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Epidemiology, Genotype Distribution, Prognosis, Control, and Management of Viral Hepatitis B, C, D, and Hepatocellular Carcinoma in Mongolia
(2018)
Baatarkhuu, Oidov
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Gerelchimeg, Tsagaantsooj
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Munkh-Orshikh, Dashchirev
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Batsukh, Badamnachin
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Sarangua, Ganbold
Mongolia is located between Russia and China. The total population of Mongolia as of December 2017 is estimated to be 3.2 million people. According to our previous study results, the prevalence of HBV was 11.8%, and anti-HDV was detected in 4.8% among the HBsAg-positive subjects. Interestingly, most HCV infection is caused by genotype 1b. Among all HBV DNA-positive samples, 98.5% were classified into genotype D, and regarding HDV genotypes, all HDV RNA-positive samples, 100%, were classified into genotype I. The second study is the baseline survey of a Nationwide Cancer Cohort Study. Prevalence of HBsAg was 10.6%. Additionally, HCV infection was observed in 9.9%, and 0.8% were coinfected with HBV and HCV among the general population aged from 10 to 64 years. The third study investigated the population-based prevalence of hepatitis B and C virus in apparently healthy population of Ulaanbaatar city, Mongolia. The anti-HCV prevalence was 9.0%. In addition, the prevalence of HBV was 8.0%. The fourth study is on the prevalence of HCV and coinfections among nurses in a tertiary hospital in Mongolia. The prevalence of HCV was 18.9%. Additionally, HBV infection was observed in 23.1%, and 1.2% were coinfected with HCV and HBV. Mongolia has the highest HCC incidence in the world (78.1/100,000, 3.5* higher than China). As a result, the Mongolia government has launched The National Viral Hepatitis Program, which is a comprehensive program that involves all aspects from prevention to care and disease control to meet a reduction goal for morbidity and mortality due to HBV, HCV, and HDV. Consequently, access to antiviral therapies is now improving in Mongolia. How to cite this article: Baatarkhuu O, Gerelchimeg T, Munkh-Orshikh D, Batsukh B, Sarangua G, Amarsanaa J. Epidemiology, Genotype Distribution, Prognosis, Control, and Management of Viral Hepatitis B, C, D, and Hepatocellular Carcinoma in Mongolia. Euroasian J Hepato-Gastroenterol 2018;8(1):57-62.
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Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)
(Springer Science and Business Media LLC, 2020-09)
Sarin, Shiv Kumar
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Choudhury, Ashok
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Lau, George K
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Zheng, Ming-Hua
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Ji, Dong
BACKGROUND AND AIMS: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. METHODS: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. RESULTS: Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR = 2.1 (1.1-3.7), p = 0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR = 8.1 (1.9-38.8), p = 0.002] predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5 (11.6%)] or acute decompensation [4 (9%)]. Liver related complications increased (p < 0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC 0.94, HR = 19.2 (95 CI 2.3-163.3), p < 0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis patients. CONCLUSIONS: SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.
