Hepatitis B: surveillance and epidemiological situation in

the Russian Federation

Professor Elena Esaulenko

Saint-Petersburg Pasteur Institute

25-26 October 2018

VHPB country meeting

Prevention and control of Viral

Hepatitis in the Russian

Federation: lessons learnt and

the way forward

Concept

Opportunity

Potential

• Get indicators of hepatitis B elimination by 2030 year.

• Diagnostics

• Preventive therapy

• Vaccination

• Availability of new vaccines

• Availability of new diagnostic tests

• Therapy coverage

Hepatitis B Elimination Program(2017-2030)

Retrospective epidemiological analysis of the incidence rate of acute hepatitis B in Russia

42.5

35.3

19.8

13.0

10.48.6

7.05.3

4.02.7 2.2 1.7 1.4 1.3 1.3 1.1 0.9 0.9

0

5

10

15

20

25

30

35

40

45

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

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Годы

Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016

Saint-Petersburg Pasteur Institute, 2018

Incidence rate of acute hepatitis B in different regions of Russia

2001 2017

Elimination rate achieved in 76.5% of regions

From the State report "On the state of sanitary and epidemiological welfare of the population in the Russian Federation

in 2017"

Regions of Russia with the highest incidence rate of acute hepatitis B

# Region of RFIncidence rate per

100,000 population

Increase/Decrease

rate in 2012-2017, %

Russian Federation 0.86 -39.44%

1 Sevastopol 3.79 -1.8 fold*

2 Republic of Crimea 3.04 -1.8 fold*

3 Vladimir region 2.80 3.32%

4 Rostov region 2.08 52.94%

5 Chukotsky Autonomous District 2.00 1.52%

6 Saratov region 1.85 1.1%

7 Tyumen region 1.77 -

8 Moscow 1.72 -1.6 fold

9 Kurgan region 1.40 -25.53%

10 Voronezh region 1.37 -11.04

11 Kaliningrad region 1.32 -3.6 fold

Data for the Republic of Crimea and the city of Sevastopol since 2014 and 2015, respectively.

Incidence rate of acute hepatitis B in different age groups (Russia, 2017)

0,23

0,03 0 0,03 0,03

0,35

1,05

2,36

1,25

0,67

0,36

0

0,5

1

1,5

2

2,5

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ep

atitis

B p

er

100,0

00

< 1year 1-2 year 3-6 year 7-10 year 11-14 year 15-19 year

20-29 year 30-39 year 40-49 year 50-59 year 60 + year

Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

Retrospective epidemiological analysis of the incidence rate of chronic hepatitis B in Russia

Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur

Institute, 2018

14.2

16.0

15.0 14.915.6

13.9 14.0 14.0 14.2 14.4

13.313.0

12.6

11.5 11.410.9

10,19,8

0

2

4

6

8

10

12

14

16

18

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

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Годы

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203443208801214760227376233190241673

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150000

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# Region of RFIncidence rate per

100,000 population

Increase/Decrease

rate in 2012-2017,

%

Russian Federation 9.94 –29.7

1 Tyva Republic 61.72 –39.9

2 St. Petersburg 46.35 –42.6

3 Republic of Sakha (Yakutia) 35.84 –48

4 Kamchatka 21.29 –327.42

5 Sakhalin 20.72 51

6 Yamalo-Nenets Autonomous District 19.93 –103.7

7 Novosibirsk region 16.87 –33.9

8 Republic of Altai 16.76 –45.88

9 Republic of Kalmykia 16.73 –33.47

10 Khanty-Mansiysk Autonomous District 15.97 –8.58

Russian regions with the highest incidence rate of chronic hepatitis B

Prevalence rate of chronic hepatitis B in different age groups (Russia, 2017)

1,5 3,3

35,8

166,1

271,8

289,5

258,3

156,9

0

50

100

150

200

250

300

350

Pre

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len

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of

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ep

atitis

B, p

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100,0

00

< 1year 1-14 year 15-19 year 20-29 year 30-39 year 40-49 year 50-59 year 60 + year

Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

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 2016 - 96.9%); this rate

has been kept at the level of 96.61-97.28% for the last 6 years.

In 2012-2017 the immunization coverage of the adult population

increased from 88.53% to 95.31% among persons aged 18-35 years, and from

59.95% to 83.56% among persons aged 36-59 years.

From State report "On the state of sanitary and epidemiological welfare of the population in the

Russian Federation in 2017"

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

Inc

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Nu

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cc

ina

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ln.

pe

rso

ns

AHB CHB HBV carriersCumulative number of

vaccinated

Step I: 2013 – 2015Goal: Drop of the incidence rate of acute hepatitis B to < 1,0 per 100,000population at 80% territories of North-West Federal District (achieved)

Step II: 2016 – 2018Goal: Achievement of the level of acute hepatitis B incidence <1,0 per100,000 population in all territories of the Northwestern federal district due tothe increase of the vaccination coverage rates and improvement of theepidemiological surveillance for chronic hepatitis B.

