I?I?NOA?NOAI IOI?IIE CAeI?IA`ss OE?A?IE

EE?ANUeEEE IAOEIAI-AeINE?AeIEE ?INOEOOO

AI?AeAI?IEIA?? OA ?IOAEOe?EIEO OAI?IA

?iai? E.A.A?IIAOAANUeEIAI

AeAI?OIANUeEA Ieaia Aieiaeeie??aia

OAeE 616.036.22:616.084:931

I?IEEA?NOUe AI?AeAI?*IIAI I?IOeANO AeEOOA???

ssE ?ACOEUeOAO ACA?IIAe?? NIOe?AEUeII? OA A?IEIA?*II?

I?AeNENOAI

14.02.02 — ai?aeai?ieia?y

Aaoi?aoa?ao

aeena?oaoe?? ca caeiaoooy iaoeiaiai nooiaiy

aeieoi?a iaaee/ieo iaoe

Ee?a — 1999

Aeena?oaoe??th ? ?oeiien

?iaioa aeeiiaia o Ee?anueeiio iaoeiai-aeine?aeiiio ?inoeooo?

ai?aeai?ieia?? oa ?ioaeoe?eieo oai?ia ?i. E.A.A?iiaoaanueeiai IIC
Oe?a?ie

Iaoeiaee eiinoeueoaio:

aeieoi? iaaee/ieo iaoe, i?ioani?

*oaeia Ethaeieea Ieo?ioai?aia, aieiaiee iaoeiaee

ni?a?ia?oiee eaai?aoi??? ea?iaaieo ?ioaeoe?e oa cania?a ?o

i?io?eaeoeee Ee?anueeiai IAe? ai?aeai?ieia?? oa ?ioaeoe?eieo

oai?ia ?i. E.A.A?iiaoaanueeiai IIC Oe?a?ie

Io?oe?ei? iiiiaioe:

aeieoi? iaaee/ieo iaoe, i?ioani?, caneoaeaiee ae?y/ iaoee ? oaoi?ee
Oe?a?ie Ca?eoeueeee Aiaoie?e I?iiae/, caa?aeoaa/
eaai?aoi???th

eeoeiaeo ?ioaeoe?e oa aeac?ioaeoieia?? Ee?anueeiai IAe? ai?aeai?ieia??

oa ?ioaeoe?eieo oai?ia ?i. E.A.A?iiaoaanueeiai IIC Oe?a?ie

aeieoi? iaaee/ieo iaoe, no.i.n.

I?eeooeueeee Ieaenaiae? Na?a?eiae/, caa?aeoaa/ eo?nii

ee?i?/ii? ?ioiieia?? oa aea?aieia?? Aeiiaoeueeiai aea?aeaaiiai

iaaee/iiai oi?aa?neoaoo

aeieoi? a?ieia?/ieo iaoe, i?ioani?

?oaeaiei Aaea A?eoi??aia, caa?aeoaa/ a?aeae?eii i?e?ia?ieia??

oa a??onieia?? ?inoeoooo o?ieia?? oa iao?ieia?? AII Oe?a?ie

I?ia?aeia onoaiiaa:

Ee?anueea iaaee/ia aeaaeai?y i?neyaeeieiiii? ina?oe ?i. I.E.Uoieea IIC
Oe?a?ie, i.Ee?a

Caoeno a?aeaoaeaoueny “27” aeiaoiy 1999 ?. i 11 aiaeei? ia can?aeaii?
niaoe?ae?ciaaii? a/aii? ?aaee Ae.26.614.02 i?e Ee?anueeiio IAe?
ai?aeai?ieia?? oa ?ioaeoe?eieo oai?ia ?i. E.A.A?iiaoaanueeiai. (03038,
Ee?a, oca?c I?ioan?a ss?,4).

C aeena?oaoe??th iiaeia iciaeiieoenue a a?ae?ioaoe? EIAe?A?O (Ee?a,
oca?c I?ioan?a ss?,4)

Aaoi?aoa?ao ?ic?neaii “22” aa?aniy 1999 ?.

A/aiee nae?aoa?

niaoe?ae?ciaaii? a/aii? ?aaee,
E.N.E?anthe

eaiaeeaeao iaaee/ieo iaoe

CAAAEUeIA OA?AEOA?ENOEEA ?IAIOE

Aeooaeueiinoue oaie

Aeeooa?iy iaeaaeeoue aei eeane/ieo iioaeoeie i ii i?aao
aaaaea?oueny iaeii?th c iaeaieueo aea/aieo iioaeoeieieo oai?ia.
Ai?iaaaeaeaiiy ianiai? aaeoeeiaoei? aeeooa?i?, oaeineiiaeaiiy aaeoeei oa
noai ?o canoinoaaiiy ii?yae ci niaoeeoi/iei eieoaaiiyi
i?ioeaeeooa?ieiith ne?iaaoeith i?ecaaee aei ?iceiai cieaeaiiy
caoai?thaaiinoi oa eaoaeueiinoi aiae oei?? aeeoy/i? e?aiaeueii?
iioaeoei? a 50-o ?ieao oa caaacia/eee noieea aiiaeaii/ia aeaaiiieo//y a
ianooiii ?iee. Oniioe i?ioieaeoeee aeeooa?i? noaee iiaenoaaith aeey
oeaii? aiaaiaiinoi i?i iiaeeeainoue iiaii? eieaiaeaoei? aeeooa?i?
(Eauaiei I.Ae.,1963, Oacaiia I.I., 1967) ? i?ecaaee aei cieaeaiiy
ianoi?iaeaiinoi aei oei?? ?ioaeoe?? ye na?aae ianaeaiiy, oae i na?aae
iaaee/ieo i?aoeiaieeia, ui aiaeaeeiny ia yeinoi i?iaaaeaiiy
i?ioieaeoe/ieo, aeiaaiinoe/ieo oa i?ioeaiiaeaii/ieo caoiaeia
(Aieioianueeee A.I.oa ii., 1986). C?inea eieueeinoue aiaeiiaeaiue oa
aaciiaenoaaieo i?ioeiieacaiue aei uaieaiue o aeioae. Ciiieany eaeaiaea?
uaieaiue uiaei iiaeiaaeaiiy iioa?aaeia iiae uaieaiiyie oa cieaeaiiy
caaaeueiiai aioeaaiiiai iaaaioaaeaiiy ia oeeee iioiicaoei?. Oea i?ecaaei
aei oiai, ui aaea a 1989 ?ioei a Oe?a?ii o aieiaie a?oii aei?ineeo aei
27 ?ieia ieoiia aaaa iacaoeuaieo aeinyaaea 52%, a noa?oa 27 ?ieia — 67%.
Oei eiioeiaaioe noi?ioaaee i?ioa?ie, iaeaieueo o?aceeaee ii aiaeiioaiith
aei aeeooa?ieii? iioaeoei? (*oaeia E.I. c niiaaao. 1992). Cieaeaiiy
eieaeoeaiiai iioiioaoo ca oiiaith iino?eiiai ?nioaaiiy ?aca?aoa?o
caoaeieea iioaeoei? o aeaeyaei aacneiioiiiiai iinienoaa (Einotheianueea
I.I., 1975, Einotheiaa I.I., 1997), caeiiiii?ii i?ecaaei aei
aeoeaicaoei? aiiaeaii/iiai i?ioeano aeeooa?i?. Noieea oaiaeaioeiy aei
iiai?oaiiy aiiaeai?/ii? neooaoei? c aeeooa?i? niinoa?iaaeanue aaea c
ii/aoeo 80-o ?ieia. 1991 ?ie ioioeieii iaieioaiee ?ieii ii/aoeo
aiiaeaii? a Oe?a?ii (WHO, 1993). Aeoeaicaoeiy aiiaeaii/iiai i?ioeano
aeeooa?i? a iiaeo iacaeaaeieo aea?aeaaao eieeoiueiai N?N? noaea iciaeith
i?iaeiaaeaiiy aaiethoei? oei?? «noa?i?» iioaeoei?. Oea aiae?iaeeei
iioa?an aei ia? a/aieo onueiai naioo (Galazka A. et al. 1995, MMWR,
1995).

Iacaaaeath/e ia iiae-oi anaai/io aea/aiinoue caoaeieea aeeooa?i?,
aeayei aniaeoe aeeooa?ieii? iioaeoei?, oaei, ye: aiiaeaiiieiai/ia
cia/aiiy iini?a iaoieneaaiieo ei?eiaaaeoa?ie oa aoiieiai/ia ?ieue
iaoieneaaiieo ei?eiaaaeoa?ie i?e aeeooa?i?; cia/aiiy cooiaiy
aa?aneaiinoi C.diphtheriae (aaeaaceaieo i oieneiiooai?thth/eo
aeanoeainoae) o aeieeiaii? aieueo oyaeeeo eeiii/ieo oi?i aeeooa?ieii?
iioaeoei? oiui, caeeoathoueny iaae?ioaieie.

Aeey aeeooa?i?, ye iioaeoei? c oe?ieei niaeo?ii ee?i?/ieo i?iya?a
(aiae aacneiioiiiiai iinienoaa aei aeeneaae/ieo oiene/ieo oi?i),
iaaecae/aeii aaaeeeaeie ? iieaeoey?ii-aeieiai/ii iaoaiicie aca?iiaei?
caoaeieea c i?aaiiciii ethaeeie, ui iaeaaeaoue aei iiiyooy
eiinoeoooeieiiai iioiioaoo (?oiyioeaa N.I., 1983). Aoaeue-yei iiaeoiaee
aei aecia/aiiy iiaeeaiaeoaeueii? ni?eeiyoeeainoi aei iioaeoei?, a oiio
/enei, caeaoiinoi aiaeiiaiaeaoe iaaeieiei caoeniei iioiioaoii aai
caeeoaoeny ?acenoaioiei o aiaeiiaiaeue ia uaieaiiy, aeiiiiiaei a
ia?aaoaeoaaoe ?iaioo c iioiii?ioieaeoeee aeeooa?i? uiaei
iiaeeaiaeoaeicaoei? noai aaeoeeiaoei?, aeei?enooaaiiy iioiiiiaeoeyoi?ia
oiui, e oei naiei ciaioeoe caoai?thaaiinoue oa eaoaeueiinoue aiae
aeeooa?i?.

I?ioa iaeaaaeeeaioei iai?yieii ea?oaaiiy aeeooa?ieiith iioaeoei?th
c /ania oniioiiai ai?iaaaeaeaiiy i?ioeaeeooa?ieii? aaeoeeie aoee i
caeeoathoueny i?aaiicaoeieii caoiaee iieiioaiiy iioiii?ioieaeoeee i
oaeineiiaeaiiy aiiaeaiiieiai/iiai iaaeyaeo. Aia?aieii caoiaee c
iioiii?ioieaeoeee aeeooa?i? c iaoith no?eiaiiy aiiaeaii?, ui aoee aaeeo?
a ?iee aiiaeaii?, iio?aaothoue iaoeiai iaa?oioiaaii? ioeiiee. Aeey
oeueiai ia?o ca ana iaeaaeeoue ioeiieoe aoaeoeaiinoue i?iaaaeaieo
aeiaeaoeiaeo ?aaaeoeeiaoe?e (“iioiiei?aeoei?”) aeioae oa ianiai?
aaeoeeiaoei? aei?ineeo. Iaeiei c iaeaaaeeeaioeo ieoaiue, yea /aea? naiai
?ica’ycaiiy, ? anoaiiaeaiiy i?e/ei caoai?thaaiiy i?euaieaieo.

E?ii ia’?eoeaieo /eiieeia aeoeaicaoei? aiiaeaii/iiai i?ioeano
/eiaeo ?ieue a neeaaeiie aiiaeaii/iie neooaoei? c aeeooa?i?, ui
neeaeany, a?aeia?aea iaaecia/aiinoue aeayeeo eeiiiei-eaai?aoi?ieo
aeiaaiinoe/ieo e?eoa?i?a. Aiaenooiinoue ocaeiiaiiai a Oe?a?ii
aecia/aiiy noaiaea?oiiai aeiaaeeo aeeooa?i? aianea aeineoue aaaaoi
noa’?eoeaicio o i?ioean aeiaaiinoeee oa iaeieo oei?? oai?iae. sse
iane?aeie, iiae ie?aieie aaeiiiino?aoeaieie oa?eoi?iyie iieaciee
caoai?thaaiinoi cia/ii eieeaaany, aea ia iia aaaaeaoeny e?eoa?i?i
aoaeoeaiinoi i?ioeaiiaeaii/ieo caoiaeia, ai i?e aeaoaeueiiio aiaeici
aeyaeyany ??ciee iiaeoiae aei anoaiiaeaiiy aeiaaiico «aeeooa?iy». Oeei
i?iaeeeoiaaii iaiaoiaeiinoue aecia/aiiy e?eoa?i?a ioeiiee aiiaeaii/ii?
neooaoei? oa aoaeoeaiinoi i?ioieaeoe/ieo i i?ioeaiiaeaii/ieo caoiaeia ia
aaeiiiino?aoeaieo oa?eoi?iyo, o iaaeao yeeo i?eeiathoueny iniiaii
?ioaiiy uiaei oaeoeee eiio?ieth ca aiiaeaii/iei aeaaiiieo//yi.

Aiiaeaiiy ea?iaaii? iioaeoei?, ui noaeany iai?eeiioei 20-ai
noieiooy, noaea aei?iaoaaiiyi ia oieueee aeey nenoai ioi?iie caei?ia’y i
iaoeiaoeia e?a?i eieeoiueiai N?N?, aea e aeey iiaeia?iaeieo i?aaiicaoeie
ioi?iie caei?ia’y, yei acyee aeoeaio o/anoue o eieaiaeaoei? ina?aaeeo
aeeooa?i? a ?a?iii.

Ioaea, ia anio ?iaiyo aiiaeaii/iiai i?ioeano a?aeaoaaeenue ?
aiaeaoaathoueny ci?ie, iaaiei /eiii iia’ycaii iiae niaith. I?ioa
o?aaeeoeieiee aiaeioe/iee iiaeoiae, ui ia?aaeaa/a? aea/aiiy ie?aieie
oao?aoeyie aocueeeo ieoaiue, yei noinothoueny iie?iaiieiai?, iioiieiai?,
eeiiiee aai nooi i?aaiicaoeieieo ieoaiue iioiii?ioieaeoeee oa
aiiaeaiiieiai/iiai iaaeyaeo, ia ni?ey? noai?aiith oeieinii? ea?oeie
aiiaeaii/iiai i?ioeano aeeooa?ieii? iioaeoei?. Oii?yaeeoaaoe i
oeieani?yiiaaii caanoe ?acoeueoaoe aeineiaeaeaiue ?icieo iaoe a ?aeeio
eiai/io nenoaio, ciaeoe ?i iaaia iinoea a no?oeoo?i aiiaeaii/iiai
i?ioeano aeicaiey? nioeiaeueii-aeieiai/ia eiioeaioeiy A.E.*a?eanueeiai
(1988) caiaeii c yeith «nenoaia yieaeaie/aneiai i?ioeanna aicieeaao e
ooieoeeiie?oao eae acaeiiaeaenoaea aeaoo iiaenenoai: aeieiae/aneie e
nioeeaeueiie. Eiee/anoaaiiua e ea/anoaaiiua i?aia?aciaaiey ia eaaeaeii
ec o?iaiae io?aaeathony ia ooieoeeiie?iaaiee anao i?i/eo o?iaiae e a
oeaeii ia yieaeaie/aneii i?ioeanna eae ia aaeeiie eioaa?aeueiie
nenoaia». Ioaea oieueee nenoaiiee iiaeoiae aei aea/aiiy aiiaeaii/iiai
i?ioeano ia an?o eiai i?aeii?yaeeiaaieo ??aiyo aiae noaeeioeiii?,
iieaeoey?ii-aeieiai/ii? aca?iiaei? caoaeieea i ethaeeie aei aeiaaeueii?
nenoaie aiiaeiaaeyaeo ca aeeooa?ieiith iioaeoei?th ciiaea ia?aaeaa/eoe
iai?yiie aaiethoei? aiiaeaii/iiai i?ioeano aeeooa?i? i aecia/eoe
iaeaieueo aoaeoeaio no?aoaaith i oaeoeeo ai?ioueae c oei?th iioaeoei?th.

Ca’ycie ?iaioe c iaoeiaeie i?ia?aiaie, ieaiaie, oaiaie

?iaioa aeeiioaaeanue a ?aieao «Aea?aeaaii? i?ia?aie
iioiii?ioieaeoeee a Oe?a?ii ia 1993-2000 ??», caoaa?aeaeaii?
Iinoaiiaith EI Oe?a?ie aiae 21.04.1993 ?. oa ca ieaiii
iaoeiai-aeineiaeieo ?iaio Ee?anueeiai IAe? aiiaeaiiieiai? oa
iioaeoeieieo oai?ia ii.E.A.A?iiaoaanueeiai (?? aea?ae?a?no?aoei? IAe?:
0194V017352; 0194V017353; 0194V017354; 0196V0093555). Aeayei aoaie
?iaioe aeeiioaaeenue o niia?iaioieoeoai c iioeie iaoeiai-aeineiaeieie oa
i?aeoe/ieie caeeaaeaie, onoaiiaaie IIC Oe?a?ie.

Iaoa i caaaeaiiy aeineiaeaeaiue

Iaoa aeineiaeaeaiiy: aecia/eoe no/aniee aoai aaiethoei? aeeooa?ieii?
iioaeoei? a nioeiaeueii-aeieiai/ieo oiiaao Oe?a?ie ia iiaenoaai
nenoaiiiai aiaeico ia?aoai?aiue aiiaeaii/iiai i?ioeano ia onio ?iaiyo
aca?iiaei? aaoa?iaaiieo iiioeyoeie caoaeieea aeeooa?i? oa eiai oacy?ia
(ethaeeie) i ?ic?iaeoe oeyoe oaeineiiaeaiiy aiiaeaiiieiai/iiai iaaeyaeo
ca aeeooa?i?th.

Aeey ?aaeicaoei? aeacaii? iaoe ae?iooaaeenue oaei caaaeaiiy:

1. Aeaoe eeiiiei-aiiaeaiiieiai/io oa?aeoa?enoeeo aeeooa?i? 90-o
?ieia a Oe?a?ii ca a?eiaeie iniaeeainoyie, nooiaiai oyaeeinoi,
eieaeicaoei?th iinoeaaiai caiaeueiiai i?ioeano oa oa?aeoa?ii
oneeaaeiaiue ia iiaenoaai ioioeieieo aeaieo.

2. Oa?aeoa?ecoaaoe noai iioiii? nenoaie uaieaieo ye i?iaiaeiee
oaeoi? caoenoo aiae aeeooa?ieii? iioaeoei? ia i?eeeaaei aea/aiiy
aoii?aeueii? oa eeioeiii? eaiee iioiii? aiaeiiaiaei aeioae, ui caciaee
aeiaeaoeiaeo ?aaaeoeeiaoe?e (“iioiiei?aeoei?”), oa aei?ineeo, 2-?aciai
?aaaeoeeiiaaieo AAeI-i a oiiaao aiiaeaii?; aecia/eoe iiaeeeai i?e/eie
caoai?thaaiinoi o uaieaieo. Ioeiieoe aieea caoiaeia c iioiii?ioieaeoeee
iiae /an aiiaeaii? ia no?oeoo?o iiioeyoeieiiai iioiioaoo oa ia iieacieee
oyaeeinoi ia?aaiao aeeooa?i?.

