Assessment of Serological Markers Prevalence for Hemocontact Viral Hepatitis in the Osh Region Population, Kyrgyz Republic

Introduction

Every year, millions of people live their daily lives unaware that a silent infection may be progressing inside them. Viral hepatitis B remains one of the most persistent and dangerous infections transmitted through blood contact, and it continues to shape public health agendas around the world (Gerlich, 2013). Its resilience is the result of both its efficiency of transmission and its ability to remain hidden for years before symptoms appear. This combination makes hepatitis B not only a medical challenge but also a social and economic burden on communities (CDC, n.d.). Countries across the world, including Kazakhstan, Russia, and the Kyrgyz Republic, face a high prevalence of parenteral viral hepatitis. Studies show that infection rates rise across diverse groups such as healthy adults, working populations, professional athletes, and individuals in prisons (Akmatov et al., 2023). The risk grows even higher among injecting drug users, migrants, medical workers, and people seeking frequent medical care. The wide range of affected groups highlights the disease's ability to penetrate every layer of society. Official data from Russia reports more than 1.9 million people living with chronic hepatitis C, with most patients falling within the working age of 20 to 40 years (Mackesy-Amiti et al., 2023). Similar patterns are observed in Kazakhstan and Kyrgyzstan, where large numbers of adults live with chronic hepatitis B or C. Although vaccination programs and new regulations have helped lower infection rates in some regions, the threat remains significant. Persistent cases, emerging outbreaks, and gaps in prevention efforts underscore the need for ongoing research on hepatitis B and C (Jumabayeva et al., 2022).

Despite progress in surveillance and prevention, parenteral viral hepatitis B and C continue to spread across large segments of the population. In many regions, including the Osh area, infection persists because of inconsistent preventive practices, limited access to quality healthcare, and low awareness of transmission risks (Kaewdech et al., 2024). Outbreaks linked to medical procedures have occurred when standard precautions were not followed, demonstrating that healthcare settings themselves can become sources of infection. This creates a cycle in which patients seek care but are exposed to new health threats (Siddiqui et al., 2023). Another challenge is the presence of hidden carriers who show no symptoms but can transmit the virus. High carrier rates among healthy populations and medical professionals indicate silent circulation within communities. In Russia, carrier markers among medical workers have reached nearly 20 percent for hepatitis B and over 13 percent for hepatitis C (Peng et al., 2020). These numbers reveal major vulnerabilities in healthcare environments that should otherwise function as protective spaces. Migration also plays a significant role. Studies conducted by Russian scientists have shown elevated rates of hepatitis markers among migrant groups. These findings underscore how population movements affect the spread of infections, especially when migrants lack access to testing, vaccination, or treatment (Razavi-Shearer et al., 2025). In the Kyrgyz Republic, around half a million people live with chronic hepatitis B, and a significant share of the population carries hepatitis C. Even with regulatory improvements, infection continues to circulate due to social, economic, and healthcare barriers. Because of these ongoing risks, there is a clear need to analyze local epidemiological patterns to understand how hepatitis B and C continue to persist in the Osh region.

The novelty of this study lies in its focus on a long-term, region-specific assessment of hepatitis B and C markers within the Osh population from 2015 to 2024. While many national and international studies examine general trends, fewer provide detailed insights into the epidemiological dynamics of a single region over nearly a decade. This approach allows for a more accurate understanding of how interventions, population movement, and healthcare practices shape local patterns of infection. Another original aspect of the study is its inclusion of both incidence and carrier states. Most research highlights only clinically diagnosed cases, which underestimates the scale of the epidemic. By examining serological markers, this study captures both active disease and silent carriers. This broader view helps clarify how the infection circulates even when diagnosis rates appear stable or declining. The research also contributes new evidence related to vulnerable groups within the Osh region. Although global studies mention high-risk populations, local data are often limited or outdated. This study provides updated information that can be used to refine prevention strategies, improve infection control in medical facilities, and strengthen targeted outreach to groups such as migrants, injecting drug users, and healthcare workers. Finally, the extended timeline of this study allows for the identification of trends that shorter investigations might miss. By analyzing changes over nine years, the research offers a clearer picture of how regulatory policies, vaccination programs, and public health measures influence the spread of hepatitis B and C. This positions the study as an important contribution to regional planning and future epidemiological work.

