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Marrone R, Mazzi C, Ouattara H, Cammilli M, Pontillo D, Perandin F, Bisoffi Z. Screening for Neglected Tropical Diseases and other infections in African refugees and asylum seekers in Rome and Lazio region, Italy. Travel Med Infect Dis 2023; 56:102649. [PMID: 37820947 DOI: 10.1016/j.tmaid.2023.102649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Few reliable data are available on Neglected Tropical Diseases (NTDs) and other infections among African refugees and asylum seekers in Italy. We aimed to estimate the prevalence of NTDs and other infections in a large cohort of African refugees and asylum seekers living in reception centers in Lazio, Italy. MATERIAL AND METHODS This is an observational, prospective prevalence study on infectious diseases in a large population of African refugees and asylum seekers (936 overall) consecutively enrolled for screening purpose at the Infectious and Tropical diseases outpatient clinic of the National Institute of Migrant and Poverty (INMP), Rome from August 2019 to December 2020. RESULTS We found a prevalence of 8.8 % and 31 % for Strongyloides and schistosoma infection, respectively, while the prevalence of human immunodeficiency virus (HIV) infection was 0.7 %, HCV antibodies 2.5%, hepatitis B virus surface antigen 10.8 % and syphilis serological tests 2.9 %. CONCLUSION Strongyloidiasis and schistosomiasis are highly prevalent among African refugees and asylum seekers in Italy, in contrast to communicable diseases (with the exception of hepatitis B). Raising awareness of NTDs among health professionals and implementing guidelines seems to be of paramount importance to prevent these diseases and their sufferers from becoming even more "neglected".
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Affiliation(s)
- R Marrone
- National Institute for Health, Migration and Poverty, 00153 Roma, Italy.
| | - C Mazzi
- Department of Infectious -Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy.
| | - H Ouattara
- National Institute for Health, Migration and Poverty, 00153 Roma, Italy.
| | - M Cammilli
- National Institute for Health, Migration and Poverty, 00153 Roma, Italy.
| | - D Pontillo
- Department of Infectious -Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy.
| | - F Perandin
- Department of Infectious -Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy.
| | - Z Bisoffi
- Department of Infectious -Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy.
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Ahmed A, EL‐Sadig SM, Eltigani HF, Bongomin F, Siddig EE. The first Helicobacter pylori-induced Guillain-Barré syndrome in Sudan. Clin Case Rep 2023; 11:e8204. [PMID: 38028082 PMCID: PMC10645600 DOI: 10.1002/ccr3.8204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/15/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message This case report highlights the role of Helicobacter pylori infection in the development of GBS. Healthcare providers should consider H. pylori in their differential diagnosis for patients with neurological syndromes. Astract We report the first known case of Guillain-Barré syndrome (GBS) associated with Helicobacter pylori infection in Sudan. This case highlights the role of H. pylori infection in the development of GBS. It also emphasizes the importance of wide screening of different endemic infections for patients with neurological syndromes for early detection and improves the case management in resource-limited settings like Sudan. Further research is needed to better understand the underlying mechanisms of H. pylori-inducing neurological disorders.
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Affiliation(s)
- Ayman Ahmed
- Swiss Tropical and Public Health Institute (Swiss TPH)AllschwilSwitzerland
- University of BaselBaselSwitzerland
- Institute of Endemic DiseaseUniversity of KhartoumKhartoumSudan
| | | | | | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of MedicineGulu UniversityGuluUganda
| | - Emmanuel Edwar Siddig
- Faculty of Medical Laboratory SciencesUniversity of KhartoumKhartoumSudan
- Department of Medical Microbiology and Infectious Diseases, ErasmusMCUniversity Medical Center RotterdamRotterdamThe Netherlands
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3
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Association of Serum 25(OH)D Deficiency with High Viral Load in HBV Infected Patients. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.3.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hepatitis B virus (HBV) is a significant public health concern, particularly in low-income countries. The host immune response plays an essential role in hepatitis B virus outcome, mainly orchestrated by cytokines and immune modulators molecules such as vitamin D. This study aimed to determine the levels of cytokines (IL-10), interferon-gamma (IFN-gamma), interferon-lambada (IFN-lambada), granzyme B, and vitamin D in Khartoum, Sudan, and to assess the association between them and variable HBV viral load as well as liver enzyme levels. A total of 174 participants were enrolled in the trial, with 100 HBV-infected patients (who were HIV and HCV negative) and 74 healthy volunteers. Patients’ HBV viral load, vitamin D levels, liver enzymes, and circulatory cytokines were measured. This study revealed a remarkable decrease in vitamin D levels in HBV infected patients with an elevation in levels of liver biomarkers. The level of IL-10 was significantly higher in patients than in apparently healthy controls (p-value <0.001). There was a positive correlation between IFN-ϒ, Granzyme B, and viral load. According to the findings of this study, there is a marked hypovitaminosis D among hepatitis B infected patients with a significant increase in IL-10, which may implicate the persistence of HBV infection. Moreover, HBV DNA levels were significantly associated with IFN- g and granzyme B levels.
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Yousif MA, Mohammed IS, Mohammed SO, Gebreel ME, Alhaj RM, Alsier DA, Abdelbasit HB, Yassin HM, Eltayeb LB. Nosocomial Transmission of Hepatitis B Surface Antigen and Anti-Hepatitis C Virus among Hemodialysis Patients. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/lccadvtrzs] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Raji YE, Toung OP, Taib NM, Sekawi ZB. Hepatitis E Virus: An emerging enigmatic and underestimated pathogen. Saudi J Biol Sci 2022; 29:499-512. [PMID: 35002446 PMCID: PMC8716866 DOI: 10.1016/j.sjbs.2021.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 02/07/2023] Open
Abstract
Hepatitis E virus (HEV) is an RNA virus causing hepatitis E disease. The virus is of one serotype but has diverse genotypes infecting both humans and animals. Based on evidence from seroprevalence studies, about 2 billion people are estimated to have been infected with HEV globally. HEV, therefore, poses a significant public health and economic challenge worldwide. HEV was discovered in the 1980s and was traced back to the 1955 - 1956 outbreak of hepatitis that occurred in India. Subsequently, several HEV epidemics involving thousands of individuals have occurred nearly annually in different countries in Asia and Africa. Initially, the virus was thought to be only enterically transmitted, and endemic in developing countries. Due to the environmental hygiene and sanitation challenges in those parts of the world. However, recent studies have suggested otherwise with the report of autochthonous cases in industrialised countries with no history of travel to the so-called endemic countries. Thus, suggesting that HEV has a global distribution with endemicity in both developing and industrialised nations. Studies have also revealed that HEV has multiple risk factors, and modes of transmission as well as zoonotic potentials. Additionally, recent findings have shown that HEV leads to severe disease, particularly among pregnant women. In contrast to the previous narration of a strictly mild and self-limiting infection. Studies have likewise demonstrated chronic HEV infection among immunocompromised persons. Consequent to these recent discoveries, this pathogen is considered a re - emerging virus, particularly in the developed nations. However, despite the growing public health challenges of this pathogen, the burden is still underestimated. The underestimation is often attributed to poor awareness among clinicians and a lack of routine checks for the disease in the hospitals. Thus, leading to misdiagnosis and underdiagnosis. Hence, this review provides a concise overview of epidemiology, diagnosis, and prevention of hepatitis E.
