaeB .11 yBeAOMAeHHlD O R.11X . Ilp.11 ITORBJ!eH.11.11 eHMUTOMOB 6oJie3H.11 6oJibllbIM HyJKHO ITpOH'I'.11 MeAHD;lffieKHH OeMOTp, AOJlJt\eH 6LITb noeTaBJieH napa3HTOJ10rHqeeKHH AHarHo3, o6ee- neqeHo .71eqeH.11e .11 noeJieA)'IO~ee Ha6.Jlll)AeH.11e. Ee.JUI Bee 3TH MepLI 6LieTpo He npeA- npHHRTLI, TO Jt\.11 3Hh 6oJibHoro .11 ~aeeJieHHR MOJt\eT OKa3aTbeR B onaeHOeT.11. Ha.1160J1ee eepbe3HaR o6eTaHOBKa B03H11JCaeT, KorAa 6oJibmaR rpynna JIH~, 3apa- Jt\eillILix P. faleiparum, OKa3LIBaeTeR epeA.11 BOeITp.11ttMq.11BOro HaeeJ1eHHR, rAe np.11- eyTeTBYJDT nepeHoeqHK.11 .11 ,n;pyr.11e 6JiaronplllRTeTB)'lf)~He 3ITHAeMHOJ10r1,1qeeK.11e ¢aKTOpLI ; B pe3yJibTaTe MOryT noeJ1eAOBaTb 3 ITHAeMH.11 .11 JieTaJibHLie e.7fY'Ia.11. Ha.11MeHee eepbe3HaR e.11rya~ B03HHKaeT, KorAa eAHllJ.,IqHLIH 3aBe3eH1II,IH e~- qaa P.vivax oKa3LIBaeTeR epeA.11 HaeeJieHHR, rAe nepeHoeqmc· oTeyTeTByeT . Ilp.11 3TOM B xy,.11;11IeM e.7fY'Iae MOJt\eT noeTpaAaTb 6oJibHOH, llO ou, BepORTHO, ITOJIHOeTI,ID .113.71eq.11TeR np111MepHo qe pe 3 AB a roAa noeJie uaqaJia 111:l¢eK~~rn. 1.3.3 AeKapeTBeHHaR yeToHqHBOeTb 3aB03 mTaMMOB P. faleiparum yeToHqll!BLIX K 4-a.Ml1HOXHHOJ1111:laM, MOJt\eT npeA- eTaBAR'I~ yrpocy eTpaHaM, HaXOARIIIHMeR B ¢a3e IlOMepJt\aHIIIR J!HICBHAa~.11 MaARplll.11 , B HeBoenpHHMqHBLIX paHoHax Heenoeo6uoeTb paeno3HaTI, TaKHe e.7fY'Iall! .11 ITpll!HRTb eOOTBeTeTBYJl)~ll!e MepLI MOJt\eT ITp1113eeT.11 K eMepT.11 60.JibRLIX. B ny6JlillCa~H B03 ( 2) AaJOTeR onpeAeJieHll!R .11 yKa3LIBaeTeR eTeneHb .11eKape1._ BeHHOH ye 'roaq.11Boe1'.11' a TaKJt\e npeA.11araJflTeR MeTOALI JieqeHll!R Jlll!Il;, yeToHqll!BLIX K .11eKapeTBaM. B EJt\eHe~eJibHOH 3ITHAeM1110.11or1,1qeeKoH eBo~Ke B03 AaeTeR en.11eoK eTpaH, B KOTOpLIX eoo6~a.11oeb O e.7fY'IaRX MaARpllllll, nepeAaBaeMOH P. faleiparum yeToaq.11BLIX K 4-aIDmOXHHOJIHHaM, C ~eJibID e6opa ITOAP06HLix eBeAeHHH O pe3.11e- TeHTHLIX e.7fY'IaRx, B03/EPB BLieLIJiaeT BeeM eBponeHeKHM eTpaHaM BOITpoeHll!K e np111- JIOJt\eHll!eM 3an111eK.11, B KOTO[JOH OITHeLIBaJOTeR IlpHH~IlLI .11 eTaH,.ZJ;apTLI, eBR3aHRLie e JleKapCTBeHHOH yeToaqHBoeTbID . XOTR B03/EPB AO eux nop He ITOJfY'Ia.Jla HHKaKHX eoo6~eH.11H O e.7fY'IaRx pe3.11eTeHTROeTH, KJIHHll!~eTLI .11 opraHH3aTopLI o6~eeTBeHHoro 3ApaBooxpaHeHll!R AOJDfCRhl 6LITb noeTaBJleHLI B 1113BeeTUOeTb 06 onaeuoeT.11 3TOH ¢opMLI 3aB03.11MOH B EBpony MaARp.11.11. 56 1.3 . 4 i1HAY~!1poBaHl!hie (npHBHBHhie) c.n:yqaH ~Hl!hie 06 Hll,lly~poBaHHhIX C.JJ.Y'la.JIX MaJIJrpHH B EBponeHCKOM perHoHe HMeIDTCR TO.JibKO 3a 1969, 1970 H 1971 rr . 06 HX yAe.JibHOM Bece B o6meM qHcAe C.JJ.Y1la- eB MaJIJrpHH, coo6meHHh!X B B03, MOlfCHO cyAHTb no AaHHhlM Ta6A . 5. '!HCAO npHBHBllhlX CJIY'lae B Ka*eTCR oqeHb He60.JibillHM no cpaBHeHl1Hl C o6mHM 'UICAOM coo6meHllhIX CJIY'laeB. XOTR nocAe,n;HHe' BepoRTHO, MOJKHO OTHeCTH 3a cqeT 3aBe3eHHblX C.JJ.Y1laeB, ecTb OCHOBaHI,ie noAaraTb' qTo coo6meHHR O npHBHBHhlX c~- qanx AaAeKo u e no~e. MaJIJrpHR MO*eT 6hlTb npHBHTa OT HOCHTeAeH MaJIJrpHH (B EBpone 3TO no 60.Jib- meH qacTH 3aB03lihle C.JJ.Y'laH) npH nepe~BaHHH KpOBHj B pe3y.JibTaTe Hepa36op- qHBoro HcnO.Jib30BaHIUI mnpH~eB HapKOMaHaMH, npH MaJIJrpHoTepanHH, a TaK*e c~- qaHHO npH Aa6opa•ropHhlX 3KcnepHMeHTax. CaMaR qacTa.JI npH'IHHa Hll,lly~poBaHHOH MaJIJrpHH - nepeAHBaHHe KPOBH. l1lut,eK~ MO*e'l' 6hl'I'b BLI3BaHa ~6b!MH BHAaMH napa3HTa, HO HaH6oAee qacTO ona Bb13LIBaeTCR P. malariae KOTOpb!H MO.>KeT coxpaHJITbCR B opraHH3Me MHoro AeT, rrpi,iqeM AOHOPhl He 3HaJ/lT, 'ITO OHH RBJlJIJ{)TCR HOCHTeJIJ!:MH. IlpHBeAeHHLie Bhilile AaHHh!e O BHAaX napa3HTOB noKa3LIBaJ/lT npeo6AaAaBH e P.malariae; TaK, H3 58 c.JIY'laeB HH<fleK~H P . vivax, o KoTophlx 6LIAO coo6me- Ho B 1971 r., B 55 CJIY'lanx, coo6meHHhIX o,n;HoH Aa6opaTopHeH B o,n;HOH cTpaHe , HCTO'IHHKOM HH<fle IC~HH 6LIAO O,n;HO tt TO *e AH~O-AOHop. KaK Y*e rOBOpHAOCb, qHcAO coo6meHHhIX C.JJ.Y1laeB nepeAa'IH 11H<fleK~H .!:_.:_ malariae B EBpone oqeHb MaAo no cpaBHeHHID c o6mHM 'IHCAOM coo6meHHMX c~- qaeB . Ho ecAH AAH'l'e.JibHOCTb *1<13HH p. v i vax H p. falciparum KOPOTKaR (npH6AH- 3HTe.JibBO ABa roAa), TO .!:.:malariae MO*eT OCTaBaTbCR B opraHH3Me X03RHHa B Te'IeHHe BCeH ~3HH H no 3TOyY RBJIJreTCR rAaBBOH npH'IHHOH C.JJ.Y'laeB 3apa*eHHR npH nepeAHBaHHH KpOBH . 3Ta npo6AeMa H Heo6XOAHMhle Mepbl npo<fJHAaKTHICH npH- BHBHOH MaJIJrpHH noApo6uo paccMaTpHBaJ{)TCR B CepHH TeXHH'IeCKHX AOKAaAOB B03 NQ 2 72 ( 3) . 2 . Heo6XOA11ML!e Mepb! Ha Ha~HOHa.JibBOM H MelK,ll,YHapo,.IQiOM ypoBHe xapaicTep Heo6XOAHMb!X Mep Ha~oHa.JibHOro yPOBHR 3aBHCHT OT c~eCTBOBa- HHR B CTpaHe-p eD;l-mHeHTe BocnpHIDf'IHBb!X H YR3BHMhlX 30H, OcHOBHhle Mepbl B O'l'HOillellHH 3aB03HhIX CJI)rqaeB - 3TO o6Hapy*eHHe HH<fJl'lD;l-!pOBaHH.hIX AH~, AHaruo3, onoBe meHHe H AeqeHHe, He npH"IHHRR npl:I 3TOM 113AHillHHX ueyAo6cTB npH6b!BillHM . 