Published: 09.02.05 Updated: 09.02.2005 18:06:45
Hepatitis A is a notifiable disease in all the countries in the region. Denmark, Norway and Northwest Russia report both laboratory confirmed cases and cases epidemiologically linked to a laboratory confirmed case. Estonia, Finland, Iceland, Lithuania and Sweden report only laboratory confirmed cases.
Figure 14. Number of cases of hepatitis A notified in 2003 per 100 000 population (1).
The Nordic countries are considered a non-endemic area for hepatitis A. Most cases are diagnosed among travellers to endemic areas. The incidence rates have remained low since the 1960s with occasional peaks in rates caused by outbreaks in high-risk groups. Since the mid-1990s, large outbreaks of hepatitis A among intravenous drug users have been reported from Sweden, Finland and Norway. In 2004, outbreaks among men who have sex with men were reported from Denmark and Norway.
Russia has long been considered an endemic area, with mostly domestically acquired cases involved in occasional water- or food-borne outbreaks. The incidence rates of hepatitis A in Northwest Russia have decreased considerably during the last 15 years. Improvements of water quality and sewage systems are important contributing factors. The fall in incidence rates are even more striking in the Baltic countries, and the incidence rates are now similar to the rates in the Nordic countries (figure 15). In Northwest Russia non-immune school children and children in day care centres are the most vulnerable group, and nosocomial infections have been reported in childrens wards. Adults in the general population in Russia and the Baltic countries have a much higher prevalence of serological evidence of prior hepatitis A virus infection than adults in other parts of the region.
Figure 15. Number of cases of hepatitis A notified per 100 000 population 1999-2003 by groups of countries or regions (1). Komi, Pskov, Novgorod and Vologda regions not included.
Traditionally, hepatitis A has been prevented by improving hygienic and sanitary conditions combined with administration of normal immunoglobulins to family contacts of diagnosed cases. This strategy is still important in combating hepatitis A in Northwest Russia. A hepatitis A vaccine became available in 1992. In the Nordic and the Baltic countries, the vaccine is at present mainly given to travellers to endemic areas and to indigenous high-risk groups such as drug users and men who have sex with men in combating outbreaks. Norway is the only country in the region where hepatitis A vaccine is given free of charge to drug users regardless of ongoing outbreaks. Finland will follow in 2005. Vaccinations of larger population groups like foodhandlers and children are considered in Northwest Russia in areas where hepatitis A is highly epidemic and on the increase. The cost of the vaccine is however, a major obstacle for large-scale vaccination.