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Affiliation(s)
- Yakubu Egigogo Raji
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 1, Malaysia
- Faculty of Natural and Applied Sciences Ibrahim Badamasi Babangida University, Lapai, Nigeria
| | - Ooi Peck Toung
- Department of Veterinary Clinical Studies Faculty of Veterinary Medicine, Universiti Putra Malaysia 2, Malaysia
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 1, Malaysia
| | - Zamberi Bin Sekawi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 1, Malaysia
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Zhang Y, Xie Y, Chen Q, Chen X, Dong Z, Tan X. Prevalence and co-infection of schistosomiasis/hepatitis B among rural populations in endemic areas in Hubei, China. Trans R Soc Trop Med Hyg 2021; 114:155-161. [PMID: 31722017 PMCID: PMC7064163 DOI: 10.1093/trstmh/trz086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 12/19/2022] Open
Abstract
Background Both hepatitis B virus (HBV) infection and schistosomiasis are important public health problems in China. Concurrent infection between HBV and schistosomiasis is often observed in areas where schistosomiasis is endemic. The aim of this study was to determine the prevalence of schistosomiasis and HBV in schistosomiasis-affected areas, to explore whether schistosomiasis patients are more susceptible to HBV and to determine if the prevalence of HBV in high-endemic areas of schistosomiasis is higher than in low-endemic areas. Methods A total of 6526 participants from 13 villages in Hubei province were included in a cross-sectional study and blood samples were collected and examined. Qualitative variables were compared between groups using Pearson’s chi-squared test or Fisher’s exact test as appropriate. Results Of the 6526 participants, the overall prevalence was 8.27% for schistosomiasis and 2.67% for HBV. The prevalence of hepatitis B among participants who were Schistosoma antibody positive (25.37%) was higher than the prevalence in participants who were Schistosoma antibody negative (0.62%; χ2=1169.358, p<0.001, odds ratio 54.659). We also observed that there was no difference in the prevalence of hepatitis B between males and females in areas where schistosomiasis was endemic (χ2=1.827, p=0.177), but the prevalence of hepatitis B in middle-aged people was higher than in other age groups (χ2=47.877, p<0.001). Conclusions There was an association between schistosomiasis and HBV infection. However, more work is needed to find the causal relationship between schistosomiasis and HBV infection.
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Affiliation(s)
- Yupeng Zhang
- Wuhan University School of Medicine, No. 115, Donghu Road, Wuchang District, Wuhan city, Hubei Province, China
| | - Yaofei Xie
- Wuhan University School of Medicine, No. 115, Donghu Road, Wuchang District, Wuhan city, Hubei Province, China
| | - Qi Chen
- Wuhan University School of Medicine, No. 115, Donghu Road, Wuchang District, Wuhan city, Hubei Province, China
| | - Xuyu Chen
- Wuhan University School of Medicine, No. 115, Donghu Road, Wuchang District, Wuhan city, Hubei Province, China
| | - Zhuangzhuang Dong
- Wuhan University School of Medicine, No. 115, Donghu Road, Wuchang District, Wuhan city, Hubei Province, China
| | - Xiaodong Tan
- Wuhan University School of Medicine, No. 115, Donghu Road, Wuchang District, Wuhan city, Hubei Province, China
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7
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Ahmed RA, Almofti YA, Abd-elrahman KA. Structural Analysis of the Polymerase Protein for Multiepitopes Vaccine Prediction against Hepatitis B Virus. BIOSCIENCES BIOTECHNOLOGY RESEARCH ASIA 2021; 18:125-146. [DOI: 10.13005/bbra/2902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Hepatitis B virus (HBV) is the most common cause of hepatocellular carcinoma and liver cirrhosis with significant morbidity and mortality worldwide. DNA polymerase protein of HBV is the immunogenic protein inducing immune response against B and T cells. The aim of this study wasto develop multi-epitope vaccine fromthe polymerase protein elicitingimmune responses.The predicted vaccine comprises epitopes against B and T lymphocytesobtained by IEDB server. The predicted epitopes were linked via suitable spacers (linkers). The 50S ribosomal protein L7/L12 was used as an adjuvant at amino terminal and His-tag at the carboxyl terminal of the vaccine construct. The candidate vaccine contains 457aa and was potentially antigenic and nonallergic. Vaccine molecular weightwas 50.03 KDa with pI of 10.04. The instability index was 25.78 and GRAVY was -0.354 indicating stability andhydrophilicity of the chimeric vaccine,respectively.Vaccine structure (Secondary and tertiary structures) were predicted, refined and used for molecular docking with TLR4.The docking with TLR4 provided energy scores of -1458.7 and -1410.3 for chain A and B, respectively, demonstrated strong binding between the chimeric vaccine and TLR4 chains.The vaccine provided favorable solubility compared to E. coli proteins. Stability via disulfide bonds engineering was predicted to reduce the entropy and mobility regions invaccine construct. Molecular dynamics simulation wasperformed to strengthen the prediction. In silicomolecular cloning was usedto guarantee the efficient clonabilityof the vaccine and translation within suitable vector.
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Affiliation(s)
- Rolla Abdalkader Ahmed
- Department of Microbiology, Faculty of laboratory science, Omdurman Ahlia University, Khartoum- Sudan
| | - Yassir A. Almofti
- Department of Molecular Biology and Bioinformatics, College of Veterinary Medicine, University of Bahri, Khartoum- Sudan
| | - Khoubieb Ali Abd-elrahman
- 3Department of pharmaceutical technology, College of Pharmacy, University of Medical Science and Technology (MUST) Khartoum- Sudan
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Amoroso P, Buonocore S, Lettieri G, Pesce G, Pierri P, De Sena R, Morelli G, Matteis B, Dell'isola C, De Marino V, Ciccaglione AR, Punzi R, Esposito C, Spada E. Changing epidemiology of acute liver failure in Italy: a single-center experience over 25 years. Minerva Med 2020; 111:330-336. [PMID: 31958920 DOI: 10.23736/s0026-4806.19.06331-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Acute liver failure (ALF) is a rare but often lethal syndrome. In Italy, recent data on its incidence and causes are lacking. We report here the epidemiological analysis of ALF cases observed in Campania, a Southern Italian region, over the last 25 years. METHODS Medical records of ALF cases hospitalized from 1992 to 2018 were retrospectively analyzed. RESULTS Two hundred ten ALF cases occurred during 1992-2018: 103 (49%) hepatitis B virus (HBV)-related (including 5 cases also infected with Delta virus), 39 (19%) from undetermined cause, 36 (17%) drug-induced, 11 (5%) Wilson's disease-associated, 8 (4%) hepatitis A virus (HAV)-related and 12 (6%) from other causes. Separate time-periods analysis of data showed a significant progressive decrease in ALF incidence mainly attributable to a decline of HBV and other viruses etiology. Already before 2010, HAV or Delta virus-related cases have no longer been observed. No hepatitis C or E virus-related ALF was detected through the study period. A progressive decrease in frequency of ALF due to undetermined causes or drug was also evident. CONCLUSIONS A decrease in ALF incidence and a changing in its etiology were observed in Campania during 1992-2018. Both results were likely mainly due to 1991 introduction of HBV universal vaccination and may be considered generalizable nationwide.
