The review focuses on respiratory syncytial virus infection (RSVI) and, based on the literature and authors' own observations, highlights epidemiological aspects and risk factors for RSVI (including severe forms of the infection), the specific clinical manifestations, challenges of laboratory diagnostics, and the benefits of various methods and their relevance in clinical practice. The available types of RSVI therapies are discussed based on meta-analyses of the data. The authors emphasize the importance of palivizumab in the specific passive prevention of respiratory syncytial virus infection in children from risk groups.

The article presents modern approaches to rational pathogenetic therapy of intestinal infections in children based on existing national and international protocols for the treatment of infectious diarrhea. Approaches to carrying out oral rehydration using solutions with reduced osmolarity are described in detail. The use of solutions with osmolarity 225–240 mOsm/l allows reduction of the diarrhea duration and contributes to improvement of outcomes.

The article presents data on the relevance of meningococcal infection and the possibility of its prevention by vaccination. Spend a literary analysis of the efficacy and safety of vaccines against meningococcal disease. The results of the epidemiological effectiveness of vaccination at mass use of conjugated vaccines.

Acute infectious diarrhea in children is a global healthcare challenge [1]. In 2015, the incidence of acute intestinal infections (AII) in the Russian Federation amounted to 545.89 per 100 thousand people; that is almost exactly the same as in 2014. AII of unknown etiology account for 63.44% of cases. There are still significant differences in the effectiveness of the etiological diagnosis of AII in different areas of the Russian Federation. Along with a reduction in the incidence of separate nosologies, the incidence of campylobacteriosis increased by 30.3%, rotavirus by 14% and norovirus by 26.4% [2].

Influenza is an acute highly contagious respiratory viral infection with a propensity for epidemic spread, affecting all age groups in various geographical conditions. A large number of annually registered cases of severe/complicated course of influenza and deaths are primarily due to the high incidence and involvement in the epidemic process of persons at risk of adverse course of the disease. The main task of the practitioner is to prevent development of severe and complicated forms of influenza that can be achieved at the expense of early diagnosis of influenza and correct evaluation of the condition of the patient given the signs of the progressive course of the disease, and by the timely indication of etiotropic therapy. The antiviral therapy should be indicated within 48 hours from the first symptoms of the disease to all patients with laboratory confirmed diagnosis «flu», as well as to patients with suspected influenza infection with a high risk of complications, regardless of vaccination status against influenza and regardless of the severity of the disease. Seasonal influenza viruses A(H3N2) and A(H1N1)pdm09 currently circulating on the territory of the Russian Federation, are characterized by high sensitivity to neuraminidase inhibitors — oseltamivir and zanamivir, which allows us to recommend these drugs as first-line drugs for the etiotropic therapy of flu.

Along with etiotropic antiviral therapeutic schemes, treatment of chronic viral hepatitis today involves administration of medications that eliminate the clinical manifestations of the disease. In particular, the use of ursodeoxycholic acid (Urdoxa®), with its high safety profile and good tolerability in case of long-term administration, is justified for the effective prevention of cholestasis.

The purpose of the review is to evaluate the efficacy and safety of using pangenotypic combination «of Sofosbuvir/Daclatasvir» — the direct action antiviral drugs in the treatment of chronic HCV infection at different stages of liver damage.

Main provisions: Sofosbuvir is the antisense nucleotide, inhibiting RNA-dependent RNA-polymerase NS5B, this drug has earned a reputation as one of the strongest anti-replication drugs, including when there is interferon resistance. Daclatasvir is a powerful non-nucleotide inhibitor of NS5А protein, catalyzing formation of replicative complexes. Both components are proven to be effect against HCV genotypes 1-6. Their combination provides pangenotypic activity, and the mutual strengthening effect diminishes the risk of development of drug resistance. Indications for the administration of a combination «Sofosbuvir/Daclatasvi» are: treatment of HCV infection at the stage of acute hepatitis (for genotypes 1–6 of the virus), treatment for HCV infection at the stage of chronic hepatitis (for genotypes 1–6 of the virus), treatment of HCV infection in co-infection with HIV, treatment of HCV infection at the stage of liver cirrhosis, treatment of recurrent HCV infection after liver transplantation, treatment of HCV infection with immune manifestations.

