Epidemiological situation of acute and chronic viral hepatitis B and C
in the Republic of Kazakhstan.
Dmitriy A. Suloev, Elena A.
Shevyakova, Galymzhan M. Seytgaliev
Introduction.
Viral hepatitis
is widely spread in all countries of the world and up to the present they are
of great socially-economic importance. According to different resources, from
170 to 200 million people of the world are affected with chronic hepatitis type
C, from 350 to 400 million people – with chronic hepatitis type B, and about 30
million people are infected with both types of hepatitis (type B and C).
Chronic hepatitis type B formation is observed among 15% sick people, 40-70% of
children that had acute hepatitis type B. Chronic hepatitis C is formed in
80-90% of patients with acute C hepatitis. [1].
The aim of the research.
The aim of the research is to study
epidemiological situation with viral hepatitis type B and C in the Republic of
Kazakhstan.
Materials and methods.
We have analyzed
the statistical data about infectious diseases in the Republic of Kazakhstan
with viral hepatitis, hepatitis type B and C, with first revealed chronic
hepatitis, chronic hepatitis type B and C during 2005-2010, given by the
Scientific and Practical Center for sanitary and epidemiological expertise and
monitoring of the Committee of the State Sanitary and Epidemiological Control
of Ministry of Health of the Republic of Kazakhstan.
Results and discussion.
Sickness rate of
population in Kazakhstan with acute viral hepatitis was decreasing during the
analyzed period, but sickness rate of chronic viral hepatitis was increasing.
Chart 1. Comparative data about infectious sickness rate of population
in Kazakhstan with acute and chronic viral hepatitis type B and C during
2005-2010.
|
|
2005 |
2006 |
2007 |
2008 |
2009 |
2010 |
||||||
|
N |
r |
N |
r |
N |
r |
N |
r |
N |
r |
N |
r |
|
|
AVH |
9934 |
65,15 |
9564 |
62,5 |
11912 |
76,93 |
7272 |
46,39 |
5742 |
36,16 |
5006 |
31 |
|
HB |
1412 |
9,26 |
1192 |
7,79 |
846 |
5,46 |
692 |
4,41 |
509 |
3,21 |
428 |
2,65 |
|
HC |
310 |
2,03 |
241 |
1,58 |
195 |
1,26 |
147 |
0,94 |
132 |
0,84 |
95 |
0,59 |
|
FRCH |
1306 |
8,57 |
1425 |
9,31 |
1751 |
11,31 |
1631 |
10,4 |
1585 |
9,95 |
1961 |
12,14 |
|
CHB |
582 |
3,82 |
603 |
3,94 |
624 |
4,03 |
614 |
3,92 |
657 |
4,13 |
785 |
4,86 |
|
CHC |
617 |
4,05 |
700 |
4,57 |
1045 |
6,75 |
920 |
5,87 |
824 |
5,17 |
1089 |
6,74 |
(A number of sick people - N, r- rates for 100 thousand people, AVH-
acute viral hepatitis, HB- acute viral hepatitis type B, HC- acute viral
hepatitis type C, FRCH- first revealed chronic hepatitis, CHB- chronic viral
hepatitis type B, CHC- chronic hepatitis type C ).
Sickness rate of
acute viral hepatitis in 2010 decreased by 49, 61% in comparison with 2005, acute viral hepatitis type B- by 69,69%,
acute viral hepatitis type C - by 69,35. A number of first revealed chronic
hepatitis in 2010 increased by 50,5% in comparison with 2005, chronic viral
hepatitis type B - by 34,88%, chronic hepatitis type C - by 76,5%.
Data review of
concrete clinical entities shows that republican sickness rate of acute viral
hepatitis type B decreased in the period of 2005-2010. Epidemiological
situation in the regions is similar to the republican one:
Diagram 1. Sickness rate of population in Kazakhstan with acute viral
hepatitis type B during 2005-2010 in the regions (a number of cases).
Chart
2. Comparative data about infectious sickness rate of population in Kazakhstan
with viral hepatitis type B during 2005-2010 (rates for 100 thousand people) in
the regions.