3. Aeaoe aiiaeaiiieiai/io iioa?i?aoaoeith iieaeoey?ii-aaiaoe/ieo
aeineiaeaeaiue uiaei ci?i a iiioeyoei? caoaeieea aeeooa?i?. Ia iniiai
aea/aiiy aeeiaiiee no?oeoo?e iiioeyoei? caoaeieea o ?icii ia?iiaee
aiiaeaii/iiai i?ioeano aecia/eoe iiaeeeaoi?ii aaeoa?iieiai/ii iieacieee
noaio oei?? iiioeyoei? oa ?aca?aoa?e aeeooa?ieii? iioaeoei? a
iiaeaiiaeaii/iee ia?iiae.

4. Aea/eoe aeayei eeioeiii oa noaeeioeiii iaoaiicie aca?iiaei?
caoaeieea i iae?ii?aaiicio, ui eaaeaoue a iniiai ?iciiai nooiaiy
ni?eeiyoeeainoi ethaeeie aei aeeooa?i? oa yaeua aaeoa?iiiinienoaa, ye
oiiae aacia?a?aiinoi aiiaeaii/iiai i?ioeano aeeooa?ieii? iioaeoei?.

5. Ioe?ieoe ia`?eoeai?noue iieaciee?a ?ioaineaiino? ai?aeai?/iiai
i?ioeano oa ae?aaiinoeee aeeooa??? a Oe?a?i?. ?ic?iaeoe e?eoa?i? ioeiiee
aiiaeaii/ii? neooaoei? oa aoaeoeaiinoi caoiaeia uiaei aeeooa?ieii?
iioaeoei? ia ?iaii aaeiiiino?aoeaii? oa?eoi?i? (iaeanoi).

Iaoeiaa iiaecia i oai?aoe/ia cia/aiiy ?iaioe

Aia?oa aeey e?aiaeueii? ?ioaeoe?? anoaiiaeaii ni?aa?aeiioaiiy
nioeiaeueii? oa aiieiai/ii? iiaenenoaie o ?icaeoeo aiiaeaii/iiai
i?ioeano aeeooa?ieii? iioaeoei?.

Aia?oa iieacaii aieea eieueeinoi uaieaiue oa noia?iiai aioeaaiiiai
iaaaioaaeaiiy ia noai aoii?aeueii? oa eeioeiii? eaiee iioiii? nenoaie
aeioae, ui caciaee aeiaeaoeiaeo ?aaaeoeeiaoeie (“iioiiei?aeoei?”).

Aecia/aii 4 aa?iaioe iioiii? aiaeiiaiaei ia 2-?aciao ?aaaeoeeiaoeith
aei?ineeo AAeI-i; anoaiiaeaii aieiai iniaeeainoi iioiii? aiaeiiaiaei ia
iaeiaeiao noaio iioiicaoei? oa aia?oa aeinoiai?ii aecia/aii aiaenioie
?ao?aeoa?ieo aei aaeoeeiaoei? aei?ineeo.

Aia?oa ca aeiiiiiaith iieiia?acii? eaioethaiai? ?aaeoei? aecia/aia
?iciianthaeaeaiinoue iaaeni?anoth/iai aaio oieneiiooai?aiiy a iiioeyoei?
iaoieneaaiieo ooaiia C.diphtheriae a Oe?a?ii. Iieacaii, ui ia aoaii
caanaiiy aiiaeaii/iiai i?ioeano a oiiaao e?eoe/iiai ciaioaiiy
oee?eoeyoei? caoaeieea eiai ?aca?aoa?aie a iiaeaiiaeaii/iee ia?iiae ?
iini? ia oieueee oieneaaiieo ooaiia, aea e iaoieneaaiieo c
iaaeni?anoth/ei aaiii oieneaaiiinoi.

Aia?oa ca aeiiiiiaith eaeoeiioanoo aeyaeaii aiaeiiiiinoi o ?aeue?oi
eeioeiii? iiaa?oii i noaii ?aoeaioi?ia o oai?eo ia aeeooa?ith oa
aacneiioiiieo aaeoa?iiiini?a oieneaaiieo ooaiia a ii?iaiyiii ?c
caei?iaeie aeiii?aie. Aea/aii iiaee ?ineeiiee eaeoei c ieiaeiiiaeie
yiiinueei? oo?ie (Diospyris kaki), yeee ca ae?eii?ioa?aeiith
niaoeeo?/i?noth ia? nii??aeiai?noue aei ?aoeaioi??a aeeooa?ieiiai
oieneio.

I?aeoe/ia cia/aiiy oa ai?iaaaeaeaiiy iaoeiaeo ?ic?iaie

Cai?iiiiiaaii aiiaeaiiieiai/io aoaeoeaiinoue caoiaeia c
iioiii?ioieaeoeee iiae /an aiiaeaii? iicia/aoe ia oieueee cieaeaiiyi
caaaeueiiai iieacieea caoai?thaaiinoi, a e ciaioaiiyi ieoiii? aaae
oiene/ieo i oyaeeeo oi?i a no?oeoo?i caoai?thaaiinoi ia aeeooa?ith.

Aeey oaeineiiaeaiiy aiiaeaiiieiai/iiai iaaeyaeo c iaoith noaaeaiiy ca
oee?eoeyoei?th caoaeieea cai?iiiiiaaii i?aaiicoaaoe ieaiiii?ia
aaeoa?iieiai/ia ianoaaeaiiy iaoe??io?a 1-2 iiaeeeaoi?ieo cae?eoeo
caeeaaeia ia eiaeiie aaeiiiino?aoeaiie oa?eoi?i? c ianyaii ianoaaeaiue
ia iaioa 1000 inia ia ?ie.

C iaoith oaeineiiaeaiiy aaeoa?iieiai/ii? aeiaaiinoeee cai?i-iiiiaaii:
aecia/aoe 4 aiio?i?/ii-eoeueoo?aeueieo aa??aioa (aiioeia) C.diphtheriae
(gravis, mitis, belfanti, intermedius); aeey ciaioaiiy aaeoa?iieiai/ii
ia?icoeo?iaaieo (eeiii/ieo) aeiaaeeia aeeooa?i? ianoaaeoaaoe oai?eo
aiaiiaie, iiaeic?ieeo ia aeeooa?ith, ia iioo iaoiaaiio oei?o, ie?ii
C.diphtheriae.

Noai?aia aaoi?nueea eieaeoeiy c 14 ooaiia C.diphtheriae, yei
oee?eoethaaee a Oe?a?ii iiae /an aiiaeaii?. Ooaie aeeth/ai? aei eaoaeiao
iocath iaoiaaiieo aeey ethaeeie i?e?ii?aai?ci?a i?e Ee?anueeiio IAe?
aiiaeaiiieiai? oa iioaeoeieieo oai?ia ca ?? 056109-056118,
052407-052409, 056319.

Io?eiaii ?acoeueoaoe aoee aeei?enoaii i?e neeaaeaiii:

1.»Iaoiaee/aneeo ?aeiiaiaeaoeee ii i?aaiecaoeee nenoaiu i?aainoaaiiinoe
aeaiiuo i?eaeai/iiai aiaiiaca ac?ineiai ianaeaiey i?e i?iaaaeaiee
ianniauo i?eaeaie», caoaa?aeaeaieo Aeiii?iiao?ia-nueeith iaeaniith NAN
14.03.1996 ?.

2. Iaoiaee/aneeo ?aeiiaiaeaoeee «Yieaeaieieiae/aneee aiaeec e e?eoa?ee
ioeaiee i?ioeeaeoe/aneeo e i?ioeaiyieaeaie/aneeo ia?ii?eyoee i?e
aeeooa?eeiie eioaeoeee», caoaa?aeaeaieo Aeiii?iiao?ianueeith iaeaniith
NAN 19.05. 1999 ?.

3. ?ioi?iaoeieiiai eenoa IIC (OOeAeNAI) «I?i aecia/aiiy aiieoeueoeaa?ia
N.diphtheriae», Aeiaeaoie aei eenoa OOeAeNAI aiae 23.04.99 05.4.1/415

4. ?ioaiiy eieaai? IIC Oe?a?ie «Noai caoai?thaaiinoi ianaeaiiy Oe?a?ie
ia iioaeoeieii oai?iae, yei ea?othoueny caniaaie iioiii?ioieaeoeee oa
caaania/aiiy ianaeaiiy iioiiaiieiai/ieie i?aia?aoaie» aiae 21.04.99 ?.

5. Iaeaco IIC Oe?a?ie ? 192 a?ae 3.08.1999 «I?i caoiaee uiaei iie?auaiiy
aaeoa?iieiai/ii? aeiaaiinoeee aeeooa?i? a Oe?a?ii».

Iniaenoee aianie caeiaoaa/a

Caaaeath/e ia oe?iea canoinoaaiiy noiiaeieo iaoeiaeo aeenoeeieii,
?iaioa aeeiioaaeanue o niia?iaioieoeoai c aeae?eueeiia
iaoeiai-aeineiaeieie oa i?aeoe/ieie caeeaaeaie, ca ui aeneiaeth?oueny
ue?a iiaeyea an?i, ooi aeiiiiaaaa o ni?euei?e ?iaio?, a naia:

?inoeooo iieaeoey?ii? aiieiai? oa aaiaoeee AI Oe?a?ie, eaai?aoi?iy
aaiaoeee ethaeeie — no.i.niia?. e.a.i. ?.N.Ea?iiaa; Oe?a?inueeee Oeaio?
Aea?aeaaiiai naiioa?ii-aiiaeaiiieiai/iiai iaaeyaeo (OOeAeNAI),
aaeoa?iieiai/ia eaai?aoi?iy — caa. eaai?aoi?i?th O.A.Aeooeaae/;
Aeiii?iiao?ianueea iaeania NAN: caa.aiiaeaiiieiai/iei aiaeaeieii
?.I.Eo?eeia, caa.aaeoa?iieiai/iith eaai?aoi?i?th — E.I.I?yaeei;
Iaeanueeee IAe? ai?onieiai? oa aiiaeaiiieiai? ii. ?.?.Ia/ieeiaa,
eaai?aoi?iy iioiieiai? — no.iaoe.niia?., e.i.i. A.A.Noii/ainueea;
Oe?a?inueeee iaoeiaee aiai?ii/iee oeaio?, eaai?aoi?iy iioiieiai? a
aiai?ii — no.iaoe.niia?, e.i.i. I.?.Aeia?nueea; Aeiii?iiao?ianueea
iaaee/ia aeaaeaiiy, eaoaae?a caaaeueii? oiii?, aiioiii? oa eeiii/ii?
oa?iaeieiai? — e.a.i.?.TH.Ienueiaiaoeueea; eaoaae?a caaaeueii? aiai?ie
oa aeieia?? — e.i.i. A.I.Aieaoeueea; E??iaia?aaenueea iaeania NAN: caa.
aiiae. aiaeaeieii — I.I.Iieiae/aiei, caa.aae.eaai?aoi?i?th — ?.I.A?e?aa.

A onio niieueieo aeineiaeaeaiiyo caeiaoaa/ a?aa iniaenoo i
aaciina?aaeith o/anoue, ii/eiath/e aiae oi?ioethaaiiy caaaeaiue,
cai?o, aeinoaaee i ia?iaee c?aceia aeey aeineiaeaeaiiy, caeii/oth/e
aiaeicii ?acoeueoaoia. Niaoeiaeueii iaoiaee aiioiii/ieo, iioiieiai/ieo,
aaeoa?iieiai/ieo aai na?ieiai/ieo aeineiaeaeaiue aoei aeeiiaii aaoi?ii
?acii ?c oao?aoeyie aeoaaeacaieo onoaiia. Iiaiinoth naiinoieii aeeiiaii
?icaeie ii aea/aiith aaeaaci? ei?eiaaaeoa?ie (ia aaci aaeoa?iieiai/ii?
eaai?aoi?i? iinueei? ?ioaeoeieii? eiea?ii Aeiii?iiao?ianueea), a oaeiae
i?iaaaeaii aiiaeaiiieiai/iee aiaeic caoai?thaaiinoi ia aeeooa?ith ca
aacith aeaieo IIC Oe?a?ie.

Ai?iaaoeiy ?acoeueoaoia aeena?oaoei?

Iaoa?iaee aeena?oaoeieii? ?iaioe aeiiiaiaeaeenue ia XIII c’?caei
Oe?a?inueeiai iaoeiaiai oiaa?enoaa iie?iaiieiaia, aiiaeaiiieiaia oa
ia?aceoieiaia ii.Ae.E.Caaieioiiai (Aiiieoey, 10-12 aeiaoiy 1996); ia 3-e
Iiaeia?iaeiie eiioa?aioei? «O?aioeiy oa Oe?a?ia, iaoeiai-i?aeoe/iee
aeinaiae o eiioaenoi aeiaeiao iaoeiiiaeueieo eoeueoo?»
(Aeiii?iiao?ianuee, 14-16 o?aaiy 1996 ?.); ia naiiia?i-ia?aaei c
aeooaeueieo i?iaeai aeiaaiinoeee oa i?ioieaeoeee iioaeoeieieo oai?ia
aeey caaiaeoth/eo aiiaeaiaeaeieaie oa aaeoa?iieiai/ieie eaai?aoi?iyie A?
E?ei, iaeanieo, Ee?anueei? oa Naaanoiiieuenueei? iinueeeo
naiaiiaenoaioeie (Ee?a, 14-15 o?aaiy 1997); ia Iiaeia?iaeiie iaoeiaie
eiioa?aioei? «No?aoaaiy i oaeoeea ai?ioueae c iioaeoeieieie
caoai?thaaiiyie» (Oa?eia, 27-29 aeiaoiy 1998). Aoee i?aaenoaaeaii ia
Eiia?ani Naioiai? Oaaea?aoei? Oe?aiinueeeo eiea?nueeeo oiaa?enoa
(Aeiii?iiao?ianuee, o?aaaiue 1994); ia Iiaeia?iaeiiio aiioiii/iiio
neiiicioii (Eaenoioi, NOA, aa?acaiue 1996); ia 2-e Iiaeia?iaeiie
eiioa?aioei? «Eaeae Ianoa?a a ai?ueaa n eioaeoeeyie»

(N-Iaoa?ao?a, ?iniy, aa?anaiue 1998); ia V c`?cae? iioaeoeiiiinoia
Oe?a?ie (Oa?iiiieue, o?aaaiue 1998); ia Ia?oiio eiia?ani eiea?ia
Iaeaaeiinueei? i?ioieaeoe/ii? iaaeeoeeie c iiaeia?iaeiith o/anoth
(Io?iae, Iaeaaeiiiy, aeiaoaiue 1998); ia iaoeiai-i?aeoe/i?e eiioa?aioei?
«No/aniee noai iaaee/ii? aaiaoeee a Oe?a?ii» (Ee?a, o?aaaiue 1999 ?.);
ia Iiaeia?iaeiie eiioa?aioei? «?ioa?eae-18» (Ii?onioo, Aaeeea A?eoai?y,
eeiaiue 1999 ?.); ia Ana?in?enuee?e iaoeiai-i?aeoe/i?e eiioa?aioe??
“Aeaoneea eioaeoeee ia ?oaaaea OO aaea: ianoiyuaa e
aoaeouaa”(N-Iaoa?ao?a, aeiaoaiue 1999).

Ioaeieaoei?

Ca iaoa?iaeaie aeena?oaoei? iioaeieiaaii 38 ?iaio, a o./. 20 — o
aeaeyae? noaoae a iaoeiaeo oaoiaeo aeo?iaeao oa ca??eao; 12 — iniaenoi
aaoi?ii.

Ianya i no?oeoo?a aeena?oaoei?

Aeena?oaoeieia ?iaioa neeaaea?oueny ic anooio, iaeyaeo eioa?aoo?e,
iieno iaoa?iaeia i iaoiaeia, o?ueio ?icaeieia aeanieo aeineiaeaeaiue,
aiaeioe/iiai ?icaeieo ocaaaeueiaiue, aeniiaeia oa nieneo aeei?enoaieo
aeaea?ae. Oaeno aeena?oaoei? aeeeaaeaiee ia 250 noi?iieao iaoeiiieno, ua
33 noi?iiee caeia? aiaeiia?aoiy, yea aeeth/a? 326 aeaea?ae (208 —
oe?a?ii-?inienueeiiiaieo oa 118 — iiicaiieo aaoi?ia). ?iaioa
iethno?iaaia 40 oaaeeoeyie oa 15 ?enoieaie.

IAOA??AEE OA IAOIAeE AeINE?AeAEAIUe

Nenoaiiee aiaeic aiiaeaii/iiai i?ioeano ia?aaeaa/aa aea/aiiy aeayeeo
aniaeoia iioaeoeieiiai i?ioeano (aiae noaeeioeiiiai aei i?aaiiciaiiiai
?iaiia), aeania aiiaeaii/iiai i?ioeano ye aca?iiaeith aaoa?iaaiieo
iiioeyoeie caoaeieea oa ethaeeie, a oaeiae nioeaeinenoaie, ye ?iaiy, aea
aiaeaoaathoueny aieiaii iiaei?, ?aaoethth/i aeoeaiinoue aiiaeaii/iiai
i?ioeano aeeooa?i? (oaae.1).

Oaaeeoey 1

A e a / a i i y a i ? ae a i ? / i i a i i ? i oe a n o ae e o o a ?
? ? ye nenoaie

? i a a i ue

N e n o a i a

A e a / a i i y a e u a

?

i

o

a

Iieaeoey?iee

?aoeaioi?ii aia?aoe oacy?ia i caoaeieea

Aioeoiene/ii aoaeaaiaei-caeaaeii nenoaie a?eo-?ioeeoia oa ne?iaaoie
e?iai ethaeeiee

oe

?

e

i Eeioeiiee Caoaeiee — eeioeia i?aaiicio oacy?ia Aaeaaciy
ei?eiaaaeoa?ie ia a?eo?ioeeoao oa oeeoi-iaoe/ia aeiy aeeooa?ieii-ai
oieneio ia eeioeiao HeLa e

e

i

?

i

oeOeaieiii- i?aaiiee

I?aaiiciaieeCaoaeiee-ie?aii i?aaie i oeaieie iae?ii?aaiicio

Aeania iioaeoeieiee i?i-?ioiia nenoaia ethaeeie: aa?iaioe iioiii?
aiaeii-aiaei, eeioeiia oa aoii-?aeueia eaiea iioiioaoo iiae aieeaii
aeiaeaoeiaeo ?aaaeoeeiaoeie

Eeiiiei-aiiaeaiiieiai/ia a

noean: caoaeiee — i?aaiici oacy?iaea?oeia no/anii?

aeeooa?i? A

i

?

ae

a

Aeinenoaiiee

Aiieiai/iee ?iaaiue aeania aiiaeaii/iiai i?ioeano (iiioeyoei? caoaeieea
i oacy?ia)

No?oeoo?a iiioeyoeieiiai ?ioiioaoo oa iiioeyoei? caoaeieea, a o./.ca
ci?noii tox-aaio; caoai?thaai?nouei

?

/ Nioeaeinenoai-i?:

— eieaeueiee

Eieaeueiee aiiaei?ioean Oee?eoeyoeiy caoaeieea a oiiaao cae?eoeo
eieae-oeaia; aaeoa??iiin?enoaii

e

e

— ?aaiiiaeueiee?aaiiiaeueiee aiiaei?ioeanAaeineiiaeaiiy
aiiaeaiii-eiai/iiai iaaeyaeo ia iaeaniiio oa aea?aeaaii-io ?iaii i

?

i

oe

a

n — aeiaaeueiee Aeiaaeueiee aiiaeaii/iee i?ioeanI?aeia?iaeia
ni?a?ia?oie-oeoai oa noai?aiiy nenoaie aeiaaeueiiai aiiaeaiiieiai/iiai
iaaeyaeo ca aeeooa???th

Oe?ieee niaeo? yaeu, yei iaee aea/aoeny, iaoiiaeee caeo/aiiy
?iciiiaiioieo iaoiaeia aeineiaeaeaiue ic noiiaeieo aeenoeeieii, a naia:
ic aiioiii?, aaiaoeee, iie?iaiieiai?, iioiieiai?. I?ioa aieiaiei
iaoiaeii aeineiaeaeaiiy aoa o?aaeeoeieiee aiiaeaiiieiai/iee aiaeic.

