[Propagation of hepatitis E virus in an endemic and nonendemic regions]. / Osobennosti rasprostraneniia virusa gepatita E v éndemichnom i neéndemichnom regionakh.

The role of hepatitis E (HE) in sporadic morbidity at an endemic territory (Southern Uzbekistan) and the incidence of anti-HEV in different populations of a nonendemic region (Russia) were evaluated. Antibodies to HEV were detected in 22.1% of patients with acute HE, including mixed infections (+ HA or HB), in the Dekhkanabad district of Kashkadarya region in 1993. The estimated incidence of acute HE was 51.7 per 100,000 population. Analysis of monthly incidence of acute HE demonstrated a seasonal pattern of the morbidity: more than 80% of total recorded cases occurred in August-September. These data indicate the presence of group HEV infections and an important role of this infection in the structure of acute viral hepatitis at the endemic territory. Anti-HEV were found in some population groups at a nonendemic territory: in free-of-charge blood donors in Surgut (4%), in patients with HIV infection (1.6%), and in medical workers in Moscow (1.1%).

[The current problems in the epidemiology and prevention of viral hepatitis B and C in the Russian Federation]. / Aktual'nye voprosy épidemiologii i profilaktiki virusnykh gepatitiov B i C v Rossiiskoi Federatsii.

The data on the epidemiological situation with hepatitides B and C in the Russian Federation in 1991-1998 are presented. Morbidity rates in hepatitis B, registered during the recent 3 years, were 35.8 (1996), 36.3 (1997) and 35.7 (1998) per 100,000 of the population. Morbidity rates in acute hepatitis C were 3.2 (1996), 9.1 (1997) and 11.6 (1998) per 100,000 of the population. Different regions of the Russian Federation were noted to have pronounced differences in the activity of the epidemic processes of hepatitides B and C.

[The vaccinal prophylaxis of hepatitis B in Russia--the achievements, problems and outlook]. / Vaktsinoprofilaktika gepatita B v Rossii--dostizheniia, problemy, perspektivy.

Certain specific features of the present epidemic situation with hepatitis B (HB) in Russia were established: significant growth of HB morbidity, starting from 1995; the prevalence of persons aged 15-29 years among HB patients, which was linked with the sharp activation of the sexual route of the transmission of HB virus in recent years; an essential increase in the number of patients having contacted this virus in the process of the intravenous use of drugs. The results of the use of vaccine "Engerix B" among persons belonging to different risk groups were considered (a decrease in HB morbidity among them by 8-19 times was noted), the study demonstrated high immunogenicity anti-HBs antibodies on protective titers were determined in 92.3-95.7% of the vaccinees) and low reactogenicity of the vaccine, as well as stable postvaccinal immunity (5 years after the course of vaccination was completed anti-HBs antibodies were retained in 70.6-74% of the vaccinees). The study showed that only the vaccination of adolescents in combination, in the presence of opportunity, with the immunization of newborn infants and young children in the first year of their life made it possible to produce an essential effect on the activity of the epidemic process. Already in 2 years such organization of work on the prophylaxis of HB in one of the cities of the Sverdlovsk region led to a decrease in HB morbidity by 2.9 times, and among adolescents 9 times.

[Spread of infection with hepatitis B and C viruses in different population groups of north-western Ukraine]. / Shirota infitsirovaniia virusami gepatitov B i C razlichnykh grupp naseleniia Severo-Zapadnoi Ukrainy.