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Affiliation(s)
- Pietro Amoroso
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy -
| | | | - Gennaro Lettieri
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy
| | - Gaetano Pesce
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy
| | - Paola Pierri
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy
| | - Raffaele De Sena
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy
| | - Giuseppe Morelli
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy
| | - Bianca Matteis
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy
| | - Chiara Dell'isola
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy
| | - Valeria De Marino
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy
| | - Anna R Ciccaglione
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Rodolfo Punzi
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy
| | - Ciro Esposito
- Department of Transplants, A. Cardarelli Hospital, Naples, Italy
| | - Enea Spada
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
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9
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El-Shabrawi MH, Kamal NM, Mogahed EA, Elhusseini MA, Aljabri MF. Perinatal transmission of hepatitis C virus: an update. Arch Med Sci 2020; 16:1360-1369. [PMID: 33224335 PMCID: PMC7667440 DOI: 10.5114/aoms.2019.83644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/02/2018] [Indexed: 12/17/2022] Open
Abstract
Infection with hepatitis C virus (HCV) is a major health problem worldwide. A large proportion of perinatal HCV infections are silent and may present later in adulthood with long-term complications. HCV has no effective immune prophylaxis and hence appropriate follow-up of all infants born to HCV-infected mothers is necessary. Universal antenatal screening for HCV is largely debatable. Intrauterine and partum transmission of HCV are both possible and higher rates are associated with a high maternal serum viral load (> 106 copies per milliliter), concomitant HIV infection, prolonged or difficult delivery, and invasive fetal monitoring during delivery. Infection during pregnancy and infancy needs to be investigated more in order to design management strategies for perinatal transmission of HCV most effectively. The recently approved new-generation, oral, direct-acting antiviral drugs may open a new era in HCV therapy for pregnant women and infected infants if proved to be safe during conception and infancy.
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Affiliation(s)
| | - Naglaa M. Kamal
- Department of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Egypt
| | - Engy A. Mogahed
- Department of Pediatrics and Pediatric Hepatology, Faculty of Medicine, Cairo University, Egypt
| | - Mona A. Elhusseini
- Department of Obstetrics and Gynecology, Red Crescent Hospital, Cairo, Egypt
| | - Mohamed F. Aljabri
- Department of Pediatrics and Pediatric Neurology, Alhada Armed Forces Hospital, Taif, Saudi Arabia
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Mursy SMEM, Mohamed SOO. Knowledge, attitude, and practice towards Hepatitis B infection among nurses and midwives in two maternity hospitals in Khartoum, Sudan. BMC Public Health 2019; 19:1597. [PMID: 31783744 PMCID: PMC6884767 DOI: 10.1186/s12889-019-7982-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 11/21/2019] [Indexed: 12/16/2022] Open
Abstract
Background Hepatitis B virus (HBV) infection creates a global health burden with significant morbidity and mortality. Healthcare workers, including nurses and midwives, are at higher risk of acquiring the disease. While health-related behaviours are affected by different aspects of knowledge, attitude, and practices (KAP), there are few studies examining the KAP level of healthcare workers towards HBV infection in Sudan. The purpose of this study was to examine the KAP level of nurses and midwives towards HBV virus infection in Khartoum, Sudan. Methods A cross-sectional descriptive hospital-based study was conducted in two public maternity hospitals (Saudi and Saad Abul-Eleella hospitals) in Khartoum state of, Sudan. A pre-tested structured questionnaire was constructed and implemented to examine KAP towards HBV infection. Statistical Package for Social Sciences (SPSS) version of 21 was utilized to conduct statistical analysis and examine the data at hand. Chi-square test was used implemented to determine the relationship between categorical variables. Results A total of 110 nurses and midwives from the both hospitals participated in this study. More than half of the respondents (58.2%) had an average level of knowledge, two-third of the respondents had a safe practice, and the majority of the respondents had a favourable attitude towards HBV preventive measures. Approximately half of the participants (51.8%) had a history of needle stick injuries. Half of the participants had inaccurate concepts about post exposure prophylaxis to HBV infection, while more than half of the nurses and midwives didn’t complete the vaccination schedule for HBV. Conclusion Most of the nurses and midwives in Saudi and Saad Abul-Eleella hospitals were aware of HBV infection. However, a significant proportion of the participants lack the requisite knowledge about post exposure management. The study revealed a low level of HBV vaccination coverage rate and a high rate of needle stick injuries. Further strategies for preventing workplace exposure, training programs on HBV infection, including post exposure prophylaxis, and increasing vaccination coverage rate of all HCWS are highly recommended.
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Charani E, Cunnington AJ, Yousif AHA, Seed Ahmed M, Ahmed AEM, Babiker S, Badri S, Buytaert W, Crawford MA, Elbashir MI, Elhag K, Elsiddig KE, Hakim N, Johnson MR, Miras AD, Swar MO, Templeton MR, Taylor-Robinson SD. In transition: current health challenges and priorities in Sudan. BMJ Glob Health 2019; 4:e001723. [PMID: 31543996 PMCID: PMC6730568 DOI: 10.1136/bmjgh-2019-001723] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/21/2019] [Accepted: 07/23/2019] [Indexed: 11/17/2022] Open
Abstract
A recent symposium and workshop in Khartoum, the capital of the Republic of Sudan, brought together broad expertise from three universities to address the current burden of communicable and non-communicable diseases facing the Sudanese healthcare system. These meetings identified common challenges that impact the burden of diseases in the country, most notably gaps in data and infrastructure which are essential to inform and deliver effective interventions. Non-communicable diseases, including obesity, type 2 diabetes, renal disease and cancer are increasing dramatically, contributing to multimorbidity. At the same time, progress against communicable diseases has been slow, and the burden of chronic and endemic infections remains considerable, with parasitic diseases (such as malaria, leishmaniasis and schistosomiasis) causing substantial morbidity and mortality. Antimicrobial resistance has become a major threat throughout the healthcare system, with an emerging impact on maternal, neonatal and paediatric populations. Meanwhile, malnutrition, micronutrient deficiency and poor perinatal outcomes remain common and contribute to a lifelong burden of disease. These challenges echo the United Nations (UN) sustainable development goals and concentrating on them in a unified strategy will be necessary to address the national burden of disease. At a time when the country is going through societal and political transition, we draw focus on the country and the need for resolution of its healthcare needs.
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Affiliation(s)
- Esmita Charani
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | | | | | - Ammar E M Ahmed
- Department of Medicine, University of Khartoum, Khartoum, Sudan
| | - Souad Babiker
- Department of Medicine, Ahfad University for Women, Omdurman, Sudan
| | - Shahinaz Badri
- Department of Pathology, School of Medicine, Ahfad University for Women, Omdurman, Sudan
| | | | | | | | - Kamal Elhag
- Department of Medicine, Ahfad University for Women, Omdurman, Sudan
| | | | - Nadey Hakim
- Department of Medicine, Imperial College London, London, UK
| | - Mark R Johnson
- Department of Medicine, Imperial College London, London, UK
| | | | - Mohamed O Swar
- Department of Medicine, Ahfad University for Women, Omdurman, Sudan
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Riebensahm C, Ka D, Sow A, Semmo N, Wandeler G. A closer look at the spectrum of drug-induced liver injury in sub-Saharan Africa. Expert Rev Clin Pharmacol 2019; 12:875-883. [PMID: 31269818 DOI: 10.1080/17512433.2019.1638251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction: Drug-induced liver injury (DILI) has become the most frequent cause of acute liver failure in high-income countries. However, little is known about the determinants of DILI in sub-Saharan Africa (SSA), where the prescription of antimicrobials and the use of potentially hepatotoxic traditional medicine are common. Areas covered: Based on an extensive literature search, we summarize current data available on the epidemiology and risk factors of DILI in SSA. We discuss the most likely causes of DILI in the region, including antimicrobial therapies and traditional medicine. We also highlight research gaps as well as barriers to diagnosis and management of the condition, and explore ways to address these important challenges. Expert opinion: DILI is underestimated in SSA and several factors challenge its early diagnosis, including lack of information on the causes of DILI in the region, sub-optimal knowledge about the condition among clinicians, and structural difficulties faced by health care systems. In order to better prevent the occurrence of DILI and its complications, it is crucial to enhance awareness among health care providers and patients, adapt drug prescription habits and regulations, and improve current knowledge on the main risk factors for DILI, including host genetic and environmental determinants.
