1.1. Epidemiologija chronic hepatitises at children and teenagers

Epidemiologiju virus hepatitises it is necessary to survey in unity of all forms of clinical implications - acute and chronic which, in turn, can have a demonstrative and asymptomatic current [224, 440].

Frequency of a registered case rate virus hepatitises varriruet from several tens cases a year in the countries with a high standard of living to several hundreds on 100 000 inhabitants in the Central Africa, JUgoYOZapadnoj Asia. In the countries of Europe, in the USA, Australia and Canada frequency of carriage HBV makes less than 1 %. In the Central Africa, Southwest Asia, Taiwan frequency of a carriage reaches 20-50 % [42, 116, 141, 204, 327, 381, 403, 258, 325, 344,353]. HBV widespread in Asia, Africa and in the western part of Pacific ocean, (from 5-20 % to 80 % of all infected people in the world) [354, 336].

About 170 million persons (about 3 % of the world population) are infected by a virus of a hepatitis With (HCV) [273, 360, 289]. Prevalence of an infection considerably differs depending on geographical region and in separate populations. So, in the Western Europe frequency of revealing anti-HCV varies from 0,4 to 1 %, while the highest prevalence HCV - infections is registered in Egypt (9 % on the country and to 50 % in some districts) [291, 365, 325].

Prevalence of a HCV-infection in children's population of the developed countries makes 0,1-0,4 %, dependence of frequency of a becoming infected on age thus becomes perceptible: in an age category of 6-11 years frequency of revealing anti-HCV makes 0,1-0,2 %, in 12-19 years - 0,4 %. [20, 253, 310, 318] In the countries with low sotsialnoyoekonomicheskim level frequency of a HCV-infection in children's population reaches 1,8-5 % [321, 368 318, 353].

In Rossi the epidemiological situation with hepatitises In and With still remains strained. On change to sharp lifting of a case rate by acute virus hepatitises [142, 183, 227], observed in 1996-1999 gg, epidemic has come
Chronic virus hepatitises, the quantity augmentation for the first time the taped cases of a chronic lesion of a liver of a virus aetiology and number of carriers of viruses In and With [33, 59, 94, 164, 224] is annually registered.

The general case rate of children and teenagers till 17 years with chronic virus hepatitises, last years, in the Russian Federation tends to depression: from 7,67 (on 100 thousand children of the given age) in 2006 to 4,34 (on 100 thousand children of the given age) in 2010. Depression follows the account reduction of number again taped HGV. Carrying out of mass immunization of the population against a hepatitis In in the Russian Federation has allowed to lower in 5 times a case rate an acute hepatitis In: with 8,6 in 2005 to 1,71 on 100 thousand population in 2011, and to the beginning of 2012 to reach the lowest for all years of observation of level of a case rate. Substantial growth of an immune layer for last years promoted double (in 2,3 times) to depression in the country of level of a carriage of a virus of a hepatitis, including at children about one year - in 5,4 times (with 42,5 in 2005 to 7,9 on 100 thousand children of the given age in 2011). In the Russian Federation case rate registration by chronic forms of a hepatitis In as a whole on the country population - at level high enough level, nearby 13-14 on 100 thousand population proceeds.

Thus the case rate chronic forms of a hepatitis In children till 14 years has decreased in 2,95 times (with 2,8 in 2006 to 1,2 on 100 thousand in 2011) [18, 141, 221].

However, the registered case rate makes only a part true as quantity of not diagnosed anicteric forms of an acute hepatitis In at least in 5-6 times exceeds number of demonstrative cases. Other indicator of a wide circulation of a hepatitis In is carriage HBV. The "Healthy" carriage, is registered much more often, by data for 2002 in the Russian Federation is fixed 74,6 (on 100 000 us.) and in Far East Federal District (DVFO) - 158,34 (on 100 000 us.) [131, 144, 164, 272].

Level of a carriage of a virus considerably fluctuates for different regions. The carriage of 1-2 % is considered an average level, more than 5 % — high. [116, 135 Franco E, Kao JT] a parity of acute cases of a hepatitis In to "carriers" in 2009
Has made 1:11,6. In 29 subjects of the Russian Federation case rate OGS exceeds average on the country. The basic specific gravity in structure of diseased OGS is made by adults — 94,5 %, on a share of children and teenagers till 17 years 5,5 % [42, 110, 94] are necessary.

