Hepatitis E outbreak in the health district of Bocaranga-Koui, Central African Republic, 2018-2019

Abstract

Background: Hepatitis E virus (HEV) is one of major public health diseases causing large outbreaks and sporadic cases of acute hepatitis. We investigated an outbreak of HEV infection that occured in september 2018 in the health district (HD) of Bocaranga-Koui in the northwestern part of Central African Republic (CAR). Methods: Blood samples were collected from 352 patients aged 0-85 years suspected for yellow fever (YF) according to the World Health Organization YF case definition. The notification forms from cases recorded were used. Water sources consumed in the areas were also collected. Human samples found negative for anti-YF IgM were then ELISA-tested for anti-HEV IgM and IgG antibodies. Positive anti-HEV (IgM and/or IgG) samples and collected water were subjected to molecular biology tests. Results: Of the 352 icterus patients included, anti-HEV IgM was found in 142 people (40.3%) and anti-HEV IgG in 175 (49.7%). Although HEV infection was detected in all age groups, there was significant difference between age groups (P = 0.001). Elevated levels of serum aminotransferase were observed in anti-HEV IgM-positive persons. Phylogenetic analysis showed HEV genotype 1e in infected patients and also in the contaminated water. Conclusion: This epidemic showed that CAR remains an HEV-endemic area. The genotype 1e strain is responsible for the HEV outbreak in Bocaranga-Koui health district. It is necessary to implement basic conditions of hygiene and sanitation to prevent the outbreak of an hepatitis E epidemic, by facilitating access to clean drinking water for the population, by launching intensive work to raise awareness for basic hygiene measures, by setting up targeted hygiene promotion activities and, finally, by making a care service available.