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Affiliation(s)
- Carlotta Riebensahm
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Daye Ka
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland.,Department of Infectious Diseases, Hôpital Fann , Dakar , Senegal
| | - Abdoul Sow
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland.,Division of Gastroenterology and Hepatology, Hôpital Principal , Dakar , Senegal
| | - Nasser Semmo
- Division of Hepatology, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Hôpital Fann , Dakar , Senegal.,Department of Infectious Diseases, Bern University Hospital, University of Bern , Bern , Switzerland
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13
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Daw MA, Daw AM, Sifennasr NEM, Draha AM, Daw AM, Daw AM, Ahmed MO, Mokhtar ES, El-Bouzedi A, Daw IM. The Epidemiology of Hepatitis D Virus in North Africa: A Systematic Review and Meta-Analysis. ScientificWorldJournal 2018; 2018:9312650. [PMID: 30356409 PMCID: PMC6178169 DOI: 10.1155/2018/9312650] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/25/2018] [Accepted: 08/27/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatitis D virus (HDV) infection has been considered a serious neglected pandemic, particularly in developing countries. The virus causes a more severe disease than mono infection with hepatitis B virus (HBV). The epidemiology of HDV is not well documented in North Africa, which is known to be endemic for HBV. In this study, we explored the prevalence of HDV infection and also attempted to identify factors associated with hepatitis D positive status among chronic hepatitis B patients in North Africa. METHODS The electronic databases PubMed, Embase, Scopus, Science Direct, Web of Science, and Google Scholar were comprehensively searched for all papers published between January 1, 1998, and December 31, 2017, using appropriate strategies containing all related keywords, including North Africa, names of countries in the region, and all permutations of hepatitis D virus. The estimated prevalence of HDV in North Africa was calculated as an average of the pooled infection prevalence in each country weighted by the ratio of the country's hepatitis D virus population to the study's sample size in the survey data analysis. FINDINGS A total of 312 studies were identified and 32 were included in this study, with a total sample of 4907 individuals screened for HDV. There was considerable variability in the prevalence estimates of HDV within the countries of the region. The overall prevalence of HDV in the general population of North Africa was 5·01% (95% CI: 1·25-8·27) and in liver disease patients it was 20.7% (95% CI:9.87-44.53). Genotype-1 was the most prominent genotype reported in five published studies. Ten studies reported on HDV RNA in participants who were seropositive for HDV, and four studies highlighted the impact of demographic factors (sex and age). No study showed the impact of risk factors on the prevalence of HDV in North Africa. INTERPRETATION This review provides a comprehensive assessment of the burden of HDV in Northern Africa. There were significant differences in seroprevalence, study population, and diagnostic testing between the countries in the region. The results presented here will alert health professionals to implement clear policies based on evidence to diminish the burden of HDV infection. Such measures may include but are not restricted to improving the laboratory diagnostic tests and initiating patient data registries and blood screening. Further epidemiological and research studies are needed to explore the risk factors, coinfections, and approaches to increase testing for HDV, particularly in high-risk subpopulations, such as intravenous drug users and immigrants, and to define the consequences of HDV infection in North Africa.
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Affiliation(s)
- Mohamed A. Daw
- Department of Medical Microbiology & Immunology, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Amina M. Daw
- Department of General Medicine, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Nadia E. M. Sifennasr
- Department of Medical Microbiology & Immunology, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Aisha M. Draha
- Department of Pharmacology, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Ahmed M. Daw
- Tripoli Medical Centre, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Ali M. Daw
- Tripoli Medical Centre, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Mohamed O. Ahmed
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Ebtisam S. Mokhtar
- Department of Medical Microbiology & Immunology, Faculty of Medicine, University of Tripoli, CC 82668, Tripoli, Libya
| | - Abdallah El-Bouzedi
- Department of Laboratory Medicine, Faculty of Biotechnology, University of Tripoli, CC 82668, Tripoli, Libya
| | - Ibrahem M. Daw
- Department of Planning, Faculty of Engineering, University of Tripoli, CC 82668, Tripoli, Libya
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Hassan-Kadle MA, Osman MS, Ogurtsov PP. Epidemiology of viral hepatitis in Somalia: Systematic review and meta-analysis study. World J Gastroenterol 2018; 24:3927-3957. [PMID: 30228786 PMCID: PMC6141335 DOI: 10.3748/wjg.v24.i34.3927] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/25/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To provide a clear understanding of viral hepatitis epidemiology and their clinical burdens in Somalia.
METHODS A systematic review and meta-analysis was conducted as Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of published studies on viral hepatitis was performed from 1977-2016 in PubMed, Google Scholar, Science Direct, World Health Organization African Index Medicus and the Africa Journals Online databases, as well as on the Ministry of Health website. We also captured unpublished articles that were not available on online systems.
RESULTS Twenty-nine studies from Somalia and Somali immigrants (United Kingdom, United States, Italy, Libya) with a combined sample size for each type of viral hepatitis [hepatitis A virus (HAV): 1564, hepatitis B virus (HBV): 8756, hepatitis C virus (HCV): 6257, hepatitis D virus (HDV): 375 and hepatitis E virus (HEV): 278] were analyzed. The overall pooled prevalence rate of HAV was 90.2% (95%CI: 77.8% to 96%). The HAV prevalence among different age groups was as follows: < 1 year old, 61.54% (95%CI: 40.14% to 79.24%); 1-10 years old, 91.91% (95%CI: 87.76% to 94.73%); 11-19 years old, 96.31% (95%CI: 92.84% to 98.14%); 20-39 years old, 91.3% (95%CI: 83.07% to 95.73%); and > 40 years old, 86.96% (95%CI: 75.68% to 93.47%). The overall pooled prevalence of HBV was 18.9% (95%CI: 14% to 29%). The overall pooled prevalence among subgroups of HBV was 20.5% (95%CI: 5.1% to 55.4%) in pregnant women; 5.7% (95%CI: 2.7% to 11.5%) in children; 39.2% (95%CI: 33.4% to 45.4%) in patients with chronic liver disease, including hepatocellular carcinoma (HCC); 7.7% (95%CI: 4.2% to 13.6%), 12.4% (95%CI: 6.3% to 23.0%) and 11.8% (95%CI: 5.3% to 24.5%) in age groups < 20 years old, 20-39 years old and > 40 years old, respectively. The HBV prevalence among risk groups was 20% (95%CI: 7.19% to 44.64%) in female prostitutes, 21.28% (95%CI: 7.15% to 48.69%) in hospitalized adults, 5.56% (95%CI: 0.99% to 25.62%) in hospitalized children, 60% (95%CI: 31.66% to 82.92%) in patients with acute hepatitis, 33.55% (95%CI: 14.44% to 60.16%) in patients with ancylostomiasis, 12.34% (95%CI: 7.24% to 20.26%) in patients with leprosy and 20.19% (95%CI: 11.28% to 33.49%) in schistosomiasis patients. The overall pooled prevalence of HCV was estimated as 4.84% (95%CI: 3.02% to 7.67%). The prevalence rates among blood donors, risk groups, children and patients chronic liver disease (including HCC) was 0.87% (95%CI: 0.33% to 2.30%), 2.43% (95%CI: 1.21% to 4.8%), 1.37% (95%CI: 0.76% to 2.46%) and 29.82% (95%CI: 15.84% to 48.98%), respectively. The prevalence among genotypes of HCV was 21.9% (95%CI: 15.36% to 30.23%) in genotype 1, 0.87% (95%CI: 0.12% to 5.9%) in genotype 2, 25.21% (95%CI: 18.23% to 33.77%) in genotype 3, 46.24% (95%CI: 37.48% to 55.25%) in genotype 4, 2.52% (95%CI: 0.82% to 7.53%) in genotype 5, and 1.19% (95%CI: 0.07% to 16.38%) in genotype 6. The overall pooled prevalence of HDV was 28.99% (95%CI: 16.38% to 45.96%). The HDV prevalence rate among patients with chronic liver disease, including HCC, was 43.77% (95%CI: 35.09% to 52.84%). The overall pooled prevalence of HEV was 46.86% (95%CI: 5.31% to 93.28%).