3TH Mepbl npeAnoAaraiflT xopolll:le 3HaHl:IR, TJllaTe.JibH)'I') noArOTO BKY MeAH~HHCKHX H callHTapllh!X pa60TllHICOB, ,ll;OAlfCHOe PYKOBOACTBO HAM npaBH.JibHOe nplU.!eHeHHe COOT- Be TCTBYJfllJIHX AHarHOCTH'IeCKHX 11 Aeqe6HhlX rrpo~eAyP . ,.11;aAeHHOH HCTOpHl:I no,.11;03pHTe.JibHOro C.JJ.Y'laR (BpeMeHH, npoBeAeHHoro B MaJIJrpH.HHb!X paHoHax) j Heo6X0,.1J;HMOCTb noBTOpHoro napa3HTOAOrHqecicoro 06cAe,.11;0BaHHR ' 57 Ta6JIHDja 5 ro.n; 1969 1970 1971 lfi1CJIO v!H,.lI;>'W1POBAHHl,IX CJIYqAEB, PACIIPE,lJ;EJIEHHl,IX no BM.ll,Y IIAPA3HTA, 0 KOTOPhlX CTPAHhl KOHTl1HEHTA.JibHOH EBPOIIJ,I COOEUJIJ1.)lli B B03/EPB C 1969 no 1971 rr. O6ll\ee 'IHCJI0 ' P. vivax P. f alciparum P. 30 11 3 27 7 3 76 58 0 58 malariae 16 17 18 KOTOpoe B nepBhlH pa3 MO*eT .n;aTb OTpH~aTeJibmre pe3y.m,TaThI; BaJKHOCTb 3HaHWI BM,Zl;OB napa3HTOB. IlpH AeqeHHH BaJKHoe 3HaqeHHe HMeeT CAe,zzyin~ee: npaBHJibHOe npHMeHeHHe COBpeMeHHhlx AeKapcTBeHHhlX npenapaTOB B COOTBeTCTBHH C BM,Zl;aMH napa3HTOB, C TeM qT06hl .n;o6HTbCJI pa.n;HKaJibHoro l13AeqeHHH (ITO.D;TBep*AeHHoro pe3yJibTaTaMH ITOCAe,izyll)~HX napa3HTOAOr!fleCKHX o6cAe,n;oBaHHH) Ill YAOCTOBepHTbCH B OTCYTCTBHH HH$eK~03HOCTH KOMapoB (AAH BOCITpHl1M'll1BhlX paHOHOB); 3HaHHe cnoco6oB aAeK- BaTHoro l1 6hlcTporo AeqeHHJI oqew, cepbe3HhlX OC~OJKHeHHH HH<l>eK~H, Bhl3hlBaeMOH P.falciparum, KOTOphle npH OTCYTCTBHH AeqeHWI 3a oqeHb KOPOTKOe BpeMJI MOryT Bhl3BaTb c MepTb, oco6eHHO y .n;eTeH. BaJKHo TaK*e HMeTb no.n; PYKOH 6hlcTpo,n;eH- cTBYJO~He npOTHBOMaAHpl11U.Ihle npenapaThI, a TaK*e o6opy.n;oBaHHe AAH ITpOTHBOIDOKOBO- ro H lffiTeHCHBHOro AeqeHWI, B BOCITpHl1M'll1BhlX CTpaHax oco6oe BH11MaHHe CAeAYeT y.n;eAHTb 0ITM,Zl;eMHOAOrH- qecKOMY Ha.D;3opy 3a "rpynnaMH pHcKa" Ill 3ITM,Zl;eMHOAor11qecKHM HCCAe.D;OBaHWIM, oco6eHHo 3HTOMOAOr!fleCKHM oco6eHHOCTHM (nAOTHOCTb nepeHocqHKOB, TeCThl Ha pe3HCTeHTHOCTb l1 T . .n;.) . ,.11;.JIH 3TOH pa6onr Heo 6xo,n;HMO JI.D;pO no.n;roTOBAeHHhlX Ill xopomo OCHa~eHHhlX pa60THHKOB. 8 CTpaHax, r.n;e AAH 3Toro HMe~TCH aAeKBaTHhle B03MOJKHOCTH, HCCAe.D;oBaHHH acneKTOB MaAHpHH, HMell)~HX Ha~oHaJibHOe 111/HAH Me*AYHapo.n;Hoe 3HaqeHHe, o6hlqHO BeAYTCH c ITOMO~~ BO3. ABHa~HOHHhle u napoxo.n;mre KOMITaHHH , MHHHCTepcTBa Tpy.n;a H .n;pyr111e MHHHCTepCTBa .D;OAJKHhl npaBHJibHO KOop,.zi;mrnpoBaTb pa6ory no caHH- •rapHOMY npocBe~eIIl,!11) 11 HH<l>OPMHPOBaHIIIII) Hae eAeHWI, oco6eHHO AH~, HaMeqaID~HX noe3.D;KH aa rpaHHey, c ~eJiblf) pacnpocTpaHeHHJI 3HaHHH o MaAHpHHlihlX pai1oHax MH- pa, 0 npo<t>HAaKT!fleCKHX Mepax (xHMHonp o<t>11.1IaKTHKe ) , ,.zi;uarHOCTHKe H AeqeHHH, no,.zi;qepKHBaH npH 3TOM Heo6xo,.zi;HMOCTb 6McTporo yBe,ll;OMAeHWI Bpaqa O aa6oAeBa- HHJIX, IT0,.11;03pHTeJibHhlX Ha MaAHplllll) (4). Cy~eCTBeHHoe 3HaqeHHe HMeeT KOOP.D;Hlla~ pa6oThl Bcex COOTBeTCTBYJfl~X IIa~HoHa.m,mrx H MeJtVJ;YHapo,.zi;HMX opraHH3a~. Jry 3aAaqy o6hI'll!O BhlITOAHHID'l' Ha Bcex ypoBHHX 06~11e CAY*6M 3.D;paBooxpaHeHWI CTpalihl C ITOMO~lf), ecAH Heo6XO.D;HMO, cne~aAH3Hp oBaHHOH rpynIThl no npoBe,n;eHH!fl Tex HAl1 l1HhIX KOHKpeTHhlX IICCAe.n;oBa- lll1H . Hcno.m,ayn ,.zi;ocTYITHhle CAY*6aM a,.zi;paBooxpaHeHWI KaHa.JlhI 11 pecypcM, cAeAYeT T aK*e nepHO.D;JfleC Kl1 npoBO.D;l1Tb o~eUKy Bocnpl111M'll1BOCTH Ill YH3BHMOCTH paHOHOB, 3$$eKTa OT npHMeHeHWI pa3AHqHhlX MeTO.D;OB 11 MeTO,ll;HK, ITOTpe6HOCTl1 B HenpephlB- HOH cne~11aA11311poBaHHoH no.n;roTOBKe 11 T . .D;. c6op 11H$opMa~111, noo~peHHe 11 KOOp,ll;HHa~H 11CCAe.D;OBaHHH; COBepmeHCTBOBaH11e Me*AYHapO,ll;HOH Tep- MHHOAor1111, CTaH,ll;apTOB 11 MeTO,ll;OAOrHH; Koop,.zi;HHa~H ycl1.IIHH no npo<t>11AaKTHKe B0306HOBAeHWI nepe,n;aq11 MaAHp1111; opraHl13a~HH COBe~aHl1H ,ll;AH o6MeHa OilhlTOMj ITOMO~ KypcaM no,.zi;roTOBKH. 59 3. HawopMaII;W{ 0 Ma.JIJipHH H ny6A11Ka~H 803 803 no.JIY1laeT OT rocyAapcTB llli$OpMa~1'IIO O Ma.JIJipHH TpH pa3a B roA H ny6- AHKyeT ee B ~opMe cBOAOK paa B noAroAa B E*eHeAe.libHoH 3nl1,ll;eMHoAorlf"'lecKoH cBOAKe (E3C); KpoMe Toro, o6aop Ma.JIJipHHHOH o6cTaHoBKH e*ero~o AaeTcn B oT1IeTe reaepaJibaoro AHpeKTopa 803 aa ceccuu 8ceMupHoH accaM6AeH 3APaBoox- paHeHHH. 8 NQ 3 E3C 3a RHBapb 1973 r. (5) AaeTCR llli$OpMarr;wr o pHCKe aapa- *eHHH Ma.JIJipHeH B pa3JlllllHhIX paHoaax MHpa; o cnoco6e caMo3a~H'Thl OT 3Toro pHCKa HO TOM, qTo AeAaTb B C.JIY1lae aa6oAeBaHHH Ma.JIJipHeH no B03Bpa~eHHH AO- MOH. 3Ta llli$OpMa~ ~eHHa TaK*e AJIJI 6IDpo nyTemecTBHH, TpaHcnopTHLIX areHCTB H TYPHCTH"'leCKHX llli$OpMaII;i1.0HllhIX 6~po; B CBO~e COAep*HTCR llli¢0pMarr;wr O puc- Ke aa6oAeBaHHH Ma.JIJipHeH BO Bcex CTpaaax, a TaK*e PYKOBOAR~e YKa3aHHH B noMO~ BpaqaM, KOHCYJibTHpYJO~ no BonpocaM npo$wraKTHKH (cM. IlpHAO*eHHe ill) . 