The impact of COVID-19 pandemic on the 2020 hepatitis C cascade of care in the Republic of Georgia.

OBJECTIVES: In 2015, the Republic of Georgia initiated a National Hepatitis C Elimination Program, with a goal of 90% reduction in prevalence of chronic hepatitis C virus (HCV) infections by 2020. In this article, we explore the impact of the COVID-19 pandemic on the 2020 hepatitis C cascade of care in Georgia. STUDY DESIGN: Retrospective analytic study. METHODS: We used a national screening registry that includes hospitals, blood banks, antenatal clinics, harm reduction sites, and other programs and services to collect data on hepatitis C screening. A separate national treatment database was used to collect data on viremia and diagnostic testing, treatment initiation, and outcome including testing for and achieving sustained virologic response (SVR). We used these databases to create hepatitis C care cascades for 2020 and 2019. Bivariate associations for demographic characteristics and screening locations per year and care cascade comparisons were assessed using a chi-squared test. RESULTS: In 2020 compared to 2019, the total number of persons screened for HCV antibodies decreased by 25% (from 975,416 to 726,735), 59% fewer people with viremic infection were treated for HCV infection (3188 vs. 7868), 46% fewer achieved SVR (1345 vs. 2495), a significantly smaller percentage of persons with viremic infection initiated treatment for HCV (59% vs. 62%), while the percentage of persons who achieved SVR (99.2% vs. 99.3%) remained stable. CONCLUSIONS: The COVID-19 pandemic had a negative impact on the hepatitis C elimination program in Georgia. To ensure Georgia reaches its elimination goals, mitigating unintended consequences of delayed diagnosis and treatment of hepatitis C due to the COVID-19 pandemic are paramount.

The burden and epidemiology of hepatitis B and hepatitis D in Georgia: findings from the national seroprevalence survey.

OBJECTIVES: The burden of hepatitis B virus (HBV) and hepatitis D virus (HDV) infections is unknown in Georgia. This analysis describes the prevalence of hepatitis B and coinfection with HDV and the demographic characteristics and risk factors for persons with HBV infection in Georgia. STUDY DESIGN: This is a cross-sectional seroprevalence study. METHODS: A cross-sectional, nationwide survey to assess hepatitis B prevalence among the general adult Georgian population (age ≥18 years) was conducted in 2015. Demographic and risk behavior data were collected. Blood specimens were screened for anti-hepatitis B core total antibody (anti-HBc). Anti-HBc-positive specimens were tested for hepatitis B surface antigen (HBsAg). HBsAg-positive specimens were tested for HBV and HDV nucleic acid. Nationally weighted prevalence estimates and adjusted odds ratios (aORs) for potential risk factors were determined for anti-HBc and HBsAg positivity. RESULTS: The national prevalence of anti-HBc and HBsAg positivity among adults were 25.9% and 2.9%, respectively. Persons aged ≥70 years had the highest anti-HBc positivity (32.7%), but the lowest HBsAg positivity prevalence (1.3%). Anti-HBc positivity was associated with injection drug use (aOR = 2.34; 95% confidence interval [CI] = 1.46-3.74), receipt of a blood transfusion (aOR = 1.68; 95% CI = 1.32-2.15), and sex with a commercial sex worker (aOR = 1.46; 95% CI = 1.06-2.01). HBsAg positivity was associated with receipt of a blood transfusion (aOR = 2.72; 95% CI = 1.54-4.80) and past incarceration (aOR = 2.72; 95% CI = 1.25-5.93). Among HBsAg-positive persons, 0.9% (95% CI = 0.0-2.0) were HDV coinfected. CONCLUSIONS: Georgia has an intermediate to high burden of hepatitis B, and the prevalence of HDV coinfection among HBV-infected persons is low. Existing infrastructure for hepatitis C elimination could be leveraged to promote hepatitis B elimination.

Tularemia transmission to humans: a multifaceted surveillance approach.