The detection rate of specific markers of hepatitides B and C among the child and adult population, including 487 children in 5 boarding schools, 338 oncological, hematological, urological patients and 206 medical staff members in Rovno and the Rovno region (North-Western Ukraine), was determined. In boarding-school the markers of HB (HBsAg, anti-HBs, summary anti-HBc) were detected 3.5 times more often than among the child population in general (in 28.3 and 8.0% respectively). In children staying in a boarding school for up to 1 year (126 children) these markers were determined in 23% of cases, and in those who stayed there for 3-5 years, in 58.1% of cases. Among the members of the groups where children with HBsAg were found the markers of HB occurred 3.3 more often then among the children in the groups having no HBsAg carriers (45.3 and 13.9% respectively). The detection rates of the markers of HB in children with various kinds of C.N.S. pathology (first of all, with mongolism) and without concomitant diseases were sharply different (they were found, respectively, in 52.9 and 19.6%, including HBsAg in 17.4 and 2.7%). At the same time the detection rate of anti-HCV among boarding-school children (including those with C.N.S. lesions) was no different from that among the child population in general, which was indicative of great differences in the activity of the nonartificial transmission routes HB and HC viruses. Patients with oncological, hematological and urological diseases who had great "parenteral load", as well as medical staff members, formed a high risk group for being infected with both HB and HC viruses.

[Spread of hepatitis C and separate genotypes of hepatitis C virus in a region with a moderately active epidemic process]. / Rasprostanenie gepatita C i otdel'nykh genotipov virusa gepatita C v regione s umerennoi aktivnost'iu épidemicheskogo protsessa.

The prevalence of hepatitis C virus (HCV) is studied in different age and risk groups in the city of Vladimir and the genotypes of the virus circulating at this territory are determined. Anti-HCV are detected in 2.4% donors and 1.4% pregnant women. Population immunity to HCV gradually increases with age. AntiHCV are detected in 0.9% children aged 3-6 years, in 1.8% in the group aged 20-29 years, and in 2.9% in the group aged 30-39 years. Medical workers, mental inpatients, hematological patients, patients hospitalized at hemoperfusion departments, and imprisoned subjects were referred to groups at risk of HCV infection: antiHCV were detected in 3.9, 5.4, 13.8, 53.6, and 24.5% of these groups, respectively. Genotype 1b predominates in the structure of HCV genotypes circulating in Vladimir: 72.9% in all examined population groups. In addition to this genotype, genotypes 2a, 2b, and 3a were detected (2.9, 2.9, and 15.7%, respectively). Genotype 3a was the most incident in children aged 0-14 years.

[The risk of becoming infected with hepatitis B and C viruses in the pupils of children's boarding schools]. / Risk infitsirovanii virusami gepatitov B i C vospitannikov detskikh internatnykh uchrezhdenii.

The risk of contamination of 487 inmates of 5 boarding schools at northwestern Ukraine with hepatitis B (HB) and hepatitis C (HC) viruses was analyzed and the role of some factors facilitating the spread of these infections among the inmates of such schools was shown. In 28.3 +/- 2.2% of the inmates the presence of HB markers was detected, while these markers occurred only in 7.2 +/- 1.9% of children attending open schools. During the survey of the child population the presence of HB markers was detected in 8.0 +/- 1.1%, which was significantly lower than among the inmates of boarding schools (p < 0.001). Among such markers, HBsAg was detected in 8.3 +/- 0.5% of the inmates and in 1.6 +/- 0.5% of other children living in the area. Among inmates with CNS pathology the sum of markers was significantly higher than in inmates without such pathology (52.9 +/- 3.8%). The occurrence of the markers was shown to depend on the duration of staying in a boarding school and on the presence of the source of infection in the collective. Anti-HCV were detected in 1.4 +2- 0.6% of the inmates of boarding schools and in 0.5 +/- 0.3% of the whole child population.

[The vaccinal prophylaxis of hepatitis B among children born to mothers with persistent HBs-antigenemia]. / Vaktsinoprofilaktika gepatita B sredi detei, rodivshikhsia ot materei s persistiruiushchei HBs-antigenemiei.

