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2021 marks the 40th anniversary of the discovery of the hepatitis E virus by an outstanding Russian virologist, academician of the Russian Academy of Medical Sciences Mikhail Surenovich Balayan. This date is an occasion to remember this remarkable scientist and person, to analyze the current state of the problem of viral hepatitis E, to sum up the research results and to correct the prospects of scientific directions, the development of which is largely related to the basic foundations laid by M.S. Balayan.The scientific heritage of M.S. Balayan is associated with the study of poliomyelitis, hepatitis A and hepatitis E. The main contribution of Mikhail Surenovich Balayan to world science was the discovery of the hepatitis E virus. This is, in first place, associated with the significance of the results obtained and the high moral value of the experimental selfinfection with hepatitis E.The paper presents data on the study of virology, epidemiology, clinical course, diagnosis and prevention of hepatitis E. The main concepts and directions of studying hepatitis E are overviewed.

Aim. To determine the prevalence of amino acid substitutions in hepatitis C virus NS5a and core proteins which are associated with resistance to direct-acting antivirals and interferon in genotype 1b (HCV-1b) strains circulating in Russia. Materials and methods. Nucleotide sequences of NS5a (n=93) and core (n=30) of HCV-1b were obtained using direct sequencing of respective amplified genome fragments. The search for resistance associated substitutions was performed for amino acid positions 28, 29, 30, 31, 32, 58, 62, 92, 93 of NS5a, and 70 and 91 amino acid positions of core proteins, respectively. Results. The total proportion of HCV-1b strains carrying resistance associated substitutions in NS5a was 22,6% (21/93). The total detection rate of L31M and Y93H substitutions that are associated with resistance to the majority of NS5a inhibitors was 10,8%. Less clinically significant substitutions L28M, R30Q, P58S/T, A92T were detected too. The proportion of infections caused by HCV-1b strains that are potentially resistant both to interferon and NS5a inhibitors was 10% (10/30). Conclusion. Testing of HCV-1b infected patients for background resistance profile could be a useful tool to prevent the choosing of initially ineffective treatment regimen.

Researches of parenteral viral hepatitis prevalence in Republic of Sakha (Yakutia) showed high frequency of hepatitis B and C infection markers. High level of HBsAg carriage among indigenous nationalities representatives living in isolated ethnic group had been revealed (12,9%). HBsAg and anti-HBc detection frequencies is 12,9% and 76,0% respectively in comparison with 5,8% and 14,6% among newcomer population (p

Aim. To determine the prevalence of hepatitis C virus (HCV) in different age groups of the conditionally healthy population of Russia.Materials and methods. Total 4764 serum samples from a conditionally healthy population of five regions of Russia (Moscow, Rostov, Sverdlovsk regions, Tyva Republic, and Sakha Republic (Yakutia) were tested. The study included persons of 10 age groups: < 1 year, 1–4 years, 5–9 years, 10–14 years, 15–19 years, 20–29 years, 30–39 years, 40–49 years, 50–59 years old, ≥ 60 years. Anti-HCV was determined in ELISA with commercial test systems. Anti-HCV positive samples were tested for HCV RNA by RT-PCR. The genotype of HCV was determined based on the analysis of the nucleotide sequences of the core and NS5B regions of the viral genome.Results. The overall prevalence of anti-HCV in 5 regions of Russia was 2,6% (126/4764), and the proportion of people with HCV RNA was 1,1% (50/4764). The highest anti-HCV positivity rate was observed in Tyva and Yakutia (3,3% in both regions), in other regions its prevalence varied from 1,7% (Moscow region) to 3,0% (Sverdlovsk region). The highest frequency of HCV RNA detection was observerd in Tyva Republic and Rostov region (1.3% in both regions). No positive for HCV RNA cases was detected among persons aged 0–19 years in any region, except for Tyva Republic (1,0% (1/98) in age group 15–19 years). Peak positivity rates of HCV RNA were detected in the age groups 20–29 years and 30–39 years in the Rostov Region (3,9% and 3,0%, respectively); in Yakutia – in the group of 30–39 years (3,7%), in Tyva – in the group of 40–49 years (3,6%), in the Moscow region – in the groups of 20–29 and 30–39 years (2,9% and 2,5%, respectively).Conclusion. The results obtained indicate a high degree of HCV infection in virtually all age groups in the interval from 20 years to ≥60 years. Specific age cohorts that might benefit from inclusion in regional HCV screening programs were identified in each region.

The records of total 123 patients with hepatitis E on treatment in the infectious diseases hospital in the city of Belgorod were reviewed. Diagnosis – «acute hepatitis E» was based on the generally accepted criteria: biochemical analysis, etiological interpretation (identification of antibodies to hepatitis E of the IgM and IgG, HEV RNA with the exception of the etiologic role of other hepatotropic viruses, including Epstein-Barr virus and cytomegalovirus). HEV RNA was determined by PCR, genotyping was performed by standard methods based on the results of sequencing. The study of clinical manifestations in patients with acute hepatitis E allowed to establish some specific features of hepatitis E: predominantly occurrence in adults at the age 30 years and more; frequent complaints of arthralgia in the prejaundice period, the lack of improvement after jaundice development; pronounced dyspeptic symptoms and long bilirubinemia combined with mild transaminase elevation, hepatomegaly with no concomitant increase in the spleen. The data on the fulminant forms of hepatitis E are presented. Herein we describe the case of fulminant course of infection with a fatal outcome. Analysis of cases of severe hepatitis E have revealed the following risk factors: heart disease, chronic biliary disease, obesity, diabetes mellitus, chronic alcohol intoxication. The analysis of specific clinical manifestations of this infection is needed to select the right strategy of patient following, to set integrated differential diagnostic approach in the management of patients with middle and old age with the presence of jaundice and patients with hepatitis of unknown etiology. The inclusion of hepatitis E markers to the diagnostic algorithm is necessary for such patients.

Abstract. The results of clinical and epidemiological studies conducted in the M.P. Chumakov’ Research Institute of Poliomyelitis and Viral Encephalitis and in the different research institutions of the world have been summarized in the current article. Data on etiology, pathogenesis, clinical symptoms, epidemiology and prevention of hepatitis E are presented. Increasing of significance of this infection for health care system in Russia is emphasized . The actual problems of hepatitis E (autochthonic hepatitis E, hepatitis E as zoonosis, chronic hepatitis E) are discussed.