|
region |
2005 |
2006 |
2007 |
2008 |
2009 |
2010 |
|
Akmola |
8,82 |
6,15 |
4,94 |
2,41 |
2,17 |
2,31 |
|
Aktobe |
11,95 |
10,42 |
6,15 |
5,65 |
5,03 |
3,32 |
|
Almaty |
3,36 |
3,23 |
1,72 |
1,87 |
1,37 |
1,41 |
|
Atyrau |
10,58 |
8,19 |
6,18 |
5,65 |
2,56 |
2,7 |
|
East Kaz. |
15,54 |
13,58 |
10,27 |
8,87 |
5,22 |
3,52 |
|
Zhambyl |
7,77 |
5,77 |
3,65 |
1,95 |
1,16 |
1,62 |
|
West-Kaz. |
10,25 |
6,38 |
3,09 |
2,92 |
1,93 |
1,44 |
|
Karaganda |
10,63 |
9,28 |
6,79 |
4,32 |
3,11 |
2,88 |
|
Kostanai |
8,84 |
9,31 |
4,34 |
4,82 |
3,38 |
2,26 |
|
Kyzylorda |
14,49 |
12,06 |
9,7 |
6,28 |
5,26 |
3,73 |
|
Mangistau |
13,29 |
9,69 |
8,28 |
7,21 |
6,68 |
6,58 |
|
Pavlodar |
2,01 |
4,3 |
1,61 |
1,34 |
0,67 |
0,53 |
|
North-Kaz. |
7,03 |
6,06 |
5,02 |
3,53 |
2,01 |
1,71 |
|
South Kaz. |
6,2 |
5,23 |
2,81 |
3,52 |
2,58 |
2,53 |
|
Almaty city |
10,79 |
8,05 |
7,51 |
4,84 |
3,84 |
3,38 |
|
Astana city |
18,49 |
14,27 |
12,61 |
9,53 |
8,29 |
4,67 |
Sickness rate of
acute viral hepatitis type C in the regions is similar to the republican one
too; everywhere a number of sick people in 2010 is lower than in 2005. However,
controlled descent was only in Karaganda and South–Kazakhstan oblasts,
variation of revealed cases was observed in other regions, that’s why we
couldn’t say exactly about the sickness rate decrease.
Diagram 2. Sickness rate of population in Kazakhstan with acute viral
hepatitis type C during 2005-2010 in the regions (a number of cases).
Chart 3. Comparative data about infectious sickness rate of population
in Kazakhstan with viral hepatitis type C during 2005-2010 (rates for 100
thousand people) in the regions.
|
region |
2005 |
2006 |
2007 |
2008 |
2009 |
2010 |
|
Akmola |
2,41 |
2,14 |
2,27 |
0,94 |
1,08 |
0,68 |
|
Aktobe |
2,24 |
1,45 |
1,29 |
1,41 |
1,54 |
0,97 |
|
Almaty |
0,87 |
0,43 |
0,25 |
0,24 |
0,6 |
0,23 |
|
Atyrau |
2,99 |
1,89 |
2,06 |
0,81 |
0,59 |
1,16 |
|
East Kaz. |
2,67 |
2,1 |
2,74 |
2,11 |
1,34 |
0,56 |
|
Zhambyl |
1,11 |
0,2 |
0,39 |
0,1 |
0,1 |
0 |
|
West-Kaz. |
1,54 |
0,82 |
0,65 |
0,97 |
0,64 |
0,48 |
|
Karaganda |
4,46 |
2,92 |
1,57 |
0,82 |
0,59 |
0,52 |
|
Kostanai |
2,4 |
2,11 |
2 |
1,68 |
1,8 |
1,24 |
|
Kyzylorda |
3,95 |
3,86 |
1,91 |
1,57 |
1,61 |
0,86 |
|
Mangistau |
4,78 |
3,4 |
4,27 |
1,92 |
1,83 |
1,97 |
|
Pavlodar |
0,81 |
1,61 |
0,8 |
0,13 |
0,53 |
0,4 |
|
North-Kaz. |
2,09 |
2,12 |
1,22 |
1,99 |
0,93 |
0,16 |
|
South Kaz. |
0,8 |
0,62 |
0,61 |
0,34 |
0,33 |
0,24 |
|
Almaty city |
0,89 |
0,39 |
0,08 |
0,37 |
0,22 |
0,07 |
|
Astana city |
3,05 |
3,62 |
1,87 |
2,26 |
2,12 |
2,55 |
Data of first
revealed chronic viral hepatitis doesn’t allow drawing a definite conclusion
about dynamics of their detectability. In whole republic in 2010 a number of
hepatitis was 1961, but in 2005 there were 1306. Epidemiological situation of
first revealed chronic hepatitis varies in the regions. So called safe regions
are Aktobe, Atyrau, Zhambyl, Kyzylorda and Mangistau oblasts. A number of sick
people there didn’t exceed 31 people. The largest number of sick people was
registered in West-Kazakhstan oblast (347 in 2007), South-Kazakhstan oblast’
(263 in 2009) and in Astana city (269 in 2008, 364 in 2009 and 429 in 2010).