CONCLUSION Our study demonstrates a high prevalence of all forms of viral hepatitis in Somalia and it also indicates that chronic HBV was the commonest cause of chronic liver disease. This highlights needs for urgent public health interventions and strategic policy directions to controlling the burden of the disease.
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Affiliation(s)
- Mohamed Abdulkadir Hassan-Kadle
- Center For the study of the Liver, Department of Hospital Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow 117198, Russia
- Abrar Research and Training Center, Abrar University, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Dufle Specialist Hospital, Mogadishu 25, Somalia
| | - Mugtaba Sulaiman Osman
- Department of Psychiatry, School of Medicine, Royal College of Surgeons in Ireland RCSI, Beaumont Hospital, Dublin 9, Ireland
| | - Pavel Petrovich Ogurtsov
- Center For the study of the Liver, Department of Hospital Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow 117198, Russia
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Coghill S, McNamara J, Woods M, Hajkowicz K. Epidemiology and clinical outcomes of hepatitis delta (D) virus infection in Queensland, Australia. Int J Infect Dis 2018; 74:123-127. [PMID: 30003953 DOI: 10.1016/j.ijid.2018.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To investigate the epidemiology, clinical characteristics and outcomes of those with hepatitis delta virus (HDV) infection in Queensland, Australia. DESIGN Retrospective cohort study of individuals tested for HDV between 1997 and 2016 in the public healthcare system in Queensland. RESULTS 179 individuals recorded positive HDV serology between 1997 and 2016, with a total of 4407 individuals undergoing testing (seroprevalence 4.1%). The majority of HDV positive individuals were male and were born overseas. Those born in Africa had a higher risk ratio (RR) for HDV infection (RR, 1.55; 95% CI, 1.14-2.09); being born in Asia was associated with a relatively lower risk of HDV infection (RR, 0.36; 95% CI, 0.27-0.58). Positive hepatitis C virus (HCV) serology was significantly associated with positive HDV serology (RR, 2.98; 95% CI, 2.36-3.78). Of the HDV positive individuals born in Australia, the majority were HCV positive (69.8%). HDV positive individuals were less likely to be Hepatitis B e antigen (HBeAg) positive (RR, 0.64; 95% CI, 0.45-0.93) and recorded lower hepatitis B virus (HBV) viral loads. Positive HDV serology was associated with increased risk of liver cirrhosis (RR, 2.3; 95% CI 1.73-3.07) and liver transplantation (RR, 1.93; CI 1.31-2.85). Only 8% of HDV positive individuals underwent HDV treatment. CONCLUSIONS In Queensland, HDV seropositivity is associated with overseas birth, particularly in Africa. HDV infection is associated with decreased HBV viraemia and more advanced liver disease.
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Affiliation(s)
- Sarah Coghill
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; School of Clinical Medicine, University of Queensland, Australia.
| | - John McNamara
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia
| | - Marion Woods
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; School of Clinical Medicine, University of Queensland, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland 4029, Australia; School of Clinical Medicine, University of Queensland, Australia
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Kirbak ALS, Ng'ang'a Z, Omolo J, Idris H, Usman A, Mbabazi WB. Sero-prevalence for Hepatitis B virus among pregnant women attending antenatal clinic in Juba Teaching Hospital, Republic of South Sudan. Pan Afr Med J 2017; 26:72. [PMID: 28451049 PMCID: PMC5398872 DOI: 10.11604/pamj.2017.26.72.11410] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/13/2017] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Hepatitis B virus infection is a major public health problem worldwide and in Africa. This would be the first ever documented study on epidemiology of Hepatitis B infections in the newly formed Republic of South Sudan. This study was designed to estimate the sero-prevalence of Hepatitis B virus infection amongst pregnant women attending antenatal services in Juba. METHODS A cross-sectional study was conducted among pregnant women attending antenatal clinic services in Juba Teaching Hospital, in the period between December 2012 and March 2013. Any pregnant woman, attending antenatal care services at Juba Teaching Hospital, was included if she was a resident of Juba County for at least 1 year before pregnancy. A Hepatitis B case was defined as any women participating in the study and was found to be positive for HbsAg and confirmed by ELISA. RESULTS This study documented that the prevalence of Hepatitis B surface antigen (HBsAg) among pregnant women attending ANC in Juba was 11% (31 out of the 280 samples). Other samples tested were indeterminate (36%), naturally immune (27.1%), susceptible (23%) and the remaining 1.8% was immune due to vaccination. Significant risk factors for Hepatitis B infection were loss of partner (OR 4.4 and CI of 1.4-13.9) and history of Jaundice (OR 1.7 and CI of 1.2-2.1). CONCLUSION These study findings show that only 29% of infants in Juba county are born to immune mothers (naturally or vaccine induced). The remaining 70% of babies would be at risk of infection, if a birth dose of Hepatitis B is not provided. We therefore recommended introduction of Hepatitis B Vaccine birth dose into routine infants' vaccination series to eliminate this risk.
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Affiliation(s)
| | - Zipporah Ng'ang'a
- Jommo Kenyatta University of Agriculture and Technology, P.O Box 62000-00200 Nairobi, Kenya
| | - Jared Omolo
- Jommo Kenyatta University of Agriculture and Technology, P.O Box 62000-00200 Nairobi, Kenya
| | - Hakim Idris
- Juba Teaching Hospital Laboratory, Ministry of Health, P.O Box 88, Juba, Republic of South Sudan
| | - Abdulmumini Usman
- World Health Organization, P.O Box 82, Juba, Republic of South Sudan
| | - William Baguma Mbabazi
- CDC/AFENET Immunization workforce development project, P.O Box 88, Juba, Republic of South Sudan
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Mohammed SEA, Abdo AE, Mudawi HMY. Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis. World J Hepatol 2016; 8:1336-1342. [PMID: 27872685 PMCID: PMC5099586 DOI: 10.4254/wjh.v8.i31.1336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/22/2016] [Accepted: 08/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis.
METHODS This is a prospective study conducted during the period from March to December 2014. Patients with portal hypertension presenting with acute variceal haemorrhage secondary to either liver cirrhosis (group A) or schistosomal periportal fibroses (group B) presenting within 24 h of the onset of the bleeding were enrolled in the study and followed for a period of 6 wk. Analysis of data was done by Microsoft Excel and comparison between groups was done by Statistical Package of Social Sciences version 20 to calculate means and find the levels of statistical differences and define the mortality rates, the P value of < 0.05 was considered to be significant.
