Overview of Hepatitis B, C, and D Epidemiology in Eastern Europe and the Newly Independent States

1
Overview of Hepatitis B, C, and D Epidemiology in
Eastern Europe and the Newly Independent States

• Michael O. Favorov MD, Ph.D., D.Sc.
• CDC Central Asia Program Director
• Elena Klimova MD, Ph.D.
• Moscow Medical and Dentistry School,
• Infection Disease Department, Associate Professor

2
Background

• High risk among intravenous drug users for Viral
  Hepatitis and HIV infection transmission has been
  demonstrated worldwide.
• Limited studies suggest significant changes in
  risk factors for viral hepatitis B, C, and Delta
  transmission occurred in the region during the
  last decade.
• Descriptive nature of epidemiological studies of
  risk factors for parenterally transmitted
  hepatitis in the region.
• Moldova study (Y. Hutin et al.,1993) nosocomial
  transitions main risk factor for HBV infection.

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Study Objective

• To assess risk factors for Viral Hepatitis in
  hospitalized adult patients and in a reference
  group in Moscow, Russia.

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MethodsStudy Population

• Cases patients with jaundice and ALT elevation
  (gt 5 times higher than normal) hospitalized at
  Infectious Disease Hospital Number 1 in Moscow,
  FebruaryMay,1998. N 430.
• Assessment of patient risk factors by collection
  of detailed information on history of injection
  practices, medical procedures, drug abuse, sexual
  behavior, alcohol consumption demographic and
  other characteristics. N 300.
• Reference group (Non-Sick) -- Volunteers from
  Medical High School and Pre-recruitment medical
  examination participants, with no history of
  jaundice. Collected AprilJune 1998. N311 .

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Methods Data and Specimen Collection

• Obtained informed consent .
• Questionnaire administered.
• Obtained blood specimens
• blood samples (5cc) drawn using disposable
  sterile materials (needles, syringes, tubes)
• Sera separated by centrifugation and storage at
  -20o C until shipment to CDC.
• ID-linked questionnaire, blood and serum tubes.

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Methods

• Specimens test site -
  CDC Hepatitis Reference Laboratory
• EIA Abbott ( North Chicago)
• IgM Anti HAV
• HBsAg
• IgM anti - HBc
• Anti-HCV
• Anti-HCV Confirmatory test.
• Anti HDV (total)
• Mosaic protein test (CDC)
• Anti HEV (IgG and IgM)

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Study Population Demographics and Education
Percent in Study Groups
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Age distributions by group
Cases Group Mean Age 23.9 /-9.7
years (Median 21) Comparison Group Mean Age
19.4 /-2.3 years (Median 19)
Numbers
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Etiology of Viral Hepatitis in Non-epidemic
Season (February May, 1998)
Number of Patients
63.7
14
10
8
4
0.3
N430
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Combined Viral Hepatitis Risk Factors among HBV,
HCV Patients and Comparison Group
HBV-Control OR 10.8 (95 CI 6.4-18.5) P lt
0.0001 HCV-Control OR 12.9 (95 CI 3.7-54.0) P
lt 0.0001
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Parenteral Exposure among HBV, HCV Patients and
Comparison Group
P lt 0.001
12
Blood Transfusion among HBV, HCV Patients and
Comparison Group
P gt 0.26
13
At Least One Night in the Hospital among HBV, HCV
Patients and Comparison Group
P to contn.lt0.01
P to contn.gt 0..6
14
At Least One Visit to Ambulatory with Parenteral
Exposure among HBV, HCV Patients and Comparison
Group
P to contn.lt0.0021
P to contn. 1.0
15
At Least One Visit to the Dentists with
Parenteral Exposure among HBV, HCV Patients and
Comparison Group
1
2
P to contn.lt0.05
P 1-2 gt 0.1
16
Illicit Drug Use among HBV, HCV Patients and
Comparison Group
P lt 0.001
17
Illicit Drug Use among HBV, HCV Patients and
Comparison Group (Blood transfusion,
Hospitalization, Dentist and Ambulatory Treatment
Excluded)
P lt 0.001
18
Illicit Drug Use History among HBV, HCV Patients
and Comparison Group
19
Number of Sexual Partners (last 6 month) among
HBV, HCV Patients and Comparison Group (other
risk factors excluded)
P gt 0.8
20
Selected Risk Factors Population Attributable
Risk for HBV/HCV patients in Moscow Russia, 1998.

- mutual exclusion - Not applicable
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Injections Associated Population Attributable
Risk for Acute Hepatitis B Patients (Drug Use
Excluded)
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Conclusions

• Injection drug use with unsafe injection practice
  strongly associated with acquiring acute
  hepatitis B and C in Moscow.
• Outpatients treatment remain highly associated
  with acquiring acute hepatitis attributable risk
  for non-drug users HBV patients 39, HCV 34.
• Hospitalization, tattooing, multiple sexual
  contacts demonstrated attributable risk for
  non-drug users 3 12.

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Recommendations

• Promote the use of single use syringes and
  needles (auto-disable) in Moscow
• Promote infection control practices in drug use
  communities in Moscow
• Educate drug use communities members and health
  care workers about the risks associated with
  re-use injection material

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Limitations

• Control group selection

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Acknowledgements

• Moscow Medical and Dentistry School
• N.D. Uschuk
• M.M. Gadzhikulieva

• CDC, Hepatitis Branch
• M. Purdy
• H. Margolis