803 OKa3UBaeT COAeHCTBHe H noMO~ B uayqeHHH Ma.JIJipliH, B TOM qucAe 3a- B03HOH. 8 CBOHX H3AaHHRX AOKYMeHTOB TeMaTH"'leCKHX COBe~aHHH H KOMHTeTOB 3KcnepTOB, B TeXl:lHqeCKHX ,ll;OKAa,n;ax H B APYTHX ny6Al11Carr;wrx B03 co6upaeT, 0606- ~aeT H ;i;eAaeT AOCTORHHeM o6~ecTBeHHOCTH MHeHHR 3KcnepTOB, AaeT PYKOBOAff~He YKa3aHHH no BonpocaM CTa~apTOB, MeTOAOB, TeXl:lHKH, HOMeHKAaTYPU ll ;i;p. CoBe~aHHR opraHH3YJOTCR qepe3 onpeAeAeHHUe npoMeJtCYTKH BpeMeHH C ~eJibID o6MeHa onuToM H KOOPAHHaII;i1.H ycuAHH Ha Me)t(,llJ'Hapo~oH ocHoBe. BCJOAY, rAe Tpe6yeTcn, eypcaM no no;i;roTOBKe npeAocTaBJIJieTcn noMo~ B BHAe AeK~, yqe6aux MaTepua- AOB (cM. "Case Studies on the Epidemiology of Malaria(6)), AeMOHCTpa~HOHHUX MaTepHaAOB, $11.7IbMOB H 6pomIDp. 4. IlpoTHBoMa.JIJipHHHUe MeponpHRT~IJI EBponeHcKoro peruoaaJibaoro 6IDpo B03 ( B03/EPB) .11.BYMH rAaBllhIMH 3aAaqaMH B03/ EPB RBJIJieTCR oKaaauue IlOMO~H B AHKBHAa~H Ma.JIJipHH B Tex, cTpaaax PeruoHa, rAe e~e npoAOA*aeTcn ee nepeAaqa,u,HeAony~e- HHe ee peHHTpO.n;yK~ B Te CTpallhI, r;i;e ona AHKBHAHPOBaHa. IlepBan H3 3THX aa,n;aq pemaeTCR nyTeM npoBeAeHllJI OCHOBHL[MH CAY*6aMH 3APaBooxpaHeHHH Meponpu- RTHH no AHKBHAa~HH no;i; PYKOBOACTBOM ~eHTpaJibHOro yqpe*AeHHR no Al1lCBHAaII;i1.H Ma.JIJipHH. IlpH pemeHHH BTOpOH aa,n;aqu MeponpHRTHR aanpaBAeHU Ha npo$wraKTHey peHHTPO.n;yKII;i1.H 6oAe 3RH nocpeACTBOM Mep 3DH,ll;eMHOAOrlf'leCKOH 6AHTe.7IbHOCTH Ha OCHOBe coo6~eHHH O C.JIY'laRX 3a60AeBaHHR H Me)t(,llJ'Hapo;i;aoro o6MeHa HH$OpMa~HeH . 0Ka31,lBaeTCR COAeHCTBHe KOOPAHHaII;i1.H AeRTeJibHOCTH pa3AH'llll>IX CTpaH H o6ecne- qHBa.JDTCR 3IlHAeMHOAOrlf'leCKHe CAY*6u. BeAeTCH uayqeaue BOCllpHHMqHBOCTH K Ma.JIJipHH H llOTeH~HaJibHOro pHCKa peHHTpO.n;yK~H 6oAe3HH B cTpaHU ID*HOH EBponu. 60 BHEJIBOI'PA<l>llil 1. Postiglione, M. (1971) The importance of malaria for seafarers today, Ann. Med. nav ., Vol. 1 2. 3. 4 . BcemrpHrur opraHMaanHH 3ApaBooxpaHeHHH (1969) XIDrnoTepanHH MaJUipMM, AoKJIM RaY'll:loH rpynm,r B03, JKeHeBa (CepIDi TeXH. AOKJI. B03, NQ 375, CTP. 32 M 71) BceMMpHa.H opraHM3aUIDi 3ApaBooxpaHelil1.H (1965) KoMMTeT 3KCnepTOB B03 no MaJUipMM 1 Aec.fIThIH ,lliOKJIM, JKeHeBa (Cep1rn TeXH. ,ll;OKJI. B03, NQ 272) BcemrpHrur opraHM3a~ 3APaBooxpaHeUM.fl (1969) Ilpe.n;ynpeJK,ll;eHtte 3aBo3a Ma- JUipMM 1 ~OK.JIM O COBe~auntt, oprautt30BaUHOM B03 , JKeHeBa (Cep11.H TeXH . ,lliOKJI. B03, NQ 374) 5 . World Health Organization (1973) S •a tus of malaria eradication, Geneva (Wkly epidem. Rec.,~) 6. World Health Organization (1971) Case studie s on the epidemiology of malaria, Geneva 7. BceM11pHa.1I opraun3anwi: 3ApaBooxpaueun.fl ( 19 1.5 7 ) KoMHTeT 3Kcnep'l'OB B03 no MaJUip1m 1 )J;Beua.D;naThltt .D;OKJiaA, JKe11eBa (CepH.II 'l'eXH . .D;OKJI . 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B TeqeHne 3Toro nepHOAa C.JJY*6hl 06111ecTBeHHoro 3ApaBooxpaHeHHR OCYJlleCTBJlJlll)T MeponpHJITHR no 6AHTeJil:,HOCTH C n;eJII:,lfl npeAOTBpa111ennJ1 pacnpocTpaueHHR MaARpnn, 3aBe3eHHOH qepe3 rpaHHIIJ>I cooT- BeTCTBYlfl~X paHOHOB. 2. Iuraccn$nxan;wt cJIYqaeB MaARpHH no nponcxom,zi;enHI/J ABTOXTOHHhle CJIY'Ian 1) MecTHhle CJIY'laH - MaARpHJI, npno6peTeHHaJI qepe3 KOMapoB B pa»oue, rAe MaARpHR BCTpeqae'l'CJI cncTeMaTH'ieCKH; 2) HHTpOAyD;l1POBaHHLie c~an - MaARpHR, npno6peTeHHaR -g:epe3 KOMapoB OT 3aBe3eHHoro CJIY'laR B paHoHe, rAe MaARpIDI BCTpeqaeTCJI HeperyARpno. l1lyl;yI!,J1PoBaHHLie (npHBHBHLie) cJIY'IaH - MaJIJipHJI, npno6peTeHHaJI ncxyccTBeH- uo, uanpHMep, npn nepeAHBaHnH KpoBn qepe3 mnpnn; 06111ero IlOJII:,30BaHIDI, B pe3yJII:,TaTe MaARpnoTepannn. Pe~HBHLie c.rryqan - B0306HOBAeHne KAHUH'leCKOH aKTHBHOCTH, HaCTYil8.lOJ11ee qepe3 npoMe*YTOK BpeMeHH 6oAee AAHTeJII:,HLIH, qeM TOT, KOTOphlH MO*eT 6MTb o6ycAOBAell A1111Il, JIBAenneM nepHOAH'iHOCTH. 62 3. Ilp 11.JioJKeH11e 1 CKpMTbie c.rryqa11 - 1130.Jll1poBaHHhle CJIY'lal1, He CBR3aHHhle co BTOPl11IllhlMH C.lfY- qaRMl1, qTo ,n;oKa3aHo COOTBeTCTBYJl)~l1M 3IT~eMl10.JIOrltf'leCKIDI 06c.Jie,n;oBaH11eM, BKJDflqa~~l1M MaccOBhle l1CCJie,n;oBaH11R KPOBl1 ITO 11CTeqeHl111 11Hey6an;110HlihIX rrep11- o,n;oB . YR3B11MOCTb H Bocrrp111u.rq11BQC Tb YH3B11MOCTI, K 11H$eK~l111 03HaqaeT Jil16o 6 .Jil130CTh K Ma.JIRpIDilihIM 3oHaM, JI1160 rro,n;aepJKeHHOCTh Bo3,n;eHCTBl1lr. qacTO rrp116MB8.Ii)~X 11H$11~11pOBaHHhIX Jll1~ 11.Jll1 rpyrrrr JDfl,n;ett 11/11.JI11 Bo3,n;ettcTB1111) 11H$eKD;110HHhIX Ma.JIRp.rli.Hhlx KoMapoB. 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HaceJieHHe B 'Ilalcnqa x MaJIRp11.R BH- IlepBo- 06-bRBJieHO Ocyii:teCTB.IUIY)TCff. npo rpaKWb( PaHollhl , xor.a;a ue uaqa.J[b_ 0 JDOCBli- JIWCBH,.ll,aD;J,lH oxpaun- 6Ll.Jla .wec-r- llO ,zi;amtu wa- 4'aaa 4>aaa 4> aaa t e""'e uoro npo- wa ... 1J1- .JUlplut lCOBC O- aTaKH noAro Beer e 06m 1rp- HCXO.lt,.Zl;elll1..R p11.KH1le (<j>aaa .11 n,1s;a- TOBK H l[l,U,{J,t UJI.H uc qe a- paHoBbl no,JAeP- Ill1J1 wepawu .Ila 6ea npH- ~a1:11111) 6opb6hl w:eee1:1W1 c xowa- c n e a,Ha.JibULl:X pa.w:u npoT1mowa.