Step III: 2019 – 2022Goal: Reduction of the incidence rate of acute hepatitis B to 0 in most partsof the North-West Federal District, certification of territories for the eliminationof acute hepatitis B.

A.B. Zhebrun S.L.Mukomolov

1942-2015 1958-2015

North-West Federal District

Territory 12 month

(timely),%

18 – 35 years,% 36 – 59 years,%

Russian Federation 96.9 94.4 79.99

N.-W. Federal District 97.3 96.1 78.6

Republic of Karelia 96.5 97.6 58.7

Komi Republic 96.8 95.6 75.7

Arkhangelsk region 96.0 93.2 60.0

NAO 88.7 90.0 80.3

Vologda region 96.98 96.7 87.5

Kaliningrad region 97.5 98.5 94.5

Leningrad region 97.3 95.5 75.8

Murmansk region 97.5 94.2 78.4

Novgorod region 97.4 89.5 69.8

Pskov region 96.6 98.6 76.7

St. Petersburg 97.9 97.5 86.0

Vaccination against Hepatitis B in Russia and in the North-West Federal District in 2016

Saint-Petersburg Pasteur Institute, 2018

Incidence rate of acute hepatitis B in the North-West Federal District in 2013-2017

Territory

2013 2014 2015 2016 2017

Cases о/оооо Cases о/оооо Cases о/оооо Cases о/оооо Cases о/оооо

Arkhangelsk region 3 0.26 0 0.00 4 0.35 6 0.53 2 0.18

Vologda region 9 0.75 9 0.75 4 0.34 5 0.42 10 0.84

Leningrad region 28 1.61 8 0.46 6 0.34 1 0.06 0 0.00

Pskov region 1 0.15 7 1.06 4 0.61 0 0.00 1 0.16

Republic of Karelia 3 0.47 4 0.63 4 0.63 4 0.63 1 0.16

Murmansk region 3 0.38 4 0.52 2 0.26 1 0.06 2 0.29

Novgorod region 5 0.80 3 0.48 3 0.48 3 0.49 4 0.65

NAO 1 2.35 0 0.00 0 0.00 1 2.29 0 0.00

St. Petersburg 91 1.82 89 1.75 43 0.83 42 0.81 37 0.71

Kaliningrad region 25 2.63 24 2.50 14 1.45 8 0.82 13 1.32

Komi Republic 8 0.90 11 1.26 12 1.38 8 0.83 5 0.59

N.-W. Federal District 177 1.29 159 1.16 96 0.69 81 0.58 75 0.51

Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

Retrospective epidemiological analysis of the incidence rate of chronic hepatitis B in Russia and North-West Federal District

27.2

31.2

24.4

26,4

29,2

27,4 28,1 29.5

31.1

33.3

30.8 29.6

31.5

29.6 28.0 27.5

25.4

22.5

14.2

16.015.0 14.9 15.6

13.9 14.0 14.0 14.2 14.413.3 13.0 12.6

11.5 11.4 10.910.1 9.8

0

5

10

15

20

25

30

35

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Inc

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Years

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)

Viral hepatitis in the Russian Federation (analytical review, issue 10), 2016; Saint-Petersburg Pasteur Institute, 2018

HBeAg-negative chronic hepatitis B – need for medical

treatment

150 - 2000 МЕ/мл

39,7%

< 150 МЕ/мл

31,5%> 2000 МЕ/мл

28,8%

• Prevailing therapy type

• Rapidly progressive and difficult to treat

• 22-50% patients require antiviral therapy

G.M. Kozhevnikova,2015; S.L. Voznesensky, 2014; E.V. Esaulenko, 2011, E.V. Esaulenko, 2018

Need for medical treatment – 14400

people

HBV subgenotypes in the North-West Federal District

E.V. Esaulenko, M.V. Ponyatishina, M.V. Alekseeva, A.V. Semenov, Yu.V. Ostankova, N.V. Ivanova. Molecular Epidemiologic Characteristics of Acute HepatitisВ in the North-West Federal District. Infectious Diseases. 2017. Т. 15. No. S1. P. 329.

D3

29,6%

D3A2

1,4%

А2

2,8%D1

18,3%

D2

47,9%

NWFD

Conclusion1. 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

Thank you for your attention!

Co-authors:

L.V. Lyalina, A.A. Sukhoruk, V.V. Skvoroda,

A.V. Semenov, Yu.V. Ostankova