Conclusion: the combination «Sofosbuvir/Daclatasvir» is shown to be highly effective in the treatment of HCV infection of genotypes 1-6 with a frequency of SVR 93—97% at the stage of the hepatitis and 88—95% — at the stage of cirrhosis. Good tolerance and high efficiency has led to active use of this combination фе the stage of cirrhosis. This combination has been successfully used for the treatment of recurrence of HCV infection in the liver graft, including co-infection with HIV.

Among the most important links in the pathogenesis of diffuse liver diseases (DLD) are macro- and microhemodynamic disorders that can develop in the liver and in the systemic circulation [2, 3, 7, 12]. Chronic hepatitis (CH) and especially liver cirrhosis (LC) are accompanied by disorders of the portal and systemic circulation, development of portal hypertension which leads to the emergence of portosystemic collaterals and hyperdynamic circulation [2, 3, 7, 12]. The resulting rheological changes in the blood, disorders of systemic hemodynamics run in parallel with the microcirculatory (MC) pathology. [8, 9, 12] In this condition, the inflammatory and reparative processes, maintainance of the adequate level of biochemical reactions in the tissues, cellular functions and changes in blood coagulation system are determined by the microcirculation (MC) status [2, 3, 12].

Modern approaches to the prevention and treatment of chronic hepatitis B are based on the use of vaccination of the population, on the one hand, and rational choice of antiviral therapy schemes in patients - on the other. This allows the physician to predict results of treatment and preventive measures. Modern analogues of nucleosides, in particular, Entecavir, has high efficacy, good tolerance and high safety profile when used in long term conditions.

The article examines the efficacy and safety of HIV integrase inhibitors (raltegravir, dolutegravir) in antiretroviral therapy (ART) regimens in various groups of HIV-infected patients: patients with high HIV RNA blood levels, patients with low CD4-lymphocytes blood count, pregnant women, patients with tuberculosis or chronic hepatitis C, and patients in later years and /or with high cardiovascular risk, neurocognitive disorders. Particular attention is paid to the minimal risk of developing delayed ART complications in using raltegravir in ART regimens and combining raltegravir and drugs of various classes.

As part of the global strategy against HIV, UNAIDS formulated the 90-90--90 targets. The targets mean that 90% of people living with HIV and receiving treatment should have achieved viral suppression. One of the main obstacles to achieving the goal is HIV resistance to antiretroviral therapy. It occurs when the virus mutates and affinity of active ingredients of drugs for the corresponding viral proteins is reduced. Drugs differ by the genetic barrier. Non-nucleoside reverse-transcriptase inhibitors lose their ability to inhibit the replication after a single mutation, and ritonavir- boosted protease inhibitors - after 5--8th mutation. The key factor for adequate viral suppression and reduction of risks is good adherence to treatment. Medication non-adherence creates a favorable environment in the body for the evolution of the virus. In the Russian Federation, the prevalence of primary resistance reaches 6.02%, and poor adherence equals 26%. The data and the results of examinations for mutations should be considered when selecting an antiretroviral regimen and approach to patient to improve adherence.

The guidelines for treatment of patients with HIV infection developed in the United States (DHHS) and the European Union (EACS) are the most globally recognised. They are used in the development of many national guidelines, including those in Russia. The guidelines of the European Union and the United States are specific in that they are characterized by high scientific validity and target countries with high income per capita. In the process of the guidelines evolution, they tended to update the recommended drugs with more efficient, safe and easy to use medications; they expanded the list of indications for antiretroviral therapy to the extent that it was recommended to all HIV patients regardless of clinical manifestations and the level of CD4 cells. The article also analyzes the changes that the guidelines underwent over the past 6 years. There are recent versions of the guidelines.

Rotavirus infection is the second after pneumococcal cause in the incidence of diseases and mortality in children under 5 years. That has defined the who’s recommendation for the introduction of vaccination against rotavirus infection in the vaccination schedules of all countries of the world. In our country that vaccination recommended for epidemic indications for introduction into the regional program. However, vaccination is carried out only in certain regions. One of the reasons for low uptake of this vaccine is the underestimation of the burden of disease.

The aim the study. To assess the significance of rotavirus gastroenteritis in the structure of acute gastroenteritis in children under 5 years receiving treatment in outpatient clinics, to study the genetic diversity of rotaviruses, to compare the costs associated with the treatment of acute rotavirus and non-rotavirus gastroenteritis.