In some regions of the country VGV till now takes at children an in the lead place, the highest indicators of a case rate of children and teenagers chronic virus hepatitises became perceptible in DVFO [rams, 39]. The republic Sakha (Yakutia) concerns regions with a high endemicity. Chronic virus hepatitises at children till 14 years in the Russian federation and in Republic Sakha (Yakutia) has made a case rate in 2010: HGV 0,97 and 3,4 (on 100 000 us.); HGS 2,1 and 0,5 (on 100 000 us.) accordingly [71, 80, 131].

Last years there were some works devoted to studying of prevalence HG in different ethnic groups. At studying of frequency and risk factors of new cases of NANOSECOND  - infections among natives and not natives in 6 regions of Canada it is defined, that among natives-patients women prevailed. Middle age of patients-natives was much less in comparison with not natives. At patients of natives the clinic of acute hepatitis S.podobnye of research more often developed are spent also to Australia [442, 453]. In territory of the Russian Federation such researches were spent in Tyve - 7,7 % HBsAg - positive persons among "conditionally healthy population [100]. A number of researchers are specified in the possible genetic factors influencing a current HBV - infections [390, 456].

In etiological structure of parenteral virus hepatitises the quantity of mikst-hepatitises [94] was sharply enlarged. In Republic Sakha (Yakutia) HDV - the infection remains an actual problem in connection with the raised circulation among sick V.Obnaruzhenie's of hepatitis of markers HDV at "carriers" HbsAg among patients HBV in republic territory was observed in 17,2 % cases whereas this indicator in the Russian Federation makes 2-4 % [28, 29, 71, 377].

In the Yakut population high frequency HBsAg-negative is taped
Observations (31,5 %) at mikst-infection HCV+HBV. Diagnostics latent HBV - infections at the given patients was based on patogistologicheskoe research bioptatov a liver both immunodetektsii antigens HBV and HCV in a native tissue of a liver [71, 85, 132].

In the Russian Federation long time 1 genotype HCV - 55,7 % prevailed less often (including 1b - 54,8 %), meet a genotype 3а - 35,1 %, are even more rare - a genotype 2 (8,2 %). In the European part more often others taped a genotype lb, and in Western Siberia and in the Far East — genotypes 2а and For, in RS () the genotype lb [144, 183, 187, 204] prevails.

However in due course the picture can vary, for example in 2009 in the Stavropol edge at infected HCV children genotypes 1 b — at 35 %, For — at 30 %, 1 and — at 5 %, 2Ь — at 5 % [39] were defined. In Republic Sakha (Yakutia) the genotype lb has been taped at 46 sick (63,1 %), a genotype 2а at 12 (16,4 %), a genotype 3a 15 (20,5 %) [136].

In Omsk area in 2005 g in children's population it was revealed, that in 6,25 % genotype viruses 1в are taped in a combination to viruses of other genotypes (1в+1а, 1в+2а, 1в+3а) [29].

The basic tank of an infection are: infections sick of the chronic asymptomatic form, so-called "carriers"; patients the chronic, clinically expressed forms of a hepatitis; acute patients with anicteric and subclinical forms of illness [52]. Presence of the latent VGS-INFECTION when at a liver is present RNK VGS is established, and in Serum are absent anti-VgS and RNK VGS, at patients with tests of steady abnormal function of a liver of an unknown aetiology [366]. Patients HGV are a powerful source of infection, especially in the closed children's collectives and in families. Frequency of detection of markers of a virus of a hepatitis at parents, children suffering HGV makes 80-90 %, including at mothers - 90, 9 %, fathers - 78,4 %, sibsov - 78,5 % [52, 92, 204, 295,463].

In connection with immunologic insufficiency infectious process at children, especially the first years of a life proceeds in the form of erased, anicteric,
Subclinical forms, forming "asymptomatic" carriers. porazhennost children HG, it is bound with high hroniogennym in potential of the originators, to which inversely proportional age: the age of the patient, the above risk of formation HG [46, 168, 204, 354, 396] less.