- .,111pHHllMx wep (3) ( 4) (5) (6) (7) (~) (9) ( JO) 7 516 273 2 061 2 06 1 5 355 9 246 628 3 366 1 688 5 682 11 2 17 16 9 252 9 252 9 82 1 6 738 1 901 1 901 8 849 1 559 1 559 17 302 27 52 4 091 4 957 4 858 99 99 5 007 2 98 1 220 9 ~76 24 41!5 24 485 50 333 4 414 4 414 21 345 325 4 369 11 390 966 1 387 2 353 ~ i M :::l PaH.ollLI , ue PaKouw., PaiioWl, BlC .Jll')q aeMW e B rAe npo- r,IJ;e cne- rpait,y 10), T HBO Wa - a;lta.J[bUhl e r.i,;e e Kaqe- JLR p KK- np oTHBo- CTli e wepw Wile npe- wa.,U1pm1- 6opb6bl mupo- napa'Iliil w.1e wepbl K O npuweUJt- Jll!III], u e npo- eTCH np o¢m- ..te rJCo 80,IJ;.RTCJI J1a.KTU'1ieCK Oe AOCTYTI- uaauaqeu11e lil,I Jteicapc TB (I 1 ) (12 ) ( 13 ) 15 132 3 305 9 037 cr, t.Jl Mosaxo 25 25 Hu,.,;ep.>!B.WIJ,I 13 413 11 258 HopBer1111 3 949 3 949 Ilo.lhma 33 632 33 513 Ilop'J'.Y1' 8.JUUJ 9 848 7 380 Py,a,ml1JI 20 8 14 12 745 Cau MapHBO 20 20 CoeA;HBeHHo e Kopo.11eecTBOA 56 755 56 755 CCCP 191 738 13 319 r TypllHJI 37 224 YJCp a1mcJCaJ1 CCP 48 392 8 ♦apepc s:u e ocTµoea 39 39 4>tmMHJJ;UJi 4 754 4 754 4>paHII.WI 5 1 925 51 764 4>Pf 63 167 63 167 l.J.eXOCJl0 B81CltJI 14 648 14 475 lllBeiiuap11J1 6 470 6 470 lllBeD,Wl 8 208 8 200 Ml rocJJaBH.H 21 145 14 71 6 BCEro 788 965 436 099 a Cor.11acao eTOpowy ;r.onoJD1ee100 JC n.119.HY onepa mlH 6 IlocJ1e,1t1:me 11M€Yll(l1ecn Aa.uJible ( 1 9 71 ) B 8JC.Jmqa.J1 Caxapy u l1cnaucJCY¥) Cesepuyr A¢,pmcy 2 155 2 15 5 11 9 11 9 2 468 2 468 8 069 8 069 1 78 419 178 003 37 224 48 384 48 :Jil-l 16 1 161 1 73 173 6 429 6 429 352 866 294 491 r [u!4>phl npeA,cT&B.JleHl,,I pyicoBoAHTe.JJ.ew 6pHr&AW npoeJCTa 1'JR 2001 ,.a; 8JCJDn\J:U OCTµOB M 3 B l1 llopwaUACKUe OC'Tpoea 41 6 4 16 36 309 9 15 37 224 38 418 5 668 1 688 45 774 11 2 15 9 1 69 Hc TOtIBKIC : Jl.oK.lla.4 o w8.Ailpm1, npeAcT&B.llelll..ll,li'\ reuepaJt.hHLUl AHPCKTopoM B03 ua .zteaAn.a.Th mec-roH ceccu u BcewupuoH. accaw:6.Jteu 3Apaeooxpaueuun e wae 1973 r. 3 305 :::::i -:, :s; ic, 0 )le ('[) t:: :s; ('[) :::::i ITPMJIOJKEHHE llf ~ l!lt•OPMAIUUI OD OIIACIIOCTII 3AllOJIEBARIUl MA!I/IPIIJ:.il B OT.D,EJILH11X CTPAIIAX - no )IARlll,LII CIJO.ll)ICJI ., A.l;JIJll~I. nmn.uu:totoil B [ll(};l!EJ1,:JILROll J mU(EMllQJIOrl1 '!ECKOil CBO.lll(E •• 3, 19 73 r. \\klv ep 1dPm. Hee. No. :3 - 19 .Jan. 1973 TatS~uma 1 (npoAo.lUli.cuue) I I I I ,ll,,lJI cTpau , r ;1e CYJlleCTByeT on acuocn, WLl.l'lpHl1 ,/1,J!J! ecex APyrH x paitou o s , ue n o x &:J8.Hl:Dil X B roa<l>e 3 OnacHOCTb Bw:coTa HU 0n&CHOCTb E wa .1.Hp1111 Mec11 DM , x orA,a ypo eHew WOpH., ropoAcxnx L'. r paua ' - (' c· n, Pa&\ouw, r;1e 6ea l:Ul)(C K OTOpoit o - 11e ·r UMPCTCff onnc- pa .:l oua,r J'> II CK & c~ ecTeyeT U OCTb X - 8CTb onacuocTb ( weTpw): 0 - U CT I 2 3 4 s 6 KeHILH X lleT 4-6 fl 11- 12 1 2cxx,2 x3 JJccoTO 0 Jl.H6CpltH X HeT 1- 1 2 . X Jl.uenAcac&.11 Apa6CKa.R X Bcfl cTpau a, aa U C JC-ir>,,,. ... ... ... Pecny6JUucn qeuue .w .z1, eyx u e 60Abm1tx oi1aro e ua r,ro-aana.a;e 4 MB.,,l,aracxap X A.IJApawac m,a , A1JTaua- 9- 3 11 00 X {J)OTC l1 1 Arneounwawo , llwep 11 pmia--4>oeo a.11H , M& Ubfl X9.UAPl1 & u a ; Hocc1~Ba , l Ma.Jl&B11 . X FfeT Ma.ur X Ff CT MaepHTllllH.J-l X .. . Maepuxa tt6 0 MapoKKo X ... Moanw61tJC X ... IlnMJ1611>1 7 • X .. . 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B•mycKaeTc11 B Ta6.rnTKax : 100 llI' (0, 1 r) 25 Mr (0 , 025 r) (,.o;JU! ,.o;eTell) XllopoxHll • <l>upMeullhle uaaeauim: aa.n.oKJiop, apaJieu, u1rnax1ru, peaox1u1 11 AP. BimycKaeTc11 a Ta6,1eTKax no 100 wr (0, 1 r) OCHOBaBH.R ( RK'T'UBHOe coe.n;H1.1euue) u a Ta6JieTxax no 150 Mr (0,15 r) ocuoaam111. ..ll,Jul ,n;eTeH TaK)KC BYnyCKR0TCff B Ta6JieTKax, co,n;ep)Ka~HX 37, 5 Mr, 50 Mr H 75 Mr OCHOBaHH.R: u e BH;J;e CKJ')ona - O,l{Ha qaHlJa.JI JJ.O)IC)Ca c 1rpona co- ,.l.ep;ttHT 25 wr u.Jt 11 50 &a- ocuoeauuil. ~ttpMeHllble HaasaHK.R: xawoxHB, cJuiaaoxIDi H .n;p. Bwrryc Kae1•cn D Ta6JieTxax , co,n;ep>Kaw;11x 150 wr (0, 15 r) 11 200 Mr (0, 20 r) ocuoaau1111 (aKTIIBUoe coe,zu-weHue). ,ll,JI.R: ,n;eTeH TaK)t(e shlnycxaeTcll s B11,ll;e apowaTuauposalilloro nopoIIIKa (cwemnaae wo r o C MO.,'lOKOM u T .,n;. ) - O,D;Ha qaH.luUI JlO>K.JCR co,n;epXHT 50 MI" OCUOBQUH.fl , Il11p11.weTaw1m • 4> ttp .Welilll,le uaasaun.R: .n;apanpu.w:, ::>p6anpe;uwa, MaJioror.n: n AP. B~cKaeTCK a Ta6JieTKax no 25 wr 11 50 wr. ,lLnJI A8Te~ TRK~e BhlnycKaeTCfl B Ta6JI8TKRX no 12, 5 wr n B Bn,n;e 3JJ.lllCCHpa UJI.H CHpona, O,n;Ha wepxa KOToporo co,n;ep>K.UT 6, 5 Mr HJlH 8 Ml' n11p111.tcTaM1llia . .-Me-",21yHapo,lllloe uenaTeHTOBaHHoe ua3aau11e (MIIJI) 67 .ll,JU! B3pOC.llhlX: .ll,JU! ,.o;eTell: - weuee 1 ro,.o; a : 25- 50 wr eJ<e.l{lleouo - 1--4 JieT: 50 wr eJ<e,lllleauo - 5-8 JieT: 75 llI' eJ<e,lllleauo - 9- 12 JICT: 100 Mr eJ<e,lll!C BUO N. B. B BhlCOKOM8.JLRpHHllhlx 3ouax, o c o6elillo a T])O- n1Nec1eoH A4>p111ce, aapocJihI M c.11e,nyeT np1rum.la'rb 0)KC,,4.ll0BUYJO .4.oay :!00 Mr. AJu{ B3pocJiblX: 3CX) MT OCHOBalHI.H O,ZUOI pa3 B He,l(eJl]f) )l,.1>1 ,.o;eTell: Me1-1ee 1 ro,n;a: 37, 5- 50 w:r ocuoaa1nrn - 1--4 JICT: 5~100 Mr OCHOBRUl1JI - 5-8 JICT: l 5~200 Mr OCHOBRUl1JI - 9-1 2 JICT: 200-300 Mr OCHOBRUl1JI N.B . B B~COKOMRJU!pmlmix pallouax o3poc ~ cJie,.o;yeT npmuo.taTb 300 Mr .n;ea pa3a e ue.n;e.nr. 11.1111, rrpe,a;- noq'fuTe .. 