Diagram 3. First revealed chronic hepatitis, a number of cases in the
regions.
Chart 4. Comparative data about infectious sickness rate of population
in Kazakhstan during 2005-2010: First revealed chronic hepatitis in the regions
(rates for 100 thousand people).
|
region |
2005 |
2006 |
2007 |
2008 |
2009 |
2010 |
|
Akmola |
8,42 |
11,36 |
12,55 |
9,66 |
4,73 |
9,63 |
|
Aktobe |
0 |
0,29 |
0,29 |
0,71 |
1,54 |
3,87 |
|
Almaty |
1,3 |
2,17 |
3,25 |
2,54 |
2,38 |
5,68 |
|
Atyrau |
1 |
1,05 |
0,41 |
0 |
0 |
0,19 |
|
East Kaz. |
8,15 |
9,24 |
8,58 |
11,76 |
10,08 |
14,79 |
|
Zhambyl |
1,71 |
1,39 |
0,79 |
0,58 |
0,48 |
0,67 |
|
West-Kaz. |
17,94 |
29,95 |
56,5 |
39,38 |
35,56 |
42,76 |
|
Karaganda |
13,38 |
12,94 |
10,74 |
8,78 |
6,6 |
7,6 |
|
Kostanai |
3,49 |
3,66 |
5,23 |
5,38 |
4,05 |
7,11 |
|
Kyzylorda |
4,44 |
2,9 |
1,43 |
1,57 |
1,46 |
2,01 |
|
Mangistau |
3,99 |
7,85 |
7,78 |
3,85 |
4,82 |
5,92 |
|
Pavlodar |
14,76 |
18,41 |
26,83 |
33,97 |
24,28 |
27,14 |
|
North-Kaz. |
10,77 |
9,99 |
5,17 |
7,67 |
7,28 |
14,49 |
|
South Kaz. |
12,9 |
8,95 |
7,62 |
8,56 |
10,93 |
9,16 |
|
Almaty city |
11,83 |
14,61 |
9,96 |
9,6 |
8,52 |
8,52 |
|
Astana city |
19,44 |
22,29 |
59,97 |
43,44 |
55,01 |
60,77 |
Epidemiological
situation of chronic viral hepatitis type B in the regions differs from the
republican one. We can’t say exactly about the sickness rate increase and
decrease. A low level of sickness rate is in Aktobe, Atyrau, Zhambyl, Kyzylorda
and Mangistau oblasts. A number of sick people there didn’t exceed 15 people.
The largest number of sick people was registered in West-Kazakhstan oblast’
(155 in 2007) and in Astana city (160 in 2009 and 205 in 2010).
Diagram 4. Sickness rate of population in Kazakhstan with chronic viral
hepatitis type B during 2005-2010 in the regions (a number of cases).
Chart
5. Comparative data about infectious sickness rate of population in Kazakhstan
with chronic viral hepatitis type B during 2005-2010 (rates for 100 thousand
people) in the regions.
|
region |
2005 |
2006 |
2007 |
2008 |
2009 |
2010 |
|
Akmola |
3,07 |
3,48 |
4,01 |
2,68 |
1,35 |
1,22 |
|
Aktobe |
0 |
0 |
0 |
0,28 |
0,56 |
1,52 |
|
Almaty |
0,75 |
1,55 |
1,66 |
2,12 |
1,79 |
2,69 |
|
Atyrau |
0,2 |
0,63 |
0,41 |
0 |
0 |
0 |
|
East Kaz. |
3,7 |
4,06 |
4,57 |
4,51 |
4,51 |
6,34 |
|
Zhambyl |
0,2 |
0,9 |
0,59 |
0,19 |
0,39 |
0,57 |
|
West-Kaz. |
7,69 |
11,13 |
25,24 |
15,07 |
14,97 |
17,23 |
|
Karaganda |
5,8 |
4,94 |
2,61 |
2,23 |
1,56 |
1,92 |
|
Kostanai |
1,31 |
1,77 |
3,23 |
1,57 |
1,24 |
2,71 |
|
Kyzylorda |
1,32 |
0,64 |
0,48 |
0,16 |
0,88 |
0,86 |
|
Mangistau |
0,53 |
3,4 |
3,76 |
1,2 |
2,29 |
2,41 |
|
Pavlodar |
9,53 |
8,33 |
7,38 |
12,7 |
6,4 |
6,78 |
|
North-Kaz. |
5,54 |
5,3 |
0,91 |
2,76 |
3,72 |
6,7 |
|
South Kaz. |
5,89 |
2,88 |
2,81 |
2,8 |
4,82 |
3,87 |
|
Almaty city |
5,23 |
9,08 |
6,59 |
4,99 |
4,04 |
3,8 |
|
Astana city |
7,43 |
6,78 |
7,67 |
16,47 |
24,18 |
29,04 |
Sickness rate of
chronic viral hepatitis type C is rather law in so called safe regions -
Aktobe, Atyrau, Zhambyl, Kyzylorda and Mangistaua oblasts. A number of
registered sick people in these regions didn’t exceed 17 people. A high level
of sickness rate is in West-Kazakhstan oblast (188 in 2007, 156 in 2010),
Pavlodar oblast (159 in 2008) and in Astana city (306 in 2007, 192 in 2009 and
215 in 2010).