Iaoa?iaee aeineiaeaeaiue. Iniiaiei aeaea?aeii iioi?iaoei? aeey
i?iaaaeaiiy aiiaeaiiieiai/iiai aiaeico aoea aaca aeaieo inoaoi/ieo
iiaiaeiieaiue i?i ani aeiaaeee aeeooa?i?, ca?a?no?iaaii a Oe?a?ii a
1992-1998 ?ieao (anueiai 18067 aeiaaeeia). Eeiii/ia ea?oeia oai?iae
i?iaiaeiciaaia o 15985 oai?eo c iaeaieueo iiaii noi?ioeueiaaiei
inoaoi/iei aeiaaiicii, ui neeaei 88.5% ioioeieii ca?a?no?iaaieo
aeiaaeeia a 1992-1998 ?ieao. Aieueo aeaoaeueii i?iaiaeiciaaia
i?euaieaiinoue 4546 caoai?ieeo ia aeeooa?ith a Oe?a?ii o 1996-1997 ??.

O iiaeiaeaniiio eeiii/iiio ineoi-iaa?ieiai/iiio oeaio?i
Aei?i?iiao?ianueea i?iaaaeaii aiiaeaiiieiai/iee aiaeic caoai?thaaiinoi,
aaeoa?iiiinienoaa oa oee?eoeyoei? caoaeieea aeeooa?i? ca ia?iiae
1991-1998?.

I?aaiiciaaii i?iaaaeaiiy i i?iaiaeiciaaii ?acoeueoaoe
aaeoa?ii-eiai/iiai ianoaaeaiiy ia iinienoai N.diphtheriae 5569
o/iia oeie- iioa?iaoia Aeiii?iiao?ianueei? iaeanoi. Aeyaeaii 111
iini?a aoee naiiaaii aioeaiioeeaie i iiaoi?ii ianoaaeaii.

I?iaiaeiciaaii ?acoeueoaoe ianoaaeaiiy 43290 oai?eo ia aiaiio c
iaoith aeyaeaiiy ei?eiaaaeoa?ie i?ioyaii 1993-1998 ?ieia a
Oeaio?aeiciaaiie aaeoa?iieiai/iie eaai?aoi?i? i.Aeiii?iiao?ianueea. 100
oai?eo ia aiaiio ianoaaeaii ia iioo iaoiaaiio oei?o, e?ii
N.diphtheriae.

?iaaiue aioeoiene/ieo aioeoie aei aeeooa?i? aoei aecia/aii o 568
ne?iaaoeao e?iai aeioae o aioei aiae 3 aei 14 ?ieia, iaoeaioeia
Aeiii?i-iao?ianueei? i Ei?iaia?aaenueei? iaeanoi; o 127 ne?iaaoeao e?iai
aeiii?ia aieii aiae 18 aei 49 ?ieia.

Aiaeic iioiia?ai ca noaiaea?oieie oanoaie aei i iiney i?iaaaeaii?
iioiiei?aeoei? i?iaaaeaii o 97 eeiii/ii caei?iaeo o/iia aeaio oeie, ui
ciaoiaeyoueny a ?icieo ca aeieiai/ieie oiiaaie ?aeiiao
i.Aeiii?iiao?ianueea (niieueii c Oe?a?inueeei iaoeiaei aiai?ii/iei
oeaio?ii).

I?iaiaeiciaaii ?acoeueoaoe ia?aeaeueiiai aecia/aiiy i?ioeaeeooa?ieieo
aioeoiene/ieo aioeoie a ?aaeoei? iaeo?aeicaoei? ia eeioeiao Vero (?I) oa
a ?aaeoei? ianeaii? aaiaaethoeiaoei?? (?IAA) 1897 ne?iaaoie e?iai aiae
488 aei?ineeo aei i iiney 2-?aciai? ?aaaeoeeiaoei? AAeI-i aiaoieneiii.

Ooaie ei?eiaaaeoa?ie aeeooa?i?, ui aea/aeeny, aoee icieueiaaii aiae
oai?eo ia aeeooa?ith oa aaeoa?iiiini?a, ainiioaeiciaaieo aei
iioaeoeieii? eiea?i? i.Aeiii?iiao?ianueea o 1994-1998 ?ieao. Aeaoaeueii
aea/aeeny 99 ooaiia C.diphtheriae, c yeeo 14 iaeaieueo oeiiaeo neeaee
aaoi?nueeo eieaeoe?th, ui caa??aa?oueny o ioca? aeeaeo eoeueoo?
EIAe?A?O.

Aea/aii iniaeeainoi oieneiiooai?aiiy o 51 oieneaaiieo ooaiia,
icieueiaaieo a 1993-1998 ?ieao a i.Iaeani, Ee?ai, Aeiii?iiao?ianueeo,
Eueaiai i *a?eanao (ia aaci Iaeanueeiai IAe? ai?onieiai? oa
aiiaeaiiieiai? ii.?.?.Ia/ieeiaa).

I?iaiaeiciaaii ?acoeueoaoe aeineiaeaeaiiy a IE? 557 iaoieneaaiieo
ooaiia C.diphtheriae, icieueiaaieo o 12 iaeanoyo Oe?a?ie aiae iini?a oa
oai?eo ia aeeooa?ith, aino?i ianiaoeeoi/ii aiaiie, oa?eiaioe oiui,
(niieueii c Oe?a?inueeei Oeaio?ii Aea?aeaaiiai
naiioa?ii-aiiaeaiii-eiai/iiai iaaeyaeo).

Iaoa?iaeii aeey aea/aiiy noaio ?aoeaioi?iiai aia?aoo eeioei o
caei?iaeo oa iioieiaaieo inia aoee a?eo?ioeeoe oa ne?iaaoee e?iai aiae
94 caei?iaeo aeiii?ia i 137 oai?eo ia aeeooa?ith, aiaiie, aaeoa?iiiini?a
oieneaaiieo i iaoieneaaiieo ooaiia ei?eiaaaeoa?ie aeeooa?i?. Aoee
aeei?enoaii aio/eciyii oieneiiaiinii noano?aoe, a iniiaiiio, i/euaiee
iaaaeni?aiaaiee aiaoienei ae?iaieoeoaa Oa?eianueeiai caaiaeo «Aiieae»,
eaeoeie Euea?anueeiai ae?iaieoeoaa «Eaeoeiioano», a oaeiae eaeoeie oi?ie
BioMakor (?c?a?eue). E?ii noaiaea?oieo eaeoeiia aeey ne?eiiiao aoa
aeei?enoaiee iaai?, ui iinoea aieueo iiae 30 eaeoeiia eiea?nueeeo ?ineei
a?oaiai i/euaiiy (niieueii c ?inoeoooii iieaeoey?ii? aiieiai? oa
aaiaoeee AI Oe?a?ie).

Iaoiaee aeineiaeaeaiue. Canoiniaaii aiiaeaiiieiai/ii, iioiieiai/ii,
aaeoa?iieiai/ii, aiioiii/ii oa noaoenoe/ii iaoiaee.

A i i ae a i i i e i a i / i i i a o i ae e. Aaca aeaieo,
noai?aia a IIC Oe?a?ie, i?noeea aiaeiiinoi ia eiaeiiai oai?iai ca?aeii c
ea?oith aiiaeaiiieiai/iiai ianoaaeaiiy ina?aaeeia iioaeoeieieo
caoai?thaaiue (oi?ia N 357o). I?ioa iaoi?iaeiciaaiinoue aeayei?
?ioi?iaoe??, oaei? ye aiaeiiinoi i?i uaieaiiy aai oi?ioethaaiiy
aeiaaiicia, oneeaaeithaaea aaoiiaoeciaaio ia?iaeo aeaieo. Aeey
iiaeieaiiy oeeo ia?aoeiae c iaoith iiaeeaeaiiai aiaeico uaiethaaeueiiai
aiaiiaco oai?eo i eeiii/ii? ea?oeie aeeooa?i? aoei ?ic?iaeaii
eeaneoieaoeieii e?eoa?i? aeey ioeiiee uaieaiinoi i inoaoi/iiai
aeiaaiico. Aeaoe caa?oaiiy, ainiioaeicaoei?, aaaaeaiiy
i?ioeaeeooa?ieii? ne?iaaoee, anoaiiaeaiiy aeiaaiico ia?aoai?thaaeenue ia
oa?iiie aiae ii/aoeo oai?iae. Iiney oi?iaeicaoei? oni?? oaenoiai?
iioi?iaoei? iiaiooai?aia aaca aeaieo iiaeaeaaaeany aoaeue-yeiio
ni?ooaaiith i aiaeico ca aeiiiiiaith eiii’thoa?ii? i?ia?aie IANOA?. Ca
aiaeiai/iei i?eioeeiii aoee oi?iaeiciaaii oa ia?iaeaii aace aeaieo aeey
aiaeico aoaeoeaiinoi iioiiei?aeoei? o aeioae oa aa?iaioia iioiii?
aiaeiiaiaei aei?ineeo ia 2-?aciao ?aaaeoeeiaoeith AAeI-i aiaoieneiii.

? i o i i e i a i / i i i a o i ae e. Ioeiiea iioiiiai noaoono
aeioae caeienithaaeanue ca ?acoeueoaoaie oaeeo noaiaea?oieo oanoia: 1)
caaaeueia eieueeinoue eaeeioeeoia (109/e); 2) % eiioioeeoia; 3)
eieueeinoue eiioioeeoia (109/e); 4) % iaeo?ioieia; 5) eieueeinoue
iaeo?ioieia (109/e); 6) %?-?OE (O-eiioioeeoe); 7) eieueeinoue ?-?OE
(109/e); 8) % ?AN-?OE (A-eiioioeeoe); 9)eieueeinoue ?AN-?OE (109/e);
10) % oaaioeeoico ae?iaeaeaeiaeo eeioei; 11)eieueeinoue oaaioeeooth/eo
iaeo?ioieia (109/e); 12) eiioeaio?aoeiy Ig A (a/e); 13) eiioeaio?aoeiy
Ig M (a/e); 14) eiioeaio?aoeiy Ig G (a/e) ca Iai/iii.

Iniiaiei iaoiaeii aecia/aiiy ?iaiy aeeooa?ieieo oa i?aaoeaaeo
aioeoiene/ieo aioeoie o ne?iaaoeao e?iai aeineiaeaeaieo aoea ?aaeoeiy
ianeaii? aaiaaethoeiaoei? c a?eo?ioeeoa?ieie aeiaaiinoeeoiaie ic
oano-nenoai «Iee?iaiaeec» (ae?iaieoeoai IAI Neioaen , i.Iineaa). Oeo?e
noaiaea?oieo ne?iaaoie c aeei?enoaieie a?eo?ioeeoa?ieie
aeiaaiin-oeeoiaie neeaaeaee: aeeooa??eii? — 1:3200, i?aaoeaai? —
1:1280.

?iaaiue aioeoiene/ieo aioeoie a ne?iaaoeao e?iai aei?ineeo aecia/aany
ia?aeaeueii a ?aaeoei? iaeo?aeicaoei? ia eeioeiao Vero (?I) ca
caaaeueiii?eeiyoith iaoiaeeeith a CDC (Aoeaioa, NOA).

A a e o a ? i i e i a i / i i i a o i ae e. Aeaeieaiiy oa
iaeaioeoieaoeiy ei?eiaaaeoa?ie caeienithaaeenue caiaeii c Iaeacii ? 450
IIC N?N? aiae 2.04.1986 ?. ?aeaioeoieaoeiy iioeo iaoiaaiieo
iie?ii?aaiiciia o iaceao c ?ioiaeioee i?iaiaeeeanue caiaeii c Iaeacii
?535 IIC N?N? aiae 22.04.1985 ?. i Aecia/ieeii aaeoa?ie Aa?aeae?.

Aaeaaceaii aeanoeainoi ooaiia ei?eiaaaeoa?ie aoee aea/aii ca
iaoiaeeeith Einotheiai? I.I. i Ea?anue N.?.(1991).

Iniaeeainoi oieneiiooai?aiiy ooaiia ei?eiaaaeoa?ie aeeooa?i?
aea/aee ca aeiiiiiaith iaoiaeeee niiaeoeueoeaoaaiiy aaeoa?ie c eeioeiaie
eoeueoo?e HeLa (A.A.Noii/ainueea c niiaaao., 1997). Oey i?eaiiaeueia i
aeineoue ianeeaaeia iaoiaeeea aeicaieyea aeaoe ia oieueee yeinio
oa?aeoa?enoeeo ae?iaeaiiai aecioieneio ca nai??iaeiinoth ii?oieiai/ieo
ciii eeioei HeLa, aea e eieueeinio ioeiieo oieneiiooai?aiiy ca
aiaenioeii ooeiaeaeaieo eeioei.

Ooaie C.diphtheriae, iaoieneaaiii a ?aaeoei? i?aoeeiioaoei?,
aeineiaeaeoaaeeny ia iayaiinoue aaio oieneaaiiinoi (tox-aai). Aai
aecia/aany iiney aiieioieaoei? a iieiia?aciie eaioethaiaie ?aaeoei?
(IE?) ca iaoiaeeeith, ?aeiiaiaeiaaiith AIIC (?oeiaiaenoai AIC, 1994) ?c
canoinoaaiiyi aeaio i?aeia?ia aei noa’iaeeieoei A aeeooa?ieiiai oieneio.

A i i o i i i / i i i a o i ae e. Aecia/aiiy eiioeaio?aoei? ooeice a
ne?iaaoeao e?iai oai?eo ia aeeooa?ith caeienithaaeinue ca aeaui
iiaeeoieiaaiith iaoiaeeeith Dische L., Shettles L. (oeeo.ca Aianaoaeee
A.Oe., 1968) ia aaci eaai?aoi?i? eaoaae?e caaaeueii? oiii?, aiioiii? oa
oa?iaeieiai? Aeiii?iiao?ianueei? iaaee/ii? aeaaeaii?.

A iniiao eaeoeiioanoo aoea iieeaaeaia ?aaeoeiy i?yii?
aaiaaethoeiaoei? a?eo?ioeeoia iaaiei iaai?ii eaeoeiia, a oaeiae ??
aaeueioaaiiy oieneiiaiinieie ?a/iaeiaie. Eieueeinii oey ?aaeoeiy
aecia/aeanue iiiiiaeueiith aaiaaethoeioth/ith eiioeaio?aoei?th eaeoeio
(IAE) a iea/ie. I?aia?ao ieiaeiiiaeie yiiinueei? oo?ie, yeee iiae /an
ne?eiiiao ?ineeiieo eaeoeiia aeyaea iaeaieueoo nii??aeiai?noue aei
?aoeaioi?o aeeooa?ieiiai oieneio, aoa i/euaiee aeaeo?ioieonoaaiiyi, ui
i?ecaaei aei aeaeieaiiy 2 eaeoeiiiiae?aieo noanoaioe?e c ??cieie
o?ceei-o?i?/ieie aeanoeainoyie, cie?aia, noia?iei ca?yaeii ? ?I. Iio?i
aoei aecia/aii ae?eii?ioa?aeio niaoeeo?/i?noue eiaeii? noanoaioe?? ca
aeiiiiiaith /enoeo i?aia?ao?a aoaeaaiae?a a ?aaeoe?? aaeueioaaiiy
aaiaaethoeiaoe??.

N o a o e n o e / i o ia?iaeo ?acoeueoaoia i?iaiaeeee ca
aeiiiiiaith eiii’thoa?ii? i?ia?aie IANOA?, i?ia?ai aeey ia/eneaiiy
na?aaeiio iieacieeia, ?o noaiaea?oieo aiaeoeeaiue oa iiieeie, na?aaeiio
aaiiao?e/ieo oeo?ia, iieacieea No’thaeaioa oa e?eoa?i?a Z oa O2 ia
iie?iAII (Eaaiia TH.E., Iiai?aethe I.I., 1990). Aeiaa?aie oa a?aoiee
aeeiioaaee ca aeiiiiiaith i?ia?aie Exel ia PC-386.

?ACOEUeOAOE AEANIEO AeINE?AeAEAIUe

Aeey aecia/aiiy no/aniiai aoaio aaiethoei? aeeooa?ieii? iioaeoei?
aoei iaiaoiaeii i?iaiaeicoaaoe i?iaiaeii ciiie nioeiaeueii? i
aiieiai/ii? iiaenenoai aiiaeaii/iiai i?ioeano aeeooa?i?, ui
aiaeaoaaeeny aei, iiae /an i iai?eeiioei aiiaeaii? 90-o ?ieia a Oe?a?ii
(oaae.2)

I a ? a ae a i i ae a i i / i e i iiaeia aaaaeaoe ia?iiae
aiaeiiniiai aeaaiiieo//y, yea aoei anoaiiaeaii caaaeyee
iaeaaiaeaeaiie nenoaii ieaiiai? ?ioiii?ioieaeoeee, oiaoi, c eiioey
70-o ?ieia (c iiiiiaeueiei ?iaiai caoai?thaaiinoi).

Aei ianiaoeeoi/ieo /eiiee?a nioeiaeueieo oiia aeeooy iiaeii aiaeianoe
ani aeaee oaeoi?ia, ui aieeaathoue ia caoai?thaaiinoue aeeooa?i?th,
ie?ii aeania yeinoi aaeoeei i noaie ?o canoinoaaiiy, a naia: noeoieii
i?a?aoeieii oa aeaiia?aoi/ii i?ioeane, niinia oa yeinoue aeeooy oe?ieeo
aa?noa ianaeaiiy, aeieiai/ii oiiae i?iaeeaaiiy. A ?aaiiiaeueiie
nioeaeinenoaii i?iaiaeiith iiaei?th, yea noaea iiooiaoii aeey
aeoeaicaoei? aiiaeaii/iiai i?ioeano aeeooa?i?, iiaeia aaaaeaoe
aeieeiaiiy nioeiaeueii-aeiiiii/ieo iaaa?acae?a, iia’ycaieo c ?iciaaeii
?aaeyinueeiai Nithco. Ianeiaeee oeueiai, aac noiiiao, aieeioee ia
aiiaeaii/iee i?ioean aeeooa?i? ye iina?aaeiuei, iiai?ooth/e yeinoue
aeeooy

Oaaeeoey 2

IA?AOAI?AIIss A NENOAI? AI?AeAI?*IIAI I?IOeANO AeEOOA???

