Hepatitis E in South Africa: Evidence for sporadic spread and increased seroprevalence in rural areas

Tucker, Timothy J.; Kirsch, Ralph E.; Louw, S.J.; Isaacs, Sedick; Kannemeyer, Jennifer; Robson, Simon C.

doi:10.1002/(sici)1096-9071(199610)50:2<117::aid-jmv3>3.0.co;2-d

Cited by 34 publications

(19 citation statements)

References 7 publications

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“…In Gabon, one study found a higher prevalence of HEV of about 2.0 times in urban (13.5%) compared with rural areas (6.4%) [73]. On the other hand, in South Africa, HEV seroprevalence is higher in rural compared with urban residents (15.3% vs. 6.6%) [98]. The difference in seroprevalence between rural and urban residents is also observed in Egypt with seroprevalence being higher in rural areas [53].…”

Section: Resultsmentioning

confidence: 99%

“…Second, studies measure the prevalence of HEV infection in dissimilar subpopulations making it difficult to compare seroprevalence. For example, it is difficult to conclude whether the overall seroprevalence of HEV infection in South Africa is higher than that in Morocco when examining studies that show seroprevalence among South Africans with a mean age of 42 years is 10.7% [98] and that among younger population in Morocco is 2.2-6.8% [84,85]. Third, studies use different criteria to define acute hepatitis.…”

Section: Discussionmentioning

confidence: 99%

“…We also discuss studies of sporadic cases and outbreaks of NANB hepatitis viruses in the Discussion Section with tables of data in the Additional file 1. The present paper includes studies from 28 (50%) of 56 African countries: Algeria [26-28], Burkina Faso [29], Burundi [30,31], Cameroon [32], Central African Republic [33,34], Chad [27,28,35-38], Côte d’Ivoire [39], Democratic Republic of the Congo [40], Djibouti [41,42], Ethiopia [6,43], Eritrea [44], Egypt [45-71], Gabon [72,73], Ghana [32,74-78], Kenya [79,80], Madagascar [81], Mayotte [82], Morocco [83-85], Namibia [86-88], Nigeria [89-91], Senegal [92,93], Somalia [94-96], South Africa [97,98], South Sudan [99], Sudan [35,100-105], Tunisia [106-111], the United Republic of Tanzania [112-114], and Zambia [115]. …”

Section: Methodsmentioning

confidence: 99%

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A systematic review of the epidemiology of hepatitis E virus in Africa

et al. 2014

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BackgroundHepatitis E Virus (HEV) infection is a newly recognized serious threat to global public health and Africa is suspected to be among the most severely affected regions in the world. Understanding HEV epidemiology in Africa will expedite the implementation of evidence-based control policies aimed at preventing the spread of HEV including policies for the use of available resources such as HEV vaccines.MethodsHere we present a comprehensive review of HEV epidemiology in Africa based on published data. We searched for articles on HEV epidemiology in Africa from online databases such as PubMed, Scopus, and ISI Web of Science and critically reviewed appropriate publications to extract consistent findings, identify knowledge gaps, and suggest future studies.ResultsTaking a particularly high toll in pregnant women and their fetuses, HEV has infected human populations in 28 of 56 African countries. Since 1979, 17 HEV outbreaks have been reported about once every other year from Africa causing a reported 35,300 cases with 650 deaths.ConclusionsIn Africa, HEV infection is not new, is widespread, and the number of reported outbreaks are likely a significant underestimate. The authors suggest that this is a continent-wide public health problem that deserves the attention of local, regional and international agencies to implement control policies that can save numerous lives, especially those of pregnant women and their fetuses.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A systematic review of the epidemiology of hepatitis E virus in Africa

et al. 2014

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“…Hepatitis E was not routinely screened for, owing to the unavailability of a testing kit for a significant portion of the study. Historic seroprevalence data from urban and rural blacks in South Africa documented an anti–hepatitis E virus seroprevalence of 6.6% and 15.3%, respectively . With new seroprevalence data awaited, the influence hepatitis E may have had on causality assessment for DILI is uncertain.…”

Section: Discussionmentioning

confidence: 99%

A clinicopathological cohort study of liver pathology in 301 patients with human immunodeficiency virus/acquired immune deficiency syndrome