In Uzbekistan and Moldova 542 children born of HBsAg carriers were immunized against hepatitis B (with vaccine Engerix B according to the immunization schedule of 4 injections). Anti-HBs antibodies in protective titers were detected by EIA and RIA techniques in 76.7% of children aged 4-5 months after the 3rd injection, in 95.7% of children aged 15-16 months and in 90.0% of children aged 2-2.5 years after the 4th (booster) injection. In the control group (117 nonimmunized children born of HBs carriers) observed during the same period anti-HBs antibodies were detected significantly less frequently (in 7.3%, 11.6% and 12.9% of these children respectively). 1-2 months after the course of immunization was completed 74.1% of the immunized children had high anti-HBs antibody titers (exceeding 1000 IU/ml) with their subsequent decrease by 2-2.5 years of age. In the control group these figures were 27.1% and 29.0% respectively. The index of immunization effectiveness obtained by the comparison of the hepatitis B morbidity rates in both groups was 7.8. No postvaccinal complications were registered.

[Genotype of hepatitis C virus in hemophiliacs]. / Genotipy virusa gepatita C u bol'nykh gemofiliei.

Testing of blood sera of 63 hemophiliacs revealed markers of hepatitides B and C in 97 and 98% cases, respectively. Polymerase chain reaction confirmed the presence of hepatitis C virus (HCV) RNA in 31 (94%) out of 33 sera tested which contained antibodies to HCV. Gene typing of the isolated strains revealed the presence of three types of HCV: 1b (94%), 2a (3%), and 3a (3%). Similar distribution of HCV genotypes was revealed in the blood sera of 39 patients with chronic hepatitis C.

[Prevalence of genotypes of the hepatitis C virus, circulating in northwestern and central parts of Russia]. / Rasprostranenie genotipov virusa gepatita C, tsirkuliruiushchikh na territoriiakh severo-zapadno i i tsentral;no i chaste i Rossii.

Testing of 90 sera for antibodies to hepatitis C virus (HCV) by genotyping methods resulted in determination of the genotype in 83 cases: 47 cases with 1b genotype, 27 with 1a, 7 with 3a, 1 with 2a, and 1 with 2b genotype. Hence, preliminary data indicate the predominance of HCV genotype 1b among patients with hepatitis C in these regions of Russia.

[Risk of infection with hepatitis B and C viruses of medical workers, patients in the hemodialysis ward, and vaccine prophylaxis of hepatitis B infection in these populations]. / Risk infitsirovaniia virusami gepatita B i C meditsinskikh rabotnikov, bol'nykh otdelenii gemodializa i vaktsionoprofilaktika u nikh gepatit B-virusnoi infektsii.

Markers of hepatitis B (HBsAg, anti-HBs) and C (anti-HCV) were detected in 1990-1992 by enzyme immunoassay in 1581 medical workers, 230 last-year students of medical schools, 269 patients hospitalized at hemoperfusion wards, and 701 blood donors. Hepatitis B markers were detected in medical workers two times more frequently than in donors (HBsAg in 4.7 and 2.2% of these, respectively, anti-HBs in 26.2 and 14.0%), and anti-HCV were found almost three times more frequently (in 3.1 and 1.1%, respectively). The incidence of these markers in students of medical schools was the same as in donors. Hepatitis B markers (HBsAg, anti-HBs) were detected in 39.0% of patients of hemoperfusion departments, HBsAg being present in 11.9%, and antiHCV in 25%. A direct relationship was revealed between the incidence of hepatitis B and C markers and duration of treatment at dialysis centers or length of service at therapeutic institutions. Three vaccinations with Engerix B 944 vaccine were administered to 944 medical workers and 162 medical students and four vaccinations in double doses to 40 patients of hemoperfusion centers who had no hepatitis B markers; a month after immunization anti-HBs in protective titers were detected in 91.4, 93.9, and 76.1% of them, respectively, and a year after vaccination these values were 77.2, 82.5, and 53.3%. No cases of hepatitis B, detection of HBsAg, or postvaccination complications in the vaccines were recorded.

[The current problems in the epidemiology and prevention of enteric viral hepatitis in Russia]. / Aktual'nye voprosy épidemiologii i profilaktiki énterial'nykh virusnykh gepatitov v Rossii.

