Seroprevalencija i epidemiološke karakteristike varičele i herpes zostera u AP Vojvodini

Abstract

Uvod: Varičela (Varicella, Ovčije boginje) i herpes zoster (Herpes Zoster) su bolesti koje izaziva virus varicella - zoster. Varičela spada u najčešće dečje osipne groznice. Herpes zoster je bolest ljudi starijeg životnog doba. Imunizacija protiv varičele i herpes zostera je dala značajne rezultate u prevenciji ovih bolesti. Raspoloživi epidemiološki pokazatelji nisu dovoljni za uvođenje adekvatnog programa imunizacije protiv ovih bolesti u našoj zemlji. Cilj istraživanja bio je da se na teritoriji Vojvodine utvrde: seroprevalencija varicella-zoster virusnih antitela, epidemiološke karakteristike obolelih od varičele u periodu 1994−2014. godine i obolelih od herpes zostera u periodu 1997−2005, uzrasno specifične incidencije i udeo hospitalizovanih u ukupnom broju obolelih od varičele odnosno herpes zostera u periodu 2010−2014. godine. Materijal i metode: Istraživanje epidemioloških karakteristika varičele i herpes zostera je sprovedeno retrospektivno, analizom podataka iz epidemiološkog nadzora. Seroepidemiološko istraživanje je sprovedeno prospektivno (april 2015−februar 2016). Prikupljeno je 3.570 rezidualnih seruma uz prethodno informisanje i pisanu saglasnost pacijenata. Uzorak je reprezentativan za populaciju Vojvodine, prema mestu stanovanja, polu i uzrastu. Imunokompromitovani i primaoci transfuzije krvi u poslednjih šest meseci su izuzeti iz istraživanja. Testiranje seruma je sprovedeno ELISA testom u Centru za virusologiju Instituta za javno zdravlje Vojvodine. Referentna evropska laboratorija prosledila je referentni panel seruma koji je testiran pre i tokom testiranja banke seruma. Standardizacija rezultata je sprovedena na osnovu jednačine koju je prosledio Public Health England (PHE). Izračunata je i analizirana seroprevalencija antitela u odnosu na uzrast, pol i područje stanovanja. Istraživanje incidencije hospitalizovanih slučajeva varičele i herpes zostera sprovedeno je retrospektivno prikupljanjem podataka o hospitalizacijama. Statistički značajnim smatrane su vrednosti na nivou značajnosti p < 0,05 a visoko statički značajnim p < 0,01. Rezultati: Seroprevalencija antitela protiv virusa varicella-zoster u testiranom uzorku populacije Vojvodine je 84%. Utvrđen je očekivano visok procenat seropozitivne dece do navršenih devet godina života (73,3%). Osim u uzrasnim grupama < 1 i 1−4 godine, seroprevalencija raste sa uzrastom. Varičela se u Vojvodini održava endemo-epidemijski sa visokim incidencijama. U posmatranom periodu, najviša uzrasno specifična incidencija varičele se registruje u uzrastu 5−9 godina (5.824,6/100.000 stanovnika) i 0−4 godine (5.000,7/ 100.000 stanovnika). Od varičele su češće obolevali muškaraci dok su žene značajno ćešće obolevale od herpes zostera (p = 0,000 < 0,01). Incidencije varičele i herpes zostera se značajno razlikuju u odnosu na mesto stanovanja. Udeo hospitalizovanih u ukupnom broju obolelih od varičele bio je od 0,7 do 0,9%. Najviša uzrasno specifična incidencija hospitalizovanih sa varičelom registrovana je u uzrastu 0−4 godine i opada sa uzrastom. Incidencija herpes zostera najviša je kod starijih od 60 godina života (970,2/100,000 stanovnika), dok je incidencija hospitalizovanih slučajeva herpes zostera najviša kod starijih od 65 godina (105,7/100.000). Udeo hospitalizovanih slučajeva herpes zostera u ukupnom broju obolelih od herpes zostera se kretao u rasponu od 2,2 do 3,6 % ( ≥2% ). Zaključak: Rezultati ovog istraživanja ukazuju da varičela i herpes zoster značajno opterećuju zdravstveno stanje našeg stanovništva zbog čega postoji osnov za uspostavljanje epidemiološkog nadzora i kreiranje adekvatnog programa imunizacije.

Introduction: Varicella (Varicella, Chicken pox) and herpes zoster (Herpes Zoster) are diseases caused by the Varicella- zoster virus. Varicella is the most common children's rash-causing fever. Herpes zoster is mainly a disease of elderly people. Immunisation against varicella and herpes zoster have led to significant results in the prevention of these diseases. Available epidemiological indicators are not sufficient for introduction of an adequate program of immunization against these diseases in our country. The aim of the research was to establish: seroprevalence of varicella-zoster virus antibodies, the epidemiological characteristics of patients with varicella in the period 1994-2014. and patients with herpes zoster in the period 1997-2005, age-specific incidence and share of hospitalized patients in the total number of patients with varicella and herpes zoster in the period 2010-2014, in Autonomous Province of Vojvodina. Material and methods: The study of epidemiological characteristics of varicella and herpes zoster was conducted retrospectively by analyzing data from epidemiological surveillance. Seroepidemiological study was conducted prospectively (April 2015- February 2016). The total of 3.570 residual sera were collected with previously taken written informed consents of patients. Immunocompromised patients and recipients of blood transfusions in the last six months were not included in the survey. The sample was representative by residence, sex and age for population of Vojvodina. Testing of sera was conducted by ELISA tests at the Center for virusology, Institute of Public Health of Vojvodina. Reference European laboratory forwarded the reference panel serum which was tested before and during the testing of serum bank. Standardization of the results was based on the equation previously sent by Public Health England (PHE). Seroprevalence of antibodies was calculated in relation to the age, sex and area of residence. Incidence of hospitalized cases of varicella and herpes zoster was determined by retrospective collection of hospitalization data. Statistically significant was considered values at a significance level of p < 0,05 and highly statistically significant at p < 0,01. Results: The seroprevalence of antibodies against Varicella- zoster virus in the sample of the population of Vojvodina was 84%. High percentage of seropositive children under the age of nine years of age (73,3%) was determined, as expected. The seroprevalence increases with age, except in the age groups <1 and 1-4. Varicella in Vojvodina maintains endemo-epidemic mode with high incidence. In the observed period, the highest age-specific incidence of varicella is registered in the age group 5-9 years (5.824,6/100.000 inhabitants) and at the age of 0-4 years (5.000,7/100.000 inhabitants). Varicella was found significantly more often in men while herpes zoster was more often in women (p= 0,000 <0,01). Incidence of varicella and herpes zoster significantly varied among the population of certain municipalities in Vojvodina. The share of hospitalized patients in the total number of patients with varicella ranged from 0,7 to 0,9%. The highest age-specific incidence of hospitalized patients with varicella was registered in the age of 0-4 years and decreases with age. The incidence of herpes zoster is highest in people over 60 years of age (970,2/100.000 inhabitants), whereas the incidence of hospitalized cases of herpes zoster was highest in patients over 65 years (105,7/100.000). Proportion of hospitalized cases in the total number of patients with herpes zoster ranged from 2,2 to 3,6% . Conclusion: The results of this study suggest that varicella and herpes zoster are significant burden of the health status of our population and there is a basis for the establishment of epidemiological surveillance and creation of an adequate program of immunization.