Diagram 5. Sickness rate of population in Kazakhstan with chronic viral
hepatitis type C during 2005-2010 in the regions (a number of cases).
Chart 6. Comparative data about infectious sickness rate of population
in Kazakhstan with chronic viral hepatitis type C during 2005-2010 (rates for
100 thousand people) in the regions.
|
region |
2005 |
2006 |
2007 |
2008 |
2009 |
2010 |
|
Akmola |
4,41 |
5,88 |
8,01 |
6,71 |
2,97 |
8,28 |
|
Aktobe |
0 |
0,29 |
0,29 |
0,42 |
0,98 |
2,35 |
|
Almaty |
0,5 |
0,56 |
1,53 |
0,42 |
0,48 |
2,99 |
|
Atyrau |
0,2 |
0,42 |
0 |
0 |
0 |
0 |
|
East Kaz. |
3,29 |
4,9 |
3,73 |
7,11 |
5,43 |
7,89 |
|
Zhambyl |
1,21 |
0,2 |
0,1 |
0,19 |
0,1 |
0 |
|
West-Kaz. |
8,71 |
17,51 |
30,61 |
22,2 |
17,7 |
24,89 |
|
Karaganda |
7,06 |
7,56 |
8,06 |
6,25 |
4,82 |
5,54 |
|
Kostanai |
2,07 |
1,66 |
1,78 |
3,81 |
2,82 |
4,4 |
|
Kyzylorda |
2,47 |
1,13 |
0,64 |
1,1 |
0,15 |
1,15 |
|
Mangistau |
3,45 |
4,19 |
3,51 |
2,64 |
2,06 |
3,51 |
|
Pavlodar |
5,23 |
10,08 |
18,65 |
21,26 |
17,88 |
20,35 |
|
North-Kaz. |
5,09 |
4,39 |
3,65 |
4,14 |
3,41 |
7,79 |
|
South Kaz. |
5,01 |
3,19 |
2,68 |
3,1 |
3,74 |
2,97 |
|
Almaty city |
5,88 |
5,21 |
3,29 |
4,32 |
4,4 |
4,44 |
|
Astana city |
12,01 |
15,52 |
52,13 |
26,97 |
29,02 |
3,46 |
Conclusion.
Thus, on the
basis of above-mentioned statistic data we can conclude that sickness rate of
acute forms of hepatitis type Band C goes lower in Kazakhstan; on the contrary
there is an increase of the number of sick people with chronic hepatitis type B
and C. The reason is probably a high cost of treatment of this kind of diseases,
that’s why sick people don’t finish the treatment o acute forms and they become
chronic. With the purpose of the improvement the epidemiological situation of
viral hepatitis type B and C, the improvement of life quality for sick people
with these diseases and taking into account the price of their treatment, The
Government of The Republic of Kazakhstan has made a decision to appropriate
financial funds for treatment of sick people with viral hepatitis type B and C.
Since 2010 treatment of children has been provided those who are affected with
hepatitis type B and C and also treatment of medical workers and the students
as they are people with a high risk of infection. Since 2011 will start the
treatment of adults by modern medicines according to international standards
taking into account individual peculiarities of sick people. The area of
treatment will grow from year to year owing to the conduction of diagnostic
researches for viral hepatitis type B and C. Within the scope of state program
“Salamatty Kazakhstan” for 2011-2015 since 2011 financial means for diagnostics
of hepatitis are provided for children and since 2012 for adults. These
measures let us expect the improvement of epidemiological situation with viral
hepatitis type B and C.
References.
1. Sobolevskaya O.L., Korochkina O.V. Prophylaxis of hepatitis type A and B
among sick people with chronic hepatitis type B, C, B+C // Epidemiology and
vaccinal prevention. 2010. ¹ 3(52). P.44-47.
2. Government resolution of the Republic of Kazakhstan ¹1350 dated
13.12.2010 On implementation of The republican law “About Republican budget for
2011-2013” (with amendments and addenda on the state for 25.10.2011)