The presence of great differences in the activity of the epidemic process of hepatitis A (HA) in some regions of Russia is shown and the data necessary for establishing the structure of HA foci in groups of children, as well as the proportion of different forms of the disease registered in such foci (the icteric form in 22.7% of patients, the obliterated form in 11.3% of patients, the nonicteric form in 45.5% of patients and the asymptomatic form in 20.5% of patients), are presented. The study revealed that the shedding of HA virus occurred at an early stage (5-10 before a rise in alanine aminotransferase activity in the blood was registered), its excretion lasted for a short time (till jaundice appeared) and no chronic carriership of HA virus was registered. The hospitalization of HA patients after the appearance of jaundice was proved to be unjustified, while measures aimed at the rupture of the fecal-oral mechanism of the transmission of HA virus were shown to have good prospects. The epidemiological features of hepatitis E (HE) are considered. HE cases constituted 2-3.6% of all patients with acute viral hepatitis in Moscow (all these cases were brought from Central Asia). The outbreaks of this infection in the countries of Central Asia were shown to be due to the transmission of the infective agent by the water route. The data on the first results of the use of high-titer specific immunoglobulin for the prophylaxis of HE among 135 pregnant women (only one of these women contacted HE, while in a similar group of women used for control 4 HE cases were registered) are presented.

[Study results and the unresolved problems in the epidemiology and prevention of parenteral viral hepatitis in Russia]. / Itogi izucheniia i nereshennye voprosy épidemiologii i profilatiki parenteral'nykh virusnykh gepatitov v Rossii.

Great differences in the activity of the epidemic process of hepatitis B (HB), the occurrence of HBsAg among the population of different regions of Russia (in the central and northwestern regions among 1.8-2.4% of the population, in Tuva among 9.8% of the population, in Yakutia among 11.6% of the population) and considerable differences in the occurrence of HBeAg among HBsAg carriers in these regions (antibodies to delta virus have been detected in 1.3-5.5% of carriers of this antigen in the European part of Russia and in 21.0% of carriers in Tuva) are shown. The structure of the transmission routes of HB virus, the proportion of the artificial and natural routes of its transmission are analyzed. The data on the frequency of cases of perinatal and intrafamily HB virus infection in regions with different activity of the epidemic process, as well as the data on effectiveness of measures for the prevention of posttransfusion HB and parenteral infection during therapeutic and diagnostic interventions, are given. The results of the use of Engerix B vaccine among 2,500 persons belonging to groups of risk are presented. The proportion of hepatitis C (HC) cases among patients with different kinds of acute and chronic viral hepatitis among the population of different regions and the occurrence of anti-HC antibodies among the population of different regions of Russia (in Moscow and St. Petersburg among 1.1-1.2% of the population, in North Caucasia among 4.5% of the population), as well as in high risk groups (3.1% among medical personnel, 19.4% among drug addicts, 25% among patients of hemodialysis wards, ets), are considered. The structure of transmission routes of HC virus is analyzed, the possible measures for the prophylaxis of HC virus infection are considered.

[The detection of antibodies to the hepatitis C virus and to HBsAg in donors with viral hepatitis and cancerous diseases in the Republic of Moldova]. / Vyiavlenie antitel k virusu gepatita C i HBsAg u donorov, bol'nykh virusnymi gepatitami i onkologicheskimi zabolevaniiami, v Respublike Moldova.

Large-scale and uneven distribution of hepatitis C and B (HC and HB) among free blood donors of different regions of the Moldova Republic was established. The rate of detection of anti-HCV (South 6.2%, North 3.6%) correlated with that of HBsAg detection (south 12.5%, north 4.5%). A great role of HCV in the etiology of acute (among them posttransfusion) hepatitis and chronic hepatitis was demonstrated. A significant frequency of detection of anti-HCV (15%) in children treated in oncohematology wards and receiving multiple hemotransfusions as well as the detected cases of acute posttransfusion HC attest to active realization of this virus transmission in the transfusions of blood and/or its components. The necessity of urgent introduction into the Blood Transfusion Service of the republic of the examination of blood donors for HBsAg, alongside with their examination for the presence of anti-HCV and vaccination prophylaxis of HB in high risk groups is substantiated.

