Regional Prevalence of Hepatitis B, Delta, and Human Immunodeficiency Virus Infection in Southern Africa: A Large Population Survey

Abstract

Although hepatitis B infection is endemic in southern Africa, a changing epidemiology of the disease has recently been documented in the region. The authors surveyed migrant southern African male mineworkers during 1986 to establish the prevalence of chronic hepatitis B and D (delta) infection in their areas of origin. Hepatitis B surface antigen (HBsAg) was tested in 29,312 adult male mineworkers from 18 geographic regions, encompassing the diverse tribal and linguistic groups in the region, as well as in expatriate mineworkers from neighboring southern African countries. The same cohort was also tested for antibody to human immunodeficiency virus (HIV). Selected hepatitis B carriers were also tested for hepatitis B virus deoxyribonucleic acid (DNA), antibody to hepatitis D (anti-HD), and alpha-fetoprotein. The overall prevalence of HBsAg in this survey was 9.9%. However, the prevalence varied from 5.5% to 14% in different ethnic groups. A minority of carriers (4.9%) had replicative hepatitis B infection and were hepatitis B virus DNA-positive. Only 0.6% of tested carriers were anti-HD-positive. Alpha-fetoprotein determinations were abnormal in 1.2% of hepatitis B-positive men. These data show that although chronic hepatitis B infection remains widespread in southern Africa, carrier rates vary significantly from region to region. In contrast, hepatitis D co-infection remains extremely uncommon. These baseline seroprevalence data also establish that HIV infection was, in 1986, a rare infection in the indigenous population of South Africa.

Use of replacement blood donors to study the epidemiology of major blood‐borne viruses in the general population of Maputo, Mozambique

“…Thus, in Ethiopia, the prevalence of HDV is 5.8% [Rapicetta et al, 1988], while in Northern Kenya it is five times higher [Greenfield et al, 1986]. The seroprevalence of HDV was zero in this study, a finding compatible with the situation in South Africa, where it ranges from 0% [Dusheiko et al, 1989a] to 0.6% [Abdool Karim et al, 1991]. This would be related to the negligible proportion of intravenous drug users in Mozambique.…”

GB virus C/hepatitis G virus infection in KwaZulu Natal, South Africa

“…The reason for the high prevalence of GBV-C/HGV in blood donors worldwide and basis for the racial differences in GBV-C/HGV infection in the South African blood donor populations is not known. Racial differences in the prevalence of HAV [Sathar et al, 1994], HBV [Dusheiko et al, 1989], and HCV [Soni et al, 1993] infections due to differences in socioeconomic factors in South Africa is well documented. Whether this difference holds true for GBV-C/HGV is not known, although a relationship was noted between GBV-C/HGV infection and the lack of waterborne sewage [Tucker et al, 1997].…”

“…Both vertical [Feucht et al, 1996] and sexual [Ibanez et al, 1998;Scallan et al, 1998] transmission of GBV-C/HGV has been suggested. HBV infection is endemic amongst the African population of South Africa and the risk of horizontal transmission of HBV is well recognised [Dusheiko et al, 1989]. Whether the association of GBV-C, GB virus C; HGV, hepatitis G virus; Coloured, persons of mixed origin.…”

Chronic hepatitis B

“…33,36,37 In sub-Saharan Africa, Alaska, and Mediterranean countries, transmission of HBV usually occurs from person to person in childhood, whereas perinatal transmission is less common (pattern 2). 25,[38][39][40] In these populations most children who are HBeAg positive have elevated ALT levels and seroconversion to anti-HBe is common near or shortly after the onset of puberty. The third pattern is usually observed in individuals who acquired HBV infection during adulthood.…”