Incidence Of Diarrheal Infections In Ukraine: Epidemiological Peculiarities

Background : Diarrheal infections remain relevant for many countries of the world. The processes of globalization, fundamental changes in nutrition and water consumption contributed to the fact that the significance of individual infection sources, etiological structure of diarrheal infections changed. Purpose of the study: on the background of the analytical study of the incidence of diarrheal infections in Ukraine under the current conditions, to determine the factors influencing epidemic situation. Methods: The reports of the Ministry of Health of Ukraine, Main Administrations of Statistics in Kharkiv, Odesa, Zaporizhia oblasts for 2011-2018 are used in the paper. Epidemiological and statistical research methods are applied. Results: The epidemic situation with diarrheal infections in Ukraine is characterized by a low incidence of typhoid fever (from 0.012 to 0.14 per 100 thousand people), shigellosis (from 1.97-6.13 per 100 thousand people), stable incidence rates without the downward trend, salmonellosis (from 17.35 till 24.1 per 100 thousand people), high incidence of diahrreal infections of specified etiology (from 115.5 to141.9 per 100 thousand people) and diahrreal infections of unspecified etiology (from 69.76 to 107.02 per 100 thousand people). The most complicated epidemic situation is observed in economically most developed regions of the country. Most diarrheal infectionsoutbreaks are connected with catering establishments 36.5 % and with children educational establishments 26.1 %. In the region with the highest shigellosis and salmonellosis incidence direct strong correlation relationships are established between the incidence and population, density, natural population movement. The oblasts with the highest diahrreal infections of specified etiology, rotaviral enteritis, diahrreal infections of unspecified etiology incidence are at least provided with water resources and have problems with provision of high-3 quality drinking water. There is a need to improve the system of epidemiological surveillance over diarrheal infections by extension of the indicators of microbiological study of drinking water quality in the regions of Ukraine, where high diahrreal infections of specified etiology, rotaviral enteritis, diahrreal infections of unspecified etiology incidence is registered; by increasing frequency of food item inspections in the oblasts, where mediana shigellosis and salmonellosis incidence exceeds the average one in Ukraine.

quality drinking water. There is a need to improve the system of epidemiological surveillance over diarrheal infections by extension of the indicators of microbiological study of drinking water quality in the regions of Ukraine, where high diahrreal infections of specified etiology, rotaviral enteritis, diahrreal infections of unspecified etiology incidence is registered; by increasing frequency of food item inspections in the oblasts, where mediana shigellosis and salmonellosis incidence exceeds the average one in Ukraine. Keywords: diarrheal infections, shigellosis, salmonellosis, rotaviral enteritis.

Background
Diarrheal infections (DI) remain relevant for many countries of the world [1,2]. The incidence is high enough both in developing countries and economically developed countries [3,4].
The processes of globalization, increase in migratory movements, development of international tourism, fundamental changes in nutrition and water consumption contributed to the fact that the significance of individual infection sources, ways of invader transmission, etiological structure of DI changed [5,6]. On the background of general environmental degradation and decrease in the immune status of population, the role of opportunistic pathogens (OP) and viruses has increased [7,8].
Objective of the paper: on the background of the analytical study of the incidence, etiological structure of DI in Ukraine under the current conditions, to determine the factors influencing epidemic situation (ES). 4 study outcome is carried out using software application Microsoft Office Excel 2010, SPSS, 12, Statstica 6.

Results
It has been established that in Ukraine in 2011-2018 typhoid fever incidence varied from 0.012 to 0.14 per 100 thousand people. Herewith, typhoid fever cases were registered only in separate regions of Ukraine: Dnipropetrovsk, Donetsk, Zakarpattia, Ivano-Frankivsk, Mykolaiv, Odesa, Ternopil, Kharkiv, Khmelnytskyi oblasts and in the city of Kyiv. Shigellosis incidence ranged from 1.97 per 100 thousand people to 6.13 (Fig. 1 It should be noted that the ES with DI nowadays was determined by sporadic morbidity, as the part of people involved in outbreaks was miserly only 1.6 %.
In order to determine the factors, which could influence DI incidence, the demographic situation in the regions of Ukraine with the highest DI incidence was studied.
Kharkiv oblast, where the highest shigellosis and salmonellosis incidence was registered, Campylobacter bacteria according to the report of the European Food Safety Authority and the European Centre for Disease Prevention and Control for 2017, are one of the most common reasons of the zoonotic diseases of food origin [11]. Incidence of the infections caused by Y. Enterocolitica is carefully controlled in the developed countries. In Africa and in the Middle East, due to the problems of diagnostics, the actual ES with intestinal yersiniosis is unknown [12]. In Ukraine the cases of campylobacter enteritis and intestinal yersiniosis were registered only in separate cases in its separate regions. Ukraine does not only has problems in provision with water resources but the situation is complicated also with the fact that their territorial distribution is uneven and does not comply with placement of water-containing economic complexes [13,14,15]. The highest level of water supply of the inhabitants is in the western and eastern oblasts of Ukraine.
The fewest number of water resources is in the southern oblasts of Ukraine, in Donbas,

Kryvorizhia.
On the background of insufficient water supply, serious problems have accumulated in Ukraine connected with industrial and public utility pollution of the water bodies, great worn-out state of water-supply and sewerage networks, low productivity of treatment facilities.
Researchers have proven that under the conditions of chronic man-made pollution of drinking water with harmful physical and chemical substances, the effect of DI agent influence can be enhanced both due to strengthening of its pathogenic peculiarities and significant decrease in resistance of susceptible persons [16,17].
As it has been already noted, the most unfavorable situation with DISE, RE is observed in In Odesa oblast, where DIUE incidence exceeds the average one in Ukraine by several times, the water supply for population is also mainly carried out from the surface sources of drinking water supply (the Dunai river and Danube lakes). The situation with water supply is complicated with the fact that the part of rural population uses imported water as the drinking one.
The water-supply system of Kharkiv oblast, where the highest shigellosis and salmonellosis incidence is registered, differs from the southern oblasts of Ukraine. The population is provided with water from the underground artesian springs and rivers -the Siverskyi Donets, Dnipro.
Taking into consideration the above mentioned, we consider the environmental state of the surface water bodies and water quality in them to be the important factors determining DI incidence, their etiological structure. Under the conditions of anthropogenic pressure, significant changes in the structure of microbiocinoses of aquatic ecosystems happen, the levels of viral contamination increase, the frequency of gramnegative and opportunistic pathogens increases, which is non-standardized by the documents of water-sanitary legislation.
During microbiological study of the municipal drinking water, total bacterial count, total coliforms, coliform bacterium, enterococci, coliphages are determined in its samples. If coliphages are found out in the samples of drinking water, virus studies are conducted.
Considering the situation with DISE and DIUE incidence, it can be assumed that the

4.
The epidemic process of DI is indirectly influenced by social factors. In the region with the highest shigellosis and salmonellosis incidence (Kharkiv oblast) direct strong correlation relationships are established between the incidence and population, density, natural population movement (r= from 0.779 to 0.908) (р<0.05). The oblasts with the highest DISE, RE, DIUE incidence (Zaporizhia and Odesa oblasts) are at least provided with water resources and have problems with provision of high-quality drinking water.

5.
There is a need to improve the system of epidemiological surveillance over DI by