Untitled

Abstract

A total of 202 serum and stool samples from acute hepatitis patients attending the Fever Hospital of Alexandria, Egypt, have been studied to reveal markers of hepatitis virus infection. Anti-HAV IgM were detected in 21 out of 202 sera (10.4%), whereas 201 sera (99.5%) had anti-HAV IgG. The first age attack was in the class-age 0-9 years with 64.7% of anti-HAV IgM positive sera. Among 202 patients, anti-hepatitis E IgG (sample/over cut off > 1.0) was identified in 90 patients (44.5%). The anti-HEV seropositivity ranged from 17.6% to 60.0% in the different age groups, with the highest level in the class-age 20 29 years. Anti-hepatitis E IgM were identified in 49 patients with the first age attack in the class-age 10-19 years (39.4%). HAV RNA was identified by nested PCR in 7 samples out of 15, whereas HEV RNA was present in 4 out of 75 stool samples. Direct DNA sequence of the latter PCR products confirmed the presence of the HEV genome; comparison of the sequences of the isolates from Egypt with those in data banks revealed the highest homology to the Burma strain. Our data confirm that HAV and HEV are common causes of acute sporadic hepatitis in Alexandria but with different peak age positivity. Occasionally, but not infrequently, dual infections (HAV-HEV and HEV-enteric viruses) were also found. The risk analysis indicates that patients living in rural areas are exposed to a higher risk of hepatitis E infection compared to the urban population, whereas the presence of anti-HEV IgG was significantly associated with consumption of common village water and use of indoor dry pit and oral therapy for schistosomiasis.

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

“…Table  5 presents a summary sorted by genotype and also provides characteristics of the sample, genomic regions tested. Genotype 1 seems to be most prevalent as it was found in Central African Republic [34], Sudan [35], Chad [28,35], Egypt [46,62,124], and Namibia [88] followed by genotype 2, which were observed in Central African Republic [34], Chad [35], Namibia [87], and Nigeria [6,89]. Genotype 3 is rare and was found in one Egyptian child [48], one acute hepatitis patient in Mayotte (originally from France) [82].…”

Viral hepatitis A to E in South Mediterranean Countries

“…Cross-sectional studies conducted in rural areas revealed very high prevalence of anti-HAV IgG reaching 100% of adults 13. Consumption of common village water, use of indoor dry pits, and contamination of drinking water with sewage represent the major risk factors for HAV acquisition in rural Egypt 16,17. In the past 2 decades, there has been significant emphasis on improving sanitation measures and hygiene in Egypt coupled with extension of municipal potable water, sewage, and solid-waste management systems projects.…”

Molecular Epidemiological Study of Hepatitis Viruses in Ismailia, Egypt

“…Finally, an alternative explanation for the lack of morbidity among anti-HEV incident cases could be that initial asymptomatic infections occur during early childhood with subsequent antibody titer boosting without illness upon re-exposure to the virus [15,16] . However, more virulent genotypes of HEV, mostly genotype 1, could be a cause of sporadic cases of HAV in Egypt [44][45][46][47] . Zoonotic transmission of HEV has been suggested.…”