Вирусные гепатиты – «вызов» глобальной и региональной политике в области здравоохранения
1. Hepatitis C and HIV co-infection Вирусные гепатиты – «вызов» глобальной и региональной политике в области здравоохранения 19 мая , 20 10 Киев December 8, 2009 Др. Ирина Ерамова , к.м.н. Отдел инфекционных заболеваний, Европейский региональный офис ВОЗ
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5. Р аспространен ность ВГС в Западной Европе December 8, 2009 А/т к ВГС (%) (66 исследований) РНК ВГС (%) (11 исследований) ПИН 37-98 26-86
6. Процентное соотношение ПИН среди всех случаев ВИЧ/СПИДа с известным и пут ями передачи , на конец 2007 Примечание: % от случаев СПИД в странах, не отмечющих случаи ВИЧ: Франция, Италия, Испания. Источники: ECDC/ВОЗ; национальные отчеты December 8, 2009 75% 25.5% 9% 5% 88% 57% 80% 28% 65% 57% 59% 16% 13% 17% 4% 15% 16% <1% 23% 82% 50% 61% 14% 71% 11% 5% 0% 11% 15% 26% 5% 77% 2% 17% 0% 9% 3% 1% 16% 24% 25% 16% 29% 76% 73% 73% 66% 78% 42% 4% 2% <20% 20-40% 40-60% 60-80% 6% 5% 11% 9% >80%
7. ВИЧ / ВГС коинфицированные (%) в Восточной Европе, конец 2007 December 8, 2009
16. Географическая доступность Страна Лаборатории Лечение Армения 1 1 Кыргызстан 1 1 Таджикистан н.и. 1 Узбекистан 1 1 Белоруссия 2 11 Украина 33 21
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Editor's Notes
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010 It is estimated globally that hundred millions of people are chronically infected with hepatitis c and hepatitis B viruses - ten times more than the estimated number of people living with HIV/AIDS. It is also estimated that millions of HIV infected people are also coinfected with Hepatitis C or Hepatitis B virus.
57% всех случаев цирроза и 78% всех случаев первичного рака печени являются результатом гепатита В и С
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010 Stine Update 2009
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010 Recently a few Western European countries have reported increases of HCV incidence in HIV infected MSM. This is linked to unprotected sex, rather than other risk factors
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010 Наличие антител к HBcAg при отсутствии HBsAg может свидетельствовать о наличии латентной (скрытой инфекции), и определение ДНК в данном случае необходимо для подтверждения или опровержения инфекции. У мед.работников антитела к HBcAg встречаются в 20 раз чаще, чем HBsAg , а у пациентов стационаров почти в 30 раз!
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010
We learn about the epidemiology of infections through surveillance systems. In the majority of countries, routine national hepatitis B and hepatitis C surveillance has only been introduced recently. The lack of standardization in the region hampers the possibility of establishing trends within countries or the region. HCV infection, during its acute stage and often chronic infection is asymptomatic. So until proactive screening is not introduced the risk of undereporting is very high.
Insufficient or weak surveillance results in the inability to correctly and completely describe the true HCV infection trends and disease burdens in countries and regionally. Data from ECDC shows that over the last decade HCV represents the most common form of viral hepatitis in the EU. Perhaps the level of HCV in the East surpasses other forms of hepatitis, but more evidence and data is needed to support this statement.
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010 Cost of HCV-RNA test varies tremendously within eastern Europe from $8 to $250, which patients must pay for themselves.
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010 In the East: Hepatitis treatment is expensive and is not covered by the MOH or health insurance, except in Belarus. The least amount is seen here in Uzbekistan at $6000 and the most expensive is in the Russian Federation at $24 000.
Note that other than in the Ukraine and Belarus, laboratory services and treatment are only available in the capital cities. While we do not have detailed information from the Russian Federation, services and treatment are also available in a number of cities.
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010 HIV-positive individuals should be vaccinated as early as possible as advanced HIV infection, chronic leaver disease are associated with reduced immune response after administration of vaccine.
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010 WHO is actively involved in programs to improve the safety of blood transfusions though promoting of volunteer blood donor programs and screening for hepatitis B and C WHO also coordinates the Safe Injection Global Network through education efforts.
Communicable Diseases Unit, WHO Regional Office for Europe July 14, 2010
The HIV epidemic has provided us with a number of important lessons that should be taken into consideration in developing global, regional and national level responses to hepatitis epidemics.