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One-year antibody kinetics and effectiveness of a BNT162b2 booster after four primary COVID-19 vaccination regimens in Mongolia
(2026-09)
Bazarjav, Purevbat
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Erdene-Ochir, Tseyenkhorloo
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Sandagdorj, Ankhbayar
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Enkhtuvshin, Altansukh
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Enkhbayar, Purevjargal
BACKGROUND: Waning immunity after primary COVID-19 vaccination and the widespread use of heterogeneous vaccine platforms have created uncertainty regarding the durability of protection following booster vaccination. Mongolia implemented a mixed-platform vaccination program and deployed BNT162b2 as a booster. We evaluated the immunogenicity, effectiveness, and safety of a BNT162b2 booster following four primary vaccination regimens with 12 months follow-up. METHODS: In this prospective observational study in Ulaanbaatar, Mongolia, adults (≥18 years) who had completed a homologous two-dose primary series with BBIBP-CorV, ChAdOx1 nCoV-19, Gam-COVID-Vac, or BNT162b2 received a BNT162b2 booster a median of 189 days (IQR 186-215) after the second dose and were grouped according to their primary vaccination regimen. Humoral immune responses (anti-SARS-CoV-2 N/S1-RBD IgG, S-RBD IgG, and neutralizing antibodies) were measured at baseline and at multiple time points up to 12 months after booster vaccination. Reactogenicity was monitored for 28 days. SARS-CoV-2 infection was ascertained by a positive antigen/lateral-flow test and/or RT-PCR. VE was estimated for prespecified follow-up intervals by comparing the risk of SARS-CoV-2 infection in each boosted group with that in an unvaccinated comparison group. FINDINGS: Among 311 participants (mean age 41.88 years [SD 13.64]; 175 [56.27%] women and 136 [43.73%] men), antibody responses peaked at day 14 and declined through day 365 in all groups. At day 14, total antibody concentrations were highest in BNT + BNT (385.03 U/mL) and lowest in Gam + BNT (341.74 U/mL). S-RBD IgG at day 14 was highest in BNT + BNT (967.0 ng/mL) and lowest in BBIBP+BNT (863.70 ng/mL). Neutralizing antibodies at day 14 were highest in BNT + BNT (368.13 AU/mL) and BBIBP+BNT (336.70 AU/mL). During follow-up, 64 participants acquired SARS-CoV-2 infection and 15 (23.44%) were admitted to hospital. Reactogenicity was predominantly mild-to-moderate, and laboratory parameters were generally within acceptable ranges. Vaccine effectiveness declined from 1 month to 12 months: BBIBP+BNT 90.54% (95% CI 59.71-97.78) to 71.17% (39.66-86.23); ChAd+BNT 84.97% (49.75-95.51) to 52.59% (8.61-75.41); Gam + BNT 89.68% (23.95-98.60) to 63.84% (15.10-84.60); BNT + BNT 91.89% (40.06-98.90) to 72.29% (34.37-88.30). INTERPRETATION: A BNT162b2 booster following diverse primary COVID-19 vaccination regimens induced strong humoral responses that declined over 12 months and showed an acceptable reactogenicity profile. VE against SARS-CoV-2 infection was highest soon after boosting and lower later in follow-up. Although antibody levels and VE showed similar temporal patterns, these findings should be interpreted as complementary outcomes rather than evidence of a direct causal relationship or a formal immunological correlate of protection.
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The Dynamics of the Prevalence of Acute Viral Hepatitis and the Strategies against Viral Hepatitis in Mongolia
(2024)
Badamnachin, Batsukh
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Badamjav, Tegshjargal
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Dondov, Ganchimeg
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Dashjamts, Gantogtokh
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Tserendorj, Chinbayar
BACKGROUND: Hepatocellular carcinoma (HCC) is the most common cancer in Mongolia. The relative importance of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in HCC etiology is known to vary greatly from one part of the world to another. Principally, 95% of HCC patients have chronic viral hepatitis, including 53% hepatitis B virus, 38.9% HCV, and 5.6% have HBV/HCV coinfection. Hepatitis D virus (HDV) infection is widely spread in our country, anti-HDV has been found in more than 25% of carriers who have HBsAg. MATERIALS AND METHODS: We analyzed data of patients who had been diagnosed with acute viral hepatitis in the Department of adult hepatitis, National Center for Communicable Diseases in Mongolia from 1952 to 2018. RESULTS: A total of 318,831 cases of acute viral hepatitis were registered in Mongolia between 1981 and 2019, which is 34.9 cases per 10,000 population. Of these, 265,931 cases of acute viral hepatitis A, or 28.6 per 10,000 populations, 48,855 cases of acute viral hepatitis B, or 5.5 cases per 10,000 populations, and 2,607 cases of acute viral hepatitis C, or 0.4 cases per 10,000 populations were recorded. CONCLUSION: The prevalence of viral hepatitis in our country was the highest in 1981-1991, but since 2012, the prevalence of infection has steadily decreased. In Mongolia, since 1960, multifaceted programs and activities to combat viral hepatitis have been successfully implemented at the national level. HOW TO CITE THIS ARTICLE: Badamnachin B, Badamjav T, Dondov G, et al. The Dynamics of the Prevalence of Acute Viral Hepatitis and the Strategies against Viral Hepatitis in Mongolia. Euroasian J Hepato-Gastroenterol 2024;14(1):65-69.