RESULTS A total of 94 patients were enrolled in the study. Thirty-two patients (34%) had liver cirrhosis (group A) and 62 (66%) patients had periportal fibrosis (group B). Mortality: The 6-wk and 5-d mortality were 53% and 16% respectively in group A compared to 10% and 0% in group B (P value < 0.000 and < 0.004). In group A; a Child-Turcotte-Pugh class C and rebleeding within 5 d were significantly associated with 5-d mortality (P value < 0.029 and < 0.049 respectively) and Child- Turcotte-Pugh class C was also a significant risk factor for 6-wk mortality (P value < 0.018). In group B; mortality was significantly associated with rebleeding within the 6-wk follow-up period and requirement for blood transfusion on admission (P value < 0.005 and < 0.049). Rebleeding: The 6-wk and 5-d rebleeding rate in group A were 56% and 25% respectively compared to 32% and 3% in group B (P value < 0.015 and < 0.002). Clinical presentation with encephalopathy was a significant risk factor for 5 d rebleeding in group A (P value < 0.005) while grade III periportal fibrosis and requirement for blood transfusion on admission were significant risk factors for 6-wk rebleeding in group B (P value < 0.004 and < 0.02).
CONCLUSION The 6-wk and 5-d mortality and rebleeding rate were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.
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Hepatitis C Virus in North Africa: An Emerging Threat. ScientificWorldJournal 2016; 2016:7370524. [PMID: 27610403 PMCID: PMC5004010 DOI: 10.1155/2016/7370524] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/21/2016] [Accepted: 07/19/2016] [Indexed: 02/08/2023] Open
Abstract
Hepatitis C virus is a major public health threat associated with serious clinical consequences worldwide. North Africa is a unique region composed of seven countries that vary considerably in the predisposing factors to microbial diseases both historically and at the present time. The dynamics of HCV in the region are not well documented. The data are both limited and controversial in most of the countries in the region. In North Africa, the epidemiology of HCV is disparate and understanding it has been hampered by regional "epidemiological homogeneity" concepts. As the dynamics of HCV vary from country to country, context-specific research is needed. In this review, we assess studies performed in each country in the general populations as well as among blood donors and groups exposed to the HCV infection. The reported prevalence of HCV ranges from 0.6% to 8.4% in the Maghreb countries and is predominated by genotype 1. In the Nile valley region, it ranges from 2.2% to 18.9% and is dominated by genotype 4. In North African countries, HCV seems to be a serious problem that is driven by different vectors even in different geographical locations within the same country. Efforts should be combined at both the national and regional levels to implement efficient preventive and treatment strategies.
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Manka P, Verheyen J, Gerken G, Canbay A. Liver Failure due to Acute Viral Hepatitis (A-E). Visc Med 2016; 32:80-5. [PMID: 27413724 PMCID: PMC4926881 DOI: 10.1159/000444915] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Viral hepatitis is still one of the key causes of acute liver failure (ALF) in the world. METHODS A selective literature search of the PubMed database was conducted, including current studies, reviews, meta-analyses, and guidelines. We obtained an overview of ALF due to viral hepatitis in terms of epidemiology, course, and treatment options. RESULTS Most fulminant viral courses are reported after infection with hepatitis A, B, and B/D, but not with hepatitis C. Hepatitis E is also known to cause ALF but has not gained much attention in recent years. However, more and more autochthonous hepatitis E virus infections have been recently observed in Europe. Reactivation of hepatitis B virus (HBV) under immunosuppressive conditions, such as after intensive chemotherapy, is also an increasing problem. For most viral-induced cases of ALF, liver transplantation represented the only therapeutic option in the past. Today, immediate treatment of HBV-induced ALF with nucleotide or nucleoside analogs is well tolerated and beneficially affects the course of the disease. CONCLUSION Although numbers in Western European countries are decreasing rapidly, reliable diagnostic screening for hepatitis A-E is necessary to identify the etiology and to determine those most at risk of developing ALF.
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Affiliation(s)
- Paul Manka
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
- Regeneration and Repair Group, The Institute of Hepatology, Foundation for Liver Research, London, UK
- Division of Transplantation Immunology and Mucosal Biology, King's College, London, UK
| | - Jens Verheyen
- Institute of Virology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Ali Canbay
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
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Chaabna K, Kouyoumjian SP, Abu-Raddad LJ. Hepatitis C Virus Epidemiology in Djibouti, Somalia, Sudan, and Yemen: Systematic Review and Meta-Analysis. PLoS One 2016. [PMID: 26900839 DOI: 10.1371/journal.pone.0149966]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To characterize hepatitis C virus (HCV) epidemiology and assess country-specific population-level HCV prevalence in four countries in the Middle East and North Africa (MENA) region: Djibouti, Somalia, Sudan, and Yemen. METHODS Reports of HCV prevalence were systematically reviewed as per PRISMA guidelines. Pooled HCV prevalence estimates in different risk populations were conducted when the number of measures per risk category was at least five. RESULTS We identified 101 prevalence estimates. Pooled HCV antibody prevalence in the general population in Somalia, Sudan and Yemen was 0.9% (95% confidence interval [95%CI]: 0.3%-1.9%), 1.0% (95%CI: 0.3%-1.9%) and 1.9% (95%CI: 1.4%-2.6%), respectively. The only general population study from Djibouti reported a prevalence of 0.3% (CI: 0.2%-0.4%) in blood donors. In high-risk populations (e.g., haemodialysis and haemophilia patients), pooled HCV prevalence was 17.3% (95%CI: 8.6%-28.2%) in Sudan. In Yemen, three studies of haemodialysis patients reported HCV prevalence between 40.0%-62.7%. In intermediate-risk populations (e.g.. healthcare workers, in patients and men who have sex with men), pooled HCV prevalence was 1.7% (95%CI: 0.0%-4.9%) in Somalia and 0.6% (95%CI: 0.4%-0.8%) in Sudan. CONCLUSION National HCV prevalence in Yemen appears to be higher than in Djibouti, Somalia, and Sudan as well as most other MENA countries; but otherwise prevalence levels in this subregion are comparable to global levels. The high HCV prevalence in patients who have undergone clinical care appears to reflect ongoing transmission in clinical settings. HCV prevalence in people who inject drugs remains unknown.
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Affiliation(s)
- Karima Chaabna
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
| | - Silva P Kouyoumjian
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- College of Public Health, Hamad bin Khalifa University, Doha, Qatar
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Chaabna K, Kouyoumjian SP, Abu-Raddad LJ. Hepatitis C Virus Epidemiology in Djibouti, Somalia, Sudan, and Yemen: Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0149966. [PMID: 26900839 PMCID: PMC4764686 DOI: 10.1371/journal.pone.0149966] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/08/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To characterize hepatitis C virus (HCV) epidemiology and assess country-specific population-level HCV prevalence in four countries in the Middle East and North Africa (MENA) region: Djibouti, Somalia, Sudan, and Yemen. METHODS Reports of HCV prevalence were systematically reviewed as per PRISMA guidelines. Pooled HCV prevalence estimates in different risk populations were conducted when the number of measures per risk category was at least five. RESULTS We identified 101 prevalence estimates. Pooled HCV antibody prevalence in the general population in Somalia, Sudan and Yemen was 0.9% (95% confidence interval [95%CI]: 0.3%-1.9%), 1.0% (95%CI: 0.3%-1.9%) and 1.9% (95%CI: 1.4%-2.6%), respectively. The only general population study from Djibouti reported a prevalence of 0.3% (CI: 0.2%-0.4%) in blood donors. In high-risk populations (e.g., haemodialysis and haemophilia patients), pooled HCV prevalence was 17.3% (95%CI: 8.6%-28.2%) in Sudan. In Yemen, three studies of haemodialysis patients reported HCV prevalence between 40.0%-62.7%. In intermediate-risk populations (e.g.. healthcare workers, in patients and men who have sex with men), pooled HCV prevalence was 1.7% (95%CI: 0.0%-4.9%) in Somalia and 0.6% (95%CI: 0.4%-0.8%) in Sudan. CONCLUSION National HCV prevalence in Yemen appears to be higher than in Djibouti, Somalia, and Sudan as well as most other MENA countries; but otherwise prevalence levels in this subregion are comparable to global levels. The high HCV prevalence in patients who have undergone clinical care appears to reflect ongoing transmission in clinical settings. HCV prevalence in people who inject drugs remains unknown.
