Резюме. Одной из серьезнейших проблем здравоохранения в мире остаются гепатотропные вирусы, вызы-вающие хронические заболевания печени. Вирус гепатита В распространен во всем мире, около 5% носите-лей инфицированы также вирусом гепатита дельта. Коинфекция или суперинфекция вирусов гепатита В и D достоверно ассоциированы со значительно более тяжелыми заболеваниями печени по сравнению с инфи-цированием только вирусом гепатита В, что повышает внимание эпидемиологов к путям передачи и источ-никам вируса гепатита D. Однако обследование носителей вируса гепатита В на наличие вируса гепатита D в большинстве регионов мира не является обязательным. Следует отметить, что полного генотипического картирования вирусов гепатитов В и D, выделяемых на территории СНГ и стран бывшего СССР, все еще нет, несмотря на постоянно ведущиеся работы, посвященные генотипированию гепатотропных вирусов на тер-ритории Российской Федерации и в сопредельных государствах. В связи с тем, что одним из предполагае-мых путей распространения вирусов является «трудовая миграция» жителей стран Средней Азии в другие страны и, в том числе, в Российскую Федерацию, появляется необходимость обратить внимание на ситуацию с вирусными гепатитами в этом регионе. Целью нашей работы было оценить распространенность генетичес-ких вариантов и особенности молекулярной эпидемиологии сочетанной инфекции хронического вирусно-го гепатита В + D в Кыргызстане. Обследовано 30 образцов плазмы от пациентов с хроническим вирусным гепатитом В и D из различных регионов Кыргызстана. На основании филогенетического анализа изолятов показано, что среди обследованных больных хроническим вирусным гепатитом В выявлен только генотип D. Показано преобладание вируса гепатита В субтипа D1 (73,34%) по сравнению с D2 (3,33%) и D3 (23,33%). Вы-явлен вирус гепатита D генотипа I с высокой вариабельностью участка гена, кодирующего дельта-антиген. Высокое сходство некоторых изолятов с изолятами, характерными для стран-соседей, эндемичных по гепа-тотропным вирусам, а также плотная кластеризация других изолятов, свидетельствуют как о множественных завозах, так и об эволюционном процессе в географически изолированном регионе, каковым является Кыр-гызстан. Выявление особенностей распространения и роль эндемичности в циркуляции генотипов вирусов гепатита В и гепатита D имеют большое значение. 233-20-92 (служебн).

Purpose. Study of the etiological structure of lethality from acute viral hepatitis and its comparison with morbidity and mortality for the period of 2009−2018.Materials and methods. State Reporting Forms No. 1 “Report on Infectious, Parasitic and Non-Infectious Diseases” for the period of 2009−2018 were studied. The data was processed by the Microsoft Office Excel statistical package.Results. In Kyrgyzstan, during the period of 2009−2018, 138,612 cases of acute viral hepatitis (AVH) were detected, of which 109 patients had fatal outcomes. In the general structure of the latter, the proportions of patients with acute hepatitis B (AHB 36.7%) and A (AHA, 35.7%) were approximately the same. In every fifth case, “unverified acute viral hepatitis (UAVH)” was diagnosed (22.9%). Acute hepatitis C (AHC) was the cause of death in 4 patients (3%), and hepatitis D virus (HDV) infection in 1 patient. Among the deceased, there were no cases of hepatitis E. Lethality from AHB was recorded in 5 children, and from hepatitis C in one child. At the same time, 9 out of 25 patients with “Unverified Acute Viral Hepatitis” were children. Over the period of 2009−2018, the incidence of AHB was 31.3 times lower than that of all AVH in general (240.9 and 7.7⁰/0000, AVH and AHB, respectively), the mortality rate was 2.7 times lower (0.19 and 0.07⁰/0000, AVH and AHB, respectively), and the lethality rate was 11.4 times higher (7.9 and 89.8⁰/0000, AVH and AHB, respectively). The average incidence of AHB in children was 6.4 times lower (7.7 and 1.2⁰/0000, total and children, respectively), the mortality rate was 2.3 times lower (0.07 and 0.03⁰/0000, total and children, respectively), and the lethality rate was 1.8 times higher (89.8 and 165.9⁰/0000, total and children, respectively).Conclusion. The existence of morbidity and lethality in adults and children from acute hepatitis indicates a high disease burden for the country. The high proportion of AHB and AHA in the structure of AVH mortality requires improving the quality of immunization of children and expanding the coverage of adults with vaccination against these viral hepatitis. The increase in lethality against the background of a tenfold decrease in the incidence of AVH points out that the number of patients who have died from this pathology does not decrease.