N i oe ? a e ue i a i ? ae n e n o a i a

A ? i e i a ? / i ai ? ae n e n o a i a

Ia??iaec a a a e ue i i /eiieee

n i a oe e o i / i i /eiieee

iiioeyoe?y o a c y ? i a

iiioeyoe?y c a o ae i e e a

Ia?aae-

ai?aea-

i?/-

ieeO?aaiicaoeiy, aeaiia?a oi/ii ciiie;

— nenoaia ?a?no?aoe?? ?ioaeoe?eieo oai?ia;

— eaiiai?y i?ioe uai-

eaiue a CI?Cieaeaiiy aioeaaiiiai iaaaioaaeaiiy ia oeeee ?ioi?caoe??;

— iaiaa?oioiaaii iaaee/ii aiaeaiaee ;

— i?eieneeCaieueoaiiy aiaenioeo ni?eeiyoeeaeo i?e aiaenooiinoi aoaeoo
i?e?iaeii? ?ioi?caoe?? Oeeeei/ii iiaeeiie aaeoa?iiiinienoaa oieneaaiieo
i iaoieneaaiieo ooaiia

N.diphtheriae

Ai?-

aea-

i?y?iciaae N?N? (i?a?aoe?y, ye?noue aeeooy, a o./.iaaee-/iiai
ianeoaiaoaaiiy;

— a?aenoaaaiiy caeiii-aeaa/i? aace a?ae iio?aa nenoaie
ai?aeiaaeyaeoOaeineiiaeaiiy eaeai-aea?y uaieaiue;

— ?ioiiei?aeoe?? ae?oae ? ia-niaa aaeoeeiaoe?y aei?ineeo;

— noa’ ?eoeai?noue ee?i?/-

ii? ae?aaiinoeee C?inoaiiy iiioeyoe?eiiai aioeoiene/iiai ?ioi?oaoo;

— nai???aeia a?eiaa no?oe-oo?a caoai?thaaiino? ia
aeeooa??th?iciianthaeaeaiiy iciaee oieneaaiiino? a iiioeyoe??
N.diphtheriaa;

— anoaiiaeaiiy aeii?ioth/eo ?eaioei?a gravis tox+I?n-

ey-

ai?-

aea-

i?/-

iee

Aeina?ae ?iaioe a ?aa?i-iao;

-noai?aiiy aeiaaeueii? nenoaie ai?aeiaaeyaeo ? aeeth/aiiy aei ia?
Oe?a?ie

Iiaee eaeaiaea? uaieaiue, i?aeaeuaia oaaaa aei iea-iiai?
?ioiii?ioeeaeoeee;

— oaeineiiaeaiiy eaai?a-oi?ii? ae?aaiinoeee Ca?eueoaiiy a?aenioeo ca-
oeuaieo, ye? iathoue ia o?eueee aioeoiene/iee, aea e aioeaaeoa??aeueiee
?ioi?oaoI I?aeaeuaiiy aaoa?iaaiiino? iiioeyoe?? i?e cieaeaii?
oee?-eoeyoe?? oieneaaiieo ? iaoie-neaaiieo ooai?a;

-oi?ioaaiiy ?aca?aoa??a ?ioaeoe??

aieueoinoi ianaeaiiy, oae i aaciina?aaeiuei, aeaci?aaiicoth/e nenoaio
iaaee/iiai ianeoaiaoaaiiy, iniaeeai a i?ioieaeoe/iie aaeoci.

Noai niaoeeoi/ii? iioiii?ioieaeoeee aoa i caeeoa?oueny i?iaiaeiei
niaoeeoi/iei nioeiaeueiei /eiieeii, ui aei? aaciina?aaeiuei ia
iioai-neaiinoue aiiaeaii/iiai i?ioeano aeeooa?i? i caaania/o? eiai
ea?oaaiiy. Iaaeieiee iioiii?ioieaeoeee, ye? aaaaeathoue iniiaiith
i?e/eiith aiiaeaii? aeeooa?i?, iaeiie/oaaeenue caaeiaai aei 1991 ?ieo
caaaeyee caniieieeeainoi i?aeoe/ieo eiea?ia uiaei «cieeath/i?» iioaeoei?
i iaooo-aaiith ieaiiaith iioiii?ioieaeoeeith na?aae aeeoy/iai
ianaeaiiy. Oaeiio noaaeaiith aei iioiii?ioieaeoeee ia iinoeyo ni?eyea
eaiiaiiy o caniaao ianiai? iioi?iaoei? (CI?) uiaei oeiaeeeainoi
uaieaiue. Iiai?oaiiy ieaiiai? iioiii?ioieaeoeee aeioae aiaeaoaaeiny
?acii c i?aeoe/iith aiaenooiinoth ?aaaeoeeiaoeie aei?ineiai ianaeaiiy.
Oea caeiiiii?ii i?ecaaei aei iaaeiiiy eieaeoeaiiai i?ioeaeeooa?ieiiai
iioiioaoo aei e?eoe/iiai ?iaiy (aei 57% caoeuaieo na?aae anueiai
ianaeaiiy Oe?a?ie o 1990-1991 ?ieao).

Oaeei /eiii, ia?aoai?aiiy a nioeiaeueii-aeieiai/iie nenoaii
aaeeeiai ?aaiiio Noiaeii? ?a?iie, ui iinoeoue e?a?ie eieeoiueiai N?N?,
i?ecaaee aei c?ooaiue ia aeinenoaiiiio (aiieiai/iiio) ?iaii, a naia:
aei ciii aieiaii? ia?aiiiii? neeaaeiai? /anoeie ia?aceoa?ii? nenoaie
aeeooa?i?, yeith ? iiioeyoeiy oacy?ia — ethaeeie.

?ioith iaaiae’?iiith /anoeith aiieiai/iiai oaeoi?o aiiaeaii/iiai
i?ioeano, yeee iaioa caeaaeeoue aiae nioeaeinenoaie, ? iiioeyoeiy
caoaeieea, ui oa?aeoa?eco?oueny iaaecae/aeiith aaoa?iaaiiinoth i
iiieeainoth. I?i c?ooaiiy o neeaaei iiioeyoei? caoaeieea iiaeia aoei
noaeeoe iaaioue ca ?acoeueoaoaie ?ooeiieo aaeoa?iieiai/ieo
aeineiaeaeaiue, ui aoiaeyoue aei nenoaie aiiaeaiiieiai/iiai iaaeyaeo ca
aeeooa?ieiith iioaeoei?th, ca niiaaiaeiioaiiyi ieoiii? aaae aiioeiia
N.diphtheriae gravis i mitis a caaaeueiie iiioeyoei?, a oaeiae
oieneaaiieo i iaoieneaaiieo ooaiia a ie?aieo aiioeiao. Iaeii?th c
oa?aeoa?ieo ?en no/anii? aiiaeaii? aoei ia?aaaaeaiiy N.diphtheriae
aiioeio gravis a aoiieiai? aeeooa?i?, a oie /an ye a ia?iiae
aiaeiiniiai aiiaeaii/iiai aeaaiiieo//y a 60-80-o ?ieao aiae oai?eo
/anoioa aeaeieyany aiioei mitis. Iaeaieueo ia’?eoeaiei iieacieeii
no?oeoo?e iiioeyoei? oee?eoethth/iai caoaeieea, yeee iaioa caeaaeeoue
aiae aiiaeaii/ii? neooaoei? i ia? i?iaiinoe/ia cia/aiiy, ? iieaciee
aenithaaiiy ia 10 oeny/ aeineiaeaeaiue oa niiaaiaeiioaiiy oieneaaiieo i
iaoieneaaiieo ei?eiaaaeoa?ie aeeooa?i?, ui aeaeieaii iiae /an
i?ioieaeoe/ieo ianoaaeaiue o i?aeoe/ii caei?iaeo inia a ?acoeueoaoi
iaeii?aciaiai ianoaaeaiiy iaceia c iina oa ciaa (oaae.3).

Oaaeeoey 3

*anoioa aenithaaiiy oieneaaiieo ? iaoieneaaiieo N.diphtheriae

i?e aaeoa?iieiai/iiio ianoaaeaiii c i?ioieaeoe/iith iaoith

(iiceoeaieo ?acoeueoaoia ia 10oen. aeineiaeaeaiue)

?ieEieueeinoue aeine?aeaeaiue

(aan.) *anoioa aenithaaiiy N.d.

(ia 10 000 i?ioieaeoe/ieo aeineiaeaeaiue)Niiaaiaeiioaiiy tox+/tox-
tox+ tox- 1984 1416419 3,0 70,4 1:23,5 1985 1289917
1,9 55,6 1:29,3 1986 1155724 2,2 iaia? aeaieo
— 1987 1113326 1,9 -”- — 1988
1437281 1,6 40,7 1:25,5 1989 1165000 1,2 56,3
1:46,9 1990 1153916 1,3 67,8 1:52,2 1991
1728128 1,3 41,2 1:31,7 1992 1664090 1,1 38,1
1:34,6 1993 1769060 2,5 31,4 1:12,6 1994
1685596 4,1 33,2 1: 8,1 1995 2136672 5,2 34,6 1:
6,6 1996 1696672 5,1 36,7 1: 7,2 1997 1486083
3,8 31,3 1: 8,2 1998 1464707 1,9 29,4 1:15,2

I?e aiaeici oeeo iieacieeia a Oe?a?ii a oeieiio ca 1984-1998 ?iee
i?eaa?ioa oaaao iiaeaeuaiee iieaciee aenithaaiiy iaoieneaaiieo ooaiia a
ia?aaeai?aeai?/i? (1989-90) ?iee. Oeae i?ioean iiaeia oyaeoe, ye
nii/aoeo caieueoaiiy caaaeueii? e?eueeino? ei?eiaaaeoa?ie aeeooa?i?, a
iioii i?ia?anoth/a ?iciianthaeaeaiiy iciaee oieneaaiiinoi a caaaeueiie
iiioeyoei? caoaeieea, ui aeaiiino?o?oueny nooo?aeie c?ooaiiyie
niiaaiaeiioaiiy oieneaaiieo i iaoieneaaiieo ooaiia a ia?iiae aiiaeaii?.

Aea/aiiy oee?eoeyoei? C.diphtheriae a oiiaao aaeeeiai
niaoeiaeiciaaiiai ineoiiaa?ieiai/iiai oeaio?o Aeiii?iiao?ianueei?
iaeanoi i?ioyaii aiiaeaii? aeeooa?i? aeyaeei aeia?aaeaeaiiy
iaeneiaeueieo iieacieeia ?iciianthaeaeaiiy aeeooa?ieii? iioaeoei?? a
cae?eoeo eieoaaeueii-aeiaaiinoe/ieo caeeaaeao c o?eaaeei ia?aaoaaiiyi
oai?eo a ii?iaiyiii c aeeiaiieith caoai?thaaiinoi ia aeeooa?ith
na?aae caei?iaiai ianaeaiiy aiaeiiaiaeiiai ?aaiiio. Aeey
oaeineiiaeaiiy aiiaeaiiieia?/iiai iaaeyaeo c iaoith noaaeaiiy ca
oee?eoeyoei?th caoaeieea aoei ?aeiiaiaeiaaii aea?aoe ia eiaeiie
aaeiiiino?aoeaiie oa?eoi?i? 1-2 iiaeeeaoi?i? cae?eo? caeeaaea, e?aua
ineoiiaa?ieiai/iiai i?ioieth c o?eaaeei ia?aaoaaiiyi oai?eo, i
i?aaiicoaaoe oai ieaiiii?ia aaeoa?iieiai/ia ianoaaeaiiy ye iaoe??io?a,
oae i ia?niiaeo, uia caaaeueia eieueeinoue i?ioieaeoe/ii ianoaaeaieo
aoea ia iaioa 1000 inia ia ?ie. Oea a aeicaieeei ia aeo?a/aoe caeaeo
eiooia ia iaei?acoeueoaoeaii i?ioieaeoe/ii aeineiaeaeaiiy anueiai
iiaeeaaeiai eiioeiaaioo caiaeii c aeith/eie iino?oeoeiyie. I?e aiaeici
?acoeueoaoia ?aeiiaiaeiaaii caa?oaoe oaaao ia oieueee ia oieneaaiii, aea
e ia iaoieneaaiii ei?eiaaaeoa?i? aeeooa?i?, iaia’yceiai aecia/aoe
aiioeie ooaiia oa ?o niiaaiaeiioaiiy. Aaaeeeaa ai?aeai?ieia?/ia
cia/aiiy iaoieneaaiieo ooai?a C.diphtheriae iaoiiaeaii, e??i ?ioiai,
oei, ui a iiaeaiiaeaii/iee ia?iiae aiie ? ?aca?aoa?ii iciaee
oieneiiooai?aiiy o aeaeyaei aaio oieneaaiiinoi, ui iaaeni?ano?oueny (ca
aeaieie IE?).

Canoinoaaiiy iieaeoey?ii-aaiaoe/ieo iaoiaeia, ui oa?aeoa?ecothoue
caoaeieea ca iniaeeainoyie ioeeaioeaeiiai neeaaeo ?o AeIE iacaeaaeii
aiae oaiioeiiaiai i?iyao aiieiai/ieo aeanoeainoae, aiaee?eei iiaee
aoai o aea/aiii aiiaeaiiieiai? aeeooa?ieii? iioaeoei?. Inoaiiii /anii
ca aeiiiiiaith iieaeoey?ii-aaiaoe/ieo iaoiaeia ?ao?iniaeoeaii
aeiaaaeaii, ui ii/aoie aeoeaicaoei? aiiaeaii/iiai i?ioeano aeeooa?i? o
Noiaeiie ?a?iii noi?iaiaeaeoaaany ciiiaie aaiaoe/iiai neeaaeo iiioeyoei?
caoaeieea: aecia/aii ?eaioeie, yei anioeiththoueny c aiiaeaii/iei
?iciianthaeaeaiiyi aeeooa?ieii? iioaeoei? a e?a?iao eieeoiueiai N?N?
(Popovic T. et al., 1996). I?ioa niaoeeoi/iinoue aieiaiiai oaeoi?o
iaoiaaiiinoi N.diphtheriae — aecioieneio — caeeoeeanue iaciiiiith
(Popovic T., 1999), oi/a caaaeyee iooaoeiyi a ?aaoeyoi?ieo aaiao (Nakao
H.et al., 1996) caieueoeany eieueeiniee ?iaaiue oieneiiooai?aiiy o
aiiaeaii/ieo ooaiia (Ai?eniaa I.TH c niaao., 1998). Oiaoi, oeeeei/iinoue
aiiaeaii/ieo ia?aoai?aiue a iiioeyoei? caoaeieea io?eiaea aeieace ia
aaiaoe/iiio ?iaii. Aea aoaeoeaiinoue caniaia niaoeeoi/ii? i?ioieaeoeee i
eieoaaiiy, yei canoiniaothoueny o anueiio naioi, ia iiaeaea?oueny
noiiiaai. A eieueeiniee ?iaaiue oieneiiooai?aiiy in vitro, oi/a i
naiae/eoue i?i aieueoo aa?aneaiinoue oee?eoethth/eo ooaiia, ia ciia
ae aiaeia?aoe i?iaiaeio ?ieue a aiiaeaii? aeeooa?i?.

Iaoi aeineiaeaeaiiy 99 ooaiia ei?eiaaaeoa?ie aeeooa?i?, ui
oee?eo-ethaaee o 1994-1998 ?ieao, ia aeyaeee aiaeiiiiinoae a
aaeaaceaieo aeanoeainoyo iiae ooaiaie, aeaeieaieie aiae ?icieo
aeaea?ae: oai?eo ia ?icii oi?ie aeeooa?i? oa aaeoa?iiiini?a. Ca
?iaiai oieneiiooai?aiiy, aecia/aiei ca niaoeeoi/iith oeeoiiaoe/iith
aei?th ia eeioeie HeLa, oieneaaiii ooaie ei?eiaaaeoa?ie, aeaeieaii
aiae iiia?eeo, oai?eo ia oiene/ii i eieaeiciaaii oi?ie aeeooa?i? oa
aiae aacneiioiiieo aaeoa?iiiini?a, oaae ia iaee inoioieo aiaeiiiiinoae:
aeayei ooaie aiae iiia?eeo iaee iecueeee ?iaaiue oieneiiooai?aiiy oae
naii, ye ooaie aiae iini?a — aeoaea aenieee ?iaaiue. Oe? aeine?aeaeaiiy
i?eioneee caa?iooeny aei aea/aiiy aeayeeo iaoai?ci?a ?aaeoeaiino?
iae?ii?aai?cio ye i?ia?aeiiai oaeoi?o o oi?ioaaii? iai?oanoii? oi?ie
aeeooa??eii? ?ioaeoe??.

I?iaiaeiith iaea?th iaoeo aeineiaeaeaiue iioaeoeieiiai i?ioeano
i a n o a e e i o e i i i i o i e e i o e i i i i o ? i a i i
aoei aecia/aiiy iioeiieo iaoaiiciia aca?iiaei? caoaeieea oa ethaeeie c
aeoeaioii ia aioo?ioiueiaeaeiaeo aa?iaoeiyo iae?ii?aaiicio ii
aiaeiioaiith aei ei?eiaaaeoa?ie oa ?o aecioieneio.

A yeinoi iiaeaei ?aoeaioi?iiai iaai?o eeioei iae?ii?aaiicio aoee
aeei?enoaii a?eo?ioeeoe ethaeeie, yei iathoue ia iiaa?oii ?a/iaeio
aeieioi?ei — iaeaioe/iee aeieieaeieno aiioaeiaeueieo eeioei, aea
?icoaoiaaii ?aoeaioi?e aeey iie?iaieo aaeaaceiia. Aea/aiiy aaeaaci?
iaeaieueo oeiiaeo oee?eoethth/eo ooaiia ei?eiaaaeoa?ie aeeooa?i? ia
a?eo?ioeeoao caei?iaeo oa iioieiaaieo inia (oai?eo oa aaeoa?iiiini?a)
iieacaei, ui aei?iithaaiiy ei?eiaaaeoa?i? a i?aaiicii ethaeeie
aiaeaoaaeiny iacaeaaeii aiae oieneaaiiinoi ooaio i ianooiii?
iaoieiai/ii? aei? aeeooa?ieiiai oieneio. Iecueea aaeaacoth/a
aeoeaiinoue ?aoeaioi?iiai oa?o a?eo?ioeeoia oai?eo ia eeiii/ii oeiiao
aeeooa?ith c oyaeeei oa na?aaeiuei? oyaeeinoi ia?aa?aii aac
aaeoa??ieia?/iiai i?aeoaa?aeaeaiiy, iaaooue, iaoiiaeth? o?aiceoi?iinoue
ia?aaoaaiiy caoaeieea a i?aaiicii ethaeeie, yea ae?ae /ooeeaa aei aei?
aeeooa?ieiiai oieneio. Iaoieiai/iee i?ioean, ni?e/eiaiee oieneiii,
oaeaeei ?icaeaa?oueny caaaeyee ?aaeoeaiinoi iae?ii?aaiicio, a naia
aaeoa?iy ia cae?iieth?oueny ia aoiaeieo ai?ioao i oiio ia iiaea aooe
aeaeieaia cae/aeieie aaeoa?iieiai/ieie iaoiaeaie. Oiaoi, i?ioeane
eieiiicaoei? oa iioieneeaoei? i?e aeeooa?ieiie iioaeoei? iiaeooue eoe
iacaeaaeii, ia?aeaeueii.

