Tatjana Tallo 1,2 , Valentina Tefanova 1 , Tatjana Plahhova 3 ,

1. HCV SUBTYPES DISTRIBUTION IN ESTONIAN BLOOD DONORS, 2007-2009 Tatjana Tallo1,2, Valentina Tefanova1, Tatjana Plahhova3, Tatiana Kuznetsova1, Ljudmilla Priimägi1, Helene Norder2 1 - National Institute for Health Development, Tallinn, Estonia 2 - Swedish Institute for Communicable Disease Control, Stockholm, Sweden 3 - North Estonia Medical Centre Blood Centre, Tallinn, Estonia valentina.tefanova@tai.ee 10th ANNUAL CONFERENCE OF NEW VISBY NETWORK ON HEPATITIS CRIGA, FEBRUARY 10-12, 2013

2. The number of acute hepatitis C cases in Estonia, 1993–2012 367 HCV reported cases, abs Introduction of HCV registration Increasing nr of IDUs HAV outbreak PegIFN + ribavirin treatment HIV epidemic Datasource: HealthBoard Adopted: DeptofVirology, NIHD

3. Chronic HCV infection, Estonia, 2004-2011 18.4 14.2 Incidenceper 100 000 population 2010 – 246 cases 2011 – 190 cases years years CVH became a notifiablesince 1998 From 2004 – accordingtoetiology Data source: Health Board

4. WHO goal: Towards100% voluntary non-remuneratedblood donationby 2020 • Uptonow, thequalityofdonor’sbloodisanissueofhighimportance. • Thesafetyofthebloodsupplycanbeestimatedbymonitoringtheprevalenceof viral markersintheblooddonor’spopulation. • Theotherapproachtoincreasequalityofdonor’sbloodistoimprovethequalityofblooddonors and oneofthesolutionsisthereplacementof paid blooddonationwithfreeblooddonationsystem.

5. Blood donation in Estonia, 1998-2009 Paid blooddonation: before 1998 Transitional period: from 1998 to 2004 • From 1998 – only Rh-neg (3.3-4.0%)apheresisdonorswere paid • From 2002 – only plasmapheresis donors (1.8-2.0%) remained paid • From 2004 – all blood donations became free - 340551 - 204559 - 57663 - 146896 Thetotal number ofblooddonors, donations, and thenumber ofrepeateddonorsincreased, respectively, in 1.2, 1.1 and 1.4 times Theratiobetween males and femalesremainedsimilar: M:F=0.9 inaverage Datasource: North Estonia MedicalCentreBloodCentre Adopted: DeptofVirology, NIHD

6. Anti-HCV prevalenceinblooddonors, Estonia, 1995-2009 1997-2001 = 0.80% % 2002-2006 =0.34% <0.1% Lack of data transitional period HCV RNA Introductionoffreedonation North Estonia MedicalCentreBloodCentre Adopted: DeptofVirology, NIHD

7. No recentdatahasbeenreported on molecularepidemiologyof HCV inEstonianblooddonors The study objectives • To investigatethe distribution of HCV genotypes in anti-HCV positive blood donors diagnosed in 2007 to 2009 • Tocomparetherelative HCV genotypesdistributioninblooddonorsbefore and afterintroductionoffreedonation • To determine genetic relatedness of isolates fromEstonian blooddonorswith isolates frompreviouslystudiedpopulationgroupsin Estonia and other parts of the world

8. Material and methods • 61 serumsamples (47%)collectedfrom131 anti-HCV positive blood donors during 2007-2009 at North Estonia MedicalCentreBloodCentre, Tallinn, wereusedas a sourceof HCV RNA • Sexdistribution: 36 males, 25 females • Meanage: 31.5±10.2 years; range: 18-57 years • Detectionofserum HCV RNA hasbeenperformedby PCR forwardedtothe 5’-UTRregion • The HCV subtypes were determined by amplification sequencing withinNS5B region and phylogenetic analysis

9. HCV molecularepidemiologyin Estonia, 1994-2004 First 2k/1b recombinant strainoutsideRussia Similarity: mainlywithstrainsfrom St.-Petersburg, Siberia and Uzbekistan • Studypopulation: • Infectiousdiseaseclinics, pts; • Hemodialysispts; • Oncohematologypts (chidrens); • HealthCareWorkers T.Tallo, JMV, 2007

10. Results: HCV subtypesdistribution All 1a subjectswereisolatedfromfirst-timedonors, males, meanage 28 yrs, fromTallinn Meanage31.5yrs; 59% males 88% - firsttimedonors 1b, 3a, 2a and 2c strains were intermixed with previously published Estonian strains and were similar to strains from Siberia and St.-Petersburg area Meanage 28yrs ; 69% males 85% - firsttimedonors T.Tallo, JMV, 2007

11. Results: Phylogeneticanalysis • 1b, 3a, 2a and 2c strains were intermixed with previously published Estonian strains sharing, ingeneral, similaritywithstrainsfromSt.Petersburg and Siberia. • Three 1a starinshavebeenfoundin 2 differentclades: • Two strains isolated from blood donors in 2007 were similar to strains from USA and Germany. • One strain obtained from blood donor in 2009 was similar to strains from Portugal. • 1a strain from our previous study isolated from HCV patients with unknown risk factor in 2001 was similar to strains from St. Petersburg.

12. Conclusions • Subtype 1b is still the most prevalent HCV subtype found in Estonian blood donors. • Therelative distribution of HCV subtypes inblooddonorsbefore and aftertheintroductionoffreedonationwassimilar; twoseparateintroductionof 1a HCV strainshavebeenobservedinEstonianblooddonor’spopulationduringstudyperiod. • Changes of the HCV subtype distribution in the Estonian blood donors reflected recent changes in relative distribution of the HCV subtypes in the Estonian IDUs reported previously. • We suggestthatblooddonors can beusedas a representative part of “a generalpopulation” for study on HCV Molecular epidemiology in Estonia.

13. Acknowledgment • Health Board (formerHealthProtectionInspectorate) • Jevgenia Epshtein, ChiefSpecialist, epidemiologist • NationalInstituteforHealthDevelopment, DepartmentofVirology • Irina Reshetnjak, scientist • Study was supported by grants from Swedish Institute, nr. 01348/2007 • and nr. 00747/2010.

14. Thank you for attention!