Now one of frequent variants of a becoming infected of children vertical transfer of a virus of infected mothers is considered. Vertical transfer of a virus is carried out mainly in regions with high prevalence of a carriage of virus. There are data about a becoming infected of pregnant women from 0,05 % to 5 % [12, 48, 51, 80, 93, 108, 218, 350]. The special group of risk is represented by the women infected with a human immunodeficiency virus (HIV), frequency of revealing HCV - and HBV-infections at which considerably exceeds frequency in population, and the HIV-infection raises risk perinatalnogo becomings infected hepatitis viruses [73, 75, 93, 108, 350, 450, 453]. The basic risk for the child is bound to possibility of a becoming infected and development in it HG [56, 87, 378, 379]. Transplacental transfer of a virus is carried out, if the woman is the carrier of a virus or is infected in the third trimester of pregnancy. Dominating number of children with HG are infected intranatalno by materinsko-fruit infusions through an umbilical vein as a result of rupture of fine vessels of a placenta during fights and in connection with hit of blood of mother on superficial grazes of a foetus during its passage through patrimonial ways [209, 280, 339, 402]. The proof of the intranatal mechanism of a becoming infected is the occurrence fact viremii at the infected newborns in 70 % of cases in 1 month and in 90 % of observations in 3 months after a birth [43].

Data on transmission frequency HBV through a placenta very different from 5-10 % of cases to 53,6 % [43, 46, 93, 108, 126, 204, 208, 295, 322, 463]. Now among patients with congenital virus hepatitises children with VGS [82, 283] prevail. Consider that as the leader by infection of children of 1st year of a life Nv - and Nanoseconds-viruses is - perinatalnyj. At patients of this age it is registered in 75,0 % of cases at VGV and in 90,0 % - at VGS. A becoming infected
HCV children in postnatalnom the period it is observed seldom. So, it is known, that RNK HCV it is defined in a low caption in thoracal milk of patients HGS [318, 362, 395, 396], that presumably carries in itself risk of a becoming infected at thoracal feeding [341, 424]. On the other hand, in numerous researches it is shown, that thoracal feeding does not enlarge risk of a becoming infected of newborns, in communication, with what it is not forbidden in the presence of a HCV-infection at mothers (under condition of absence of disturbance of integrity of papillas and a mucosa of a mouth of the newborn) [392]. The probability of development of chronic carriage HBV considerably increases at a becoming infected, an event perinatalno, and also in thoracal and early age [288, 424]. Early age - one of the most important factors contributing to synchronisation of a hepatitis: at a becoming infected on 1 year of a life its frequency reaches 70-90 %, in 2-3 years - 40­70 %, in 4-6 years-10-40 % and at children is more senior 7 years - 6-10 %, i.e. Coincides with a similar indicator at adults. [199, 327, 424,445].

The most probable ways of a becoming infected a hepatitis virus In children of younger and school age (from 2 till 15 years) concern: household (contacts in a family) - 30 %, perinatalnyj-14,2 %, an injection of medical preparations - 14,1 %, operative measures - 8,3 %, transfusions of integral blood and plasma - 5,9 % It is primary frequency of natural ways in a becoming infected a hepatitis virus In has led to prevalence subclinical and innaparantnyh forms OGV which pass in the chronic form [26 is much more often, 51, 93, 108, 204, 377, 390, 456].

According to Ministry of Health of Russia, in 1990 50-60 % sick a hepatitis In caught in treatment-and-prophylactic establishments, in the late nineties - only 5-10 %. Already in the late nineties the share of medical manipulations in becoming infected HBV does not exceed 10-15 %, hemotransfusions - 1 % [24, 43, 98, 168, 424]. It is necessary to underline, that the risk of infection with a hepatitis virus In at hemotransfusions 10 times exceeds that at a hepatitis With [358].

HCV-infection transmission frequency in a life much more low, than at VGV, but in in certain conditions such way of a transmission of infection is possible [274]. In

Becoming infected a virus of a hepatitis With at teenage age, start to play a role such risk factors, as invasive medical/paramedical manipulations and intravenous introduction of psychoactive agents (last factors are typical for developing countries) [94, 98, 168, 424]. In the developed countries prior to the beginning of 1990th years of the XX-th century the basic mechanism of a becoming infected has been bound to hemotransfusions at treatment hematological (including onkogematologicheskih) diseases of the [283] or other diseases demanding regular hemotransfusions [444, 358]. From the moment of testing introduction

Donor blood and its products on markers of viruses of a hepatitis, including HCV, including by means of PTSR-DIAGNOSTICS, about 1992-93 in the USA and the countries of Europe cases postransfuzionnogo a hepatitis are observed kazuisticheski seldom, and the basic part of children with HGS is infected perinatalno.


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Scientific source Dmitriev Tatyana Gennadevna. CHRONIC VIRUS HEPATITISES At CHILDREN And TEENAGERS In REGION GIPERENDEMICHNOM. The PROGRAM of PERFECTION of RENDERING of the MEDIKO-SOCIAL HELP. The dissertation on competition of a scientific degree of the doctor of medical sciences. Yakutsk - 2014. 2014

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