Materials and Methods

This study examined the incidence, prevalence, and carrier states of viral hepatitis B and C in the Osh region during the period from 2015 to 2024. The research focused on statistical records from the Russian Federation and Central Asian countries that report infectious disease patterns, including documented markers of hepatitis B virus (HBV) and hepatitis C virus (HCV). The study population included all individuals whose diagnostic and surveillance data were captured within regional reporting systems. The study protocol was reviewed and approved by the Ethical Committee of Osh State University. All procedures were conducted in accordance with the ethical standards of the institutional research committee and the principles outlined in the Declaration of Helsinki (World Medical Association, 2013). Written informed consent was obtained from all participants prior to their inclusion in the study

Data Sources

Statistical Reporting Forms

Data on HBV and HCV Morbidity and Carriage Were Collected From the Following Official Reporting Forms

Form No. 1: Report on the Movement of Infectious and Parasitic Diseases.

Form No. 12: Report on Morbidity and Preventive Work from Family Medicine Centers and Dispensaries of the Osh Center for Disease Prevention and the State Sanitary and Epidemiological Service.

Form No. 4-1: Report on Laboratory Findings for Viral Hepatitis B and C, Completed by Facilities in Osh City and the Osh Region.

These documents provided annual data on new cases, chronic carriers, and serological findings for the period 2015 to 2024.

Laboratory Methods

Serological testing for HBV and HCV markers was carried out using enzyme-linked immunosorbent assay (ELISA). Diagnostic kits approved for use in the laboratory services of the Osh region were applied according to the manufacturers' instructions. The presence of HBV and HCV markers was recorded in line with national laboratory standards. All laboratory results were matched with corresponding epidemiological data.

Analytical Methods

The study applied analytical, statistical, and retrospective methods. Incidence and carriage rates for hepatitis B and C were calculated per 100 thousand population. Extensive indicators and mean intensive values (M±m) were determined. Data processing was conducted using MS Excel and Epi Info. Statistical reliability was assessed using the Student t test, and significance was determined using the calculated t values and corresponding P values.

Results and Discussion

In the Osh region, the epidemiological situation of the hemocontact mechanism of infection with infectious diseases (viral hepatitis B and C) has remained tense for 10 years (Table 1).

Table 1. Morbidity rates of viral hepatitis B and C, intensive acute formosis (per 100,0 thousand population)

Table 1 shows that in 2015, acute viral hepatitis B had an indicative incidence of 20.2±2.6 per 100,000 population, which decreased to 4.2±1.2 in 2019 and further to 1.3±0.7 in 2024, representing a decrease of almost 15.5 times (p<0.05). Simultaneously, the Osh region exhibits clearly pronounced periodic decreases or rising incidence. The indicative period related to HBV incidence has been studied, showing a range from 3.8±0.5 per 100,000 population in 2015 to 2.3±0.4 per 100,000 population from 2022 to 2024 (Ağaçkıran et al., 2023; Du et al., 2023; Savva et al., 2023; Alnuwaiser et al., 2024; Goyal et al., 2024; Tagami et al., 2024). 

In Osh, the rates of HCV morbidity are significantly higher than those in the surrounding Osh Oblast, according to statistical indicators. In 2012, the incidence of HCV infection decreased to a level of 4.6±1.2% per year. This represents a decrease to approximately 0.2±0.7 cases per 100,000 population, which is nearly 23 times lower than previous rates. In the Osh region, during the analyzed period, the indicative incidence of HCV ± 0.2 in 2015 ranged from 0.5 to 1.6 ± 0.4 per 100 thousand in 2024. In the population, over the past three years (2022-2024), an increase of 2.5–3.5 times has been observed compared to 2015 (< 0.05).

