Chapter 8. The CONCLUSION

Virus hepatitises it is a serious medical and social problem of public health services of Russia and the majority of the countries of the world. First of all, it concerns to hepatitises with haemocontact by a becoming infected.

Formation among born children of chronic carriers defines possibility of the further transmission of infection to following generation. Now thanks to introduction of bacterination against GV in a national calendar of inoculations the number of cases OGV has essentially decreased and, steadily decreases, number of cases HGV. Doubtless successes in treatment HG, especially HGS are reached. Despite the reached successes in diagnostics, treatment and preventive maintenance of a hepatotropic virus infection, this problem is far from the decision (M.I.Mihajlovti 2004; K.R. Harris, A.S. Dighe, 2002; Y. Poovorawan, P. Chatchatee V. Chongsrisawat 2002).

The republic Sakha (Yakutia) always concerned to giperendemichnym to regions. The case rate of the population of Yakutia throughout all years of observation exceeded that on the average on the country.

Last years case rate depression by virus hepatitises, especially acute forms becomes perceptible considerably. However long epidemiological trouble has generated an appreciable layer of chronic patients. Unfortunately, HG is it is long current chronic disease which remains many years not noticed. Prevalence of the given disease, especially among children of teenagers remains not clear. On the basis of indirect signs it is possible to judge about
Enough high risks of infection VG at children and teenagers. So the share of pregnant women with Hbs-antigenemiej for 2000-2011 has made 3,29 %, thus in dynamics the tendency to depression was not traced. Frequency infitsirovannosti a virus of a hepatitis With has made 1,1 % (Sleptsova S.S. 2012). Because at children's age the risk perinatalnoj transmissions of infection level infitsirovannosti pregnant women is extremely high has great value. Appreciable diffusion HG among adult population RS () testifies to wide contacts to these patients of children and teenagers (Semenov S.I. 2007).

In our research some problems of early diagnostics VG in children's practice are taped. Them concerns first of all, the minimum clinical implications of illness at early stages. On our data in overwhelming majority of cases diagnosis HG is a casual find. At HGV - 71,2 % of cases, at HGS - 56,9 %, at mikst-hepatitises - 54,2 %. As often enough the diagnosis is put at inspection of patients «on contact»: in 17,6 %, in 18,1 % and in 28,5 % of cases accordingly.

Serious problem is the weak diagnostic base in republic districts. Frequently inspection on MVG is limited only to definition HBsAg. These can explain considerably larger number for the first time taped patients HGS, at inspection in the republican medical organisations in comparison with HGV (15,3 % and 46,8 % accordingly). Besides, in our research we have shown, that including in screening a - HBcor allows to tap patients with HGV HBsAg-negative.

There is also a problem of observation and the control over children and
Teenagers with HG. Absence of a speciality «children's infektsionist» leads to that children with HG on places are not on the dispensary account and are not observed properly. Especially it is characteristic for the Arctic and subarctic regions of republic, where a number of the objective reasons (low population density, remoteness and small number of settlements, the difficult transport scheme, often nomadic or seminomadic way of life) complicate to people access, not only, to specialised, but also in general to medical aid.

In the majority of regions of the country, thanks to introduction of bacterination against GV in a national calendar of inoculations, the case rate both acute and chronic forms of a HBV-infection (Baranov A.A. 2012) has essentially decreased. Such tendency is observed and in our republic (Nikitin Of this year, Sleptsova S.S. 2012). But despite good coverage by bacterination of children till 14 years (95,8 % in 2012) and depression of number of new cases GV, in RS (), HGV is diagnosed more, than for half of children and teenagers with HG (67,1 %).

The ethnic accessory of patients undoubtedly concerns features of epidemiological process HG at children and teenagers in RS () also. At studying of distribution of children of patients HG on a national identity following results have been received: children of the Yakut nationality have made 64,2 % (195 patients), Russian patients - 25,5 % (78 patients), representatives of small indigenous peoples of the north - 3,6 % (11 patients), other nationalities

- 6,6 % (20 patients). According to last population census the indigenous population share (Yakuts and MKNS) in RS () does not exceed 47 %, however among children with HG it makes 71,1 % of cases. Among patients of Yakuts (196 children) most often met HGV (HbsAg +) - at 86 patients, that has made (43,9 %), HGV (HbsAg-)

- At 22 patients (11,2 %), HGS - at 64 patients (32,7 %), mikst-hepatitises - at 22 patients (11,2 %). Among Russian patients (77 children) most often met HGS - at 36 patients that has made (46,8 %), HGV (HbsAg +) - at 24 patients (31,2 %), VGV (HbsAg-) - at 8 patients (10,4 %), mikst-hepatitises - at 9 patients (11,7 %). Among the patients concerning to MKNS (11 children)
The overwhelming majority had HGV (HbsAg +) - at 7 patients, that has made (63,6 %), HGS - at 4 patients (36,4 %). At sick other nationalities (20 children) most often met HGS - at 12 patients (60 %), HGV (HbsAg +) - at 5 patients (25 %), HGV (HbsAg-) - 1 patient (5 %), a mikst-hepatitis at 2 patients (10 %). Thus, statistically significant differences on frequency of revealing HGV, HGS and mikst-hepatitises at sick different nationalities (r