Aeey aea/aiiy iiaeeaiaeoaeueii? ni?eeiyoeeainoi aei aeeooa?ieiiai
oieneio aac o/anoi iioiii? nenoaie iaie aoee aeei?enoaii iiaeeeainoi
eaeoeiia ye iieaeoey?ieo ciiaeia c ?iciiiaiioiith aeieii?ioa?iiaith
niaoeeoi/iinoth aeey aecia/aiiy noaio eeioeiieo ?aoeaioi?ia ? o
caoaeieea, i o iae?ii?aaiicio. I?iaaaeaii ne?eiiiaiai aeineiaeaeaiiy
?icieo noaiaea?oieo oieneiiaiinieo ?a/iaei c aaeeeei iaai?ii
eaeoeiia aeicaieeee aecia/eoe iaeaieueo niaoeeoi/iee aei ?aoeaioi?o
aeeooa?ieiiai oieneio noaiaea?oiee eaeoei ni?aeo aiaia — SBA, a oaeiae
aea/eoe ?ineeiiee eaeoei c aiaeiai/iith niaoeeoi/iinoth — ic
ieiaeiiiaeie yiiinueei? oo?ie. Aeae?eai? c inoaiiueiai 2
aaiaaethoeioth/? noanoaioe?? ca aoaeaaiaeiith niaoeeo?/i?noth iaeaaeaee:
ia?oa (?I<5,2) - aei L-ooeice ? ?aiiice; ae?oaa (?I>8,0) — aei
oiiae?i?oei noeueoaoo oa a?aeo?iiiai? eeneioe. A ?aaeoe?? c SBA-eaeoeiii
aoee aecia/aii iniaeeainoi noaio ee?oeiieo ?aoeaioi??a aei
aeeooa??eiiai oieneio o caei?iaeo oa iioieiaaieo inia c ?icieie oi?iaie
iioaeoei? (aiae aaeoa?iiiinienoaa aei oyaeei? oiene/ii? aeeooa???).
Na?aae caei?iaeo aeiii??a aeyaeaii 17,6% in?a c? noaiii niaoeeo?/ieo
?aoeaioi??a, iiae?aiei aei oaeiai o aaeoa??iiin??a. Oiaoi, aea/aiiy
nii??aeiaieo aei ?aoeaioi?o aeeooa?ieiiai oieneio eaeoei?a oa ?ic?iaea
iaoiaee/ieo i?aeoiae?a aei aeyaeaiiy inia c aiiiaeueiei noaiii
?aoeaioi?ia aiaee?eea iiaeeeaino? aeey aecia/aiiy ?iciianthaeaeaiino?
iciaee noeeueiino? aei aaeoa??iiin?enoaa a iiioeyoe?? oacy?ia.

E??i noaio eeioeiieo ?aoeaioi?ia aei aeueoa?iaoeaii? nenoaie
aioeoiene/iiai caoenoo ethaeeie iaeaaeaoue ne?iaaoeiai aioeaaeaaciie
(ooeicicaeaaei? ae?eii?ioa?aee), yei iiaeooue ciaoeiaeaeoaaoe
aeeooa?ieiee oienei, aeia?aaeaeath/e aai iiaeneethth/e aeith
aioeoiene/ieo aioeoie.

I?ioa aecia/aeueiei /eiieeii iani?eeiyoeeainoi aei aeeooa?i? ye
ie?aii? iniae, oae i iiioeyoei? oacy?ia a oeieiio, ? aioeoiene/ii
aioeoiea, ui ae?iaeythoueny o aiaeiiaiaeue ia aaeoeeiaoeith aai
iioaeoeith. Oiio aeey nenoaiiiai aiaeico aiiaeaii/iiai i?ioeano ia
o e a i e i i i — i ? a a i i i i o ? i a i i aoea ia?aia
aeiyeueiinoue iioiii? nenoaie ethaeeie, oiaoi iioiieiai/ia
?aaeoeaiinoue.

Noaia i?ioieaeoe/ii? iioiicaoei? i?ioe aeeooa?i? ? aeineoue
neeaaeiith, i?ioa ?? aaeineiiaeaiiy caeaaieueoiai caiaeeoueny aei
cai?iiiioaaiiy aeiaeaoeiaeo ?aaaeoeeiaoeie. Iiae oei aioeaaiia
iaaaioaaeaiiy aaeoeeiieo i?aia?aoia i eieueeinoue ?o aaaaeaiue i?e
aaaaoi?aciaie noaii ?ioi?caoe?? iaaaeaeoae? ye aeey aoaeoeaiinoi
aaeoeeiiiii?ioieaeoeee iaaii? iniae, oae i aeey ooieoeiiiaeueiiai noaio
?? iioiii? nenoaie, i?i ui naiae/aoue iaoi aeineiaeaeaiiy aoaeoeaiinoi
«iioiiei?aeoei?» o aeioae. I?ecia/aia aeey i?aeaeuaiiy caoeuaiino?
ae?oae i?ae /an ai?aeai?? «iioiiei?aeoeiy» ia?aaeaa/aea aeiaeaoeiai,
iicaieaiiai ?aaaeoeeiaoei? aeioyi ?iciiai aieo, yei aoee uaieaii c
ii?ooaiiyie. I?iaaaeaia o 1993-94 ?ieao iioiiei?aeoeiy ia i?ecaaea aei
?aaeeeaeueiiai iie?auaiiy aiiaeaii/ii? neooaoei? c aeeooa?i?, i?ioa
aieueoa 4 iieueeiiia aeioae a Oe?a?ii iaea?aeaee iicaieaiiai uaieaiiy,
ui oneeaaeieei ieoaiiy i?i iiaeaeueoo noaio ?o ieaiiaeo
?aaaeoeeiaoeie. Aea/aiiy iioiieiai/ii? aoaeoeaiinoi aeiaeaoeiaeo
?aaaeoeeiaoeie aeioae cana?ae/eei ?? iaioo aoaeoeaiinoue a ii?iaiyiii c
ieaiiaeie i?ioieaeoe/ieie uaieaiiyie ca noaiith, ui i?eeiyoa a Oe?a?ii.
Iaeiaio aoaeoeaiith aoea ?aaaeoeeiaoeiy oeiey?ia 11-14 ?ieia aeai?aciaei
aaaaeaiiyi AAeI-i aiaoieneio. Oiaoi caeai uaieaiiy i?aia?aoaie ic
ciaioaiei aioeaaiiei iaaaioaaeaiiyi caiinoue i/ieoaaiiai aonoa?iiai
aoaeoo, iaaooue, i?ecaaee aei aeniaaeaiiy iioiii? nenoaie /a?ac /anoa
iiae?aciaiiy.

Inoaii? i?eiouaiiy ciaeoei iiaeoaa?aeaeaiiy o aea/aiii aeayeeo
c?ooaiue iniiaieo iioiieiai/ieo iieacieeia o aeioae 7-9 ?ieia, ui
caciaee iioiiei?aeoei?. I?e aiaeici iioiia?ai iiney aeiaeaoeiaeo
?aaaeoeeiaoeie aeyaeaii iiaeaeuaiiy ia 10% ieoiii? aaae aeioae, yei
iaee i?eaii/aio O-eeioeiio nenoaio; o 16,4% ae?oae cao?eniaaii
i?eaii/aiiy aoii?aeueii? eaiee iioiioaoo, i?e /iio c o?ueio eeania
iioiiaeiaoe?iia noi?ani? caciaee aeeeth/ii Ig G. I?e aea/aiii
aioeoiene/iiai iioiioaoo aei aeeooa?i? aoei i?iaiaeiciaaii ca’ycie iiae
noia?iei aioeaaiiei iaaaioaaeaiiyi i?ioyaii aeeooy oa ?iaiai
i?ioeaeeooa??eieo aioeoie /a?ac 1-1,5 ?iee iiney inoaiiueiai uaieaiiy o
aeioae 10-13 ?ie?a c ??cieie aiaeoeeaiiyie a iioiia?aii iiney
iioiiei?aeoei?. C’yniaaii, ui i?e ia?aa?eueoaii? iioeiaeueiiai
aioeaaiiiai iaaaioaaeaiiy, yea aei??aithaaei a na?aaeiueiio 87,7+3,2 Lf
ia oeeee ?ioi?caoe??, c?inoaiiy ?iaiy aioeoie aaea ia aiaeaoaa?oueny, a
a iioiiie nenoaii niinoa?iaa?oueny aeecaaeain ia?aaaaeii o a?e
i?eai?/aiiy aoii?aeueii? ? O-ee?oeiii? eaiee.

Aa?iaioe iioiii? aiaeiiaiaei ia 2-?aciao ?aaaeoeeiaoeith aei?ineeo
AAeI-i aaeoeeiith aoee aecia/aii oeyoii aea/aiiy aeeiaiiee i?aeaeuaiiy
aioeoiene/ieo aioeoie o ne?iaaooei e?iai eiaeiiai uaieaiiai, ii/eiath/e
c ?iaiy aei ?aaaeoeeiaoei? /a?ac iaaii iioa?aaee /ano iiney ia?oiai i
ae?oaiai uaieaiiy. Iniaeeaa oaaaa caa?oaeanue ia inia c ii/aoeiaei
?iaiai aioeoie ieae/a caoeniiai, ieoiia aaaa yeeo neeaea 57% aiae
ianoaaeaieo. Aiaeic aeeiaiiee ca?eueoaiiy eiioeaio?aoei? aioeoie a
?aaeoei? iaeo?aeicaoei? ia eeioeiao Vero (?I) o inia c ?iaiai
ii/aoeiaiai iioiioaoo ieae/a caoeniiai (0,1 II/ie) aeicaieea aecia/eoe
4 aa?iaioe iioiiiai ?aaaoaaiiy ia 2-?aciao ?aaaeoeeiaoeith (?en.1).
Ia?aeaeueia aeineiaeaeaiiy oeeo aea ne?iaaoie ca aeiiiiiaith ?IAA
aeicaieeei ioeiieoe oienei-iaeo?aeicoth/i i aiaoienei-iia’ycoth/i
aeanoeainoi i?ioeaeeooa?ieieo aioeoie ye aeiaeaoeiao oa?aeoa?enoeeo
iioiii? aiaeiiaiaei ia ?aaaeoeeiaoeith.

1 aa?iaio (53,6% aiae iacaoeuaieo inia) — oaeaeea ?aaeoeiy ca oeiii
aoi?eiii? iioiii? aiaeiiaiaei, eiee aaea /a?ac 7 aeiia iiney uaieaiiy a
e?ia iaaeoiaeeee iiaiioeiiii aioeoiea c aenieith
iaeo?aeicoth/ith

aeoeaiinoth a eiioeaio?aoei?, ui nyaaea caoeniiai ?iaiy. Iecueeee
?iaaiue oee?eoethth/eo aei ?aaaeoeeiaoe?? aioeoie o oeeo inia iiaeii
?icoeiieoe ye iniaeeainoue ?o iioiii? nenoaie, yea, aoaeo/e oeieeii
eiiiaoaioiith i?e cono?i/i ci caoaeieeii, ia iiaeo?eio? iinoieii aenieee
?iaaiue caoenieo aioeoie.

2 aa?iaio (27,3%) — oiiaieueiaia, aea aoaeoeaia ?aaeoeiy inia,
ia-aaeoeeiiaaieo aai aaeoeeiiaaieo aieueoa 10 ?ieia oiio
ca oeiii ia?aeiii? iioiii? aiaeiiaiaei. Caoeniee ?iaaiue
aioeoie o ieo aoa

?en.1 Aa??aioe ?ioiii? a?aeiia?ae? ia ?aaaeoeeiaoe?th AAeI-i o aei?ineeo

aeinyaiooee oieueee /a?ac 30 aeiia iiney ia?oiai uaieaiiy, a ae?oaa
uaieaiiy aeinoiai?ii iiaeaeuoaaei eiioeaio?aoeith aioeoie i ni?eyei
o?eaaeiio caa?aaeaiith iioiioaoo. I?e oeueiio aa?iaioi aiaeiiaiaei
nii/aoeo c?inoaea aiaoienei-iia’ycoth/a aeoeaiinoue aioeoie, a
oienei-iaeo?aeicoth/a iiiioii caieueooaaeany ia ?aiioa, iiae /a?ac
iinyoeue iiney ia?oiai, i nyaaea iaeneioio iiney ae?oaiai uaieaiiy.

3 aa?iaio (6,5%) — iiaieueia, neaaea aiaeiiaiaeue ;

4 aa?iaio (12,6%) — aiaenooiinoue aoaeoeaii? iioiii? aiaeiiaiaei ia
aiaoienei.

3 e 4 aa?iaioe naiae/aoue i?i o?iaeaeaiee aai iaaooee /anoeiaee
iioiiaeaoioeeo, ai oa?aeoa?ecoaaeeny ia oieueee iaaeinoaoiueith
eieueeinoth, aea e iaiiaiioeiiiinoth ae?iaeaieo aioeoie, yei i?iyaeyee
aeayeo iioiieiai/io aeoeaiinoue a ?IAA, aea /anoio ca ana aoee ia
caeaoii iaeo?aeicoaaoe aeeooa?ieiee oienei. Iniae, o yeeo ??aaiue
aioeo?e o a?aeiia?aeue ia aiaoienei ei?ioei/anii aeinyaa? caoeniiai
??aiy (3 aa?iaio), iiaeeeai, iio?aaothoue iiaeeaiaeoaeueieo noai
aaeoeeiaoei?, yei iinoeee a ia oieueee aeiaeaoeiai ?aaaeoeeiaoei?, aea
e iioiinoeioethth/o oa?aiith. Oiea?aioiinoue aeienii ?ao?aeoa?ieo
inia, yei ia ?aaaothoue ia aeeooa?ieiee aiaoienei ae?iaeaiiyi
caoeniiai ??aiy aio?oee (4 aa?iaio), i/aaeaeii, iaoiiaeaia aaiaoe/ii.
?ao?aeoa?ii ia aaaaeaiiy aeeooa?ieiiai aiaoieneio neeaaeathoue 12,6%
aiae iacaoeuaieo aai 7,2% aiae onio ianoaaeaieo. Oea, iaaooue, oie
aiaenioie, iaioa yeiai i?aeoe/ii ia cieaeo?oueny ieoiia aaaa
iacaoeuaieo i?ioe aeeooa?i? a iiioeyoei? iaaioue i?e caieueoaii?
aioeaaiiiai iaaaioaaeaiiy aai eieueeino? ?aaaeoeeiaoeie.

Aiaeic aieiaeo iniaeeainoae iiioeyoeieiiai i?ioeaeeooa?ieiiai
iioiioaoo iiaeoaa?aeea niinoa?aaeaiiy i?i oa, ui na?aae aei?ineeo
iaeaieueo iaaeaaiiieo/iith aieiaith a?oiith a 1991-97 ?ieao aoee iniae
aiae 30 aei 49 ?ieia, iniaeeai 40-49 ?ieia. Aeiiiaiaiiyi aei oeeo
niinoa?aaeaiue noaea oa?aeoa?enoeea aa?iaioia iioiii? aiaeiiaiaei ia
2-?aciao ?aaaeoeeiaoeith AAeI-i aiaoieneiii aei?ineeo ?icieo
aieiaeo a?oi. Iieacieee ieoiii? aaae na?iiaaaoeaieo oa iacaoeuaieo aei
?aaaeoeeiaoei? (81,6%) i ia anio aoaiao ?aaaeoeeiaoei? aeienii aoee
iaeaeueie a a?oii 40-49 ?i/ieo. E?ii oiai eiaeai o?aoie c iacaoeuaieo
oeueiai aieo iaaeinoaoiuei aoaeoeaii ?aaaoaaa ia 2-?aciao
?aaaeoeeiaoe?th: o 11,3% aecia/aia oiiaieueiaia neaaea aiaeiiaiaeue (3
aa?iaio), 24,3% aoee ?ao?aeoa?ieie (4 aa?iaio). Oei eiio?aniioa
aeaeyaea? ia oeueiio oiii no?oeoo?a iioiieiai/ii? ?aaeoeaiinoi inia
noa?oeo ca 50 ?ieia, na?aae yeeo, iacaaaeath/e ia 55.6% iacaoeuaieo aei
?aaaeoeeiaoei?, 80% ieoo?ai a?ae?aaaoaaee ia ia?oa uaieaiiy ca oeiii
aoi?eiii? iioiii? aiaeiiaiaei, ua 18% — ca oeiii ia?aeiii?
aiaeiiaiaei, i oieueee 1 iniaa aoea ?ao?aeoa?iith. Oiaoi, no?ie, yeee
i?ieoia iiney inoaiiuei? ?aaaeoeeiaoei?, yeui i?i?iooaaoeny ia aie
aei?ineeo, ia iiaea iiynieoe iaeai?oi iieacieee iioiieiai/ii?
?aaeoeaiinoi aei aeeooa?ieiiai aiaoieneio o 40-49-?i/ieo inia.

sseui i?iaiaeicoaaoe io?eiai? aeai? c iiceoeie iiioeyoeieii? aaiaoeee,
eaeaoueny ia oieueee i?i iaaeieiinoue aoii?aeueiiai iioiioaoo,
iaea?aeaiiai ai?iaeiaae aeeooy ie?aii? ethaeeie, a i?i ciiio aaiaoe/ii?
no?oeoo?e iiioeyoei? a oiiaao iaiaaeaii? aei? naeaeoeaiiai /eiieea
i?e?iaeiiai aeiai?o — nia?oaeueii? aeeooa?ieii? iioaeoei?. Iniae, ui
ia?iaeeeeny o iiai?ii? ?iee (1946-1955), aoee ia?oei iieieiiiyi, yea
aoei iaaeieii caoeuaii ianiaith iioiii?ioieaeoeeith a aeeoeinoai i ia
caciaei aiiaeaiie. O?aaa oaeiae cacia/eoe, ui oea iieieiiiy aoei
iauaaeeaie oeo, ooi ia?iaeeany o 20-o-30-o ?ieao, eiee nia?oiinoue i
eaoaeueiinoue aiae aeeooa?i? a N?N? ciaioeeanue o 2-3 ?ace a ii?iaiyiii
c iiia?aaeiiie ?ieaie caaaeyee oe?ieiio ai?iaaaeaeaiith
i?ioeaeeooa?ieii? ne?iaaoee, a iiciioa ii/aoeo iioiii?ioieaeoeee. Oiaoi,
i?ioyaii i?eiaeiii aeaio iieieiiue aeiiiiaoeiy iniaeeai /ooeeaeo aei
aeeooa?ieii? iioaeoei? inia a iiioeyoei? ethaeeie aoea iaeaea i?eieiaia
caaaeyee aeinyaiaiiyi ethaenoaa a ai?ioueai c oei?th nia?oaeueiith
iioaeoei?th.

I?e aiaeici eaoaeueieo aeiaaeeia aiae aeeooa?i? a Oe?a?ii caa?iooi
oaaao ia i?aeaeuaio ni?eeiyoeea?noue aei?ineeo 40-49 ?ie?a aei
aeeooa???. Iieaciee nia?oiinoi a oe?e a?eia?e a?oi? ca ani ?iee
aiiaeaii? aoa a 3 ?ace aieueoei, iiae caaaeueiee ii Oe?a?ii i a 7
?acia aieueoei, iiae aiaeiai/iee iieaciee na?aae inia 18-29 ?ieia. A
1996 ?ioei 40-49- ?i/ii neeaaeaee iaeaea iieiaeio onio iiia?eeo aiae
aeeooa?i? aei?ineeo, a ca eaoaeueiinoth iinooiaeeny oieueee aeioyi aei
2-o ?ieia. I?e oeueiio aieueoa iieiaeie c ieo (52,4%) iiia?ee a
ia?oee oeaeaeaiue aiae ii/aoeo caoai?thaaiiy, a oie /an ye a onio
iioeo aieiaeo a?oiao aei?ineeo o aieueoi? /anoee caoai?ieeo nia?oue
ianoaea ia ae?oaiio-o?aoueiio oeaeii caoai?thaaiiy. Aeiaaiic
«aiia?oiene/ia oi?ia aeeooa?i?» anoaiiaeaiee i’yoe iiia?eei a aioei
40-49 ?ieia (11,9%), a na?aae onio iioeo aei?ineeo — oieueee aeaii
(4,5%). E?ii oiai oai?i ia aeeooa?ith a oeueiio aioei aeinoiai?ii
aiae?iciyeenue aiae iioeo aei?ineeo aieueoith ieoiiith aaaith oiene/ieo
i oneeaaeiaieo oi?i.

