viral hepatitis prevention and control in russia · 2014-12-03 · viral hepatitis clinical...
TRANSCRIPT
Viral Hepatitis Prevention and Control in Russia
Vladimir Chulanov
Two Decades of the VHPB: Achievements, Impact and Remaining Challenges in Prevention and Control of Viral Hepatitis
Antwerp, 13-14 November 2014.
Central Research Institute of Epidemiology Reference Center for Viral Hepatitis
Moscow, Russia
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Incidence and prevalence of hepatitis B and C in Russia;
• Prevention and screening strategies;
• Chronic hepatitis B and C treatment options;
Presentation Outlines
165,5
117,2 110,1 109,9
123,5
87,4
50,4
34 30,2
57,3
79,36
46,9
28,3 30 30,2
15,7 10,3 8,1 7,3 6,3 4,3 5,5
0
50
100
150
200
250
5.8
204.3
per 1
00 0
00 p
opul
atio
n Incidence of Acute Hepatitis A in Russia
1990-2013
Official Bulletin of the Federal Center for Hygiene and Epidemiology, Russia
30,2
79,4 63,2
183,5
112,4
0
100.000
200.000
300.000
400.000
500.000
600.000
0
50
100
150
200
250
300
Hepatitis A immunizationIncidence of HAV children under 14 yearsIncidence of HAV total population
Incidence of Acute Hepatitis A and immunization program in Russia, 1999-2013
per 1
00 0
00 p
opul
atio
n
abso
lute
num
ber
Total n = 660 301 1 924 1 728 975 850 6 438
Rate of anti-HAV IgG in Different Age Groups 2004-2009, Russia
Rat
e of
ant
i-HAV
IgG
, %
0
10
20
30
40
50
60
70
80
90
<15 15-19 20-29 30-39 40-49 >50
27 25
36
47
56
81
Age
0
10
20
30
40
50
60
70
All Age Groups <20 20-40 >40
62
40
49
69
44
24
38
65
20042009
Total n = 338 1984 86 217 168 1182 84 585 4730
Decrease in the Seroprevalence of HAV 2004-2009, Russia
Rat
e of
ant
i-HAV
IgG
, %
0
10
20
30
40
50
60
70
All Age Groups <20 20-40 >40
62
40
49
69
44
24
38
65
20042009
Total n = 338 1984 86 217 168 1182 84 585 4730
Decrease in the Seroprevalence of HAV 2004-2009, Russia
Rat
e of
ant
i-HAV
IgG
, %
Incidence of acute Hepatitis B in Russia 1999-2013 (per 100 000 population)
43,7
1,3 0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
45,0
50,0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Incidence of acute Hep B in different age groups in Russia, 1997-2007 (per 100 000 population)
32,6
13,8 6,6 5,7 7,1
12,6
141,9
102,5
24,1
12,3 7,4 3,1 5,2 1,3 0,2 0,3 0,2 0,5
5,6 17,7
7,5 3,4 2,1 0,7 0
20
40
60
80
100
120
140
160
1997
2007
Age groups
Age
grou
ps
per 1
00 0
00 p
opul
atio
n
5,2 5,6
17,7
7,5
1,3 0,0 0,0 0,0 0,1 0,4
2,9 3,4
0
2
4
6
8
10
12
14
16
18
2007200820092010201120122013
Age groups
per 1
00 0
00 p
opul
atio
n Incidence of acute Hep B in different age groups
in Russia, 2007-2013 (per 100 000 population)
Proportion of IDUs among Acute Hepatitis B Cases in Russia, 1997-2013
10743
11248
16486
15233
9584
3515 2108
1489 1263 938 905 654 600 447 360 259 332
0
5
10
15
20
25
30
35
40
45
0
2.000
4.000
6.000
8.000
10.000
12.000
14.000
16.000
18.000
Proportion of IDU Absolute number of IDU
Abs
olut
e nu
mbe
rs
%
Reference Center for Viral Hepatitis, 2014
Hepatitis B immunization coverage, Newborns, 1999-2013, Russia
2,8 9,4
42,7
80,5
93,6 96,1 97,2 97,7 98 98,5 98,1 97,9 97,7 97,7 97,7
0102030405060708090
100
%
Hepatitis B immunization coverage, Teenagers, 1999-2013 Russia
1,7 6,5 8,2
24,1
36,5
49,1
60,1
92,7 97,8 98,6 99 99,2
99,3 99,3 99,5
0102030405060708090
100
%
0
10
20
30
40
50
60
70
80
90
0,1 0,8 2,0 4,5 7,5 10,6 13,9
24,9 27,9 30,0 31,7 33,4 35,1 36,8 38,5
0,04 0,1 0,4 0,7 1,8 3,5 6,5 10,0 13,6 17,3
29,1
39,0
52,1
64,2
71,3 74,5 80,2
84,4 mln
Children under 14 General Population
Cumulative Number of Hep B Vaccinated People in Russia, 1996-2013
Incidence of acute and chronic HBV infection in Russia 1999-2013 (per 100 000 population)
43,7
1,3
109,5
29,7
0,0
20,0
40,0
60,0
80,0
100,0
120,0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
acute HBV chronic HBV and HBV carriage
0
0,5
1
1,5
2
2,5
3
3,5
4
4,5
5
2004 2005 2006 2007 2008 2009
3,8
2,4 2,1 2,1
1,8 1,9
≈ 2.0%
Total n = 5 817 14 631 25 056 35 853 56 735 48 154 186 495
Prevalence of HBV Infection in Moscow, 2004-2009
Rat
e of
HB
sAg
dete
ctio
n, %
0
5
10
15
20
25
30
35
40
45
CHC AHC
Incidence of Acute and Chronic Нep С Russia, 1999-2013 (per 100 000 population)
21.1
1.5
39.2
12.9
Incidence of CHC in different age groups Russia, 2010
17,9
32,4
43,1
92,4
70,3
16,4
2,0
1,2
2,1
3,0
3,5
0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0 90,0 100,0
> 60 лет
50-59 лет
