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

This study assesses the risk factors for viral hepatitis in hospitalized patients in Moscow, Russia. The findings reveal the association between drug use, unsafe injection practices, and the acquisition of acute hepatitis B and C. Recommendations for promoting infection control practices and educating individuals about the risks of injection material reuse are provided.

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

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  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.

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

  4. MethodsStudy Population • Cases – patients with jaundice and ALT elevation (> 5 times higher than normal) hospitalized at Infectious Disease Hospital Number 1 in Moscow, February–May,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 April–June 1998. N=311 .

  5. 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.

  6. 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)

  7. Study Population: Demographics and Education Percent in Study Groups

  8. 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

  9. Etiology of Viral Hepatitis in Non-epidemic Season (February – May, 1998) Number of Patients 63.7% 14% 10% 8% 4% 0.3% N=430

  10. Combined Viral Hepatitis Risk Factors among HBV, HCV Patients and Comparison Group HBV-Control: OR= 10.8 (95% CI 6.4-18.5)P < 0.0001 HCV-Control: OR= 12.9 (95% CI 3.7-54.0)P < 0.0001

  11. Parenteral Exposure among HBV, HCV Patients and Comparison Group P < 0.001

  12. Blood Transfusion among HBV, HCV Patients and Comparison Group P > 0.26

  13. At Least One Night in the Hospital among HBV, HCV Patients and Comparison Group P to contn.<0.01 P to contn.> 0..6

  14. At Least One Visit to Ambulatory with Parenteral Exposure among HBV, HCV Patients and Comparison Group P to contn.<0.0021 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.<0.05 P 1-2 > 0.1

  16. Illicit Drug Use among HBV, HCV Patients and Comparison Group P < 0.001

  17. Illicit Drug Use among HBV, HCV Patients and Comparison Group (Blood transfusion, Hospitalization, Dentist and Ambulatory Treatment Excluded) P < 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 > 0.8

  20. * Selected Risk Factors Population Attributable Risk for HBV/HCV patients in Moscow Russia, 1998. * - mutual exclusion; ** - Not applicable

  21. Injections Associated Population Attributable Risk for Acute Hepatitis B Patients (Drug Use Excluded)

  22. 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%.

  23. 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

  24. Limitations • Control group selection

  25. Moscow Medical and Dentistry School N.D. Uschuk M.M. Gadzhikulieva CDC, Hepatitis Branch M. Purdy H. Margolis Acknowledgements

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