Published: 06.10.05 Updated: 06.10.2005 11:28:54
Hans Blystad, Lars Blad, Johan Giesecke, Swedish Institute for Infectious Disease Control, Sweden, the Steering Group of the project Building a Network for Infections Disease Surveillance in the Baltic Sea Region
Hepatitis A is a notifiable disease in all the countries in the region.
In the Nordic countries and Germany, the incidence rates have remained low since the 1960s with occasional peaks in rates caused by outbreaks of hepatitis A in high-risk groups such as drug users. The Nordic countries may be considered as a non-endemic area for hepatitis A. Northwest 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, but have again increased during the last few years. The Baltic countries and Poland are in an intermediate category with lower rates that are still falling.
In the Nordic countries most cases of hepatitis A are diagnosed among travellers to endemic areas. However, outbreaks have been observed in drug user communities in many Nordic countries. Such outbreaks have not been recognized in the Baltic countries or Northwest Russia where non-immune school children are the most vulnerable group and nosocomial infections have been reported in childrens wards. Adults in the general population in Russia, the Baltic countries and Poland have a much higher prevalence of serological evidence of prior hepatitis A virus infection than the rest of the region.
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 was introduced in 1992. This vaccine is mainly given to travellers to endemic areas and to a lesser extent to indigenous high-risk groups such as drug users. The vaccine is widely used in most of the region in combating outbreaks, such as those among drug addicts. Vaccination of larger population groups of children are considered in Northwest Russia in areas where hepatitis A is highly epidemic and is on the increase. The cost of the vaccine is however, a major obstacle for large-scale vaccination.