Journal of microbiology, epidemiology and immunobiologyJournal of microbiology, epidemiology and immunobiologyЖурнал микробиологии, эпидемиологии и иммунобиологии0372-93112686-7613Central Research Institute for Epidemiology127610.36233/0372-9311-330ORIGINAL RESEARCHESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯResearch ArticleHepatitis C virus care cascade for children in Moscow RegionКаскад медицинской помощи детям с инфекцией, вызванной вирусом гепатита С, в Московской областиhttps://orcid.org/0000-0002-1960-6868MeskinaElena R.МескинаЕлена Руслановна
Russian Federation

D. Sci. (Med.), Head, Сhildren's infectious disease department

д.м.н., зав. отд. детских инфекций отдела терапии

meskinaelena@rambler.ruhttps://orcid.org/0000-0002-0052-2867GalkinaLidiya A.ГалкинаЛидия Алексеевна
Russian Federation

Cand. Sci. (Med.), senior researcher, Childrens infections disease department

к.м.н., с.н.с. отд. детских инфекций

meskinaelena@rambler.ruhttps://orcid.org/0000-0002-0586-8402TselipanovaElena E.ЦелипановаЕлена Евгеньевна
Russian Federation

Cand. Sci. (Med.), senior researcher, Childrens infections disease department

к.м.н., с.н.с. отд. детских инфекций

meskinaelena@rambler.ruhttps://orcid.org/0000-0001-5214-8072OdinaevaNuriniso D.ОдинаеваНуринисо Джумаевна
Russian Federation

D. Sci. (Med.), Professor, Chair of рediatrics, M.F. Vladimirsky Moscow Regional Research and Clinical Institute; Director, Research Clinical Institute of Childhood

д.м.н., профессор кафедры педиатрии МОНИКИ им. М.Ф. Владимирского; директор Научно-исследовательского клинического института детства

meskinaelena@rambler.ruMoscow Regional Research and Clinical InstituteМосковский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоResearch Clinical Institute of ChildhoodНаучно-клинический институт детства071220229955255392208202214112022Copyright ©; 2022, Meskina E.R., Galkina L.A., Tselipanova E.E., Odinaeva N.D.Copyright ©; 2022, Мескина Е.Р., Галкина Л.А., Целипанова Е.Е., Одинаева Н.Д.2022Meskina E.R., Galkina L.A., Tselipanova E.E., Odinaeva N.D.Мескина Е.Р., Галкина Л.А., Целипанова Е.Е., Одинаева Н.Д.https://creativecommons.org/licenses/by/4.0https://microbiol.crie.ru/jour/article/view/1276

Background. Children and adolescents with infection caused by the hepatitis C virus (HCV) have not been given sufficient attention due to mild forms of HCV and delays in approval of antiviral treatment regimens. Omissions in the studies of pediatric cohorts and shortcomings of management policies aimed at children should be eliminated by improving screening coverage and access to treatment.

The aim of the study was to present the results of the cascade sequence of diagnostic testing, care and treatment of children with HCV in the Moscow Region (MR).

Materials and methods. The study included all HCV seropositive children of MR (n = 175), who underwent screening tests, and it did not include patients living with HIV/HCV coinfection. Children were observed from 2017 to 2022. The HCV RNA was detected in 164 children and HCV genotypes were identified in 99 children. The stage of liver fibrosis was assessed in 73 children by transient elastography and by FIB-4 index calculation.

Results. In MR, 93.7% of seropositive children were tested for HCV RNA; 71.2% of adolescents over 12 years of age received treatment. The prevalence of HCV seropositivity was estimated at 0.113/1,000 children population; the prevalence of chronic HCV infection was at least 0.059/1,000. The dominant HCV subtypes were GT 1b (43.4% [the 95% confidence interval, 33.5–53.8%]), GT 3a (23.2% [15.3–32.8%]) and GT 3a/3b (20.2% [12.8–29.5%]). The incidence of viremic HCV infection per 100,000 children was 3.3 among children under 3 years of age; 7.0 – among children aged 3–6 years; 7.7 – among children aged 7–11 years, 4.4 – among adolescents older than 12 years. Natural HCV clearance was reported at the frequency of 19.5% [13.8–26.4%]. Extrahepatic manifestations were of rare occasion – 2.9% [0.9–6.5%]. Vertical transmission was the primary route of HCV transmission (78.3% [71.4–84.2%]); infection is assumed to occur during medical invasive procedures — 7.4% [4.0–12.4%], drug using — 0.6% [0.01–3.10%], in the family household – 0.6% [0.01–3.10%]. New cases of HCV infection were more frequently detected during routine examination of children prior to hospitalization or children born to mothers with HCV. Viremic HCV was confirmed in 90.2% [84.6–94.3%], including HCV infection – in 53.4% [45.0–61.6%], chronic liver disease – in 35.8% [28.1–44.1%] having low activity and occasional consequences (the fibrosis METAVIR score of F1 and F1-2 – 17.8% [9.8–28.5%]). No significant clinical and epidemiological differences between the natural course of chronic HCV infection and the liver disease caused by HCV have been found. The burden of pediatric HCV in MR is aggravated by a significant proportion of socially vulnerable patients and patients with comorbid conditions.