Tularemia has sustained seroprevalence in Eurasia, with estimates as high as 15% in endemic regions. The purpose of this report is to characterise the current epidemiology of Francisella tularensis subspecies holarctica in Georgia. Three surveillance activities are summarised: (1) acute infections captured in Georgia's notifiable disease surveillance system, (2) infectious disease seroprevalence study of military volunteers, and (3) a study of seroprevalence and risk factors in endemic regions. Descriptive analyses of demographic, exposure and clinical factors were conducted for the surveillance studies; bivariate analyses were computed to identify risk factors of seropositivity using likelihood ratio χ2 tests or Fisher's exact tests. Of the 19 incident cases reported between 2014 and August 2017, 10 were confirmed and nine met the presumptive definition; the estimated annual incidence was 0.12/100 000. The first cases of tularemia in Western Georgia were reported. Seroprevalences of antibodies for F. tularensis were 2.0% for military volunteers and 5.0% for residents in endemic regions. Exposures correlated with seropositivity included work with hay and contact with multiple types of animals. Seroprevalence studies conducted periodically may enhance our understanding of tularemia in countries with dramatically underestimated incidence rates.

CONFLICT IN EASTERN UKRAINE: STRATEGY FOR TUBERCULOSIS.

This root cause analysis concerns the conflict in the Eastern Ukraine and its impact on healthcare delivery in the context of treating internally displaced persons (IDPs). Inadequate treatment of tuberculosis (TB) was selected as a major topic for intervention planning in conflict areas in Ukraine. With respect to treating TB among IDPs, rapid diagnosis and adequate nutrition and shelter are important components of care and disease control. The DOT, supported by trained primary healthcare providers equipped with rapid MDR TB diagnostic capacities, need to provide appropriate shelter and nutrition to IDPs. In addition to active disease management, this paper discusses the important role of ongoing project monitoring and communicating evaluation findings with all the major stakeholders shaping the national TB strategy in Ukraine. A comprehensive strategy is essential for successful transitioning and re-structuring of TB healthcare delivery both during after conflict resolution.

IMPORTANT ASPECT OF HEALTH CARE ASSOCIATED INFECTIONS IN GEORGIA WITH THE FOCUS ON VENTILATOR-ASSOCIATED PNEUMONIA (REVIEW).

Health care associated infections are the most frequent adverse event accompanying healthcare delivery worldwide. Of these, respiratory tract infections, including ventilator-associated pneumonia (VAP), have been recognized as the most common infections in acute hospitals. Sparse anecdotal and epidemiologic data from intensive care units (ICU) and infectious diseases physicians, as well as several publications in this field, suggest that the etiology of VAP in Georgia is most likely Klebsiella pneumoniae. This review article discusses the challenges of infection control in the Georgian health care system, with a focus on VAP. We present the most significant risk factors as well as potential strategies to remediate infection control practices and reduce the prevalence of VAP.

[ETHIOLOGY OF LEPTOSPIROSIS IN GEORGIA].

Investigation of leptospirosis was initiated in 1950s, when the first cases in humans were detected in Gudauta rayon. Serology test confirmed the diagnose. High level of antibodies to serogroup Pomona was revealed in all cases. Later on the infection encountered as sporadic cases, the exception was 1986, when a large outbreak was reported in Sukhumi. At present leptospirosis is widely spread in the country, especially in Ajara region, where indicators of morbidity recently reached 11.4 per 100 thousand population. It is likely that warm humid climate creates exceptionally favorite conditions for spreading of Leptospira. In order to determine the true magnitude of the infection in the country a seroprevalence study was carried out in 50-60-ies of the past century in humans, agricultural animals and rodents. It was found that serotgroups Pomona, Icteroheamorrhagiae and Grippothypos prevailed in humans, Serogroup L. Pomona - dominated in animals, while in rodents the dominated serotgrouo was L. Icteroheamorrhagiae. Similar study, conducted by us in 1990-2005 showed that L.Pomona and L. Icteroheamorrhagiae prevailed in humans and rodents while L. Icteroheamorrhagiae was the only serogroup isolated in gray rats, trapped in Tbilisi. Infectivity of rodants composed 70%. Currently lesptosirosis is caused by a new serogroups of Leptospira - L. Sejroe, namely by serotypes Wolfii and Hardjo, L. Australis (serotype Bratislava) and L. Autumnalis along with the previously occurring serogroups L. Icteroheamorrhagiae, L. Bataviae, L. Hebdomadis. In our opinion the recent increase in leptospirosis in the country is attributable to the improvements in diagnostics of the infection as well as to the emergence of new serogroups of Leptospira, which in turn is a result of intensive migration processes in the country.

