Epidemiological features of hepatitis A in the Voronezh region for the period from 2017 to 2023


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Abstract

The topic of hepatitis A morbidity has not lost its relevance for many years. Recently, the epidemic process has intensified: the structure of morbidity has changed, the priority route of transmission has been determined, and the situation with incidence has changed. The aim of the study is to analyze the incidence of hepatitis A in the Russian Federation and Voronezh region and the effectiveness of preventive measures. Materials and Methods. The materials used were statistical forms No. 2 of the Federal State Statistics Service (Rosstat) for 2017-2023, state reports “On the state of sanitary and epidemiologic well-being of the population in the Russian Federation” and “On the state of sanitary and epidemiologic well-being of the population in the Voronezh region”; the method used was retrospective epidemiologic analysis. Results. During the study period, there was no clear trend towards a decrease or increase in the incidence of hepatitis A, more characterized by cyclicality. Incidence peaked in 2017-2018 in both pediatric and adult populations, with increased flooding intensity playing a role. In the epidemic process, both contact and waterborne routes of transmission are relevant. In epidemiologic terms, the water route has significant consequences. Conclusions. As it is known, of great importance in reducing morbidity rates is specific prophylaxis - vaccination against hepatitis A, which is carried out according to epidemic indications on the territory of our country through the use of inactivated vaccines of domestic and foreign production. It should be noted that the most important role in improving the quality of drinking water was played by preventive measures aimed at its purification and disinfection, as evidenced by the results of microbiological studies.

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Introduction. Hepatitis A, is an urgent problem both in the Russian Federation and in the Voronezh region, despite the fact that over the past few decades there has been a decrease in morbidity. A lower incidence rate is observed due to improvements in the quality of drinking water, socio-economic conditions. There is also an “iceberg phenomenon”, which in turn is caused by registration of mainly acute jaundice forms. We found that the incidence of viral hepatitis A is mainly due to contact and household transmission. Infection occurs in small doses, which is a distinctive feature compared to the registered morbidity in the late 20th and early 21st centuries. [3]. The household contact route has not fully replaced the water route and there is a risk of infection when bathing in water bodies, water spills, accidents at water supply systems. Hepatitis A ranks second in the structure of viral hepatitis, predominantly affecting adults (65%) [1]. This trend dictates the need to increase the effectiveness of specific prevention measures, which includes greater coverage of the population with hepatitis A vaccine, and to increase the level of nonspecific prevention.

The aim of the work is to retrospectively analyze the incidence of hepatitis A in Voronezh region and some indicators for comparative assessment of the effectiveness of preventive measures.

Materials and methods of research. Retrospective analysis of morbidity according to the data of the reporting form No. 2 of the Federal State Statistics Service (Rosstat) for 2017-2023, data from the state reports “On the state of sanitary and epidemiological well-being of the population in the Russian Federation” and “On the state of sanitary and epidemiological well-being of the population in the Voronezh region”.