1hHo, no 100 MT e.)(.e,.10.I C BH O ..ll)ul B3p u,· .1ILJ:x: 3CXJ--l00 ..wr ocuoaa1t1u1 l pa3 e ue;i; c.ror.: .ll,JU! ,.o;eTeii: - Meuee 1 ro,n;a : 50 MI' OCllOBallUH - 1-1 JieT: 50-100 Mr OCHODaHIIJI - 5-8 JleT: l 50-200 Mr OCHOBRUH.ll " - 9-1 2 JteT: 2(X)...J()() wr OCHOBaUUR " N .B . B a~coK0MaJU!p11llmlx pallouax B3poc.llhlll cJie,.o;yeT npHHnW:a'I'b JCX) wr ,.a;sa pa3a a He,n;e...llh1 U.JlM 200 wr TpH paaa B H8A8Jll0 .ll,JU! B3POC.llhlX: 25-50 Mr O,.'IHH pa3 B ue,.o;eJOO .ll,JU! ,.o;eTeii: - .weuee 1 ro,.o;a: 6, 25 wr " - 1--4 JleT: 6,25-12 ,5 Mr " - 5-8 .,1eT: 12,5 Mr " - 9-12 Jl8T: 1 2,5-25 Mr " 0, CX; MAJlllPIDUl.Afl CHTY AilWI no )l,AHHWM HA 30 1-WJHJI 19 72 r . ~~ L ~ i ..-----1 ({) V V ,q u ~ :c"' - ,-.. (,), i r11a.,1,e,1y 11 a W>Ollll(a ~ -• 11nm-• • <'a u ra .1r"•u1a r,a. ,~a.,tu• ,]; ,,x~ ..... ,,. ro6u·o T)11Ull\,l;a.A Q o-•• K.eAn Sep.a; A( iv-\\ \/ .-)"-' 17"' <.. ;f-~ ? .. _ <" r o 11.-0 11r ' I lit.1 1t llO I \ --~ Ft•)"I • 11 t 44; r - :1.t r, ,a,- ~ -~.·w•u1P ~ a - .-, .. o6a pCK-~r..,J..') \b .U..l, ll■ <.: lo.>IC 0-11 0-■a I, ii) - ~. --... r• . . -, ~--~,.. ( """ " illllt ,dl -~- "',-! 'J ' ' -~ . .. J r ertt t.01111 \ tt ·!!Wt!' !'11".lp1t..'IW r . I D PaHoHLI, 8 KOTOpWX waJtHpH.R Hcqe3Aa , AKICBHAHPOBaHa, HJIH ue c ylQ.e CTBoBaJia D PaHOHl,I B $a3e KOliCOA H,ll;R~HH (oqeub MR.llhlH pHCK) _..,....---.. HHKor;,;a V D - PaHoew c nepeAaqel KJIH soawonioH nepeAaqeA waJIJlpHH KapTa, nowem;euuaJ< B "Weekly Epidemiologica l Record" , N'l 3, 1973 r. \ ~ C/ l '"O ~ ::::l 'O ~ 0 "' (1) ti: :s: (1) E,l l1CIIOJib 30BAHl1E Cl!E 'ffiO-Bhl l{J1CJil1TEJibH11X MAilil1H B IIPOrPAMMAX BAKII,[1HA].1}Il 11 l1MMYHl13Al.[J111 ,11;- p T. MaK.71 . reJIJioy311 CneII;11aJU:1cT 3,ll;paBooxpaueu11x rpaclJcTBa CoBeT rpaclJcTBa 3anaAHNi':i CacceKc ~wrecTep, Coe,ll;l1HeHHoe Kopo.JieBCTBo Pa3pa6oTKa 3a noc.Jie~11e ro,ll;l,I auT11reH0B npoT11B pR,ll;a nu¢eKD;l10llllhIX 6o.Jie3- uei':i oKa3a.Jia 6oJlbmoe no.JioJK11Te.JibHoe BJil1RHl1e ua 3,ll;opoBbe HaceJJe1m11. J 'l'O y.J~/'i- meH11e 113Mep11MO VI ,ll;aeT 60.Jibmoe YAOBJieTBopeu11e, OAUaKO 11Mel"II\11eC.>! B0 3 MOJKHOCTl1 11cnOJlb30Ball11H 3'I'Oro HOBoro cpe,n;cTBa oxpallhI 3,ll;OPOBb.ff ell\e no .JIDOCTblfl ue 11cno.Jih- 3)'lflTC.fi . Jhr.6an KOMJJJJeKCHaR cxeMa Ba1CII;11Han;1111 11 11MMYHl13an;1111 CBR3aua C p.fi,ll;OM npo- Ile,ll;)rp' Ha'!HHa.Jr,II\11XCR B pauueM ,ll;eTC TBe 11 npO,ll;OJIJKa.!'111\HXCR' no 1epa11ue11 Mepe' Ha IlpOTRJKeHVIVI Bcero illKO.JibHOro B03pacTa. p •,ll;l1Te.Jil1 C 'l'peMJITCR K TOMY' 'IT06hl 11X ,ll;eT11 6hl.Jil1 3all\1111\elihr OT npe,ll;OTBpaTl1Mh!X 3a o o .JieBa1m11; TaK, B ue,ll;aBuei':i cep1111 12 000 noc.Jie,ll;onaTeJlbllhIX ,ll;eTopoJKAeH1111 B 3 a na,ll;ll o M CacceKce cor.Jiac11a po,ll;l1'reJJe11 Ha npo¢11.JiaKTWiecic11e npl1B11BK11 ue 6hl.JIO no.Jr'J'IeUo JJl1illb B 7 CJIY'laRX; Bpaq11 B paB- ll011 Mepe pa,n;M B03MOJKHOCTl1 npe,ll;OC'l'aBHTb CBOl1 YCJTyr11 B 3'1' 011 o6.JiaCTl1. TeM ue Me uee, noKa3aTeJJVI 3all\11'I'bl, T . e . 'HIC.JlO ,ll;C'l'C l1 pa 3W,IX B03pacTUhlX rpyun, KOToph!e no.JIIlOC Tbl'l npom.JIH Bee npo11e~h! no 06 ecneqeu1nr, l1MeyUOJJor11qe- cK011 3all\11Thl, uey,ll;OBJieTBOpl1TeJlbl:lh[. 8 AurJU:111 ,ll;aHUhle B 1 D 7 1 r. B OTllOillelllll! KOKJJJ.r,illa, A11¢Tep1111 11 noJU:10M11eJJ11Ta cocTaBl1JU:I COOTBeTCTBeHHO 78 % , 78 % 11 80~ , O,ll;UaKo 3'1' 11 1111¢phl, OTUOC.flll\VleCR KO ncei':i C 'l'paue, ue OTpaJK3.1'1T 'roro clJaKTa, '-ITO B TO BpeMJI Kaic Bee 6oJlbmeey 'l11CJIY MecTllh!X opraHoB 3,ll;paBooxpaueu1111 y,ll;ae'l' CR 06ecneq11Tb 3all\11TY Bcex 11JU:I no'!Tl1 Bcex ,ll;eTe11, no,ll;Beprair,II\11XcR onacuocT11 3a- 60JJeBaH11H, ,ll;pyr11e oprallh! 06ecneq11BrurT 3all\11T)' Jll1lIIb noJJOBHHhl (11.JI11 ,ll;aJKe MeHee no.JIOBl1Hhl) Bcex ,ll;e'I' e11. 1 Bpa'M 11 pO,ll;HTe.JI11 npe11cno.Jlllellh! 3HTY3Ha3Ma; ue cyll\eCTByeT a6cOJil'lTUO u11- Ka1Cl1X clJHHaucoBh!X 6apbepoB. Hcxo,ll;R 113 cBoero JIH'llloro Oilh!Ta, aBTOP y6eJKAeH B TOM, 'ITO Hey,ll;a'!a B no.JIY'leui,111 60.Jiee Bh!COKl1X noica3aTeJJei':i o6yc.JIOBJieua npo6- JJeM011 a,ll;ID!Hl1CTpaTVIBHOro ynpaBJieUl1.ff 11 CBR311 . Ilo.1Ij"!e1111e corJJac1111 Ha BaKD;11Haill1]f') 11 11MMY11113aill1]f), Be,ll;eu11e Y'ieTa, 3anoM11- uau11c BeCbMa CJIOJKHOl1 11 IlOCTO.ffllllO MeH.mr.11\eHcR CXeMhI npl1BHBOK 11 ee ,ll;06pocoBecT- llOe np11Meueu11e np11 COCTaBJieHl111 11 o6pa6oTKe icapT ua MUor11e 'l'bICR'lH JIVIIl, KOTO- J)h!M CJie,ll;yeT C,ll;e.JiaTb Ilp11B11BKl1, (BKJJJ.r,'-JaR CBO!r. pa6ory no 11X 11AeUTl1clJH1caa;i,111' ua- 3uaqeui,nr, Ha Ilpl1B 11B.!Cl1 11 T . ,ll; . ) - Bee 3TO 3a,ll;aq11, KO'l' Opble Mory'r 3clJclJeKT11BHO 1 United Kingdom, Department of Health and Social Security (1971) On the state of the public health, Appendix A 69 pemaTh<' H o·r,zi;eJ1aM11 3,zi;paBooxpaneH1u1, Ho, KaK npaBl1JIO, He MoryT xopomo BLI- ITOJIWI'l'bCJl ceMeHHbIMH BpaqaMH' 3a HCKJlll)'leHHeM TeX CJIY1IaeB' Kor,zi;a pa6oTa 11X Ka- 611ue'rOB opraH113oB::nw. u eo6blqaHHo qeTKo. 