Pneumococcal infections remain a major medical problem associated with high morbidity and mortality. Moreover, the resistance of Streptococcus pneumoniae to conventional antibiotics is constantly growing. The implementation of pneumococcal conjugate vaccines (PCVs) in the last decade has dramatically reduced the incidence of the vaccine type-associated invasive pneumococcal diseases in many countries. However, information on the seroepidemiology of S. pneumoniae in Russia is limited. We report the results of serotyping and antibiotic susceptibility testing performed on 863 non-invasive pneumococcal isolates collected prospectively in 2009-2013 from children (median age 3.5 years) who sought medical care at five pediatric hospitals in Moscow. The isolates were recovered from the nasopharynx (71.2%), middle ear fluid (14.3%), and lower respiratory tract specimens (13.6%). In total, we identified 45 different serotypes. The six leading serotypes (prevalence >5%) included 19F (21.7%), 6B (12.8%), 23F (10.1%), 14 (9.0%), 6A (8.4%), and 3 (7.5%). Serotype 19A isolates had a prevalence of 2.3%. The proportion of PCV-13 serotypes was 78%; the coverage by PCV-7 was 58.2% and was similar to that of PCV-10 (59.8%). The rate of multidrug-resistant pneumococci (i.e., resistant to ≥3 antimicrobials) was 22%. The majority of the multidrug-resistant isolates were serotype 6B, 14, 19A, and 19F. Penicillin non-susceptibility was displayed by 28% of the isolates. The resistance rate to erythromycin was 26%. Among the examined erythromycin-resistant strains, 54% had the erm(B) gene and 13% had the mef gene as a single resistance determinant, whereas both determinants were found in 31% of these strains. Our data predict a good coverage of the circulating S. pneumoniae by the PCVs and could be useful for evaluating the serotype distribution in support of the introduction of PCV in Russia. In addition, the antimicrobial resistance rate of S. pneumoniae in Russia is substantial, and the emergence of pneumococcal strains with a dual macrolide resistance mechanism is alarming.

WHO recommends the inclusion of PCVs in childhood vaccination programs world-wide. Many countries including the Russian Federation are currently planning the inclusion of PCVs in their National Immunization Programs and, therefore, data on the pneumococcal serotype distribution is important to estimate the potential disease impact. Here we review eight recent epidemiological studies on the pneumococcal serotype distribution from Russia. Across all studies, serotypes 6B, 14, 19F and 23F were the most prevalent. Interestingly, serotype 3 was relatively common. Serotype 19A was prevalent among AOM, CAP and nasopharyngeal isolates and among antibiotic resistant isolates in all age groups. The differences in serotype coverage between PCV10 and PCV13 were up to 26%. Based on the current data on serotype distribution, a wide use of PCVs in Russia may lead to a significant reduction of the pneumococcal disease burden.

The Ministry of Health of the Russian Federation jointly with professional association and experts in the field of pediatrics, infectious diseases and resuscitation has revised guidelines “Clinical Features and Management of the Disease Caused by New Coronaviral Infection (COVID-19) in Children” in order to provide the child population with effective medical care during the pandemic of the new coronaviral infection. The practical experience of specialists from various countries was considered during the development of this document. Special attention should be given to the evidence base of the presented data, as well as to the efficiency and safety issues of medications used in treatment of coronaviral infection and its complications. The authors highlight the problems of prevention, diagnostics and management of pathological conditions caused by COVID-19 in the article according to the presented guidelines. Patient’s management is presented depending on the age and severity of the disease itself. The therapy is considered with regard to etiological, pathogenetic and symptom focus.

The article is devoted to acute respiratory viral infections (ARVI) in children. ARVI take one of the leading places in a childhood morbidity structure. The article provides an overview of the clinical guidelines developed and approved by the professional association «Union of Pediatricians of Russia» for acute respiratory infections in children. These guidelines summarize the experience of the leading world and domestic specialists, contain scientific and practical data that correspond to the most relevant trends in the management of children with this pathology. The authors present modern information on the etiology, pathogenesis, classification, clinical findings and differential diagnosis of various nosological forms of acute respiratory tract infections in the pediatric population. The general (strategic) principles of drug-free and drug treatment are discussed in detail.

The Ministry of Health of the Russian Federation jointly with professional association and experts in the field of pediatrics, infectious diseases and resuscitation has developed guidelines “Clinical Features and Management of the Disease Caused by New Coronaviral Infection (COVID-19) in Children” in order to provide the child population with effective medical care during the pandemic of the new coronaviral infection. The practical experience of specialists from various countries was considered during the development of this document. Special attention should be given to the evidence base of the presented data, as well as to the efficiency and safety issues of medications used in treatment of coronaviral infection and its complications. The authors highlight the problems of prevention, diagnostics and management of pathological conditions caused by COVID-19 in the article according to the presented guidelines. Patient’s management is presented depending on the age and severity of the disease itself. The therapy is considered with regard to etiological, pathogenetic and symptom focus.

Данные о распределении серотипов Streptococcus pneumoniae в РФ крайне ограничены. В России лицензированы три пневмококковых конъюгированных вакцины, но еще ни одна из них не реализована в рамках национальной программы по иммунизации населения. Вместе с тем именно сведения о серотиповом спектре пневмококковых инфекций могут рассматриваться как прогностический критерий эффективности национальных программ вакцинации. Целью настоящего исследования явилось определение циркулирующих серотипов S. pneumoniae и распространенность инфекций пневмококковой этиологии в структуре бактериальных инфекций у госпитализированных в 5 стационаров Москвы в 2011–2012 гг. детей младшего возраста. Всего в исследование было включено 864 пациента. Подавляющее большинство (86%) пациентов составили больные острым гнойным средним отитом и синуситом. Внебольничная пневмония была диагностирована у 9% больных, сепсис и бактериемия — у 3,6%, гнойный менингит — у 1,2% пациентов. Выявлено, что S. pneumoniae является основным патогеном в структуре назофарингеального носительства у госпитализированных по поводу острой бактериальной инфекции детей младше 5 лет, а также ведущим бактериальным возбудителем острого среднего отита в этом возрасте. При анализе назофарингеального носительства пневмококка преобладающими оказались серотипы 19F, 14, 23F, 3, 6A и 6В, они встречались в 3/4 всех случаев, причем наиболее высока доля серотипа 19F (> 20%). Разнообразие выделенных серотипов S. pneumoniae в жидкости среднего уха было менее значимым (всего 17 серотипов против 24 в носоглотке). Среди них доминировали следующие пять: 19F, 3, 14, 23F, 6B, 19А (суммарно > 75%). Частота выявления 3 и 19А серотипов в жидкости среднего уха значительно превышала таковую при назофарингеальном носительстве. При исследовании инвазивных инфекций в нашем исследовании были выявлены серотипы 14, 23F, 3 и 15С. Эти данные могут быть использованы в качестве отправной точки для мониторинга и оценки в будущем влияния вакцин PCV на эпидемиологию серотипов и антибиотикорезистентность S. pneumoniae в стране после введения PCV в национальный календарь вакцинопрофилактики.