[The spread of hepatitis C markers among the population of regions of Russia and Central Asia]. / Rasprostranenie markerov gepatita C sredi naseleniia nekotorykh regionov Rossii i Srednei Azii.

A total of 2,217 blood serum samples taken from the population of some regions of the former USSR were studied for the presence of antibodies to hepatitis C virus (HCV) with the use of a commercial enzyme immunoassay system (obtained from Ortho, Japan). Perceptible changes in the detection rate of these antibodies throughout the territory of the former USSR were established. Most frequently anti-HCV antibodies were detected among the population of the republics of Central Asia (5.3-2.9%), as well as Tuva and Yakutia (2.5-3.0%), their lowest detection rate was in Moscow (1.3%). In Moscow the results of the assay in adults were positive twice as frequently as in children, and in donors with an elevated level of alanine-transferase activity the presence of these antibodies was confirmed in 8.9% of cases. The frequency of the confirmation of the presence of anti-HCV antibodies by recombinant immunoblotting was 70.7% in all positive sera and 100% in the sera from a group of donors with an elevated enzyme level. In many respects coincidence between the regularities in the spread of viral hepatitic C and hepatitides B, D was noted.

[The importance of the blood transfusion factor in the epidemic process in hepatitis C in the patients of chronic hemodialysis units studied using a computer simulation model]. / Issledovanie znachimosti faktora gemotransfuzii v épidemicheskom protsesse pri gepatitie C u patsientov otdelenii khronicheskogo gemodializa s pomoshch'iu imitatsionnoi komp'iuternoi modeli.

Examinations for the presence of antibody to hepatitis C virus (HCV) were carried out in 144 patients of chronic hemodialysis wards and 83 blood donors. The anti-HCV were found in 26.4% of the patients and only in 1.2% of the blood donors. A definite increase in the incidence of HCV infection in the patients of hemodialysis wards was established in relation to the duration of the treatment, namely from 17.4% in the patients treated for up to 1 year to 37.5% in those treated for 6 years or more. Significant differences were observed in the rate of anti-HCV findings in the patients with kidney transplantation and in those who had not experience this operation. The results obtained by an imitation computer model indicated that the hemotransfusion factor is not the only one determining the high rate of HCV infection in patients of chronic hemodialysis wards, however its influence on the intensity of the epidemic process in hepatitis C in these wards was sufficiently high.

[The incidence of detecting hepatitis C viral antibodies in different age groups of the population in northeastern Ukraine]. / Chastota obnaruzheniia antitel k virusu gepatita C v razlichnykh vozrastnykh gruppakh naseleniia severo-vostochnoi Ukrainy.

Examinations for the presence of antibodies to hepatitis C virus (anti-C100-3) were carried out in 1143 human subjects, residents of the town of Sumy, Ukraine (681 blood donors, 176 school children, 286 subjects hospitalized for abortions and for treatment of acute traumas). Anti-HCV were determined by enzyme immunoassay using a commercial test system "Abbott" of the first generation, with confirmation of the positive findings by neutralization test. Anti-HCV were found in 2.3% free-giving blood donors and in 1.2% career donors, and in 0.8% of schoolchildren aged from 6 to 14 years. In older age groups anti-HCV findings were more frequent (in subjects of 40-49 years 4.0%, 50-59 years 5.26%, 60 years and over 6.25%).

[The epidemiological diagnosis of "fecal-oral" hepatitis E in Tajikistan]. / Epidemiologicheskaia diagnostika "fekal'no-oral'nogo" gepatita E v Tadzhikistane.