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MaK.71 . rE.7I.7IOY JH Cnea;11a.7111c •r 3Apaaooxpaneu1,rn rpacf>cTBa □ 1 , ✓ •• fl:WM THE COUNTY HEALTH DEPARTMENT METROPOLI TAN HO USE NOR lH GAl l CHICHFSTER SUSSEX Ttler t,on e CH ICHESTER 85100 [)I J86 VACCINATION & IMMUNISATION GENERAL PRA CTITIONER / CLINIC LI ST r·.:c- ( ;'.. <. [ ~ • , 1-- r, f>' ~ ... . I • , ~ UU TO O? ( name an:1 ad<i r ess o; doc to are enter ed he r e ) 1 I ---;::;- ,~ .... · , -- •A,pp.,,,1 ........ J l' l I;; I i • ~1 ' LJ Tk lPLF Al'ITIGEN •~~MY r L~ ( fir st name} _ •12 . 151 ( s urname of child) I F I 1 .. ; I . - I ri 02 .15 ~u~ 02 .15 --- 02 .1" --- - i:: !J 2. 15 Ol . l 5 02 .1• 1 11 1 -- j M I j I 01 . 1 s 0 2.1~ • 1 FI 02.15 ~ F _i UU I 02. I 5 02.15 02.1~ "I 0 7.15 ,. i - ~ Ol~HTHE•IA-TETANUS + 0 0 LIO~YELITI S 07. 15 02 . 15 ;;J uu NOTE S 4 l 'l! 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J .._, 73 0 02 17 .: >l, - I 1. 00 o ~llll>• 5 1 ----- ,- 1. 3 0 . 1,j,)l 9 1 >R 52 GENERAL PRACTIT IO NER S ONLY 1 PLEASE RING O NE NUMBER ONLY U NDER TH[ APPR OPRl.6.TE HEADING IN COL 6 TO HELP IN ARRANGING fUlUfH APPOINl M(NTS 1 C(RTIFY THAT TH[ A80Vl PROCEDURES MA I,' ( BHr, CARRIH: o ~ r ANO I H[R(BY CLAI M TH[ HES TO WHICM I AM l ~ l1 TL£ D 2 I f SITE OF INJE CTIO N IS OT H ER THAN LEFT UPPER AR M PLlAS[ tNOlCATE I N COL 9 I lNHNO 10 HOLD TH[ N[Xl CLINIC ON CO~MP, ( , '1;,j AT 3 BAT CH No OF VACCI NE USED M UST BE ENTERED IN COL 8 4 SMALLPOX PLEASE RI NG THE APPROPRIATE LETTE R IN COL 7 FOR RES ULT OF SMALLPOX VACCINATION AND NOTE AN Y COMPUCATIONS OR UNUSUAL DATE SIGNATURE REACTION If RESULT IS I OR C A SECOND APPOINTMENT Wlll BE OFFERED -- - --- ---t A. :r M AJOR RE.ACTIO N B ::: EQUIVOCAL Rl.A.CTION C :. NO LOCAL REACTION CLINICS ONLY tP: S DOCTORS ARRAN GI NG THEIR OWN SESSIO NS ARE ASKED TO ENTER (A l COL I ) THE OAT£ THE TRFAT M["' T l'i GIV[N : 6 IT IS ESSENTIAL THAT THIS FORM BE CO MPLITEO AND RETURNED TOGETHER W ITH ANY CO MPLETE D U NSCH EDUL£0 ._PPOtNlMfNTS GIV£ N FORM S s: ~, TO THE COUNTY HEALTH DEPART M ENT NOT LATE R THAN THE DATE SHOWN Al THE TOP Of THIS FOR M Fo,m 20J"i 69 I C(RflfY THAT TH[ ABOV E PROC[ OU R[S ... .,, , , eu·. r A•'US ,<'." OL"I OAT£ SrGNAH.• Rf 'ti :s: ('l "" Ka.Hn;eJUrpcKaR pa6oTa no 3anoJIHeH11r. ,n;aHHoro ,ZJ;OK)'MeHTa BO BpeMR np11eMa B KJllllil1K e 3aBl1MaeT Ml1HJ1MaJII:,HOe BpeMR, 11 3a 15 Ml11IYT 06CJI}TJKJ1BaeTCJi B cpe,n;HeM 28 ,n;eTeli. 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CHcTeMa RB.JIReTCR qpe3Bhl'laHHo rw6KOH, H BHeceHHe H3MeHeHHH B nopR,lJ;OK npoD,e,n;yp He IlpHBO,lJ;HT K KaKOH-JIH6o nyTaHHil,e. BHenJiaHOBhle Ha3Ha'leHl1Jl H nepe- ,lJ;BH*eHHR Me*,lJ;Y BpaqaMH naD,HeHTOB, npH6hlBa.Jr~HX B rpa$CTBe H Bhl6hlB~~HX H3 Hero, He CBR3aHM C KaKHMH-JIH6o 3aTpy,n;HeHHRMH. JTOT 060,n;pJill)~Hff OilbIT y6e,n;HTeJibHO noKa3hlBaeT, 'ITO CHCTeMhl 3.JieKTpOHHOH o6pa6oTKH ,n;aHHMX OTKphlB~T HOB~ 3py B 06.JiaCTH Me,lJ;HII;l1HCKOro yqeTa H opraHH- 3all,HH CJiy*6 3,n;paBooxpaHeHHR. 1 Saunders, J. (1970) Brit. J. prev. Soc. Med., 24, 187 74 Paapa6oTamr 11: Ilp0,.1J;OJIJK8Jl)T paapa6aThIBaTbCH ,.11;pyrHe BH,ll;hI IlplU!eHeHHH CHC'reM. CHC'l'eMhI TaJCo r o po,.11;a 11CIIOJ!b3)Tlf}TCH Bee 60.JibfilHM 'IHCJIOM yqpeJK,.11;eHJ,ffl 3,.1J;paBooxpa- HeHl1R. BepOHTHO , IIpe,lJ;CTOH~aH peopraHH3aD;IDI. Ha~HOHaJibHOH CJIY*6M a,.11;paBoox- paHeH11R IlpHBe,ll;eT lC IIOBCeMeCTHOMY 11CIIOJib30BaH¥D0 B CTpaHe COBpeMeHHMx MeTO,ll;OB YIIPaBJieHHH 11 cBH3H . BHB.7ll10 rP M> IDI Ayyar, R. D. , Ramakrishnan, S .P . & Singh, B. (1963) An analysis of the cases of typhoid, diphtheria and tetanus admitted to the Safdarjun g Hospital, New Delhi, in 1961, Antiseptic (Madras), 60, 371 Brown, G.D. et al. (1964) Responses of infants to DTP-P vaccine used in nine injection schedules, Publ. !-11 t h Rep. (Wash. ), 79, 585 Davenport, F .M . et al. ( 1965) Further o bse rvations on the relevance of serologic recapitulations of human infect ion with influenza viruses, J . exp. Med . , 120, 1087 Evans, D.G. & Smith, J.W.G. (1963) Respons e of you ng infants to active immunization, Brit. med. Bull., ~. 225 Fox , IV. (1962) Lancet, I, 413, 374 Galloway, T. Mc L . (1963) Management of vaccination and immunization procedures by elect roni c computer, Med. Offr, 109, 232 Hanlon, J .J . (1950) Principles of public health administration, St. Louis Herbert, W.J. (1965) Multiple emulsions: a new form of mineral oil anti gen adjuvant, Lancet, I, 771 Hilleman, M.R., Hampil, B. & Sweet , B. H. (1963) Poliovirus vaccines in mineral oil adjuvant: I. Ani mal toxicity and serologic response data, J. Allergy , 34, 413 McQueen, J.L . (1966) Personal communication Medical Research Council (1959a) Vaccination against whooping-cough, Bri t . med. J . , l, 994 Medical Research Councii (1959b) BCG and vole bacillus vaccines in the prevention of tuberculosis in adolescents, Brit. med . J., I, 379 75 Medical Research Co uncil (1962) Inefficiency of purified diphtheria formol- toxoid in primary immunization a gainst diphtheria, Brit . med. J . , ~. 