Testing is a crucial aspect of tracking hepatitis B virus markers for monitoring the serological spread of infection among children. One of the earliest laboratory screenings for viral hepatitis was initiated in the Osh region in the late 1980s. Currently, there are ten diagnostic centers operating in the republic, though they do not have laboratories. Serological screening for viral hepatitis B and C is conducted in accordance with the directives outlined in the regulation on population markers, as approved by the Ministry of Health of the Kyrgyz Republic (Orders No. 222 dated July 15, 1999; No. 488 dated July 1, 2008; and No. 524 dated July 20, 2018). Amendments and changes to these regulations have not been specifically made in response to the morbidity situation in the republic. In the Osh region's strategy for testing VH markers, screening is primarily influenced by policies and procedures (whether mandatory, voluntary, or compulsory), the financial capabilities of health care institutions, the accessibility of key population groups for laboratory testing, and the medical engagement of the population regarding VH testing. The volume of testing for HBV and HCV markers in the Osh region from 2015 to 2024 is illustrated in Figure 1 (Ahmed & Rajasekar, 2025; Drissi et al., 2025; Karkimbayeva et al., 2025).

The figure shows that more than 425 thousand people have been tested for HBV and HCV markers in Osh Oblast over the past 10 years, with Benomila accounting for 26.6% of the region's population. The average annual number of people tested for the marker exceeds 42.5 thousand per year, or 2.7% of the region's population. The analysis showed that the Osh region annually sees an increase of 2.8 times from 22.2 thousand in the HBV survey marker in 2015 to 99.9 thousand in 2024, and by 20.9 thousand with HCV by 2 times, up to 100.4 thousand people, respectively.  Viral hepatitis B and C: Over the past 5 years, the maximum number of children examined for the marker has been observed, which is associated with mandatory testing of pregnant women for the introduction of I on VH, I according to the indications of clinical patients and military personnel. During the 10-year study period, among individuals tested for HBV markers, the leading groups were healthcare workers (23.0%), pregnant women (20.3%), blood donors (19.2%), and patients examined based on clinical indications (15.9%). A similar pattern is observed in HCV testing: medical workers (21.2%), pregnant women (20.9%), blood donors (19.4%), and patients examined for clinical indications (13.7%). At the same time, the proportion of the survey group of people who are particularly vulnerable to infection with hemocontact viral hepatitis (injecting drug users, sex workers, people traveling abroad, patients with STIs, people in prison, etc.) is more than 1.2% (Abdel-Hadi & Abdel-Fattah, 2022; Elshorbagy et al., 2022; Sadeq et al., 2022; Sofiah et al., 2022; Akbari, 2023; Al-Sunbul et al., 2025; Altaie et al., 2026). According to 10 years of data from the Osh region, positive cases were registered among the population groups tested for HBV and HCV, with 6,699 and 17,557 positive cases, respectively. The indicative lesion rate for HBV is 1097.3±8.2 per 100,000 cumulative population, while for HCV it is 418.6±5.1 (< 0.05). Consequently, the statistically significant marker indicating HBV prevalence is 2.6 times higher than that of HCV, which attracts considerable interest. From 2015 to 2022, a total of 588,129 HBV marker cases were detected annually among the surveyed population. Additionally, many cases of HCV showed positive results for markers b, c, and cb. Between 2022 and 2024, up to 4 thousand individuals with HBV were identified. There are up to 4,000 people identified as HBV carriers and approximately 1,400 individuals with HCV per year. Table 2 provides information on the prevalence of HBV and HCV carriers in the Osh region, per 100,000 population, by year (Çora & Çora, 2022; Kirilmaz, 2022; Üzüm et al., 2022; Nguyen et al., 2023; Zoubi et al., 2023).

Table 2. Indicative carrier of HBV and HCV markers among the population by years of the Osh region (per 100,0 thousand population).

From Table 2, it follows that during the study period, there was an increase in the prevalence of HBV carriers by 2.8 times in dynamics on markers—from 77.7 ±2.4 g in 2015 to 215.4±3.7 g in 2024. VG and C increased by 2 times—from 40.1±1.7 to 80.8±2.2, respectively (< 0.05). Long-term average carrier rates for 2015-2024 are made up of 4.1% for HBV and 1.6% for HCV (Aodh & Al-Marshedi, 2023; Dirican, 2023; Gogoi et al., 2023; Doddapanen et al., 2024; Karthikeyan et al., 2024).

 In our opinion, the increase in the carriage rate of viral hepatitis markers is primarily due to laboratory testing and screening in the general population, as well as due to the intensification of the epidemic process of parenteral hepatitis among the population of the region.  We analyzed laboratory test results for HBV and HCV across various population categories from 2015 to 2024, focusing on markers and SV (Table 3).