40-49 лет
30-39 лет
20-29 лет
15-19 лет
11-14 лет
7-10 лет
3-6 лет
1-2 года
до 1 года
Per 100 000 population
95,9%
4,1%
anti-HCV (-)anti-HCV (+)
n=43,866
Rate of anti-HCV detection in General Population in Moscow, 2005-2009
Viral Hepatitis Screening Programs in Russia
Screening groups Schedule - Blood donors At every donation
- Pregnant women During I and III trimester
- Newborns of women with CHB or CHC 0, 3,6 months; 1, 2, 3 years of age
- Health care workers At hiring, then every year
- In-patients At the point of admission
- Out-patients (Drug and alcohol abuse clinics, STI clinics)
At the first appointment; then every year
- Patients on hemodialysis At the first appointment; then on regular basis
- Orphanage At admission; then every year
- Households and contacts At index case identification; then every year
- Military personnel At hiring; then every year
Sanitary and Epidemiological Regulations СП 3.1.958-00
Nosocomial Acute Hepatitis B and C in Russia
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2200
Acute Hep B Acute Hep C
Abs
olut
e nu
mbe
rs
Reference Center for Viral Hepatitis, 2014
Additional HCV Screening Programs in Russia (2014)
Screening groups Schedule - Risk groups As soon as risk factor identified
- IDUs and their sexual partners
- Sex workers and their sexual partners
- MSMs
- Prisoners At admission
Sanitary and Epidemiological Regulations СП 3.1.3112-13
HCV RNA + anti-HCV Screening Programs (2014)
Screening groups Schedule - Donors of blood, tissues and sperm At every donation
- Newborns of women with CHC or HIV 2, 6 and 12 months
- Immunocompromised patients
- Patients with liver disease of unknown etiology
As soon as the condition diagnosed
- Patients on hemodialysis At the first appointment; then on regular basis
- Households and contacts At index case identification; then every year
Sanitary and Epidemiological Regulations СП 3.1.3112-13
Treatment Options
Chronic Hepatitis B
• Nucleoside Analogues – Lamivudine – Telbivudine – Entecavir – Tenofovir
• IFNs – Standard – Pegylated
Chronic Hepatitis C
• IFNs – Standard – Pegylated
• Ribavirin • NS3 Protease Inhibitors
– Boceprevir – Telaprevir – Simeprevir
Viral Hepatitis Clinical Guidelines
• Guidelines for the diagnosis and treatment of adult patients with hepatitis C. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2013; 23 (2): 41-70. [in Russian].
• Clinical guidelines of the Russian Gastroenterological Association and the Russian Society for the Study of liver for the diagnosis and treatment of adult patients with hepatitis B. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2014; 3: 58-88. [in Russian].
Current Issues and Future Challenges
• Development of sound National Strategy on Viral Hepatitis;
• Improvement of Access to diagnostics and treatment;
• Improvement of viral hepatitis surveillance system;
• Increasing awareness;
• Decreasing stigmatization;
43
9 1,7 1,1
0
10
20
30
40
50
60
70
80
90
100
All HCV infected anti-HCV tested HCV care Treated Cured
Reference Center for Viral Hepatitis, 2012
Cascade «Screening-Care-Treatment» in Russia
Federal Service on Inf. Dis. Surveillance
Federal Ministry of Public Health
Regional MPH
Municipal Health Administration
Municipal clinic
Regional Service on IDS
Regional Center for H&E
Local Dep. of RS on
IDS
Local Branch of RC for H&E
Regional Hepatology
center
Federal Center for Hygiene and Epidemiology Federal Level
Regional Level
Municipal Level
Adm.
Officer
Tertiary center
Organogram of the Federal Viral Hepatitis Registry
Physician
Chief Physician
Administrator
Nurse
Pharmacist
Control of completeness of registration and quality of clinical supervision
Adm.
Officer
Adm.
Officer
Adm.
Officer
Adm.
Officer
Adm.
Officer
Adm.
Officer
Adm.
Officer
Reference Center for Viral Hepatitis
Adm.
Analyst
Tech. support
Conclusions • Over the last 10 years a steep decline in the
incidence of acute Hep A, B and C cases was observed. However the burden of chronic infection due to Hep B and C is still very significant.
• Universal vaccination against Hep B was implemented in 2002. By January 2014 more than 80 mln people had been vaccinated.
• An extensive range of obligatory screening programs for Hep B and C are in place, covering major risk groups;
• An access to treatment programs for chronic Hep B and C is very limited
• National strategy on Viral Hepatitis needs to be developed;