Trends in the Acute Hepatitis B and Acute Hepatitis C in Bulgaria.

INTRODUCTION: Bulgaria joined European Union (EU) on 1 January 2007. Since the accession all regulations, directives, decisions, recommendations, and opinions of the European Parliament, the Council of the European Union, and the European Commission are being implemented. AIM: The purpose of this study was to present the morbidity of acute hepatitis B virus (HBV) and acute hepatitis C virus (HCV) in Bulgaria before and after accession to the EU. MATERIALS AND METHODS: A retrospective study was performed. The morbidity of acute HBV and acute HCV infections in Bulgaria was analyzed over a period of sixteen years (2000-2016). The collected data were based on the National Center of Infectious and Parasitic Diseases (NCIPD) and the National Center of Public Health and Analyses (NCPHA). RESULTS: Between 2000 and 2016, 11038 cases of acute HBV infection and 1681 cases of acute HCV infection were reported in Bulgaria. Before the accession to EU, the morbidity rates of acute HBV and acute HCV infections were 12.77 cases per 100 000 population (95% CI: 11.45-13.97) and 1.52 cases per 100 000 population (95% CI: 1.17-1.96), respectively. After the accession to the EU, the morbidity rates of acute HBV and acute HCV infections were 5.29 cases per 100 000 population (95% CI: 3.86-6.73) and 1.14 cases per 100 000 population, respectively. CONCLUSION: Analysis of the data suggests that there is a tendency for lower morbidity rates of acute HBV. The situation with acute HCV is relatively stable over the years regardless of EU membership.

Clinical Characteristics of Ulceroglandular Tularemia in Two Bulgarian Regions, 2014-2015: a Report of Five Cases.

We present here the first five human cases with tularemia from two regions in South Bulgaria in which there had been no previous report of the infection. The cases occurred over a period of 8 months (December 2014 - August 2015). They were treated at the Department of Infectious Diseases in Stara Zagora University Hospital, Bulgaria. We present the clinical, epidemiological and laboratory data for four men and one woman (age range 52 to 73 years). Three men were hunters, four patients took part in handling, preparing/skinning and cooking the game animals. One man marked agricultural work and contact with straw stems. After a mean incubation period of 4.8±1.4 days ulcers appeared, followed by local painful lymphadenitis. All patients presented with liver enlargement and elevation in acute phase reactants. The etiological diagnosis was made by tube agglutination test in all cases, PCR positive result was found in one. The administered antibacterial treatment was a combination of aminoglycosides and 4-quinolones with the outcome being favorable for all patients. The current report suggests presence of Francisella tularensis in South Bulgaria.