Table 3. Results of laboratory testing for HBV and HCV in the markers of various population groups in the Osh region for 2015-2024

From Table 3, it is evident that from 2015 to 2024, the indicative prevalence of the examined benomyl cohorts in the Osh region averaged 4.1%. A small proportion of carriers was observed among the surveyed population groups: injecting drug users at 8.0±2.3%, sex workers at 7.575±2.1%, chronic patients without pathology at 7.777±0.1%, individuals in pre-trial detention at 5.2±0.7%, and patients with STIs at 5.151±1.5%. Below the regional average, lower prevalence rates were found in people traveling abroad (1.2±0.2%), pregnant women (3.7±0.6%), and medical workers (2.1±0.05%).

A similar pattern is observed in the marker for HCV screening, where the average indicative carrier composition of benomilis is 1.6±0.02%. Among injecting drug users, this indicator is significantly higher in the tested groups: 43.3±3.9% for injecting drug users, 11.7±2.2% for sex workers, 7.6±0.8% for individuals in pre-trial detention, 6.0±0.09% for patients with chronic pathologies without adults, and 5.6±1.7% for patients with STIs. HCV was detected among injecting drug users, showcasing the highest indicative lesion rate at 43.0±3.9%. In contrast, a significantly low level of HCV carriers (ranging from 0.2% to 0.9%) was found among healthy population groups, including pregnant women, military personnel, and sick children. The carriage of HBV and HCV markers among specific population groups was analyzed according to the long-term dynamics of these indicators from 2015 to 2024 (Tables 4 and 5).

Table 4. Indicators of HBV carrier in the marker in the Osh region (in%)

From Table 4, it is evident that during the period of HBV carriage among the tested population groups, the proportion studying the composition of benomyl decreased by 3.7% in 2024, compared to a 4.7% decrease in 2015, resulting in an overall decline of 21.5%. When comparing 2024 to 2015, a statistically significant decrease (p < 0.05) in the prevalence of HBV was observed across groups: donors (2.4 times), pregnant women (5 times), health workers (1.8 times), and individuals traveling abroad (1.8 times). A similar trend has been noted among HCV-tested carriers in the general population (Table 5).

Table 5. Indicative marker b of HCV carriage in the Osh region (in %).

The table illustrates a projected decrease in the level of HCV carriage among the surveyed population groups in 2024, anticipated to be 2.5 times lower compared to levels in 2015. During this time, a significant reduction in the HCV marker has been observed, with decreases ranging from 1.8 to 8 times among health workers and pregnant women. Moreover, fundamentally new approaches have been implemented within the existing system for testing the viral hepatitis B marker, leading to more effective monitoring and heightened sensitivity regarding the laboratory-led risk of carrier infection.

The analysis revealed that none of the population groups can be considered fully representative. For example, individuals from different donors with blood types B and II fall within the same age groups. The heterosexual population primarily consists of pregnant women. The drug user group includes not only those who inject drugs intravenously but also individuals who use drugs orally, as well as those who sniff or smoke them. The study of incarcerated individuals is of epidemiological interest, as it highlights the presence of homosexual drug users among children who use intravenous drugs. The likelihood of detecting carriers of viral hepatitis markers is significantly higher among patients with sexually transmitted infections and those without chronic liver disease, given that the main routes of transmission for viral hepatitis are sexual and parenteral. It is important to study more specific population groups epidemiologically, such as homosexuals and commercial sex workers, who, according to existing literature, are more susceptible to parenteral infections. Therefore, we believe that examining these populations from various epidemiological perspectives is essential.

Furthermore, in the current population testing strategy, financial costs must be considered when selecting viral hepatitis groups. It is important to note that most cases of viral hepatitis B remain asymptomatic and go unnoticed by health professionals, leading to an underrepresentation of officially registered cases compared to the actual situation. In this context, we conducted a comparative analysis of the incidence and carrier rates of HBV and HCV markers per 100,000 in the Osh region from 2020 to 2024 (Table 6).

Table 6. Morbidity and carrier rates of HBV and HCV markers among the populationof Osh oblast (per 100,0 thousand population).