Sharapov Makhmudkhan B, Favorov Michael O, Yashina Tatiana L, Brown Matthew S, Onischenko Gennady G, Margolis Harold S, Chorba Terence L
Tashkent Pediatric Medical Institute and Central Asia Epidemiology Network, Ministry of Health, Tashkent, Republic of Uzbekistan.
BMC Infect Dis. 2009 Mar 25;9:35. doi: 10.1186/1471-2334-9-35.
In Uzbekistan, routine serologic testing has not been available to differentiate etiologies of acute viral hepatitis (AVH). To determine the age groups most affected by hepatitis E virus (HEV) during documented AVH epidemics, trends in AVH-associated mortality rate (MR) per 100,000 over a 15-year period and reported incidence of AVH over a 35-year period were examined.
Reported AVH incidence data from 1971 to 2005 and AVH-associated mortality data from 1981 to 1995 were examined. Serologic markers for infection with hepatitis viruses A, B, D, and E were determined from a sample of hospitalized patients with AVH from an epidemic period (1987) and from a sample of pregnant women with AVH from a non-epidemic period (1992).
Two multi-year AVH outbreaks were identified: one during 1975-1976, and one during 1985-1987. During 1985-1987, AVH-associated MRs were 12.3-17.8 per 100,000 for the general population. Highest AVH-associated MRs occurred among children in the first 3 years of life (40-190 per 100,000) and among women aged 20-29 (15-21 per 100,000). During 1988-1995 when reported AVH morbidity was much lower in the general population, AVH-associated MRs were markedly lower among these same age groups. In 1988, AVH-associated MRs were higher in rural (21 per 100,000) than in urban (8 per 100,000) populations (RR 2.6; 95% CI 1.16-5.93; p < 0.05). Serologic evidence of acute HEV infection was found in 280 of 396 (71%) patients with AVH in 1987 and 12 of 99 (12%) pregnant patients with AVH in 1992.
In the absence of the availability of confirmatory testing, inferences regarding probable hepatitis epidemic etiologies can sometimes be made using surveillance data, comparing AVH incidence with AVH-associated mortality with an eye to population-based viral hepatitis control measures. Data presented here implicate HEV as the probable etiology of high mortality observed in pregnant women and in children less than 3 years of age in Uzbekistan during 1985-1987. High mortality among pregnant women but not among children less than 3 years has been observed in previous descriptions of epidemic hepatitis E. The high mortality among younger children observed in an AVH outbreak associated with hepatitis E merits corroboration in future outbreaks.
在乌兹别克斯坦，尚无常规血清学检测方法来区分急性病毒性肝炎（AVH）的病因。为确定在有记录的AVH流行期间受戊型肝炎病毒（HEV）影响最严重的年龄组，研究了15年期间每10万人中与AVH相关的死亡率（MR）趋势以及35年期间报告的AVH发病率。
检查了1971年至2005年报告的AVH发病率数据以及1981年至1995年与AVH相关的死亡率数据。从流行期（1987年）住院的AVH患者样本和非流行期（1992年）患AVH的孕妇样本中确定甲型、乙型、丁型和戊型肝炎病毒感染的血清学标志物。
确定了两次多年的AVH暴发：一次在1975 - 1976年，另一次在1985 - 1987年。在1985 - 1987年期间，普通人群中与AVH相关的MR为每10万人12.3 - 17.8。与AVH相关的最高MR出现在1至3岁的儿童中（每10万人40 - 190）以及20至29岁的女性中（每10万人15 - 21）。在1988 - 1995年期间，普通人群中报告的AVH发病率低得多，在这些相同年龄组中与AVH相关的MR明显较低。1988年，农村地区与AVH相关的MR（每10万人21）高于城市地区（每10万人8）（RR 2.6；95% CI 1.16 - 5.93；p < 0.05）。1987年396例AVH患者中有280例（71%）以及1992年99例患AVH的孕妇中有12例（12%）发现急性HEV感染的血清学证据。
在缺乏确诊检测的情况下，有时可以利用监测数据，通过比较AVH发病率与AVH相关死亡率，推断可能的肝炎流行病因，以采取基于人群的病毒性肝炎控制措施。此处提供的数据表明，HEV可能是1985 - 1987年期间乌兹别克斯坦孕妇和3岁以下儿童中观察到的高死亡率的病因。在先前戊型肝炎流行的描述中，观察到孕妇死亡率高，但3岁以下儿童死亡率不高。在与戊型肝炎相关的AVH暴发中观察到的年幼儿童高死亡率值得在未来暴发中进一步证实。