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Enhancing access to treatment and programmes for viral hepatitis in an endemic country: a narrative review of literature from 2000 to 2025 (Mongolia)
(Informa UK Limited, 2026)
Dorj, Gantuya
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Lkhagva, Undram
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Dorj, Gereltuya
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Badamnachin, Batsukh
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Gurbadam, Unenbat
BACKGROUND: Mongolia continues to experience the world's highest incidence of hepatocellular carcinoma (HCC), driven by chronic hepatitis B (HBV) and hepatitis C (HCV) infections. In response, the Mongolian Government has implemented comprehensive public health interventions, including the national 'Healthy Liver Programme,' to reduce viral hepatitis transmission and liver-related morbidity. This narrative review aims to evaluate national strategies, progress, and ongoing challenges in HBV and HCV control. METHODS: Policy documents from government agencies, WHO, and NGOs were reviewed, along with scientific publications retrieved from PubMed, and Embase using terms such as 'HBV,' 'HCV,' and 'treatment access.' Grey literature was also analysed. The review focused on (i) national strategies and action plans; (ii) programmatic interventions, vaccination, screening, and treatment scale-up; and (iii) reported trends in coverage, treatment uptake, and progress towards WHO 2030 elimination targets. Findings were synthesised by comparing policy commitments with implementation outcomes and triangulating evidence across multiple sources. RESULTS: Forty-four peer-reviewed articles and 12 policy documents were included. Mongolia has achieved >95% infant HBV vaccination and 93.9% hepatitis A coverage, reducing HBsAg prevalence among children under five to 0.3% by 2023. Among adults, HBsAg prevalence declined from 6.9% in 2015 to 5.5% in 2023, while HCV prevalence decreased from 6.7% to 3.7%. More than 120,000 HCV infections have been diagnosed, with over half treated through national initiatives; by 2023, 4,700 HBV and 66,959 HCV patients had initiated therapy. Liver cancer incidence decreased from 39.1% in 2016 to 32.7% in 2021, and annual HCC cases fell from 857 in 2015 to 567 in 2022. DISCUSSION: Mongolia aims to reduce viral hepatitis prevalence by 90% and liver-related mortality by 85% in the coming decade. CONCLUSION: While substantial progress has been made, strengthened health system capacity and improved monitoring mechanisms are essential to close remaining gaps and accelerate progress towards hepatitis elimination. SUMMARY: Policy implementation: Mongolia implemented several key policies, including the Targeted Prevention and Control Program to Eradicate Viral Hepatitis (1988-2000), mandatory HBV vaccination, and the Healthy Liver programmes (2016-2020 and 2022-2025).Vaccination programmes: Mongolia was among the first to introduce hepatitis B vaccination for newborns in 1991 and added a pentavalent vaccine in 2005. The HAV vaccine was introduced in 2012, with high coverage rates for children under one year.Healthy liver programme: This programme improved access to diagnostic and treatment options for viral hepatitis, including introducing antiviral medicines and reimbursement for antiviral therapy costs through national health insurance.Success achieved: The incidence of total viral hepatitis was reduced to 0.7 per 10,000 population by 2022, surpassing the goal of 10 per 10,000. HBsAg prevalence in children under five met WHO's regional goal, and HCV prevalence among adults significantly decreased.Treatment access: Patients in Mongolia have access to treatments for HBV, HCV, and HCC with significant reimbursement from the Health Insurance Fund. The affordability of these treatments has improved, making them accessible to a larger population.