O aei?ineeo iieiaeoiai a?eo, a oaeiae o ae?oae i?ia?aeio ?ieue o
ni??eiyoeeaino? aei aeeooa??? a?ae?a?aaaee ye?noue ?ioi?caoe?? ? no?ie
i?ney inoaiiueiai uaieaiiy. Aiaeic uaiethaaeueiiai aiaiiaco caoai?ieeo
aeioae aeyaea inioaaiiy /ioeiai ca’yceo iiae oyaeeinoth caoai?thaaiiy
ia aeeooa?ith o aeioae oa ?o uaieaiinoth, cie?aia, aeio?eiaiiyi
i?iiiiiaaieo aaeoeei i noai ?o canoinoaaiiy. I?aaeeueii i?euaieaii
aeioe yeui i oai?iee ia aeeooa?ith, oi cia/ii eaaoa i ia iiie?aee.

Iacaaaeath/e ia ia’?eoeaii ia?aoai?aiiy, ui aiaeaoaathoueny ia
aiieiai/ieo ?iaiyo aiiaeaii/iiai i?ioeano i?e aca?iiaei? iiioeyoeie
caoaeieea aeeooa?i? oa ethaeeie, inoaoi/ia noaiiaeaiiy aiiaeaii/iiai
i?ioeano ye nioeiaeueii-aeieiai/iiai yaeua aiaeaoaa?oueny i?e eiie?aoieo
nioeiaeueieo ianoaaeiao iaaiiai eieaeoeao ethaeae, ia iaaiie
aaeiiiino?aoeaiie oa?eoi?i?, a iaaiie aea?aeaai, yea ae?ioo? aeayei
no?aoaai/ii ieoaiiy, ni?yiiaaii ia iieiioaiiy ioi?iie caei?ia’y oa
aiiaeaiiieiai/ii? aaciaee ianaeaiiy. Iani?eyoeea? /eiieee a
?aaiiiaeueiie nioeaeinenoaii iiiiiaeeee aeith aiieiai/ieo /eiieeia, ui
i?ecaaei aei c?inoaiiy caoai?thaaiinoi aei ?icii?ia a i i ae a i i ?.
C?inoaiiy caoai?thaaiinoi ia aeeooa?ith a Oe?a?ii iiaieicoaaei neee
i?aaiia ioi?iie caei?ia’y ia ai?ioueao c iath. Iaaiaeeeaaeii caoiaee
uiaei ?icoe?aii?, a iioii ianiai? iioiicaoei? ianaeaiiy aeineoue oaeaeei
iiaeaeueee ?iaaiue eieaeoeaiiai iioiioaoo (aei 76,1% o 1994 ?ioei),
aea aieeioee ia ?iaaiue caoai?thaaiinoi ?c caiiciaiiyi ia 2-3 ?iee.
I?ioa cinoaaeaiiy aeeiaiiee ?iaiy caoai?thaaiinoi c ieoiiith aaaith
oyaeeeo i oiene/ieo oi?i (?en.2) cana?ae/eei, ui ia aiaeiiio aiae
caaaeueii? caoai?thaaiinoi, iie yei? i?eiaaeaa ia 1995 ?ie,
iaeneiaeueia ieoiia aaaa oiene/ieo oi?i aoea aiaecia/aia o 1993
(33,3+0,9%), a oyaeeeo oi?i — o 1994 ?ioei (19,5+0,8%).

?en. 2 Aeeiai?ea caoai?thaaiino? oa ieoiii? aaae oyaeeeo ? oiene/ieo
oi?i aeeooa??? a 1992-1998 ??.

Oaeei /eiii, iiaeaeuaiiy iiioeyoeieiiai ?ioiioaoo aei aeeooa?i? a
1993-1994 ?ieao aieeioei ia?o ca ana ia no?oeoo?o caoai?thaaiinoi ia
aeeooa?ith. Iieaciee caoai?thaaiinoi, yeee iinoeoue eaaei, a o./.
aoeiiai oi?ie, ciaioeany iiciioa, aianeiaeie iinooiiaiai caanaiiy
aiiaeaii/iiai i?ioeano.

A aoiieiai/iie no?oeoo?i aeeooa?i? ia?aaaaeaee oieneaaiii ooaie
C.diphtheriae aiioeio gravis, ui aoee aeaeieaii aiae 56-75% oai?eo
ia aeeooa?ith ai?iaeiaae aiiaeaii?.

Eeiiiei-aiiaeaiiieiai/ia ea?oeia aeeooa?i? ? iaeaaaeeeaioith
oa?aeoa?enoeeith aiiaeaii/iiai i?ioeano ia i ? a a i i c i a i i i o
?iaii i i?iaiaeiei /eiieeii o aecia/aiii aaiethoeieiiai aoaio
aeeooa?ieii? iioaeoei?. Eeiii/ia ea?oeia aeeooa?i? ca oa?aeoa?ii
oneeaaeiaiue i eieaeicaoei?th iinoeaaiai caiaeueiiai i?ioeano a
ia?iiae aiiaeaii? 90-o ?ieia ia iaea nooo?aeo aiaeiiiiinoae a o?iiicii
aei ie?aieo nenoai i oeaiei a ii?iaiyiii c iaeaeeae/ei
ia?aaeaiiaeaii/iei ia?iiaeii (oaae.3).

Oaaeeoey 3

Eieaeicaoeiy i iioe?aiinoue iinoeaaiai caiaeueiiai i?ioeano

(ca aeaieie inoaoi/ieo aeiaaiicia a 1992-1998 ??.,%)

Oi?ia aeeooa?i? ca eieaeicaoei?th A na?aaeiueiio ca 1992-98 ?iee
Iaeneioi i iiiiioi a ie?aii ?iee Aeeooa?iy ?ioiaeioee 90,2
88,1-93,0 — ai?oai? 0,73 0,43-1,1
— iina 0,61 0,15-0,82
— oei?e, i/ae oa ii. 0,08 0 — 0,14 a o./.
eieaeiciaaia 62,2 59,3-68,3 iioe?aia
29,4 25,1-31,1 Eiiaiiiaaia: 8,4
5,2-10,9 a o./. — ?ioiaeioea i iin 3,8 2,4 — 5,2
— ?ioiaeioea i ai?oaiue 3,0 1,6 — 3,8 — ?ioiaeioea,
iin, ai?oaiue 0,77 0,43 — 1,6 — ?ioiaeioea, iin, ai?oaiue,
o?aoay, a?iioe 0,55 0,43 — 0,66
— iioi eiiaiiaoei? 0,2 0,07 — 0,38
Anueiai
oai?eo

(100%) 12225 *

I?eiioea: *- aei aiaeico ia aeeth/aii oai?i c
oiene/ieie oi?iaie aac

aeacoaaiiy eieaeicaoei? iinoeaaiai caiaeueiiai i?ioeano

Iaenooo?aioith aiaeiiiiinoth eeiii/ii? ea?oeie aeeooa?i? a aiiaeaii/iee
ia?iiae a ii?iaiyiii c ia?aaeaiiaeaii/iei neiae aaaaeaoe iiaeaeuaio
ieoiio aaao oiene/ieo oi?i aeeooa?i?, ?acii c noaoiene/ieie: 28,4+0,4%
o 1992-1998 ??. o ii?iaiyiii c 17,7% o 1979-1988 ??. (Aieioianueeee
A.I., E?theia A.TH., 1990). Iaeaieueo o?aaeaieie aieiaeie a?oiaie ca
oyaeeinoth ia?aaiao, aiaenioeii oiene/ieo, oneeaaeiaieo i nia?oaeueieo
aeiaaeeia aoee aeioe 4-6 ?ieia i aei?inei 40-49 ?ieia. «Aeeooa?iy
i?euaieaieo» c ia?aaaaeii eaaeei, aoeiiaei aai noaeeiii/iei ia?aaiaii,
niinoa?iaaeany o iiaeeioeia oa aei?ineeo aei 30 ?ieia.

Niiaeiaaiiy ia oaeaeea iiaeieaiiy aiiaeaii? nooi
aaeoeeiii?ioieae-oe/ieie caoiaeaie noaei ia ia?aoeiaei noai?aiiy ?aeeieo
i?eioeeiia eeiii/ii? i eaai?aoi?ii? aeiaaiinoeee, ui ? i?ia?aeiith
oiiaith ia`- ?eoeaiino? iieaciee?a, iieeaaeaieo a iniiao
ai?aeai?ieia?/iiai aiae?co neooaoe??. A Oe?a?ii i?ioyaii aiiaeaii? 90-o
?ieia ia aeeoei aeiaeiiai ioioeieiiai aeieoiaioo, yeee ae ?aaeaiaiooaaa
iciaee noaiaea?oiiai aeiaaeeo aeeooa?i?, aai e?eoa?i? anoaiiaeaiiy
inoaoi/iiai aeiaaiico aeeooa?i?. Ciaiiy iniiaieo caeiiiii?iinoae
aiiaeaii/iiai i?ioeano aeeooa?i? aeicaiey? ca aeayeeie iciaeaie
ia?aai?eoe ?iaaiue ia’?eoeaiinoi aeiaaiinoeee eeiii/ieo oi?i
aeeooa?ieii? iioaeoei?. Oea, iai?eeeaae, aenieee ?iaaiue eaoaeueiinoi
i?e iecueeiio ?iaii caoai?thaaiinoi, ui naiae/eoue i?i aiiiaeiaaiinoeeo
eaaeeo oi?i aeeooa?i?. I?ae /an aiiaeaii? 90-o ?ieia a e?a?iao
eieeoiueiai N?N? iieaciee eaoaeueiinoi cia/ii eieeaaany,
aiaeia?aaeoth/e ?iciee iiaeoiae aei iaeieo eaaeeo oi?i aeeooa?i?. Oae,
a 1993 ?ioei eaoaeueiinoue neeaaeaea a A?ea?oni — 28%, o Eeoai — 14%,
a Iieaeiai — 11,4% (Ia?eaae/ I.E., Oui/aeianeay E.I., 1996). A
Oe?a?ii i ?ini? eaoaeueiinoue a 1993-1994 ?ieao eieeaaeanue aiae 2,6%
aei 3,8%. Ia oeueiio oiii eiio?anii aeaeyaeaee aeayei aaeiiiino?aoeaii
oa?eoi?i? Oe?a?ie, aea eaoaeueiinoue a ie?aii ?iee aiiaeaii? nyaaea
25-50% (*a?iiaaoeueea, Oiaeueieoeueea iaeanoi). Aiaeiiaiaeii, iieaciee
caoai-?thaaiinoi a oeeo ?aaiiiao aoa oei iaioei, /ei aieueoith aoea
eaoaeueiinoue.

A ?iciaei aiiaeaii? i?e oe?ieiio ?iciianthaeaeaiii caoaeieea a
oiiaao iiaeaeuaii? oaaae eiea?ia oa i?aaiia naiaiiaeneoaeae
aiiiaeiaaiinoeea eaaeeo oi?i iiaea ia?aeoe a iioo e?aeiinoue —
aiia?aeiaaiinoeeo aeeooa?i? ca ?aooiie aoeiiaeo, noaeeiii/ieo
aeiaaeeia, i?e yeeo ?aeeia iaaia iciaea aeeooa?i? — oea aeaeieaiiy
oieneaaiiiai, a a Oe?a?ii iaaioue iaoieneaaiiiai ooaio ei?eiaaaeoa?ie
aeeooa?i?. Iai?eeeaae, a 1996 ?ioei caaaeueiee iieaciee caoai?thaaiinoi
ia aeeooa?ith o Ee?ai a 11 ?acia ia?aaeuoaaa aiaeiai/iee iieaciee o
Ee?anueeie iaeanoi. A oie aea /an iioaineaii iieacieee
caoai?thaaiinoi oiene/ieie oi?iaie ia oeeo aeaio oa?eoi?iyo iaeaea ia
aiae?iciyeeny. Ia’?eoeaiith iciaeith a?ia?ae?aaiinoeee iiaea aooe
niiaaiaeiioaiiy oai?eo i aaeoa?iiiini?a. sse i?aaeei aaaaea?oueny, ui ia
1 oai?iai i?eiaaea? i?eiaeiii 4 iiniy, a caiaeii c E.A.A?iiaoaanueeei —
aeaeieueea aeanyoeia. Aeyaeaia ia i?aeoeoei iioeiaeueia niiaaiaeiioaiiy
oai?eo aei iini?a neeaaea? 1: 2-3. Aaeeea ieoiia aaaa eaaeeo oi?i i
cai?ioi? niiaaiaeiioaiiy eieueeinoi oai?eo aei aaeoa?iiiini?a (1,4 : 1)
a 1996 ?ioe? iiaee naiae/eoe i?i aiia?aeiaaiinoeeo aeeooa?i? a Ee?ai
ii?iaiyii c iioeie aaei?i?no?aoeaieie oa?eoi?iyie.

Iaeaaaeeeaioei iiaeeeaoi?ii aeiaaiinoe/iiai i?ioeano, ui oa?aeoa?eco?
aca?iiaiaeiineie iiae eeiiioeenoaie oa aaeoa?iieiaaie, ? iieaciee
aaeoa?iieiai/iiai iiaeoaa?aeaeaiiy aeiaaeeia aeeooa?i? aeaeieaiiyi
oieneaaiieo ooaiia C.diphtheria. A 1996 ?ioei oeae iieaciee eieeaaany
aiae 48% o i.Ee?ai aei 95,6% a Ee?anueeie iaeanoi. ?aaeueii
iiaeeeainoi ?ooeiiiai aaeoa?iieiai/iiai iaoiaeo uiaei aeaeieaiiy
caoaeieea aeeooa?i? neeaaeathoue ia aieueoa 80 aiaenioeia. I?ioa
iiia?aaeiie aeiaaiic «aeeooa?iy», aai «aiaiia» i?ioyaii aiiaeaii?
iae/anoioa ciiithaaany aiaeiiaiaeii aei ?acoeueoaoo aaeoa?iieiai/iiai
aeineiaeaeaiiy ia C.diphtheriae.

I?eiouaiiy aoiieiai/ii? ?iei iaoieneaaiieo ooaiia C.diphtheriae o
aeieeiaiii aeeooa?i? noaei iniaeea?noth eeiii/ii? aeiaaiinoeee a
ia?iiae aiiaeaii? a Oe?a?ii. Anoia?a/ eeane/i?e oya? i?i iaoiaaiac
aeeooa?i?, caiaeii c yeith ?aeeiith i?e/eiith iinoeaaiai oia?iiiciiai
caiaeaiiy, oieneeico i niaoeeoi/ieo o?aaeaiue aioo?ioiio i?aaiia i?e
aaia?aeiciaaiie iioaeoei? ? aeeooa?ieiee aecioienei, iioaeoeiiiinoe
caeaaieueoiai Ee?ao oa Iaeanueei? iaeanoi aaaaeaee, ui aiaiie, i?e yeeo
aeaeieaii iaoieneaaiii ooaie ei?eiaaaeoa?ie aeeooa?i?, oaae ? eaaeeie,
«eaoa?aeueieie» oi?iaie aeeooa?i?. Caaaeath/e ia oa, ui a Oe?a?ii
ieoiia aaaa aeiaaeeia aeeooa?i?, i?e yeeo aeaeieaii iaoieneaaiii ooaie,
iaooeeueii c?inoa? (o 1998 ?ioei aiia neeaea aaea 14,8%), noaei
aeioeieueiei i?iaiaeicoaaoe oeth i?iaeaio a aiiaeaiiieiai/iiio aniaeoi.
Ia i?aenoaa? aea/aiiy /anoioe aeaeieaiiy iaoieneaaiieo ooaiia
C.diphtheriaa o oai?eo oa caei?iaeo aeioae uaieaieo oa iauaieaieo i?ioe
aeeooa?i?, aeyaeaiiy aaeeei? ieoiii? aaae noaee?i?/ieo oa aiaiianoe/ieo
aeiaaee?a, aei oiai ae aeieeath/eo ia oe? aenieiai ?iaiy aioeoiene/iiai
i?ioeaeeooa?ieiiai iioiioaoo, aoei c?iaeaii aeniiaie, ui ia ne?ae
aaaaeaoe aeeooa???th aia?io aac ee?i?/ii oeiiaeo iciae o?a??iiciiai
caiaeaiiy o?eueee ia i?aenoaa? aeae?eaiiy iaoieneaaiiiai ooaio
C.diphtheriaa.

I?ioa aecia/aiiy ca aeiiiiiaith iieiia?acii? eaioethaiai?
?aaeoei? tox-aaio a 557 iaoieneaaiieo ooaiao C.diphtheriaa, ui
aeaeieaii i?ioyaii 1997-98 ?ieia aiae oai?eo c ae?aaiicii “aeeooa?iy”,
c aino?eie ianiaoeeoi/ieie caoai?thaaiiyie EI?-i?aaiia oa aiae
aaeoa?iiiini?a a 12 iaeanoyo Oe?a?ie, i?iaeaiiino?oaaei iayaiinoue o
10,3% iaoieneaaiieo ooaiia tox-aaio, ui ia aeeeth/a? iiaeeeainoi
/anoeie c ieo aiaeiiaethaaoe oieneiiooai?thth/o ooieoeith i a aeayeeo
aeiaaeeao aeeeeeaoe aeeooa?ith. Aeienii, ooaie, aeaeieaii aiae oai?eo c
aeiaaiicii «aeeooa?iy», iinoeee tox-aai a 2-2,5 ?ace /anoioa, iiae
ooaie aiae oai?eo c ianiaoeeoi/iei caiaeaiiyi EI?-i?aaiia i aiae
eeiii/ii caei?iaeo aaeoa?iiiini?a. Oea iiaea naiae/eoe i?i caeaoiinoue
oeeo ooaiia aei iaiinoieii? aai neaaei? oieneaaiiinoi, yea ia aeinyaa?
ii?iaa /ooee-ainoi noaiaea?oieo eaai?aoi?ieo oanoia. I?ioa ia
i?aaiiciaiiio ?iaii i?iaiaeiei oaeoi?ii aeieeiaiiy oai?iae aenooia? ia
noieueee nooiiiue iaoiaaiiinoi caoaeieea, neieueee ?aaeoeaiinoue
iae?ii?aaiicio-oacy?ia.

C 1997 ?ieo niinoa?iaa?oueny noaea oaiaeaioeiy aei iacai?ioiueiai
ciaioaiiy caoai?thaaiinoi ia aeeooa?ith. Oeae i i n e y a i i ae a i i
/ i e e i a ? i i ae oa?aeoa?eco?oueny iaaiei noaiii iiaenenoai
aiiaeaii/iiai i?ioeano (oaae.2). A nioeiaeueiie iiaenenoaii neiae
aiaecia/eoe iaaooee i?aeoe/iee aeinaiae i?ioeaiiaeaii/ii? ?iaioe i
i?aaiicaoei? ianiaeo iioiii?ioieaeoe/ieo caoiaeia ia iinoeyo. C aieo
iiaeia?iaeieo i?aaiicaoeie iaea?aeaia aaeeea iaoa?iaeueia i
eiinoeueoaoeaia aeiiiiiaa aeey ai?ioueae c aeeooa?i?th. Iiae aaiaeith
AIIC ?ic?iaeaia oaoiieiaiy niieueii? aeiyeueiinoi eaai?aoi?ie o
aeaeyaei ?a?iiaenueei? eaai?aoi?ii? ?iai/i? a?oie c aeeooa?i?, eoaee
Oe?a?ia oaieoea, ii/eiath/e c iiiaioo noai?aiiy o 1993 ?ioei. Oaeei
/eiii, i?aaiiciaaia nenoaia aeiaaeueiiai aiiaeiaaeyaeo ca aeeooa?ieiith
iioaeoei?th. Ca?ac a Oe?a?ii aei? oaeineiiaeaiee eaeaiaea?
i?ioieaeoe/ieo uaieaiue (Iaeac N14). Ciiieeiny aiaeiioaiiy aei
uaieaiue ye o ianaeaiiy, oae i o eiea?ia. Oaeineiiaeaia eaai?aoi?ia
aeiaaiinoeea aeeooa?i?.

