Molecular and epidemiological characteristics of hepatitis B virus in conditions of mass vaccine prophylaxis

A V Polyanina,T N Bystrova

doi:10.21145/2225-0026-2019-2-10-39

Abstract

The urgency of the problem of hepatitis B is due to the significant economic damage, medical, social and epidemiological significance of this disease, the ubiquity, severity, high frequency of adverse outcomes of infection, active involvement in the epidemic process of persons of reproductive and working age. The socio-economic significance of hepatitis B is evidenced by the morbidity, prevalence and mortality from this infection. The decrease in the incidence of acute hepatitis B, which is observed in Russia at the present time, is not a reason for an optimistic view of the problem, since the incidence of chronic hepatitis B over the past five years is almost at the same level (9–10 cases per 100 000 population). To date, laboratory diagnosis of viral hepatitis is based on the determination of specific markers by enzyme immunoassay. The use of molecular genetic methods opens up new prospects in the study of infection, allows us to identify patterns of manifestation, mechanisms of regulation of the epidemic process, including the study of the variability of the pathogen in space and time. The use of molecular genetic research methods should be considered not as an alternative, but as a mandatory addition to the regulated diagnostic schemes, which will effectively identify the pathogens of viral hepatitis, assess the identity of viral isolates and on this basis improve epidemiological surveillance and control of these infections.

Highlights

The urgency of the problem of hepatitis B is due to the significant economic damage, medical, social and epidemiological significance of this disease, the ubiquity, severity, high frequency of adverse outcomes of infection, active involvement in the epidemic process of persons of reproductive and working age
The decrease in the incidence of acute hepatitis B, which is observed in Russia at the present time, is not a reason for an optimistic view of the problem, since the incidence of chronic hepatitis B over the past five years is almost at the same level (9–10 cases per 100 000 population)
The use of molecular genetic methods opens up new prospects in the study of infection, allows us to identify patterns of manifestation, mechanisms of regulation of the epidemic process, including the study of the variability of the pathogen in space and time

Summary

Introduction

Прекращение ВГВ-инфекции почти всегда связано с исчезновением в сыворотке крови HBsAg и появлением анти-HBs. Однако в некоторых спорадических случаях заболевания ГВ, развившихся, несмотря на проведенную вакцинацию, у пациентов, одновременно выявляются HBsAg и анти-HBs. Анализ вирусных изолятов, выделенных от таких пациентов, показал наличие мутаций в а-детерминанте HBsAg. Мутантный HBsAg, выделенный от пациентов, при исследованиях in vitro не распознавался моноклональными или поликлональными антителами, специфичными для а-детерминанты «дикого» типа. Мутация pre-Core/Core-гена приводит к прекращению синтеза HBeAg (сыворотка пациентов не содержит HBeAg, а гепатоциты, пораженные мутантным вирусом, не экспрессируют HBeAg на своей поверхности), а также к развитию латентной инфекции, вызванной ВГВ, при которой в отсутствии сывороточных маркеров (кроме анти-HBcore) вируса выявляется репликация ВГВ (ДНК в крови или ткани печени методом ПЦР).

Results

Conclusion