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ALBI Score for Predicting Acute Liver Failure in Patients with Acute Hepatitis B and D in Mongolia
(Mongolian National University of Medical Sciences, 2021-04-01)
Badamnachin Batsukh
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Chimedsuren Оchir
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Sarantuya Gidaagaya
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Baatarkhuu Oidov
Objectives: Mongolia is known as one of the countries with a high prevalence of hepatitis B and D virus infection. Although the number of acute hepatitis D cases is decreasing since the national vaccination program against HBV launched in 1991, it is still a main cause of acute liver failure (ALF) in Mongolia. The aim of this study is to determine the prognostic value of an ALBI score in patients with acute hepatitis B with or without D. Methods: A total of 114 patients (58 patients with acute hepatitis B (AHB), five patients with HBV/HDV co-infection, and 51 patients with HBV/HDV superinfection), who were admitted to the National Center for Communicable Diseases between 2017 and 2019 were enrolled into this study. Results: We compared the AHB group to the HBV/HDV superinfection group. The mean age was 25.8±6.5 years in the AHB group vs. 28.9±7.4 years in the HBV/HDV superinfection group (p = 0.019). Also, a majority of patients live in Ulaanbaatar (87.5% vs. 62.7%, p = 0.037). The mean hospitalization days was 23± 11 in the AHB, on the other hand it was 28± 13 in the HBV/HDV superinfection group (p = 0.022). The ALF patients had a higher ALBI score, total bilirubin, transaminase, and INR compared with the non-ALF group. The platelet count was significantly lower in the AHB and HBV/HDV infection group with ALF compared with AHB and HBV/HDV infection without ALF. This study showed that the ALBI score in AHB with ALF patients was significantly higher than in AHB without ALF (p = 0.001 ), and H BV/HDV superinfection with ALF had a higher ALBI score than HBV/HDV superinfection without ALF (p = 0.041 ). The area under the curve (AUC) value was 0.766 for ALBI scores. The cut-off value, sensitivity and specificity of ALBI score values were -1. 71, 72.2%, and 75.6%, respectively. Conclusions: ALBI score determined on admission indicates the likelihood of survival of patients with AHB and AHD.
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Risk factors associated with hepatitis D virus infection and preventive strategies in Mongolia
(Ovid Technologies (Wolters Kluwer Health), 2024-05)
Su, Chien-Wei
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Ochirkhuree, Bayarmaa
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Namdag, Bira
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Badamnachin, Batsukh
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Ganbold, Sarangua
BACKGROUND: Hepatitis D virus (HDV) infection is highly prevalent in Mongolia. We aimed to identify the risk factors associated with HDV infection, propose preventive strategies, and evaluate the outcomes of a 3-year collaborative project between Taiwan and Mongolia. METHODS: In 2016 and 2018, we conducted onsite visits to Mongolia. Mongolian investigators collected questionnaires focusing on risk factors, demographic characteristics, and serum samples for acute HDV infections. Furthermore, 19 Mongolian seed teachers participated in a 1-week workshop on infection control in Taiwan. Subsequently, these seed teachers trained more than 400 medical personnel in Mongolia. To assess secular changes in acute HDV infection, we reviewed the registration data from the National Center for Communicable Disease (NCCD) in Mongolia between 2011 and 2021. RESULTS: Among the 194 Mongolian patients, 108 had dual infection with hepatitis B virus (HBV) and HDV, while 86 had acute hepatitis B (AHB). Patients with HBV/HDV dual infections were older (28.6 vs 25.5 years, p = 0.030) and had lower rates of positive hepatitis B e antigen in their sera, lower rates of serum HBV DNA exceeding 2000 IU/mL, and higher rates of having received dental treatment (59.4% vs 40.5%, p = 0.014) and injection therapy (64.2% vs 44.0%, p = 0.009) compared with those with AHB. Analysis of NCCD data revealed that new HDV infection cases were more prevalent between 2011 and 2015 (111.20 ± 29.79 cases/y) and decreased to 54.67 ± 27.34 cases/y between 2016 and 2021 ( p = 0.010). CONCLUSION: Dental treatment and injections were associated with a higher risk of acute HDV infections in Mongolia. Through collaborative efforts, the incidence rate of HDV infection has declined in recent years.

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