A aiieiai/iie iiaenenoaii ia?iiae niaaeo aiiaeaii?
noi?iaiaeaeo?oueny oaeaeeei ciaioaiiyi oee?eoeyoei? oieneaaiieo ooaiia.
I?e oeueiio /anoioa iinienoaa iaoieneaaiieo ooaiia caeeoa?oueny
iaciiiiith, neeaaeath/e 1-2% caei?iaiai ianaeaiiy. Oi?io?oueny
?aca?aoa? caoaeieea aeey caa?aaeaiiy iioaeoei? a iiaeaiiaeaii/iee
ia?iiae o aeaeyaei o?eaaeeo iini?a C.diphtheriae, yei, neeaaeath/e
iaioa 0,3% aiae ianoaaeaieo caei?iaeo aeioae cae?eoeo eieaeoeaia, o
26,7% aeiaaeeia ianooue iciaeo oieneiiooai?aiiy o yaiiio (oieneaaiii
ooaie), aai i?eoiaaiiio aeaeyaei (IE?-iiceoeaii iaoieneaaiii ooaie
ia?aaaaeii aiioeio mitis).

Iiioeyoeieiee aioeoiene/iee iioiioao aei aeeooa?i? aeinya o 1998 ?ioei
86% caoeuaieo. I?e oeueiio /anoeia ianaeaiiy e?ii iinoaaeoeeiaeueiiai
iaaoea iinoiioaeoeieiiai iioiioaoo. Oea aea? iaaii aa?aioi?
iiaeaeueoiai cieaeaiiy caoai?thaaiinoi ia aeeooa?ith aei nii?aaee/iiai
?iaiy i caa?aaeaiiy aiiaeaii/iiai aeaaiiieo//y i?eiaeiii o iaeaeeae/i 10
?ieia.

Oaeei /eiii, nenoaiiee aiaeic aiiaeaii/iiai i?ioeano aeeooa?ieii?
iioaeoei? aeicaiey? aecia/eoe aiiaeaiith 90-o ?ieia ye ?acoeueoao
ia?a-oai?aiue, iia’ycaieo c aca?iiei i?aeneethth/ei aieeaii
iani?eyoeeaeo /eiieeia ia onio ?iaiyo aiieiai/ii? oa nioeiaeueii?
iiaenenoai, ui iaeiie/oaaeenue i?ioyaii aeanyoeeioue aaeoeeiaeueii? a?e.
Aiiaeaiiy aeeooa?i? aeiaaea iaiiaeeeainoue eieaiaeaoei? aeeooa?i? ye
iicieiai/ii? oi?ie aeeeth/ii oeyoii ieaiiai? iioiii?ioieaeoeee. E?ii
oiai ca oiiaaie cieaeaiiy caoai?thaaiinoi aei nii?aaee/ii? i
iaiiaeeeainoi i?e?iaeii? iioiicaoei? ianaeaiiy iiaeaeuo?oueny cia/aiiy
iaooeeueiiai aeio?eiaiiy ?aaeaiaioiaaieo a aeaiie e?a?ii noai
aaeoeeiii?ioieaeoeee. Noaaeaiiy ca noaiii eieaeoeaiiai iioiioaoo i
oee?eoeyoei?th caoaeieea iathoue oo?eiaoe iaaia iinoea a nenoaii
aiiaeaiiieiai/iiai iaaeyaeo ca aeeooa?ieiith iioaeoei?th ye ia’?eoeaii
iiaeeeaoi?e c?ooaiue a nenoaii aiiaeaii/iiai i?ioeano.

AENIIAEE

1. I?iaiaeiith oiiaith ia’?eoeaii? ioeiiee aiiaeaii/ii? neooaoei?
c iaoith oaeineiiaeaiiy no?aoaai? i oaeoeee ai?ioueae c aeeooa?i?th ?
nenoaiiee aiaeic ia?aoai?aiue aiiaeaii/iiai i?ioeano ia onio ?iaiyo
aiae noaeeioeiii?, iieaeoey?ii-aeieiai/ii? aca?iiaei? caoaeieea i
ethaeeie aei aeiaaeueii? nenoaie aiiaeiaaeyaeo ca aeeooa?ieiith
iioaeoei?th.

2. Aeyaeaii iacaeaaeiinoue nooiaiy aa?aneaiinoi ooaiia caoaeieea
aiae aeaea?aea ?o aeaeieaiiy — oai?eo, iiia?eeo aai aaeoa?iiiini?a.
Aaaeo/o ?ieue o aeieeiaiii iaiioanoii? oi?ie oai?iae aiaeia?a? ia
nooiiiue aa?aneaieo aeanoeainoae iie?ii?aaiicio-caoaeieea, a
?aaeoeaiinoue iae?ii?aaiicio-ethaeeie.

3.Ii/aoie aea/aiith iaoai?ci?a eiinoeoooeieiiai ?ioi?oaoo aei aeeooa???
iieeaei aecia/aiiy eaeoei?a, eiieo?oth/eo ca ?aoeaioi?e c aeeooa?ieiei
oieneiii (eaeoei ni?aeo aiaia, ieiaeii?aeie yiiinueei? oo?ie), i
?ic?iaea iaoiaee/ieo iiaeoiaeia uiaei aea/aiiy noaio a?aeiia?aeieo
?aoeaioi?ia ia a?eo?ioeeoao ethaeeie. Ne?ei?ia caei?iaeo aeiii??a
aeyaea 17,6% in?a c aiiiaeueiei noaiii niaoeeo?/ieo ?aoeaioi??a, ui
iiaea na?ae/eoe i?i ?o noeeuei?noue aei aaeoa??iiin?enoaa.

4. Anoaiiaeaii, ui iioiieiai/ia aoaeoeaiinoue aeiaeaoeiaeo
?aaaeoeeiaoeie aeioae («iioiiei?aeoeiy») ieae/a aiae aoaeoeaiinoi
ieaiiaeo i?ioieaeoe/ieo uaieaiue. Aiaeic iioiia?ai iiney
iioiiei?aeoei? aeyaea o 16,4% aeioae i?eaii/aiiy aoii?aeueii? eaiee
?ioi?oaoo (aeeeth/ii Ig G). C’yniaaii, ui ?nio? iioeiaeueia aioeaaiia
iaaaioaaeaiiy, i?e ia?aaieueoaiii yeiai c?inoaiiy ?iaiy aioeoie aaea ia
aiaeaoaa?oueny, a a iioiiie nenoaii niinoa?iaa?oueny aeecaaeain.

5. Aeyaeaii, ui na?aae aei?ineeo, yei ia iathoue caoeniiai ?iaiy
i?ioeaeeooa?ieieo aioeoiene/ieo aioeoie, 53,6% ?aaaothoue ia aaaaeaiiy
aaeoeeie AAeI-i ca oeiii aoi?eiii? iioiii? aiaeiiaiaei; 27,3% inia —
ca oeiii ia?aeiii? iioiii? aiaeiiaiaei. O 6,5% inia iiaieueia, neaaea
aiaeiiaiaeue naiae/eoue i?i /anoeiaee iioiiaeaoioeeo; 12,6% aiae
iacaoeuaieo aei ?aaaeoeeiaoei? iaeaaeaoue aei ?ao?aeoa?ieo inia, yei ia
?aaaothoue ia aaaaoi?aciaa aaaaeaiiy aiaoieneio ae?iaeaiiyi caoeniiai
??aiy aioeo?e. Aiaenioie ?ao?aeoa?ieo aiae caaaeueii? eieueeinoi
ianoaaeaieo neeaaea? 7,2%, aiae inia o aioei 40-49 ?ieia — 19,2%.

6. Anoaiiaeaii, ui iioiii?ioieaeoeea oe?ieeo aa?noa ianaeaiiy, yea
?icii/aeeny a Oe?a?ii c 1991 ?ieo, oi/a i iaea iaaeinoaoith
aiiaeaiiieiai/io aoaeoeaiinoue uiaei oaeaeeiai cieaeaiiy ?iaiy aai
oaiiia ?inoo caoai?thaaiinoi, aaea o 1993-1994 ?ioei ciiieea ia e?aua
no?oeoo?o caoai?thaaiinoi aeeooa?i?th: ciaioeeanue ieoiia aaaa oyaeeeo i
oiene/ieo oi?i.

7. Aiaeic aoiieiai/ii? no?oeoo?e aeeooa?i? i?iaeaiiino?oaaa, ui
i?ioyaii ai?aeai?? ia?aaaaeaee oieneaaii? ooaie C.diphtheriae aiioeio
gravis (56-75%). C 1995 ?ieo a aeeiaiioei aoiieiai/ii? no?oeoo?e
aeeooa?i? c’yaeeeny aeai oaiaeaioei?: ia?oa — c?inoaiiy ieoiii? aaae
iaoieneaaiieo ooaiia (c 7,1% a 1995 aei 14,8% a 1998); ae?oaa —
caieueoaiiy /anoioe iaaaoeaiiai ?acoeueoaoo aaeoa?iieiai/iiai aiaeico
o oai?eo ia aeeooa?ith (aei 18% a 1998 ?ioei). Iaeaea iaeiaeiaa
/anoioa aeaeieaiiy iaoieneaaiieo ooaiia o oai?eo oa caei?iaeo aeioae
uaieaieo oa iauaieaieo i?ioe aeeooa?i?, eaaeinoue ia?aaiao i
ii/anoioaiiy aeiaaeeia, ui aeieeathoue i?e aenieiio ?iaii
aioeoiene/iiai i?ioeaeeooa?ieiiai iioiioaoo, iiaeaeathoue noiiiaai
i?eiouaiiy aoiieiai/ii? ?iei iaoieneaaiieo ooaiia C.diphtheriaa o
aeieeiaiii aeeooa?i?.

8. Ca aeiiiiiaith iieiia?acii? eaioethaiai? ?aaeoei? o 10,3%
iaoieneaaiieo ooai?a C.diphtheriaa aecia/aii iayaiinoue tox-aaio, yeee
ia aeni?ano?oueny. Iaoieneaaii? ooaie, aeaeieaii aiae oai?eo c
aeiaaiicii «aeeooa?iy», iinoeee tox-aai a 2-2,5 ?ace /anoioa, iiae
ooaie aiae oai?eo c ianiaoeeoi/iei caiaeaiiyi EI?-i?aaiia i aiae
eeiii/ii caei?iaeo aaeoa?iiiini?a. Oea iiaea naiae/eoe i?i caeaoiinoue
oeeo ooaiia aei iaiinoieii? aai neaaei? oieneaaiiinoi, yea ia aeinyaa?
ii?iaa /ooeeainoi ?ooeiieo eaai?aoi?ieo oanoia.

9. Aiaecia/aii iiaeaeuaiee iieaciee aenithaaiiy iaoieneaaiieo ooaiia ye
a ia?aaeaiiaeaii/iee ia?iiae (1989-90 ??.), oae i iai?eeiioei
aiiaeaii? (1998 ?ie). Oea iiaeoaa?aeaeo? aaaeeeaa i?iaiinoe/ia cia/aiiy
aiaenioeo iinienoaa iaoieneaaiieo ooaiia C.diphtheriae na?aae i?aeoe/ii
caei?iaeo inia aeey aecia/aiiy ia?iiaeo aiiaeaii/iiai i?ioeano.

10. Aeyaeaii aeia?aaeaeaiiy iaeneiaeueieo iieacieeia
?iciianth-aeaeaiino? aeiooa?ieii? iioaeoei? a cae?eoeo
eieoaaeueii-aeiaaiinoe/ieo caeeaaeao. Aeey oaeineiiaeaiiy
aiiaeaiiieiai/iiai iaaeyaeo i?iiiiiaaii i?aaiicoaaoe ieaiiii?ia
aaeoa?iieiai/ia ianoaaeaiiy ia oieneaaiii i iaoieneaaiii ei?eiaaaeoa?i?
aeeooa?i? iaoe??io?a 1-2 iiaeeeaoi?ieo cae?eoeo caeeaaeia ia eiaeiie
aaeiiiino?aoeaiie oa?eoi?i? aeey noaaeaiiy ca oee?eoeyoei?th caoaeieea.

11. Aiaeic ia’?eoeaiinoi aeayeeo o?aaeeoeieieo iieacieeia, yei
oa?aeoa?ecoaaee iioaineaiinoue aiiaeaii/iiai i?ioeano aeeooa?ieii?
iioaeoei? ia ie?aieo aaeiiiino?aoeaieo oa?eoi?iyo, aeyaea eieeaaiiy
aiae aiii- aei aiia?aeiaaiinoeee o ca’yceo c iaaecia/aiinoth caaaeueieo
i?eioeeiia eeiii/ii? i eaai?aoi?ii? aeiaaiinoeee aeeooa?i? ia ?iaii
aea?aeaae.

IA?AE?E ?IA?O, UI IIOAE?EIAAI? CA OAIITH AeENA?OAOe??

1.Aeaiioianueea I.A., Oea?aanueeee TH.I., Eaeiiiia A.I., ?na?a A.?.
Iieacieee aioeoiene/iiai iioiioaoo aei aeeooa?i? oa i?aaoey o oai?eo
ia aeeooa?ith// Aeeoy/i iioaeoei?. Oe?.iiaeaiae. ca. — 1995.- Aei.23 —
N.35-40

2. Aeaiioianueea I.A. Aeeiaiiea eieaeoeaiiai iioiioaoo oa
no?oeoo?e iiioeyoei? caoaeieea o ca’yceo c aeoeaicaoei?th aeeooa?i?//
?ioaeoeieii oai?iae. — 1997.- ?1. — N.12-16.

3. Aeaiioianueea I.A., Aeia?nueea I.?. Aieea aeiaeaoeiaeo
?aaaeoeeiaoeie i?ioe aeeooa?i? ia noai niaoeeoi/iiai oa ianiaoeeoi/iiai
iioiioaoo o aeioae oeieueiiai aieo// Iaaee/ii ia?niaeoeae — 1997. — O.2,
?4.- C.83-86.

4. Aeaiioianueea I.A., Oea?aanueeee TH.I., Eo?eeia ?.I., Eaeiiiia
A.I., ?na?a A.?. Noai iiioeyoeieiiai iioiioaoo aei aeeooa?i? a oiiaao
aiiaeaii? // Iaaee/ii ia?niaeoeae — 1997. — O.2, ?2.- C.82-84.

5. Aeaiioianueea I.A., E?anthe E.N., Ii?ic E.A. Aae?iaiiaa O.A.
I?e/eie caoai?thaaiinoi oa eaoaeueiinoi aiae aeeooa?i? aeioae a
oiiaao aiiaeaii?// Aeeoy/i iioaeoei?.Oe?.iiaeaiae.ca.- E.,1998.-
Aei.24.- N.9-12.

6. Aeaiioianueea I.A., Iieyi/eeia A.I., Eo?eeia ?.I., Iieiae/aiei
I.I., Iai?aiei I.E. Oeyoe aaeineiiaeaiiy aeiaaiinoeee oa ?a?no?aoei?
aeeooa?i? ia no/aniiio aoaii// Aeeoy/i iioaeoei?.Oe?.iiaeaiae.ca.-
E.,1998.- Aei.24.- N.42-46.

7.Aeaiioianueea I.A. I?iaeaie aeiaaiinoeee aeeooa?ieii? iioaeoei? ia
no/aniiio aoaii // Iaaee/ii ia?niaeoeae — 1998. — O.3, ?4.- C.48-49.

8.Aeooeaae/ O.A., Ia?oeaithe I.E., A.A.Aeaieoianeay, AEa?aaei I.I.
I?eiaiaiea IOe?-aiaeeca aeey aeeaaiinoeee aeeooa?ee: ia?niaeoeau e
i?iaeaiu// Oe?a?inueeee iaaee/iee /aniien.- 1999.- 1(9).- N.145-147.

9.Aeooeaae/ O.A., Aeaieoianeay A.A., AEa?aaei I.I. Eaai?aoi?iay
aeeaaiinoeea aeeooa?ee// Eaai?aoi?ia ae?aaiinoeea.- 1998.- ?4.- N.25-29.

10. E?anthe E.N., Ii?ic E.A., Aeaiioianueea I.A. Aea/aiiy i?e/ei
caoai?thaaiinoi ia aeeooa?ith aeioae, uaieaieo i?ioe oei?? iioaeoei? //
Aeeoy/i iioaeoei?.- E., 1999.- Aei.25.- N.9-12.

11. Aeaiioianueea I.A. Aaeaaceaii aeanoeainoi Corynebacterium
diphtheria uiaei a?eo?ioeeoia ethaeeie// Aeeoy/i iioaeoei?.- E., 1999.-
Aei.26.- N. 29-33.

12. Aeaieoianeay A.A. I?iaeaiu aeeaaiinoeee aeeooa?eeiie eioaeoeee//
Eiea?nueea ni?aaa.- 1999.- ?.3. — C.129-131.

13. Aeaiioianueea I.A., *oaeia E.I., Ienithe A.A. Aea/aiiy
aiaoienei-iia’ycoth/eo oa oienei-iaeo?aeicoth/eo aeanoeainoae
i?ioeaeeooa?ieieo aioeoie o aeeiaiioei iioiii? aiaeiiaiaei ia
?aaaeoeeiaoeith o aei?ineeo // Eaai?aoi?iay aeeaaiinoeea.- 1999. —
?1. — N.22-24.

14. Aeaieoianeay A.A. Oa?aeoa?enoeea eiioiiiai ioaaoa ia
?aaaeoeeiaoeeth aeeooa?eeiui aiaoieneiii o eeoe n ieceei o?iaiai
oee?eoee?othueo aioeoiene/aneeo aioeoae // Eaai?aoi?iay aeea-aiinoeea.-
1999.- ?2.- N.26-28.

15. Aeaiioianueea I.A., *oaeia E.I. Aiiaeaiiy aeeooa?i? a Oe?a?ii:
iiaenoiee i ocaaaeueiaiiy// Oe?. iaaee/iee /aniien.- 1999.- 3(12).-
N.56-58.

16. Aeaieoianeay A.A. Aeeooa?ieaeu e iaoieneaaiiua Norynebacterium
diphtheriae a yoeieiaee aeeooa?ee //Iie?iaiie.aeo?iae.- 1999.- O.61,
?3.- N.81-89.

17. Aeaieoianeay A.A., Aeooeaae/ O.A., AEa?aaei I.I. Iaoieneaaiiua
ei?eiaaaeoa?ee aeeooa?ee a yieaeaieieiae/aneii aniaeoa // Iaaeaeoia?iae.
iaaeeoe. aeo?iae.- 1999.- O.5, ?3.- N.114-116.

18. Aeaieoianeay A.A. Ioeaiea yooaeoeaiinoe aeiiieieoaeueiuo
?aaae-oeeiaoeee aeaoae i?ioea aeeooa?ee e noieaiyea // Yieaeaieieiaey
e eioaeoeeiiiua aieacie.- 1999. — ? 4. — N.