Results of the study. As a result of analyzing the incidence of hepatitis A, we found that the average annual rate in the Voronezh region is lower than the similar indicator for the country as a whole: 2.23 per 100 thousand population against 3.42, respectively. At the same time, the rise in morbidity both in the Voronezh region and in the Russian Federation as a whole occurred in 2018. Incidence in 2018 was 3.56 cases per 100 thousand population in the Voronezh region and 5.62 cases in the country. The peak of incidence for the study period in the Voronezh region was observed in 2019, when the rates were 3, 78 cases per 100 thousand population, which also coincides with the exceeding of the all-Russian indicators. It is known that in 2018, according to the Ministry of Emergency Situations of Russia, there was an increase in the intensity of floods on the territory of the region, as a result of which 16 settlements, 143 residential houses, where 332 people lived, including 63 children, 688 homestead plots, 15 low-water bridges and one section of highway were flooded. 59 people, including 15 children, were resettled [5, 6].In the year of the disease incidence rise, exceeding hygienic standards of water samples was recorded in 6 municipalities: Anninsky-40%, Kalacheevsky-46.2%, Liskinsky-42%, Novousmansky-55.7%, Pavlovsky-42.6%, Rossoshansky-68.9%. Microbiological indicators were exceeded in Pavlovsky District-2.5%, Borisoglebsk Urban District-4.6%, and Voronezh Urban District-3.5% [2]. In this situation, the risk of hepatitis A morbidity increased. 
By the end of 2023, the share of the population of the Voronezh region with drinking water of good quality in terms of epidemiological safety amounted to 98.5%. In the modern world, the role of contact mechanism of sexual transmission is also noted, the category of risk for this mechanism of transmission includes persons of non-traditional sexual orientation. Viral hepatitis A is characterized by an autumn-winter seasonality, with a rise starting in September, peaking in October and declining in November, with a second weaker seasonal rise in January, probably reflecting the statistical transition of cases from the end of the year to the new reporting year. The seasonality of hepatitis A is most noticeable in epidemic years [3]. At the same time, there is a shift in the pattern of enteric hepatitis incidence toward the adult population, whereas previously the incidence was more characteristic of the pediatric population, especially for hepatitis A outbreaks. At the beginning of 2017, an increase in the incidence of the disease was registered in the adult population, which occurred in January-March, and an increase among children - in April (2, 12 cases per 100,000 population). When analyzing morbidity among children and adults separately, it was noted that during the study period, morbidity among children exceeds morbidity among adults by about 1.5 times.
However, there is a downward trend in incidence from 2017 to 2023, with 2.99 cases in 2017, 2.99 cases in 2018. - 3.56 cases, in 2019 - 3.78 cases, in 2020. - 1.51 cases, in 2021 - 1.13 cases, in 2022 - 0.83 cases, in 2023 - 1.97 cases (in recalculation per 100 thousand population). At the same time, the peak incidence among children, as well as among adults, was in 2018 (4.65 cases per 100,000 children), which is comparable with the indicator for Russia as a whole. The average annual rate in the Voronezh region is lower than in Russia as a whole (2, 23 per 100 thousand population vs. 3, 43 per 100 thousand population, respectively).
Analyzing the prevention of enteric hepatitis, it should be noted that an important role is played by specific prophylaxis - vaccination against hepatitis A, which in the Russian Federation is carried out according to epidemic indications. However, immunization has a more significant impact when vaccinating risk groups, when immunizing contact persons [4].
Four monovaccines against hepatitis A have been registered in Russia - one domestic (Algavac-M) and three imported (Avaxim-France, Vacta-USA, Havrix-Belgium). In studies of the effectiveness of vaccine prophylaxis, it was noted that no cases of manifest forms of these infections were registered among those vaccinated against HA and HB during 3 years (observation period).

Conclusion. Thus, having analyzed the incidence of hepatitis A in the Voronezh region and in the Russian Federation as a whole for the analyzed period, no dynamics of decrease or increase in the incidence of the disease has been established, but cyclicity is more characteristic. From these positions it becomes clear that this result is achieved due to the timely implementation of preventive and anti-epidemic measures, while the applied methods of nonspecific prophylaxis are being improved in accordance with modern scientific observations and developments.
We have found a change in the structure of morbidity - the main share of the diseased are adults, previously the incidence was registered mainly among children. In our opinion, the main role in infection is given to water and contact and domestic transmission. In addition, it is becoming more evident that the improvement of water quality has reduced the risk of infection of the population, and the epidemic process has become sporadic.

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About the authors

Evgeniya Vladislavovna Sergeeva

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: sergeevaevgeniya5@gmail.com
ORCID iD: 0000-0001-7643-0662

5th year student of the Faculty of Medicine and Preventive Medicine, head of the Student Scientific Circle of the Epidemiology Chair

Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

Nikolai Petrovich Mamchik

Voronezh State Medical University named after N.N. Burdenko

Email: mamchik1949@mail.ru
ORCID iD: 0000-0002-6952-0018

Doctor of Medical Sciences, Professor, Head of the Department of Epidemiology

Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

Olga Vladimirovna Kameneva

Voronezh State Medical University named after N.N. Burdenko

Email: gigob@sanep.vrn.ru
ORCID iD: 0000-0001-9087-9458

Candidate of Medical Sciences, Associate Professor of the Epidemiology Department

Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

Margarita Mikhailovna Bulgakova

Voronezh State Medical University named after N.N. Burdenko

Email: litochka1203@gmail.com
ORCID iD: 0000-0003-3543-2818

Assistant of the Department of Epidemiology

Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

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