Methods. Prospective, observational, epidemiological study. The inclusion of participants under the age of 5 years with the symptoms of acute gastroenteritis who meet the criteria of inclusion/exclusion. Examination, medical history, samples of faeces were carried out in the first day of treatment (day of inclusion in the study). Parents were given a questionnaire for 14 days. The severity of the disease was determined according to the scale of Vesicare, the disease dynamics was assessed by the answers of the questionnaire. Examination of feces samples was carried out centrally by PCR. Rotavirus positive samples were genotypically PCR and in case of detection of rare genotypes have been sequenced genomic RNA.

Results. The study included 501 baby — boys — 286 (57,1%), girls — 215 (42,9%). The average age was 22.6 ± 15.2 months. 50 children (10.0 per cent) mentioned various background pathology, the others were deemed healthy. Rotavirus was diagnosed in 151 patients 31.4% (95% CI: 26.9 percent - 35.3 percent), which accounted 66,52% (151 of 227) among all cases with confirmed etiology. Genotyping was prevalent G1P [8] to 34.5%, and G4P[8] — 39,2%. Clinical manifestations in rotavirus gastroenteritis was more severe, severe course observed in 65.5% of cases in the comparison group -at 30.4%. Significantly more often than in the comparison group (Р χ2 < 0,001) was observed vomiting (140
cases из151 — 93,3%, compared to 239 of 336 -71,1%) and elevated temperature (146 of 151 — 97,3% compared with 254 of 336 — 75,6%). The average temperature was 38,5 ± 0,6 OS in the comparison group — 38,0 ± 2,2 OS, remained 3,1 ± 1,4 and 2.5 ± 1.2 day, respectively. The frequency of episodes of diarrhoea in the first day of illness was 6.4 ± 2.7 times, in comparison with 5.2 ± 2.8, duration of diarrhea was 6.3 ± 3.2 days and 4.5 ± 2.6 days. The costs for parents of patients with acute rotavirus gastroenteritis was (M ± SD) 2873.4 ± 2276.4 rubles, against 2007.4 ± 2150.4 rubles in the comparison group (t = 3.965; p= < 0,001, as amended by Starlite for inequality of variances).

Conclusion. The introduction of routine vaccination of children in the first year of life will reduce by more than a third of the number of appeals to medical institutions about intestinal infections and partially prevent the costs associated with the treatment of this pathology.

The article tells about the evolution of the etiotropic treatment of patients with shigellosis. The key principles of treatment of the disease are demonstrated. Taking into account the variability of the pathogen, the etiotropic use of fluoroquinolones in the 90s of the 20th century is substantiated. The dynamics of shigella infection in the Russian Federation over the past 15 years against a background of fluoroquinolones is highlighted.

The article discusses the problem of COPD combined with CAD, determination of inflammatory markers and the prognostic BODE, DOSE and ADO indices. The aim of the study was to evaluate the effect of PCV13 immunization on clinical and functional manifestations of systemic inflammation in patients with COPD and CAD, as well as the relationship with the prognostic markers. Material and methods: The study included 36 male patients with COPD and 36 patients with COPD and CAD, FC II-III stable angina who were treated at Regional Clinical Hospital _4 in Chelyabinsk during the period 2015--2016. Conclusions: 1. Patients with COPD combined with CAD had statistically significant clinical and functional disorders manifested by an increase in the degree of dyspnea and reduction in FEV1. 2. In patients with COPD concomitant with CAD, against the background of the comorbidities, the levels of systemic inflammation markers — C-reactive protein, fibrinogen and procalcitonin — were more overt than in patients only with COPD. 3. Monitoring changes in procalcitonin levels could be used as an additional highly informative method for estimating the probability of the presence of bacterial inflammation and effectiveness of therapy. 4. The prognostic BODE, DOSE and ADO indices tend to decrease unidirectionally under the impact of vaccination with pneumococcal conjugate vaccine. 5. PCV13 can reduce the level of systemic inflammation within 1 year after its application.

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease of zoonotic nature, characterized by systemic lesions of small vessels, hemorrhagic diathesis, hemodynamic disorders and a peculiar renal disease (interstitial nephritis with acute renal failure).

The article summarizes the results of randomized clinical and epidemiological field studies to assess the reactogenicity and immunogenicity of the national combined vaccines against diphtheria, pertussis, tetanus and hepatitis B - Bubo-M and Bubo-Coc, and the experience of their use within the National Vaccination Schedule.