On the basis of the results of the retrospective epidemiological analysis of hepatitis A morbidity for many years in the Leninabad (now Hojend) region of Tajikistan the possibility of the epidemiological diagnosis of fecal-oral hepatitis non A, non B, also known as hepatitis E, was confirmed. Analysis of the specific features of a sharp morbidity rise in hepatitis A in this region in 1986-1987 made it possible to establish that this rise was caused by hepatitis E. This was testified by the explosive character of morbidity; the prevalence of persons aged 15-29 years, found to have antibodies to hepatitis A virus in 95% of cases (among patients, these persons constituted 67.5% of the total number of hepatitis A patients and children of preschool age constituted only 8.8% of such patients); sharply pronounced irregularity in the distribution of morbidity in individual settlements, depending on the state of water supply; a low number of the foci of infection in patient's families; the unfavorable course of the disease in pregnant women with high mortality rate (19%) among them. Similar epidemiological features were noted in hepatitis E outbreaks, occurring at the same period in the adjoining regions in Kirghizia and Uzbekistan, where the etiology of the disease was established by excluding the markers of hepatitides A and B in most of the patients. Some data indicate that the causes of these outbreaks of hepatitis E were linked with the water route of the transmission of hepatitis E virus.

[The prevalence of the markers of viral hepatitis B and delta among the population in regions differing in the level of morbidity]. / Raspprostranenie markerov virusnykh gepatitov B i del'ta sredi naseleniia regionov, kontrastnykh po urovniu zabolevaemosti.

From two regions differing by the levels of incidence of hepatitis B, 2019 blood serum specimens from normal population were examined for markers of HBV infection. In Moscow, among 1040 samples examined HBsAg was found in 2.0%, anti-HBs in 10.0%, anti-HBc in the absence of HBsAg and anti-HBs in 4.5%. In the Osh Province of Kirgizstan, among 979 subjects examined the same markers were found in 10.3%, 22.4%, and 14.0%, respectively. In this area, HBsAg was detected most frequently among infants (14.9% in infants under 1 year), in whom HBs-antigenemia was combined with the presence of HBeAg in 54.5% and with anti-HBc-IgM in 69.2%. Antibody to delta antigen (anti-delta) was found in 24 (25.8%) out of 93 HBsAg-positive subjects in the Osh Province but in none of 21 subjects with HBs-antigenemia in Moscow.

[The incidence of detecting antibodies to the hepatitis C virus in children in specialized children's institutions]. / Chastota vyiavleniia antitel k virusu gepatita C u detei spetsializirovannykh detskikh uchrezhdenii.

Marked differences in the distribution of markers of hepatitis C and B among children in closed children's institutions was established. The frequency of detection of anti-C100-3 in children varied from O in St. Petersburg to 29.4% in Nalchik. A high rate of infection in children is primarily associated with a low level of medico-sanitary service. The results indicate the advisability of specific prophylaxis of viral hepatitis C in specialized children's institutions.

[The etiological structure of acute viral hepatitis in Tadzhikistan in a period of decreased morbidity]. / Etiologicheskaia struktura ostrykh virusnykh gepatitov v Tadzhikistane v period snizheniia zabolevaemosti.

In the period of reduced incidence of viral hepatitis in Tajikistan, January-December, 1990, 1562 patients with acute viral hepatitis (AVH) were examined in the first days of the jaundice phase (928 children under 14 years and 634 adults) in Dushanbe. Markers of hepatitis A, B, and D (HBsAg, anti-HA IgM, anti-HBc IgM, anti-delta IgM) were determined by enzyme immunoassay. Hepatitis A occurred in 25.8% of the patients with AVH, mostly children of 1-6 years, HB in 22.8%, HD co- and superinfection) in 9.2%. In 42.1% of the patients who had no HA, HB, or HD markers in the blood, non-A, non-B hepatitis (mostly hepatitis E) was diagnosed, mainly in the age groups of 30-39 years (70.7%) and 15-29 years (59.2%). Thus, in Tajikistan hepatitis E occurs not only during outbreaks of this infection but also sporadically.