Purpose. Study of the etiological structure of lethality from acute viral hepatitis and its comparison with morbidity and mortality for the period of 2009−2018.Materials and methods. State Reporting Forms No. 1 “Report on Infectious, Parasitic and Non-Infectious Diseases” for the period of 2009−2018 were studied. The data was processed by the Microsoft Office Excel statistical package.Results. In Kyrgyzstan, during the period of 2009−2018, 138,612 cases of acute viral hepatitis (AVH) were detected, of which 109 patients had fatal outcomes. In the general structure of the latter, the proportions of patients with acute hepatitis B (AHB 36.7%) and A (AHA, 35.7%) were approximately the same. In every fifth case, “unverified acute viral hepatitis (UAVH)” was diagnosed (22.9%). Acute hepatitis C (AHC) was the cause of death in 4 patients (3%), and hepatitis D virus (HDV) infection in 1 patient. Among the deceased, there were no cases of hepatitis E. Lethality from AHB was recorded in 5 children, and from hepatitis C in one child. At the same time, 9 out of 25 patients with “Unverified Acute Viral Hepatitis” were children. Over the period of 2009−2018, the incidence of AHB was 31.3 times lower than that of all AVH in general (240.9 and 7.7⁰/0000, AVH and AHB, respectively), the mortality rate was 2.7 times lower (0.19 and 0.07⁰/0000, AVH and AHB, respectively), and the lethality rate was 11.4 times higher (7.9 and 89.8⁰/0000, AVH and AHB, respectively). The average incidence of AHB in children was 6.4 times lower (7.7 and 1.2⁰/0000, total and children, respectively), the mortality rate was 2.3 times lower (0.07 and 0.03⁰/0000, total and children, respectively), and the lethality rate was 1.8 times higher (89.8 and 165.9⁰/0000, total and children, respectively).Conclusion. The existence of morbidity and lethality in adults and children from acute hepatitis indicates a high disease burden for the country. The high proportion of AHB and AHA in the structure of AVH mortality requires improving the quality of immunization of children and expanding the coverage of adults with vaccination against these viral hepatitis. The increase in lethality against the background of a tenfold decrease in the incidence of AVH points out that the number of patients who have died from this pathology does not decrease.

Objective. To compare epidemiological, clinical and laboratory characteristics of chronic hepatitis B (ChHB) associated with/without delta agent (ChHB+DV) study.Materials and methods. The Kyrgyzstan State Reporting Form No. 12 covering 2010–2017 period was examined. For this, 133 and 130 case histories of ChHB and ChHB+DV patients, respectively, were analyzed. The data were statiastically processed by using Microsoft Office Excel software.Results and discussion. Over the 2010–2017 period, prevalence of the “HBV Carrier” (60.4 ) was higher by 20-fold than that one for ChHB [3.8 , 95% CI (2.4–4.0)] and CVHD [3.4 , 95% CI (2.2–3.4)], as the vast majority of patients were not thoroughly examined after detecting HBsAg, and the HBV Carrier was empirically diagnosed at the primary health care units. As a result, routine case definitions for such conditions were revised and an improved system of epidemiological surveillance of viral hepatitis was developed, according to the 2016 WHO recommendations approved by the Ministry of Health of the Kyrgyz Republic (Order No. 524, dated of July 20, 2018). Asthenia was observed in ~60% of patients in both groups, whereas arthralgia — in ~5–10% of patients, more often in those comorbid with ChHB+DV, and myalgia — in as low as ~3% of cases. Impaired central nervous system functions manifested as headache and restless sleep were evenly recorded in about 10–15% of patients, without significant difference between groups. In contrast, dominating dyspeptic manifestations such as poor appetite (72±3.9% vs. 20.6±3.5%, p < 0,05), nausea (23.8±3.7% vs. 7.3±2.3%, p < 0,05), vomiting (12.3±2.6% vs. 3.3±1.5%, p < 0,05) and flatulence (27±3.9% and 13±2.9%, p < 0,05) were revealed in ChHB+DV patients. Pain in the right hypochondrium was noted in 52–56% of patients, insignificantly differed between patient groups. Incidence of yellowness of the sclera and skin layers as well as skin itching were recorded by 2–3 and 8 times, respectively, more frequently in ChHB+DV patients. A more profound cytolysis and signs of altered bilirubin metabolism were also more common in HBV patients comorbid with the delta agent. Thus, a more severe ChHB+DV course requires that all patients with primary HBsAg detection were mandatorily examined for anti-HDV antibodies to ensure early diagnostics and timely organization of the secondary and tertiary preventive measures in the Kyrgyzstan.

The purpose of the study is to research the morbidity, mortality and case fatality rate y of chronic viral hepatitis B without and with a delta agent from 2010–2017. in Kyrgyzstan.Materials and methods: analyzed state reporting forms No. 12 “Report on morbidity and preventive work (family medicine center, dispensary)” and “C51 — Distribution of deaths by sex, age groups and causes of death” from 2010–2017. Data processed by Microsoft Office Excel.Results: In the country from 2010–2017 3292 cases of chronic viral hepatitis B were detected, 1738 patients of them verified an independent course (СhHBV), and 1,554 patients combined with a delta agent (СhHDV), while the incidence did not have a statistically significant difference (3.80/0000, 95% CI 2.4–4.0 and 3.40/0000, 95% CI 2.2–3.4, СhHBV and СhHDV, respectively) were 20 times lower compared to the HBV Carrier (60 40/0000). There was no statistically significant difference between the cumulative morbidity, mortality, case fatality rate and the proportion of deaths in СhHBV and СhHDV. The death rate СhHBV increased by 4.7 times (0.090/0000 and 0.410/0000), case fatality rate — by 11.8 times (1355.00/0000 and 16025.60/0000) amid a decrease the incidence is 2.5 times (6.40/0000 and 2.50/0000) from 2014 to 2017, respectively. At СhHDV, the mortality rate was also increased by 4.7 times (0.030/0000 and 0.160/0000), case fatality rate — by 32.3 times (793.70/0000 and 25641.80/0000) against the background of a decrease in incidence by 6.9 times (4.40/0000 and 0.60/0000) from 2014 to 2017, respectively.Conclusion: In Kyrgyzstan from 2010–2017, relatively low detectability of chronic forms of HBV infection with and without delta agent was found, compared with the “HBV carrier”. There has been an increase in mortality and case fatality rate over the past 4 years, with a sharp rise in 2017 against the background of a downward trend in the incidence of СhHBV and СhHDV.