Sonderup

Wainwright²,

Hall³

et al. 2015

Hepatology

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Liver disease complicates human immunodeficiency virus (HIV)/acquired immune deficiency syndrome; however, liver pathology data are limited, particularly from high HIV prevalence countries. We investigated the spectrum and clinicopathological correlates of liver pathology in a high HIV burden setting. In a single-center study, all HIV/acquired immune deficiency syndrome patients with complete clinical and demographic data who underwent liver biopsy were analyzed and clinicopathologically assessed by hepatologists and one of two experienced liver pathologists. We evaluated 301 patients, with a median age of 34 (interquartile range 29-40) years. Women (n 5 143) were younger than men (n 5 158), with a median age of 33 (interquartile range 28-37) versus 35 (interquartile range 31-41) years, P 5 0.001. The majority, 76.1%, were black African. Median CD4 at time of biopsy was 127 (52-260) cells/mm 3 . Drug-induced liver injury was the predominant finding (42.2%), followed by granulomatous inflammation (29%), steatosis/ steatohepatitis (19.3%), hepatitis B (19%), and hepatitis C coinfection (3.3%), with more than one pathology in 16.2%. With granulomatous inflammation, 52% met the criteria for tuberculosis immune reconstitution syndrome. By univariate analysis, cotrimoxazole and antiretroviral therapy conferred risk for drug injury (odds ratio [OR] 5 2.78 [1.72-4.48], P < 0.001; OR 5 1.69 [1.06-2.68], P 5 0.027). In multivariate analysis, cotrimoxazole was associated with a cholestatic or ductopenic injury (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).89], P < 0.001; OR 5 17.6 [3.26-95.3], P < 0.0001); efavirenz was associated with nonspecific hepatitis or submassive necrosis (OR 5 4.3 [1.92-9.83], P < 0.001; OR 5 10.46 [2.7-40.5], P < 0.001). Cholestatic injury was associated with female gender and a CD4 of >200 cells/mm 3 , and submassive necrosis was associated with younger age. Hepatitis B demonstrated no association. Conclusion: In a high HIV burden area, drug-induced liver injury due to antiretroviral therapy and cotrimoxazole was a frequent clinicopathological finding; Mycobacterium tuberculosis was the leading opportunistic infection, with more than half of patients fulfilling criteria for tuberculosis immune reconstitution syndrome; liver biopsy remains a useful diagnostic procedure in this setting. (HEPATOLOGY 2015;61:1721-1729

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“…HEV transmission, both sporadic and epidemic, is common in Africa having been identified in Egypt [8], Djibouti [7], Sudan [16], Kenya [18], Ethiopia [27], Somalia [4], South Africa [28], Algeria and Chad [29] and Morocco and Tunisia [5]. HEV is transmitted mainly be the fecal-oral route and large epidemics due to this virus have been associated with contaminated water.…”

Section: Introductionmentioning

confidence: 99%

Molecular characterization of a hepatitis E virus isolate from Namibia

Binn

Tsarev

et al. 2000

J Biomed Sci

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Hepatitis E virus (HEV) causes sporadic and epidemic acute viral hepatitis in many developing countries. In Africa, hepatitis E has been documented by virus detection (reverse transcriptase polymerase chain reaction, RT-PCR) in Egypt, Chad, Algeria, Morocco and Tunisia. Cases of presumptive hepatitis E also have been documented by detection of antibody to HEV in the Sudan, Kenya, Ethiopia, Somalia, Djibouti and South Africa. Recently, we reported the recovery of 9 isolates of HEV from feces collected during an outbreak of jaundice in Namibia. These specimens were stored frozen for many years at the South African Institute for Medical Research awaiting new methods to determine the etiology of jaundice. HEV genomic sequences were detected by antigen-capture RT-PCR with primers that amplified 2 independent regions of the HEV genome (ORF-2 and ORF-3). To further characterize the HEV 83-Namibia isolates, we determined the nucleotide (nt) sequence of the 3' end of the capsid gene (296 of 1, 980 nt in ORF-2) and ORF-3 for 1 isolate. The capsid gene sequence shared 86% identity with the prototype Burma strain and up to 96% identity with other African strains at the (nt) level, and 99% identity with Burma or other Africa strains at the amino acid level. A 188 (nt) fragment amplified from ORF-3 was also highly homologous to other HEV but was too short for meaningful comparison. Phylogenetic analysis indicated that HEV 83-Namibia is closely related to other African isolates, and differs from Burmese, Mexican and Chinese HEV. These data link the HEV causing the 1983 Namibia outbreak to more recent HEV transmission in northern and sub-Saharan Africa, suggesting this subgenotype of HEV is firmly established throughout the continent.

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Hepatitis E in South Africa: Evidence for sporadic spread and increased seroprevalence in rural areas

Cited by 34 publications

References 7 publications

A systematic review of the epidemiology of hepatitis E virus in Africa

A systematic review of the epidemiology of hepatitis E virus in Africa

A clinicopathological cohort study of liver pathology in 301 patients with human immunodeficiency virus/acquired immune deficiency syndrome

Molecular characterization of a hepatitis E virus isolate from Namibia

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