Conclusion. One of the solutions for detection of new pediatric cases of HCV infection in MR can be offered by improvement of collaboration and continuity of care among healthcare organizations and early treatment of women of childbearing age. Further research is required to evaluate the effectiveness of routine testing of all socially vulnerable pediatric groups. Early application of pan-genotypic antiviral treatment regimens can contribute significantly to control of the HCV infection incidence in children.

Актуальность. Детям и подросткам с инфекцией, вызванной вирусом гепатита С (ВГС), уделялось недостаточно внимания из-за более лёгкого течения и отставания одобрения схем противовирусной терапии. Следует устранить пробелы исследований в педиатрических когортах и недостатки политики ведения детей, обеспечив организацию доступа к тестированию и лечению.

Цель исследования — представить результаты каскадной последовательности мер оказания медицинской помощи детям с ВГС в Московской области (МО).

Материалы и методы. Включены все серопозитивные к ВГС дети МО (n = 175), прошедшие скрининговое тестирование, и не включены пациенты, живущие с коинфекцией ВИЧ/ВГС. Дети наблюдались в 2017–2022 гг. РНК ВГС определена у 164 и его генотипирование — у 99. Стадия фиброза печени оценена у 73 детей с помощью транзиторной эластографии и расчёта индекса FIB-4.

Результаты. В МО охват тестированием на РНК ВГС-серопозитивных детей составил 93,7%, пролечено 71,2% подростков старше 12 лет. Распространённость серопозитивности к ВГС оценивается как не менее 0,113/1000 детского населения, хронической ВГС-инфекции — как не менее 0,059/1000. Доминировали субтипы G1b (43,4% [95% доверительный интервал 33,5–53,8%]), G3a (23,2% [15,3–32,8%]) и G3a/3b (20,2% [12,8–29,5%]). Заболеваемость виремической ВГС на 100 тыс. детей составила 3,3 у детей младше 3 лет; 7,0 — у детей 3–6 лет; 7,7 — у детей 7–11 лет, 4,4 — у подростков старше 12 лет. Естественный клиренс ВГС зарегистрирован с частотой 19,5% [13,8–26,4%]. Внепечёночные проявления встречались редко — 2,9% [0,9–6,5%]. Основной путь передачи ВГС — вертикальный (78,3% [71,4–84,2%]), предполагаемое заражение при медицинских инвазивных процедурах — 7,4% [4,0–12,4%], употреблении наркотиков — 0,6% [0,01–3,10%], в семейном очаге — 0,6% [0,01–3,10%]. Новые случаи ВГС-инфекции выявлялись чаще при плановом обследовании детей перед госпитализацией или у рождённых от матерей с ВГС. Виремическая ВГС подтверждена у 90,2% [84,6–94,3%], в том числе ВГС-инфекция — у 53,4% [45,0–61,6%], хроническая болезнь печени — у 35,8% [28,1–44,1%] с низкой степенью активности и редкими последствиями (фиброз по шкале METAVIR F1 и F1-2 — 17,8% [9,8–28,5%]). Не установлено существенных клинико-эпидемиологических отличий между естественным течением хронической ВГС-инфекции и болезни печени, вызванной ВГС. Бремя педиатрической ВГС в МО утяжелено значительной долей социально уязвимых и коморбидных пациентов.

Заключение. Резервом для выявления новых случаев ВГС-инфекции в МО у детей может быть укрепление преемственности между медицинскими организациями и раннее лечение женщин детородного возраста. Необходимы исследования, чтобы оценить эффективность рутинного тестирования всех социально уязвимых педиатрических групп. Раннее применение пангенотипных схем противовирусной терапии, вероятно, быстро позволяет контролировать заболеваемость ВГС-инфекцией у детей.

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