[Leptospirosis in Georgia].

The aim of the article was to study epidemiological patterns of leptospirosis in Georgia from 2001 to 2011. The investigation revealed that formal registration of the infection began in 1950s. Single cases were reported annually in the country with the exception of 1986, when water-borne outbreak broke out in Sukhumi with 21 detected cases. Low morbidity level of disease was reported during 2001-2005. Since 2006 significant increase of leptospirosis has been observed. The highest incidence was reported in 2011-1.81 per 100 000 population. The increase is likely to be mainly attributed to the improvements in diagnostics of the infection. Young and middle-age persons are more frequently vulnerable to leptospirosis in Georgia, 54.8% of the cases are reported among age group of 30-59. Incidence of the infection is the highest in males - 60-65% of the detected cases. In addition, leptospirosis is characterized by high case-fatality rate - 8.7 ± 3.6% (95% CI=5.7-11.7). Case fatality is especially high in persons over 60 and over reaching 24.3 ± 8.1%. Only single cases are observed in children under 14. In 21st century ethiological structure of leptospirosis has being changed somehow. By contrast, in the earlier period the disease was mainly caused by L. icterohaemorrhagiae and L.grippotyphosa, nowadays we encounter such causative agents which were not observed in 20th century - L. autunnalis, L. mankarso, L. wolffii and others. Water is mainly implicated as a risk factor in the infection transmission. Finally, to study of epidemiological characteristics of leptospirosis in Georgia, identified that, the infection is widely distributed in the country, has an increasing tendency and duration of the disease frequently is a severe.

Water-borne outbreak of oropharyngeal and glandular tularemia in Georgia: investigation and follow-up.

BACKGROUND: In November 2006, an outbreak of waterborne tularemia occurred in an eastern region in the Republic of Georgia. Outbreak investigation revealed 26 cases: 21 oropharyngeal and 5 glandular tularemia cases. METHODS: The presentation of the index case triggered an outbreak investigation involving the collection of clinical/ epidemiological data, application of tularine skin test, and laboratory confirmation of the possible cases using the tube agglutination test and polymerase chain reaction (PCR) testing. Serology results were verified by enzyme-linked immunosorbent assay (ELISA) and Western blot. A case- control study along with follow-up was conducted 4 months after the index case presentation. RESULTS: Exudative pharyngitis, predominantly laterocervical adenitis, fever, and headache were the most prevalent clinical signs/symptoms observed. Depressed mood, concentration difficulties, and sleep disturbance were also detected. Bubo aspirates tested by PCR were positive in 4/4 cases and pharyngeal swabs also tested by PCR were positive in 2/3 cases. Francisella tularensis was isolated from the water samples. Comparison of the cases and controls did not reveal any statistically significant risk factors. A follow-up investigation revealed cases with protracted symptoms of fatigue, headache, and sleep disturbance. Additionally, 8/26 cases still had cervical adenopathy of prominent size. A delay in diagnosis was associated with persistent lymphadenopathy on follow-up examination (p = 0.05). CONCLUSION: We observed unique features of persistent neuropsychiatric symptoms and lymphadenopathy 5 months after tularemia infection which were associated with delayed diagnosis and the lack of prompt response to therapy. This outbreak of oropharyngeal tularemia emphasizes the importance of a rapid diagnostic and investigative response to tularemia. This type of response can prevent ongoing exposure, as well as provide expeditious treatment to mitigate persistent symptoms.