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Affiliation(s)
- Karima Chaabna
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
| | - Silva P. Kouyoumjian
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
| | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America
- College of Public Health, Hamad bin Khalifa University, Doha, Qatar
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Hepatitis C Virus Epidemiology in Djibouti, Somalia, Sudan, and Yemen: Systematic Review and Meta-Analysis. PLoS One 2016. [PMID: 26900839 DOI: 10.1371/journal.pone.0149966].] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To characterize hepatitis C virus (HCV) epidemiology and assess country-specific population-level HCV prevalence in four countries in the Middle East and North Africa (MENA) region: Djibouti, Somalia, Sudan, and Yemen. METHODS Reports of HCV prevalence were systematically reviewed as per PRISMA guidelines. Pooled HCV prevalence estimates in different risk populations were conducted when the number of measures per risk category was at least five. RESULTS We identified 101 prevalence estimates. Pooled HCV antibody prevalence in the general population in Somalia, Sudan and Yemen was 0.9% (95% confidence interval [95%CI]: 0.3%-1.9%), 1.0% (95%CI: 0.3%-1.9%) and 1.9% (95%CI: 1.4%-2.6%), respectively. The only general population study from Djibouti reported a prevalence of 0.3% (CI: 0.2%-0.4%) in blood donors. In high-risk populations (e.g., haemodialysis and haemophilia patients), pooled HCV prevalence was 17.3% (95%CI: 8.6%-28.2%) in Sudan. In Yemen, three studies of haemodialysis patients reported HCV prevalence between 40.0%-62.7%. In intermediate-risk populations (e.g.. healthcare workers, in patients and men who have sex with men), pooled HCV prevalence was 1.7% (95%CI: 0.0%-4.9%) in Somalia and 0.6% (95%CI: 0.4%-0.8%) in Sudan. CONCLUSION National HCV prevalence in Yemen appears to be higher than in Djibouti, Somalia, and Sudan as well as most other MENA countries; but otherwise prevalence levels in this subregion are comparable to global levels. The high HCV prevalence in patients who have undergone clinical care appears to reflect ongoing transmission in clinical settings. HCV prevalence in people who inject drugs remains unknown.
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Abdalla M, Hamad T. Hepatitis B Virus Seroprevalence Among Children With Cancer in Sudan. Pediatr Blood Cancer 2016; 63:124-6. [PMID: 26375506 DOI: 10.1002/pbc.25720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 07/28/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The seroprevalence of hepatitis B among children with cancer in Sudan is unknown. The aim of this study was to detect the seroprevalence of hepatitis B virus (HBV) infection in children with malignancy and its correlation with different risk factors. PROCEDURE This study included 178 children with malignancy presenting to the Radioisotope Center in Khartoum during the period of May-July 2011. Sixty-four healthy children served as controls. Sera from patients and controls were investigated for HBV total anti-core antibody, HBV surface antigen (HBsAg), and HBV e antigen (HBeAg). RESULTS HBV total anti-core antibody was positive in 71/178 (39.9%), HBsAg was positive in 38 (21.3%), and HBeAg was positive in 19 (10.7%). Blood product transfusion, surgical exposure, chemotherapy, malignancy type, and sex did not affect the seroprevalence of HBV in this study. Vaccinated children had reduced rates of exposure compared to non-vaccinated patients. CONCLUSION There is a high seroprevalence of HBV in children with malignancies in Sudan. Vaccination appears to play a major protective role.
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Affiliation(s)
- Mohammed Abdalla
- Pediatric Department, University of Khartoum Faculty of Medicine, Khartoum, Sudan
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Elzupir AO, Alamer AS. Quantitative cancer risk of aflatoxin in peanut butter and vegetable oils: Sudan case study. TOXIN REV 2014. [DOI: 10.3109/15569543.2014.942320] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Adam AOA, Dafalla MMM, Mohammed HAA, Elamin MY, Younis BM, Elfaki MEE, Musa AM, Elhassan AM, Khalil EAG. Visceral leishmaniasis-hepatitis B/C coinfections: a rising necessity to triage patients for treatment. Ann Saudi Med 2014; 34:143-6. [PMID: 24894783 PMCID: PMC6074856 DOI: 10.5144/0256-4947.2014.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Visceral leishmaniasis (VL) is a life-threatening infection caused by Leishmania species. In Sudan, VL is caused by L donovani. Most drugs used to treat VL, especially pentavalent antimony compounds (sodium stibogluconate, SSG), are potentially hepatotoxic. A number of fatal catastrophes happened because patients with VL-hepatitis B/C coinfection were indiscriminately treated with SSG in settings where VL and viral hepatitis coexist. This study aimed to study biochemical and hematological parameters of patients with VL-hepatitis B/C coinfections with the aim to modify treatment protocols to reduce coinfection.added morbidity and mortality. DESIGN AND SETTINGS This was a prospective analytical, hospital-based, and case-controlled study. The study was done at Kassab Hospital and Professor Elhassan Centre for tropical medicine during the period of February 2008 to April 2013. MATERIALS AND METHODS Following informed consent by the participants, 78 parasitologically confirmed VL patients with either hepatitis B or C or both and 528 sex- and age-unmatched VL patients without hepatitis B/C coinfection (control group) were enrolled sequentially. Diagnosis of hepatitis B or C was made using immunochromatographic test kits and confirmed by an enzyme-linked immunosorbent assay. RESULTS VL patients with hepatitis B/C coinfections had significantly increased levels of AST, ALT, and total bilirubin compared to the control group (P=.0001 for all), with significantly decreased levels of albumin and platelets counts (P=.0029 for both). CONCLUSION VL-hepatitis B/C coinfections are an emerging entity that needs anti-leishmanial treatment modification. Alternative treatments like paromomycin and amphotericin B (AmBisome) could be reserved for these patients.
