Hepatitis B: surveillance and epidemiological situation in the Russian Federation

Transcription

1 Hepatitis B: surveillance and epidemiological situation in the Russian Federation Professor Elena Esaulenko Saint-Petersburg Pasteur Institute October 2018 VHPB country meeting Prevention and control of Viral Hepatitis in the Russian Federation: lessons learnt and the way forward

2 Hepatitis B Elimination Program( ) Concept Get indicators of hepatitis B elimination by 2030 year. Opportunity Potential Diagnostics Preventive therapy Vaccination Availability of new vaccines Availability of new diagnostic tests Therapy coverage

3 Incidence rate per 100,000 population Retrospective epidemiological analysis of the incidence rate of acute hepatitis B in Russia Годы Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

4 Incidence rate of acute hepatitis B in different regions of Russia Elimination rate achieved in 76.5% of regions Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016 Saint-Petersburg Pasteur Institute, 2018

5 Regions of Russia with the highest incidence rate of acute hepatitis B # Region of RF Incidence rate per 100,000 population Increase/Decrease rate in , % Russian Federation % 1 Sevastopol fold* 2 Republic of Crimea fold* 3 Vladimir region % 4 Rostov region % 5 Chukotsky Autonomous District % 6 Saratov region % 7 Tyumen region Moscow fold 9 Kurgan region % 10 Voronezh region Kaliningrad region fold Data for the Republic of Crimea and the city of Sevastopol since 2014 and 2015, respectively. From the State report "On the state of sanitary and epidemiological welfare of the population in the Russian Federation in 2017"

6 Incidence rate of acute hepatitis B per 100,000 Incidence rate of acute hepatitis B in different age groups (Russia, 2017) 2,5 2,36 2 1,5 1,25 1 1,05 0,67 0,5 0,23 0,35 0,36 0 0,03 0 0,03 0,03 < 1year 1-2 year 3-6 year 7-10 year year year year year year year 60 + year Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

7 Incidence rate per 100,000 population Cumulative cases 18 Retrospective epidemiological analysis of the incidence rate of chronic hepatitis B in Russia ,1 9, Годы Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

8 Russian regions with the highest incidence rate of chronic hepatitis B # Region of RF Incidence rate per 100,000 population Increase/Decrease rate in , % Russian Federation Tyva Republic St. Petersburg Republic of Sakha (Yakutia) Kamchatka Sakhalin Yamalo-Nenets Autonomous District Novosibirsk region Republic of Altai Republic of Kalmykia Khanty-Mansiysk Autonomous District

9 Prevalence of chronic hepatitis B, per 100,000 Prevalence rate of chronic hepatitis B in different age groups (Russia, 2017) ,8 289,5 258, ,1 156, ,8 1,5 3,3 0 < 1year 1-14 year year year year year year 60 + year Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

10 State Report "On the state of sanitary and epidemiological welfare of the population in the Russian Federation in 2017" The main measure of hepatitis B prevention continues to be the immunization of the population within the national calendar of preventive vaccinations. In 2017 about 3.27 mln persons in the Russian Federation were vaccinated against hepatitis B, including 1.77 mln children (in 2016, 3.9 mln persons were vaccinated). The total number of persons vaccinated in the country since the beginning of the immunization program is about 100 mln. The timely coverage of vaccination against hepatitis B in newborns within the first 12 hours of their lives in 2017 was 97.15% (in %); this rate has been kept at the level of % for the last 6 years. In the immunization coverage of the adult population increased from 88.53% to 95.31% among persons aged years, and from 59.95% to 83.56% among persons aged years.

11 Incidence rate per 100,000 population Number of vaccinated, mln. persons The dynamics of the incidence rate of acute hepatitis B, chronic hepatitis B and the carrier state of hepatitis B virus, per 100,000 population, and the cumulative number of vaccinated against hepatitis B, million people Cumulative number of vaccinated AHB CHB HBV carriers From State report "On the state of sanitary and epidemiological welfare of the population in the Russian Federation in 2017"

12 North-West Federal District A.B. Zhebrun S.L.Mukomolov Step I: Goal: Drop of the incidence rate of acute hepatitis B to < 1,0 per 100,000 population at 80% territories of North-West Federal District (achieved) Step II: Goal: Achievement of the level of acute hepatitis B incidence <1,0 per 100,000 population in all territories of the Northwestern federal district due to the increase of the vaccination coverage rates and improvement of the epidemiological surveillance for chronic hepatitis B. Step III: Goal: Reduction of the incidence rate of acute hepatitis B to 0 in most parts of the North-West Federal District, certification of territories for the elimination of acute hepatitis B.

13 Vaccination against Hepatitis B in Russia and in the North-West Federal District in 2016 Territory 12 month (timely),% years,% years,% Russian Federation N.-W. Federal District Republic of Karelia Komi Republic Arkhangelsk region NAO Vologda region Kaliningrad region Leningrad region Murmansk region Novgorod region Pskov region St. Petersburg Saint-Petersburg Pasteur Institute, 2018

14 Incidence rate of acute hepatitis B in the North-West Federal District in Territory Cases о / оооо Cases о / оооо Cases о / оооо Cases о / оооо Cases о / оооо Arkhangelsk region Vologda region Leningrad region Pskov region Republic of Karelia Murmansk region Novgorod region NAO St. Petersburg Kaliningrad region Komi Republic N.-W. Federal District Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

15 Incidence rate per 100,000 population Retrospective epidemiological analysis of the incidence rate of chronic hepatitis B in Russia and North-West Federal District Заболеваемость ХГВ на 100 тыс. населения в СЗФО Заболеваемость ХГВ на 100 тыс. населения в РФ Poly. (Заболеваемость ХГВ на 100 тыс. населения в СЗФО) ,4 29,2 27,4 28, Years Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

16 HBeAg-negative chronic hepatitis B need for medical treatment > 2000 МЕ/мл 28,8% < 150 МЕ/мл 31,5% МЕ/мл 39,7% Prevailing therapy type Rapidly progressive and difficult to treat 22-50% patients require antiviral therapy Need for medical treatment people G.M. Kozhevnikova,2015; S.L. Voznesensky, 2014; E.V. Esaulenko, 2011, E.V. Esaulenko, 2018

17 HBV subgenotypes in the North-West Federal District D3 29,6% NWFD D3A2 1,4% А2 2,8% D1 18,3% D2 47,9% E.V. Esaulenko, M.V. Ponyatishina, M.V. Alekseeva, A.V. Semenov, Yu.V. Ostankova, N.V. Ivanova. Molecular Epidemiologic Characteristics of Acute Hepatitis В in the North-West Federal District. Infectious Diseases Т. 15. No. S1. P. 329.

18 Conclusion 1. Expansion of the vaccination coverage of the adult population 2. Defining of causes of high percentage of seronegative persons after vaccination 3. Introduction of III generation vaccines 4. Use of modern laboratory methods for hepatitis B diagnostics, including highly sensitive test systems, in medical organizations 5. Making modern antiviral therapy more easily available and extensive in its coverage

19 Thank you for your attention! Co-authors: L.V. Lyalina, A.A. Sukhoruk, V.V. Skvoroda, A.V. Semenov, Yu.V. Ostankova