267 Miller, D.L. (1964) Frequency of complications of measles, 1963, Brit. med. J ., ~. 75 Office of Health Economics (1963) The price of poliomyelitis, London, pp. 16-25 Smith, R.T. & Eitzman, D.V. (1964) Development of immune response: Characterization of response of human infant and adult to immunization with Salmonella vaccines, Pediatrics, 33, 163 Sutherland, I. (196 6) Personal communication Winslow, C.-E.A. (1951) The cost of sickness and the price of health, Geneva (World Health Organization: Monograph Series, No. 7) World Health Organization (1960) European Technical Conference on the Control of Infectious Diseases through Vaccination Programmes: Report, Geneva (Wld Hlth Org. techn . Rep. Ser., 198) World Health Organization (1961) The role of immunization in communicable disease control, Geneva (Public Health Papers, No. 8) 76 1. TYBEPKY.7IE3 B EBPOIIE ,ll;-p M. Apu1p11 Per110Ha.JibmIH cnen;11aJU1cT no xpoHl1'IeCK11M 6oxe3HJIM xerK11x EBponeHcxoe per11oaa.JibHoe 6ropo B03 KoneurareH, ,ll;aH11R K 11cTop1111 Bonpoca ITocxe BTopoH M11pOBOH BOHHJ,I aacexeu11e EBpomr,TJIJl(exo nocTpa.n;aBmee OT BOeHHJ,IX ,ll;eHCTBl1H, BhmyqeHo 6LUO CTO~HYTbCJI c ell\e O,ll;H11M 6e,ll;CTBl1eM - 'l'J'6ep- Kyxe30M . 3Ta 6oxe3Hb, KOTOP)'lfl pauee y,11;aBaxocb orpaH11'111Tb ,11;0 onpe.n;exeHHJ,IX npe.n; exoB, XO'I'JI ee Hl1Kor.n;a He no6eqax11 O.!COH'laTeJibHO), Bcrrw:xayxa BHOBb. 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Yc11.Jil!IR, npe,.11;npHHRTble o6m:ecTBOM B 3TOH o6.JiaC'l'l1, He 6bl.Jil1 6ecn.JIO,.Zl;HhlMH; TeM He MeHee, pe3yJD:,TaTbl MOr.Jil1 6bl 6hITb JI)"lIDHMl1, a HMe~m:HecR cpe,.Zl;CTBa Mor.JIM 6hl HCITOJD:,30BaTbCJ{ 60.Jiee 3$$eICTHBHO H 3ICOHOMH'IHO. 81 HaICoHeu;, cJie,.n;yeT o •rMeTH'l'b, 'ITO npo6JieMbI, 113.JIOJKeHHh!e 3,.n;ecb .ll;JLJI Toro, q •ro6hl C'I'ldMYJIJ1POBa'I'b HX paccM0TpeH11e opraHH3a 0ropaM11 o6~ecTBeHHoro 3,.n;paBooxpa- ueH11H, yJKe o6cyJK,.n;aJIHCb Ha COBe~aHHRX HeCICOJlblCl1X rpynn cneu;11aJIHCTOB, opraHH- 30BaHHhlx EBponeucICHM perHoHa.ThHh!M 6~po BceM11pHoH opraHH3aD;Hli 3,.n;paBooxpaHe- HHR, Cpe,.n;H H11X - TeMaTJ1'IeCICOe coBe~aH11e no BOTipocaM 6opb6hl C TY6epICyJie30M B ce.JlbCICl1X paHoHax (3arpe6, 29 ceHTH6pn- 1 OICTH6pH 1970 r.), TeMaT111IeCICOe COBe~aHHe no 11HTerpau;1111 6opb6hl C ry6epeyJie30M C ,.n;eHTe.JlbHOCTb~ 06~11x CJI)1JK6 3,.n;paBooxpaHeliHH (Ilap11 JK , 20- 2 2 anpe.JIH 19 71 r. ) , HccJie,.n;oBa1111e 3cpcpeIC •r11BHOCTJ1 nporpaMM 6op1,6L1 c T,)'6eplC)' Jie3oM (BapmaBa, 1968 r.; l13MJ1P 11 CTaM6yJI, 1969 r.; Koneurareu, 1970 r.), CeMHHap no ou;eHICe nporpaWd 6opb6hl c ry6epeyJie3oM (KoneHrareH, 19- 23 111fl'HH 1972 r. ) . 82 Ta6.11H~ 1 CMEPTHOCTh OT TYBEPKYJIE3A B EBPOilE RA 100 000 HACEJIEHl1ll B 1947-49, 1957-59, 1967-69 H 1910 rr. ~· 1947-49 1957-59 ABcTpHH 84,0 25, 5 Be.JlbrHH 55,6 18 ,9 Bo.11rapHH - - BeurpHH 107,6 32,7 r.zn, 146,3 22,2 fpemrn - 19,3 A!<HHH 24,4 4,3 HpJlaH)IHH 106,2 21,0 Hc./lRH)IHH - - Hcnaa11n 118, 5 28, 5 HT&JIHJI 62,7 19, 1 HH,11ep.11aH,llhl 29,9 4,2 HopeerHn 48 ,4 7,6 IloJlhma - 46,9 Ilopryra.llHH 151,9 53, 5 Pyw>,IHHH - 38 ,6 6 Coe,zt:1WeHHoe Kopo.11eBCTBO ,\Hr.llHH H Y3.JlbC 49,4 9,7 Ceaepuax Hp.llali)IHI! 66,2 11, 2 filoT JIRH)IHII • 73,6 12 ,8 4' HHJIHH)IHH 152,2 33,1 4'Pf 61, 2 17, 3 4'p8.Hil,lUI 73,5 25 ,0 4.eXOCJIOB&KHJf - 33,4 filaei!~pHH 53,7 16,2 maemrn 40,3 7,9 IOroc.11aeHJ1 - 53, 48 a 1969 6 Archives of the Balkan Medical Union, 1964, ~. No. 3-4 B = Tuberculosis in Yugoslavia 1956-66, Belgrade , 1967 HcTo1IllHKH: ()TqeT no MHpOBoH canHT&peo~ eTaTHcTmce, E, ~ 8, 1970 r. E~ero,lQiHJC MHpoeoH caHHT&peoH CT&THCTHKH, .!., 1970 r. 83 1967-69 15,4 8,4 12,4 21, 7 12 ,8 10,8 2,0 9,2 2,2 13, 5 8,9 1,4 3,6 29,1 23 ,7 21,5 4, 1 4,3 5, 0 9,3 10,3 11, 2 10,0 7 , 6 4,4 20,0 1970 13,0 a 7,7 10,5 19,3 11, 1 9,5 2,8 7,5 1,0 a 12 ,8 7,0 1, 2 2,7 25,5 15,1 18, 5 3,3 4,3 5,4 8,3 8,2 8,2 9,6 6,3 4,8 18,5 ~ CMEP1l!OC'!1, OT TYBEPIO'JIE3A B EDPOIIEWCIGIX CTPAHAX HA 100 000 HACEJIERIUI B 1957-1 959 H 1967-1969 rr. R H,ll; e pJialf.llhl I I 1957- 59 rr ~---~ .ll,aH11JI HcJiaH,ll;HR RopBerHR AllrJIHR 11 Y :JJlhc Ce BepuaR HpJiau- llHR l!IB e D;HJI illoTJiaH,ll;HR BeJibrHR HTaJIHJI HpJiaB,ll;HJI <l>HHJIJIH,ll;HJl 'ieXOCJIOBaKH>l <l>Pf fpeD;HJI <l>pa11D;HJ1 BoJirapH11 Hc nauHR AB CTP HR borocJiaBHR fyMJ,[HHR BeurpHR lloP'ryraJ11111 lloJibma 8 ><>0 >( ◊ >( ◊< ,A ><>0 >< 0 >OQ ,A :::>◊< "'~ ><>0 >OQ ,., ·y :x :>:X I I I I I t"\ l'v /V'V IV><)IV'V """1' 0 ..,,...,,,,..,v...,,..,_,..,....,...., V"V' ""' 888888&3888888888~ :> ,A 'V "V 'X') ....... ":::I 'V ,,..,c,,, ~ >O "-' V "-' V "-'"V~ V 10 20 30 84 19 67- 69 rr I I t I I I I I 40 50/100 000 P11c. 2 70 60 50 ~ = QJ "l QJ 0 40 al = § 8 ... al = ~ 30 0 0 ~ "" QJ ;,i (.) 