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Affiliation(s)
- Abubakr O. A. Adam
- From the Leishmaniasis Research Group/Sudan, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Mohamed M. M. Dafalla
- From the Leishmaniasis Research Group/Sudan, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Hatim A. A. Mohammed
- From the Leishmaniasis Research Group/Sudan, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Mohamed Y. Elamin
- From the Leishmaniasis Research Group/Sudan, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Brima M. Younis
- From the Leishmaniasis Research Group/Sudan, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Mona E. E. Elfaki
- From the Leishmaniasis Research Group/Sudan, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Ahmed M. Musa
- From the Leishmaniasis Research Group/Sudan, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Ahmed M. Elhassan
- From the Leishmaniasis Research Group/Sudan, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
| | - Eltahir A. G. Khalil
- From the Leishmaniasis Research Group/Sudan, Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
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Molecular characterization of hepatitis B virus in liver disease patients and asymptomatic carriers of the virus in Sudan. BMC Infect Dis 2013; 13:328. [PMID: 23865777 PMCID: PMC3722059 DOI: 10.1186/1471-2334-13-328] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 07/16/2013] [Indexed: 12/12/2022] Open
Abstract
Background Hepatitis B virus is hyperendemic in Sudan. Our aim was to molecularly characterize hepatitis B virus from Sudanese individuals, with and without liver disease, because genotypes play an important role in clinical manifestation and treatment management. Methods Ninety-nine patients - 30 asymptomatic, 42 cirrhotic, 15 with hepatocellular carcinoma, 7 with acute hepatitis and 5 with chronic hepatitis- were enrolled. Sequencing of surface and basic core promoter/precore regions and complete genome were performed. Results The mean ± standard deviation, age was 45.7±14.8 years and the male to female ratio 77:22. The median (interquartile range) of hepatitis B virus DNA and alanine aminotransferase levels were 2.8 (2.2-4.2) log IU/ml and 30 (19–49) IU/L, respectively. Using three genotyping methods, 81/99 (82%) could be genotyped. Forty eight percent of the 99 patients were infected with genotype D and 24% with genotype E, 2% with putative D/E recombinants and 7% with genotype A. Patients infected with genotype E had higher frequency of hepatitis B e antigen-positivity and higher viral loads compared to patients infected with genotype D. Basic core promoter/precore region mutations, including the G1896A in 37% of HBeAg-negative individuals, could account for hepatitis B e antigen-negativity. Pre-S deletion mutants were found in genotypes D and E. Three isolates had the vaccine escape mutant sM133T. Conclusion Sudanese hepatitis B virus carriers were mainly infected with genotypes D or E, with patients infected with genotype E having higher HBeAg-positivity and higher viral loads. This is the first study to molecularly characterize hepatitis B virus from liver disease patients in Sudan.
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Abd El Kader Mahmoud O, Abd El Rahim Ghazal A, El Sayed Metwally D, Elnour AM, Yousif GEA. Detection of occult hepatitis B virus infection among blood donors in Sudan. J Egypt Public Health Assoc 2013; 88:14-18. [PMID: 23528527 DOI: 10.1097/01.epx.0000427065.73965.c8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Sudan is classified among countries with a high hepatitis B surface antigen (HBsAg) endemicity of more than 8%. Cross-sectional studies have showed a marked increase in the prevalence of occult hepatitis B infection (OBI) in patients with cirrhosis or hepatocellular carcinoma. In terms of OBI infectivity by transfusion, it is largely unknown whether residual risk estimates translate into true rates of infection. AIM The current study aimed to determine the frequency of OBI among blood donors in Sudan. MATERIALS AND METHODS This study was carried out during the period between 2011 and 2012. It included 100 HBsAg-negative blood donors who attended the Central Blood Bank in Sudan. Sera collected from all donors were tested for HBsAg, antibodies against hepatitis B core antigen (anti-HBc), antibodies against hepatitis Be antigen (anti-HBe), and antibodies against hepatitis B surface antigen (anti-HBs) by enzyme-linked immunosorbant assay. Anti-HBc-positive patients were tested for hepatitis B virus (HBV)-DNA. RESULTS The anti-HBc was detected in 42% of the blood donors, among whom 90.5% were positive for HBV-DNA. Two main profiles have been detected, namely, the presence of the three genes (S, C, and X genes) together in 35.7% of the blood donors or the presence of the X gene in addition to the core gene. CONCLUSION AND RECOMMENDATIONS With the use of HBsAg as the sole detection marker for HBV, there is a danger of HBV transmission through blood transfusion. Anti-HBc testing should be added to the routine blood donor screening test if occult hepatitis B is to be diagnosed.
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Affiliation(s)
- Ola Abd El Kader Mahmoud
- aDepartment of Microbiology Medical Research Institute, University of Alexandria, Alexandria, Egypt bDepartment of Haematology, Faculty of Medicine, University of Elimam Elmahdi, Kosti cMedical Laboratory Science, University of Khartoum, Khartoum, Sudan
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Daw MA, Dau AA. Hepatitis C virus in Arab world: a state of concern. ScientificWorldJournal 2012; 2012:719494. [PMID: 22629189 PMCID: PMC3354686 DOI: 10.1100/2012/719494] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 01/18/2012] [Indexed: 12/17/2022] Open
Abstract
Hepatitis C virus has been considered to be one of the most important devastating causes of chronic hepatitis, cirrhosis, and hepatic cellular carcinoma. The prevalence of such virus varies greatly over the world. Arab world has a unique geography and consists over nineteen countries who share the same heritage and customs and do speak the same language. In this area, the epidemiology of hepatitis C is not well understandable. Hepatitis C virus was found to be endemic in Arabia. The serostatus of such virus was found to be variable among these countries with uniform patterns of genotypes. Such prevalence varies tremendously according to the risk factors involved. Blood and blood products, haemodialysis, intravenous, and percutaneous drug users, and occupational, habitual, and social behavior were found to be the important factors involved. Hepatitis C will have major social, economic, and even political burdens on such young and dynamic societies. Thus, strategies and clear policy of intervention are urgently needed to combat the consequences of HCV both regionally and at state level of each country.
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Affiliation(s)
- Mohamed A Daw
- Department of Medical Microbiology & Immunology, Tripoli Medical Centre, Faculty of Medicine Tripoli, PO Box 82668, Tripoli, Libya.
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Al-Shamiri AH, Al-Taj MA, Ahmed AS. Prevalence and co-infections of schistosomiasis/hepatitis B and C viruses among school children in an endemic areas in Taiz, Yemen. ASIAN PAC J TROP MED 2011; 4:404-8. [PMID: 21771686 DOI: 10.1016/s1995-7645(11)60113-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 02/27/2011] [Accepted: 03/15/2011] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the disease prevalence and its relationship with hepatitis B and C viruses among school children in five endemic areas by schistosomiasis. METHODS During June 2007 and March 2009, 1 484 school children aged between 5 - 16 years participated in the current study from 32 basic schools in five districts (Al-Dhabab, Hedran, Warazan, Al-Barh and Al-Shmaytin) in Taiz Governorate, Republic of Yemen. Out of school children who participated in the study; 1 406 stool samples, 1 484 urine samples and 214 blood samples were collected and examined. RESULTS Schistosoma mansoni (S. mansoni) was found in all the studied areas except Al-Barh. However, Schistosoma haematobium (S. haematobium) was recorded only in Al-Shmaytin and Al-Barh. Both S. mansoni and S. haematobium were observed in Al-Shmaytin district. The overall prevalence was 20.76% for S. mansoni and 7.41% for S. haematobium. The prevalence rate of infection among males was higher than females, showing no significant differences. Rate of light, moderate and heavy infections in the case of S. mansoni were 41.78%, 25.34% and 32.87% respectively. Whereas, for S. hematobium it was 50.90% for light infection and 49.09% for heavy infection. Regarding to the prevalence of viral hepatitis among infected school children with schistosomiasis, it could be noticed that hepatitis B virus was higher than the prevalence of hepatitis C virus. But, the presence of HBsAg and anti-HCV was not associated with Schistosoma infection. CONCLUSIONS Schistosomiasis infection is an important public health problem in Taiz Governorate, Republic of Yemen. There was a correlation between S. haematobium and hepatitis B, but no association between S. mansoni infections and hepatitis B and C viruses.
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Affiliation(s)
- Adam H Al-Shamiri
- Department of Microbiology, Faculty of Applied Science, Taiz University, Yemen.
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