19. Aeaiioianueea I.A. Aoiieiai/iee aeiaaiic a iioaeoeieiie
iaoieiai? // Iaaee/ii ia?niaeoeae. — 1999.- O.4, ?3.- N.

20. Aeaieoianeay A.A., *oaeiay E.I., Oa?aee E. Aa?eaiou eioiiiai ioaaoa
ia ?aaaeoeeiaoeeth aeeooa?eeiui aiaoieneiii o ac?ineuo// AEo?i. iee?ia.,
yieaeaieie., eiioiiaeie. — 1999.- O. , ?5. — N.

21. Oea?aanueeee TH.I., Aeaiioianueea I.A., ?na?a A.?. Ioeiiea
aaaeeinoi ia?aaiao aeeooa?ii o ca’yceo ci uaieaiinoth oa iayaiinoth
aioeoiene/iiai iioiioaoo o oai?eo //Iaoa?. Eiia?ano Naioiai?
Oaaea?aoei? Oe?a?inueeeo eiea?nueeeo oiaa?enoa.- Aeiii?iiao?ianuee,
1994.- N.66.

22. Aeaieoianeay A.A., Oea?aaneee TH.I., Eo?eeia A.I.,Aiaei?aoeeay A.A.
No?oeoo?a caaieaaoeo aeeooa?eae ii i?eaeoinoe e iaee/eth enoiaeiiai
aioeoiene/aneiai eiioieoaoa// Aeo. i?iaeaiu nioeeaeueiie iaaeeoeeiu,
i?aaiecaoeee cae?aaiio?. e iooe eo aeaeueiaeo.?acaeoey a Oe?aeia.Na.o?.-
Aei-ne, 1994.- N.123-124.

23. Aeaieoianeay A.A. E aii?ino ia yieaeaieieiae/aneie cia/eiinoe
iineoaeae iaoieneaaiiuo ooaiiia ei?eiaaaeoa?ee // Aeo. aii?.
iaaeeoeeiu e aeieiaee. — Aei-ne, 1995.- Aui.6.- N.22.

24. Aeaieoianeay A.A., Oea?aaneee TH.I., Nieieiaa E.A., I?yaeei E.A.
Oa?aeoa?enoeea iiioeyoeee aicaoaeeoaey aeeooa?ee a aeeiaieea
yieaea-ie/aneiai i?ioeanna // Nia?aiaiua oaiaeaioeee a ?acaeoee
iaaeeoeeiu e cae?aaiio?-iey.- Aei-ne, 1995.- N.46-47.

25. Aeaieoianeay A.A., Oea?aaneee TH.I., Enaaa A.E., Eo?eeia A.I.,
Eaeeieia A.I. Oa?aeoa?enoeea yieaeaie/aneiai i?ioeanna aeeooa?ee a
Aeiai?iiao?ianeie iaeanoe// Iaoa?. eiio. «Aeo.nioe-aeaeai. e
eeeieei-yieaeai. i?iaeaiu ie?oae.n?aaeu, eioaeoe.iaoieiaee».-
Aeiai?iiao?iane, 1996.- N.75-77.

26. Aeaieoianeay A.A., Nieieiaa E.A., Iaieia E.A. Aioo?eaeaeiaia
oeie?iaaiea ei?eiaaaeoa?ee aeeooa?ee, auaeaeaiiuo a Aeiai?iiao-?ianeie
iaeanoe // Iaoa?. iao/ii-i?aeo.eiio. «Aeo.nioe-aeaeai. e
eeeieei-yieaeai. i?iaeaiu ie?oae.n?aaeu, eioaeoe.iaoieiaee».-
Aeiai?iiao?iane, 1996.- N.77-79.

27. Aeaiioianueea I.A. Aaeaaciy ei?eiaaaeoa?ie aeeooa?i? ia
a?eo?ioeeoao ethaeeie ye i?iya eiinoeoooeieiiai iioiioaoo // Iaoa?.
OIII c’?caeo Oe?.iaoe.oiaa?enoaa iie?ia.,aiiaeai.,ia?acio.(9-11 aeiaoiy
1996?).- Ee?a-Aiiieoey,1996.- N.97-98.

28. Aeai?oianueea I.A., I?yaeei E.I., Ae?eeaiei O.A. I?yia
aaeoa??ineii?y ye iaoiae eaai?aoi?ii? ae?aaiinoeee aeeooa???// Iaoa?.
OIII c’?caeo Oe?.iaoe.oiaa?enoaa iie?ia.,aiiaeai.,ia?acio.-
Ee?a-Aiiieoey, 1996.- N.110.

29.Aeaieoianeay A.A., Oea?aaneee TH.I., Aaeeoeeay Y.I. Iniaaiiinoe
eieeaeoeaiiai eiioieoaoa e aeeooa?ee ia oa??eoi?eyo n ?acee/iie
noaiaiueth caa?yciaiey aoiinoa?iiai aicaeooa // III Iiaeia?iaeia eiio.
«O?aioeiy oa Oe?a?ia, iaoe.-i?aeo.aeinaiae o eiioaenoi aeiaeiao
iaoe.eoeueoo?»(14-16 o?aaiy,1996)-Oace aeiiiaiaeae.-Aei-nuee,1996.- o.2,
/.1.- N.94.

30.Demikhovskaya Ye.V.,Sokolova I.Y. Biology of Corynebacterium
diphtheriae epidemic strains and their resistance to heavy metalls//
Keystone Symposia on Molecular & Cellular Biology.- USA, 1996.- ?.? D7,
405.

31. Aeaieoianeay A.A. E aii?ino i aeieiae/aneeo oaeoi?ao aeoeaecaoeee
yieaeaie/aneiai i?ioeanna aeeooa?ee// Oac. naieia?a-niaauaiey
“Aeo.i?iae. yieaeaieie.,aeeaaiino.,i?ioeeaeo. eio. a-iae.- Eeaa, 1997.-
N.59.

32. Aeooeaae/ O.A., Aeaieoianeay A.A., Ia?oeaithe I.E., AEa?aaei I.I.
*anoioa iaia?oaeaiey aaia oieneiiia?aciaaiey o iaoieneaaiiuo ooaiiia
N.diphtheriae, oee?eoee?othueo a Oe?aeia// Iaoa?. 2-e iaaeae.eiio.
«Eaeae Ianoa?a a ai?ueaa n eioaeoeeyie»(1-4 naioya?y 1998a).-N-Iaoa?a,
1998.- N.180

33. Demikhovskaya Ye.V. The causes of vaccinated persons` illness with
diphtheria in Ukraine// Procc.1-st Congr. Physicians Macedonian
preventive medicine(October 6-10, 1998) Ohrid, Rep.Macedonia.- Scopie,
1998. — P.472.

34. Iaoa??aa ?.I., *a?oeiaa ?.I., sseiaaiei A.?., Aeai?oianueea I.A. oa
?i. No?oeoo?a eaai?aoi?iiai aiae?co aeey ae?aaiinoeee aeeooa???// Iao. V
c`?caeo ?ioaeoe?ii?no?a Oe?a?ie — Oa?iii?eue, 1998.- N. 120-121.

35. Eco/aiea iinoaaeoeeiaeueiiai eiioieoaoa e aeeooa?ee e noieaiyeo o
aeaoae, i?iaeeaathueo a ?acee/iuo yeieiae/aneeo oneiaeyo/ Aeaieoianeay
A.A., ssoeeia A.A., Eeniye A.I. e ae?. // ?aaoeyoeey a aeeauo
nenoaiao.- Aeiai?iiao?iane: AeAO.- 1998.-N.51-52.

36. Ea?iiaa E.N., Ei?aoeeay I.A., Aeaieoianeay A.A. Eaeoeiu a
eco/aiee eiaeeaeaeoaeueiie aini?eei/eainoe e aeeooa?eeiie eioaeoeee//
Iaoa?. iaoe-i?aeo. eiio. «No/aniee noai iaaee/ii? aaiaoeee a
Oe?a?ii» (19-20 o?aaiy 1999?.).- Ee?a,1999.- N.82-83.

37. Earpova I.S.,Koretskaya N.V., Demikhovskaya E.V. Some properties of
Diospyros kaki Th.Lectins// Abstracts of papers presented at Interlec
18. University of Portsmouth, UK.- 1999. — P.22.

38. E?anthe E.N., Aeaieoianeay A.A. I?e/eiu caaieaaaiey aeeooa?eae
aeaoae, i?eaeouo i?ioea yoie eioaeoeee// Iaoa?. Ana?inneeneie
iao/ii-i?aeoe/. eiio. “Aeaoneea eioaeoeee ia ?oaaaea OO aaea: ianoiyuaa
e aoaeouaa”(5-7 ieoya?y 1999a.)- N-Iaoa?a., 1999.-

AIIOAOe??

Aeai?oianueea I.A. I?ieea?noue ai?aeai?/iiai i?ioeano aeeooa??? ye
?acoeueoao aca?iiae?? nioe?aeueii? oa a?ieia?/ii? i?aenenoai. —
?oeiien.- Aeena?oaoe?y ia caeiaoooy a/aiiai nooiaith aeieoi?a iaaee/ieo
iaoe ca oaoii — 14.02.-02.- ai?aeai?ieia?y. — Ee?anueeee
iaoeiai-aeine?aeiee ?inoeooo ai?aeai?ieia?? oa ?ioaeoe?eieo oai?ia ?i.
E.A.A?iiaoaanueeiai IIC Oe?a?ie, Ee?a, 1999.

Ai?aeai?y aeeooa??? 90-o ?ie?a OO noie?ooy ?icaeyaea?oueny ye
?acoeueoao neeaaeieo aca?iia?aeiinei i?ae nioe?aeueiith oa a?ieia?/iith
i?aenenoaiaie ai?aeai?/iiai i?ioeano aeeooa??eii? ?ioaeoe?? o
aaeoeeiaeueio a?o. Ia iiaenoaai nenoaiiiai aiaeico onio ?iai?a
aca?iiaei? aaoa?iaaiieo iiioeyoeie caoaeieea aeeooa?i? oa eiai oacy?ia
(ethaeeie) a?ae noaeeioeiiiai ??aiy ?ioaeoe?eiiai i?ioeano aei
aeiaaeueii? nenoaie aiiaeai?ieia?/iiai iaaeyaeo aecia/aii no/aniee aoai
aaiethoei? aeeooa?ieii? iioaeoei? a nioeiaeueii-aeieiai/ieo oiiaao
Oe?a?ie i ?ic?iaeaii oeyoe oaeineiiaeaiiy aiiaeaiiieiai/iiai iaaeyaeo ca
aeeooa?i?th. Iaaeaia eeiiiei-aiiaeaiiieiai/ia oa?aeoa?enoeea
aeeooa?i? 90-o ?ieia a Oe?a?ii ia iiaenoaai io?oe?eieo aeaieo.
I?iaiae?ciaaii ?ioiieia?/io aoaeoeai?noue aeiaeaoeiaeo ?aaaeoeeiaoe?e
(“?ioiiei?aeoe??”) o ae?oae oa aieiai iniaeeainoi iioiii? aiaeiiaiaei
aei?ineeo ia ?aaaeoeeiaoe?th AAeI-i. Ia iniiai aea/aiiy no?oeoo?e
iiioeyoei? caoaeieea o ?icii ia?iiaee aiiaeaii/iiai i?ioeano aecia/aii
iiaeeeaoi?ii aaeoa?iieiai/ii iieacieee noaio oei?? iiioeyoei? oa
?aca?aoa?e N.diphtheriae a iiaeaiiaeaii/iee ia?iiae. I?iaiae?ciaaii
ye?noue ee?i?/ii? oa eaai?aoi?ii? ae?aaiinoeee ae?ooa???. ?ic?iaeai?
iaoiaee/i? iiaeoiaee aei aea/aiiy noaio ee?oeiieo ?aoeaioi?ia aeey
aeeooa?ieiiai oieneio ca aeiiiiiaith eaeoei?a.

Eeth/ia? neiaa: aeeooa??y, ai?aeai?/iee i?ioean, nenoaiiee aiae?c,
ai?aeai?ieia?/iee iaaeyae, aaeoeeiii?io?eaeoeea, Nirynebacterium
diphtheriae, aeeooa??eiee oienei.

Aeaieoianeay A.A. Eciai/eainoue yieaeaie/aneiai i?ioeana aeeooa?ee eae
?acoeueoao acaeiiaeaenoaey nioeeaeueiie e aeieiae/aneie iiaenenoai. —
?oeiienue.- Aeenna?oaoeey ia nieneaiea o/aiie noaiaie aeieoi?a
iaaeeoeeineeo iaoe ii niaoeeaeueiinoe — 14.02.-02.- yieaeaieieiaey. —
Eeaaneee iao/ii-enneaaeiaaoaeueneee einoeooo yieaeaieieiaee e
eioaeoeeiiiuo aieaciae ei. E.A.A?iiaoaaneiai IC Oe?aeiu, Eeaa, 1999.

Yieaeaiey aeeooa?ee 90-o aiaeia OO aaea ?anniao?eaaaony eae ?acoeueoao
neiaeiuo acaeiiioiioaiee iaaeaeo nioeeaeueiie e aeieiae/aneie
iiaenenoaiaie yieaeaie/aneiai i?ioeanna a aaeoeeiaeueioth y?o. Ia
iniiaaiee nenoaiiiai aiaeeca anao o?iaiae acaeiiaeaenoaey aaoa?iaaiiuo
iiioeyoeee aicaoaeeoaey aeeooa?ee e aai oicyeia (/aeiaaea) io
noaeeaoi/iiai o?iaiy eioaeoeeiiiiai i?ioeanna aei aeiaaeueiie nenoaiu
yieaeaieieiae/aneiai iaaeci?a ii?aaeaeai nia?aiaiiue yoai yaiethoeee
aeeooa?eeiie eioaeoeee a nioeeaeueii-yeieiae/aneeo oneiaeyo Oe?aeiu e
?ac?aaioaiu iooe oniaa?oainoaiaaiey yieaeaieieiae/aneiai iaaeci?a ca
aeeooa?eae. Aeaia eeeieei-yieaeaieieiae/aneay oa?aeoa?enoeea
aeeooa?ee 90-o aiaeia a Oe?aeia ii noaiaie oyaeanoe, eieaeecaoeee
ianoiiai ainiaeeoaeueiiai i?ioeanna e oa?aeoa?o ineiaeiaiee ia
iniiaaiee naaaeaiee i 16 oun. aieueiuo (88% ioeoeeaeueii
ca?aaeno?e?iaaiiuo a 1992-1998aa). Iieacaii, /oi ia?ii?eyoey ii
aaeoeeiii?ioeeaeoeea a ia?eiae yieaeaiee iiaeeyee i?aaeaea anaai ia
iieacaoaee oyaeanoe oa/aiey aeeooa?ee. I?iaiaeeciaaia yooaeoeaiinoue
aeiiieieoaeueiuo ?aaae-oeeiaoeee (“eiioiiei??aeoeee”) o aeaoae e
aic?anoiua iniaaiiinoe eiioiiiai ioaaoa ac?ineuo ia 2-3-e?aoioth
?aaaeoeeiaoeeth AAeN-i. Iieacaii, /oi n?aaee ac?ineuo, ia eiathoeo
caueoiiai o?iaiy i?ioeaiaeeooa?eeiuo aioeoiene/aneeo aioeoae, 53,6%
?aaae?otho ia aaaaeaiea aaeoeeiu ii oeio aoi?e/iiai, 27,3% — ii oeio
ia?ae/iiai eiioiiiai ioaaoa; o 6,5% eeoe ioia/ai neaaue, iaaeeaiiue
ioaao, a 12,6% ioianaiu e ?ao?aeoa?iui eeoeai, ia ioaa/athuei ia
iiiaie?aoiia aaaaeaiea aiaoieneia au?aaioeie caueoiiai o?iaiy aioeoae.
Iiauoaiiay caaieaaaaiinoue, nia?oiinoue e eaoaeueiinoue io aeeooa?ee
ac?ineuo a aic?anoa 40-49 eao iauyniyaony n iiceoeee iiioeyoeeiiiie
aaiaoeee: aeaaiaea?y oniaoai ianniaie aaeoeeiaoeee e ?aceiio nieaeaieth
aeaoneie nia?oiinoe io aeeooa?ee a ia?aii iineaaiaiiii iieieaiee
aic?inea aeiey ?ao?aeoa?iuo e aaeoeeiaoeee a yoie aic?anoiie a?oiia (aei
19,2% ii n?aaiaieth n 7,2% o eeoe noa?oa 18 eao). Ia iniiaa eco/aiey
no?oeoo?u iiioeyoeee aicaoaeeoaey a ?acee/iua ia?eiaeu yieaeaie/aneiai
i?ioeanna, ii?aaeaeaiu eiaeeeaoi?iua aaeoa?eieiae/aneea iieacaoaee
ninoiyiey yoie iiioeyoeee (niioiioaiea oieneaaiiuo e iaoieneaaiiuo
ooaiiia C.diphtheriae, iineoaeuenoai iaoieneaaiiuo ei?eiaaaeoa?ee
aeeooa?ee n?aaee i?aeoe/anee caei?iauo eeoe a cae?uouo o/?aaeaeaieyo ia
100 ianeaaeiaaiiuo). N iiiiuueth iieeia?aciie oeaiiie ?aaeoeee
ii?aaeaeaii iaee/ea iayeni?anne?othuaainy aaia oieneiiia?aciaaiey o
10,3% iaoieneaaiiuo ooaiiia C.diphtheriae, auaeaeaiiuo a 12 iaeanoyo
Oe?aeiu a 1997-98 aiaeao. I?iaiaeece?iaaii ea/anoai eaai?aoi?iie e
eeeie/aneie aeeaaiinoeee aeeooa?ee. ?ac?aaioaiu iaoiaee/aneea iiaeoiaeu
e eco/aieth ninoiyiey eeaoi/iuo ?aoeaioi?ia aeey aeeooa?eeiiai oieneia n
iiiiuueth eaeoeiia.

Eeth/aaua neiaa: aeeooa?ey, yieaeaie/aneee i?ioeann, nenoaiiee aiaeec,
yieaeaieieiae/aneee iaaeci?, niaoeeoe/aneay i?ioeeaeoeea,
Corynebacterium diphtheriae, aeeooa?eeiue oienei

S U M M A R Y

Demikhovska O.V. Changeability of diphtheria epidemic process as a
result of social and biological subsystems` interaction. — Manuscript.-
Thesis for degree of doctor of medical sciences on speciality —
14.02.02.- epidemiology.- Gromashevsky Kyiv Research Institute of
Epidemiology and Infectious Diseases, Ministry of Health of Ukraine,
Kyiv, 1999.

Diphtheria outbreak in the 90th of XX century is considered as a result
of the complex interaction between social and biological factors of
epidemic process during the vaccination era. The present stage of
diphtheria evolution was determined by systemic analysis of the
reciprocity of heterogenic populations of the patogene and the host
(man) at all levels from cellular mechanisms of infection to the
regional and global surveillance system. The main clinical and
epidemiological features of diphtheria in Ukraine were described basing
on official date of nearly 16000 cases of illness during 1992-1998 yrs.
The immunological effectiveness of overschedule revaccinations for
children and 2-times revaccination for adults was evaluated.
C.diphtheriae population’s structure and changes of its biotypes,
toxigenicity and keeping of silent tox-gene during preepidemic,
epidemic and early postepidemic periods was studed. The approach to the
studying of the state and structure of cellular receptors for diphtheria
toxin by plant lectins is worked out.

Key words: diphtheria, epidemic process, system analysis, epidemic
surviellance, vaccinoprophylaxis, Corynebacterium diphtheriae,
diphtheria toxin.

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