20 10 0 0 CMEPTHOC.Th OT TYBEPICY JIE3A ( BCE ~OPIAI) HA 100 000 HACEJIEHHII B 20 EBPOIIE~CICIDC CTPAHAX 3A 1957-1959 rr . H 1967 r . l -4 no PACl!IHPEHmlM B03PAC1IDIM rPYnnAM npellWl!euue ypoBBJI cwepTHOCTH B 1957-1959 rr. ypoaeBL B 1967 r. 5-14 15-24 25-44 Boapa.cTH1,1e rpynm1 85 45-64 65-74 75+ l 00 90 80 l:! = ~ 70 II> " aS = § 60 § so aS = ~ 40 " 0 ~ ~ 30 l 20 0 CIDIJKEIDIE CMEPTHOCTH OT TYBEPIO'JIE3A B EBPOrrrltCKOM PErH<EE CMEP'llIOCTb B 1967 r. KAK 'lACTb CMEP'llIOCTH B 1957/ 1959 r. l -4 5-14 15-24 25-44 45-64 65-74 BoapacTBWe rpynmz 86 1957/ 1959 1967 75+ HAiiji!OOAJibllbIE TIPOrPAMMl,I 3IIl1,.1l;J:[A.11;30PA 3A MH<l>EICl.lJ1OHllbIMl1 BOJIE3H.flMI1 B EBPOTIE ,lJ,-p M. P . 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CCCP TyplOLH. ♦ HU.11.HUAIUI 4ip&UWU1 l(exoc.11ottax1LH illBeHuap 1U1 l0roc.11aeu.R al969 6 19 10 8 1967 ,ll,auuw e u enp u cw.JJ:e M!l .n,am.wx H CT 5 2 17 GU 2 15 Of-li II ·16 11 51 260 94 59 I 75 239 113 ti 3.,1 5 ll 105 18 20 550 80 () , 7 0,0 16,6 11,8 1 , 1 17 ,8 8 ,2 0, 4 13,3 9 ,9 0,9 17, I 10, 7 0 ,8 1 2 I 7 11, 9 0, 5 16, 5 11, 5 I , 2 15, 2 9, I 0 ,8 14, I 10,2 1,0 18 , I 8,7 llcTO'-CUUXU : United Nations (1972) Demograph ic Yearbook 1971 Worl d tleal th Organizati on ( 1973) Wor ld Healt h S tatistics Report, £§_ , 6 , 9 94 'Il!CJIO 3APErl!CTPHPOBAl!IIWX Ii COOBIUllHLlX B B03 CJIY'IAEB l!ll♦EK!lj100l!Oro l'EIJATIITA HA 100 000 HACEJIEIHIII B EBPOl!EllCKOM PErHCIIE B 1962 r . l > HJO rzza -c::J )laHHWe 803 H e H3Be C THW .lt&HHWe ,11.1111 Typwm , 1963 r. 100-10 ~ HcTo,mmc11 ; OpraHH3aIIWI 06'he,11;KJ:1.elllll,IX Hai::udl ( 1972) .n,eworpa4>H11ec1ndt eJ1C.ero,n;u11JC 1971 BcewKpH&JI oprauuaaa;HR 3,4paeooxpaueuM ( 1973) JCeueHa ( ueony6JDDCo- BaHHWe M&TepH&JIU ) 95 KapTa 2 'O!CJIO JAPErliCTPIIPOBAIIIIWX 11 COO!llLEIIHWX B BOJ CJIY'iAEB IIB♦ EIOll1CJIBOro f'EilATliTA HA 100 000 HACEJIEIIHJI B EBPOm:l!CiaJII PErI!<EE B 1972 r. I , 2 w . . . . . . . . > too rzz.a -c:::J .llalon,ie BOJ He H3BeCTHW I )IILBHlole ,llJISl Ilop'l')'l'&AHH , 1969 2 )IILBHlole ~JIJI BoArapHH H ~HH. 1971 100-10 1:-:-.-:-:-1 ...::: 10 llCT0'DIHJCH : ()prasu3&UHJI O6'>.e~1meBH1o1x Hamd! (1972) .n;evorpa4>1,:qecxHi! exero,'!Hwc 19 71 BceMHJ>HU opr aHH3&IlHJl MpasooxpaHeHwt: (1973) Xl!HeBa (ueony6im:oB&KllJ,le M&Tepl18.JIW ) 96 'll!CJIO JAPErHC'n'IIPOBAHIIMX II COQflll.EIIIIJ,[X B 803 CJIY'IAEB nOJil!OllllEJIIITA BA 100 000 BACE.1IEJIIIJI B EBPOm:llCICOM PErHCEE B 1953-195 7 rr . l - >10 ~ C:::: 0, 1 ~ CJ 10 - 1 ~e B03 ue H3B8CTHW 1 - 0, 1 ~Hmle ;J;JUI ♦ KH..lUDl,.ll;HH H HcnaHHH OTl:lOCJITCJI TOJ[h.lCO JC nap&JI.HTH'l0CltOA ¢,opwe noJIHOMH8.llHT& llcT0'DIHXH : Oprauuaa= 06-,,e,a;HUeWD,lX Hundt ( 1972 ) )!euorpa4>lf'lec 1rnll exero,a;11ux 19 71 BceWKpHU opr&HH3&D)UI 3A;p&B OOXJ)&H8HHR ( 1973 ) :»Ceueea (ueony6.llHXOB&Hl:Dtl e M&Tep H&.Dl ) 97 q11CJIO 3APErHCTPl1P0BAHJILIX 11 COOBIUJIHJ,IX B B03 CJIY'IAEB nOJn10Ml1E.iIIITA HA 100 000 HACE.IJEIHI/I B EBP0IIrnCIWM PErl10HE B 1972 r . 1 , 2 • 3 . w . . . . . . . . - >10 i:z:=]< 0,1 10 - 1 )la.uHWe 803 u e H3eec'I"HW 1 - 0, 1 1 AalllDle ,D;JIJI ~HlLJUIH.,2l;HH H H cn&HHH OTHOC.A: TCII TOJJ:hlCO 8 napaJU1TH"18CJtoA cf)opwe TIOJWOI018Jll1Ta 2 .,!laH.Hwe .ll.lUI MapOICICO H nop'l')'l'&.XHII , 1970 3 AallHlale A.JUI Bo.11rapm1, fepwaucxol Aewox.paTlf'Clecaco'1 Pecrry6JrnJu1 u Pyl,oimH1:t: , 1971 IICTO'DlHICH: Op raBH3&1l)U< 06'J.e,llKH81lllWX Haa;dl ( 1972) ,!l,eworpa<1> ..... ec1rnl! 8Jlt8 I'O;r;HWC 19 71 . BceWHpH8.Jf oprB.l:IH3a~u,r a~aeooxpa.u eHWI ( 1973 ) xeueea ( ueony6.11HJCoea.HlDle MAT8p H&JIW: ) 98 '!HCJI) 3APEC'HCTPHPOBAIIHWX 11 COO!lll;EHIIWX B B03 CJIY'IAEB nltA 11 IlAPAnl♦A HA 100 000 HACEJIEHHJI B EBPOIIEACl!OM PEC'HCllE B 1962 r _ l, 2 w . . . . . . . . . -CJ > 10 ~ ~e B03 He uaeec THW )laHHWe ,ll.llJI AJu<upa, 1961 ~ J 1 - Jf.aHH1,1e A.JUI lll:Bea;HH BJCJlr.llJU')T ,.-pyrHe KH4'8IUlHH I BW3l1Bae ww e C AJ[bMOH8JtJIOit 11cTO"IHHXH : OprauuaaIIIIJI 06i.e)IHl[eBJD,1X Harod! (1972) ,lleworpag>1AecxHl! eJ1tero,.yrnx 1971 BceMHpH&II opr&BH3&IJ;HJI 3,l{J)&BOOxp &BeBHII ( 1973 ) Xeueea ( Heony6Al1XOB&HH!i(8 M& TepH&JDl) 99 'IHCJIO JAPE!'IICTPl!P0 BAIIIIWX 11 COOlllllJlmlX B 803 CJIY'iAEB Tll♦A 11 IIAJ>ATll♦A HA 100 000 HACEJIEHl1/l B EBP0!IEl\CICOM PE!'IICIIE 8 1972 r .1,2, 3 -::>10 ~ l~I C=:J ~ e 803 H e U3B8C THW 1 )laHHWe ,llJIJ! nop'I')'l'&AHH , 1969 2 )laHuwe ,llJIJ! Mapouo, 19 70 3 ,!laem1e ,llJIJ! BoAraplOI u Pyw>muu , 1971 ~C:::::.l 11c TO'[BID<H : OpraHK3&SWI 06'1. e,a;KHeamix Hagidl (19 72 ) ,lleworpag,K'lecxuil e1tero@rnx 1971 Bc e MHpHu: opr&11HO&IUU1 3APaaooxpaseaHJ1 ( 1973) Xeue ea (ueony6AHJCoeaHJWe K&T8pH&Jllil) 100