Hepatitis E Infection in Nigeria: A Systematic Review

Seroprevalence patterns of viral hepatitis B, C, and E among internally displaced persons in Borno State, Nigeria

Objectives

Following the outbreak of hepatitis E in camps for internally displaced persons (IDPs) in Borno State in 2017, we assessed hepatitis B, C, and E biomarkers (hepatitis B surface antigen [HBsAg], anti-HBC, anti-hepatitis E virus [HEV] immunoglobulin [Ig] G, and anti-HEV IgM) among IDPs in three camps in Borno State, Nigeria, to determine seroprevalence rates in these understudied populations.

Methods

A total of 454 IDPs, including pregnant women and breastfeeding mothers, were randomly selected, and their demographic, clinical, and epidemiological data were collected. Blood samples were tested for HBsAg and anti-hepatitis C virus (HCV) using rapid tests, anti-HEV IgM, and anti-HEV IgG using enzyme-linked immunosorbent assay.

Results

The seroprevalences were 13.7% for HBsAg, 1.3% for anti-HCV, 41.9% for anti-HEV IgG, and 0% for anti-HEV IgM. There were differences between the camps depending on the displaced community. Common detection occurred in 0.2% for HBsAg/anti-HCV, 4.2% for HBsAg/anti-HEV IgG, and 0.7% for anti-HCV/anti-HEV IgG. In pregnant women, HBsAg/anti-HEV IgG co-detection rate was 28.6%, whereas HBsAg and anti-HEV IgG rates alone were 13.4% and 32.8%, respectively. Among breastfeeding mothers, 17.1%, 2.4%, and 36.6% were positive for HBsAg, anti-HCV, and anti-HEV IgG, respectively, whereas 2.2% of them were positive for both HBsAg and anti-HEV IgG.

Conclusions

The prevalence of viral hepatitis biomarkers among the IDPs studied was higher than those reported in national figures and differed according to camps and population subgroups. There is a need for improved surveillance and access to testing for viral hepatitis biomarkers for the purpose of improved disease prevention and control in these medically underserved populations.

Detection of hepatitis viruses in suspected cases of Viral Haemorrhagic Fevers in Nigeria

There have been several Viral Hemorrhagic Fever (VHF) outbreaks in Nigeria which remains a public health concern. Despite the increasing number of suspected cases of VHF due to heightened surveillance activities and growing awareness, only a few cases are laboratory-confirmed to be VHF. Routinely, these samples are only tested for Lassa virus and Yellow fever virus with occasional testing for Dengue virus when indicated. The aetiology of the disease in these VHF suspected cases in Nigeria which are negative for Lassa, Yellow fever and Dengue viruses remains a puzzle. Since the clinical features exhibited by suspected VHF cases are like other endemic illnesses such as Hepatitis, there is a need to investigate the diversity and co-infections of hepatitis viruses as differentials and possible co-morbidity in suspected cases of VHFs in Nigeria. A total of three hundred and fifty (350) blood samples of 212 (60.6%) males and 138 (39.4%) females, aged <1-70 years with a mean age of 25 ±14.5, suspected of VHFs and tested negative for Lassa, Yellow fever and Dengue viruses were investigated for Hepatitis A, B, C and E viruses at the Centre for Human and Zoonotic Virology (CHAZVY), College of Medicine, University of Lagos (CMUL) using serologic and molecular techniques. The serologic analysis of these VHF suspected cases samples revealed that 126 (36%) were positive for at least one hepatitis virus. Individual prevalence for each of the hepatitis virus screened for showed that 37 (10.6%), 18 (5.1%) and 71 (20.3%) were positive for HBV, HCV and HEV respectively. All the samples were negative for HAV. A co-infection rate of 11.9% was also observed, with HCV/HEV co-infections being the most prevalent and the Northern region having the greatest burden of infection. The evidence of hepatitis virus infections in suspected cases of VHF was documented. Thus, their associations as co-morbidities and/or mortalities in this category of individuals require further investigations in endemic countries such as Nigeria. Therefore, the possible inclusion of screening for hepatitis viruses and other aetiologic agents that could mimic infections in suspected cases of VHFs in Nigeria should be thoroughly evaluated to guide informed policy on the diagnosis and management of these cases.

Hepatitis E Seroprevalence and Detection of Genotype 3 Strains in Domestic Pigs from Sierra Leone Collected in 2016 and 2017

Hepatitis E virus (HEV) is the main cause of acute hepatitis in humans worldwide and is responsible for a large number of outbreaks especially in Africa. Human infections are mainly caused by genotypes 1 and 2 of the genus Paslahepevirus, which are exclusively associated with humans. In contrast, viruses of genotypes 3 and 4 are zoonotic and have their main reservoir in domestic and wild pigs, from which they can be transmitted to humans primarily through the consumption of meat products. Both genotypes 3 and 4 are widespread in Europe, Asia, and North America and lead to sporadic cases of hepatitis E. However, there is little information available on the prevalence of these genotypes and possible transmission routes from animal reservoirs to humans in African countries. We therefore analysed 1086 pig sera collected in 2016/2017 in four districts in Sierra Leone for antibodies against HEV using a newly designed in-house ELISA. In addition, the samples were also analysed for HEV RNA by quantitative real-time RT-PCR. The overall seroprevalence in Sierra Leone was low with only 44 positive sera and a prevalence of 4.0%. Two serum pools were RT-PCR-positive and recovered partial sequences clustered into the genotype 3 (HEV-3) of the order Paslahepevirus, species Paslahepevirus balayani. The results are the first evidence of HEV-3 infection in pigs from Sierra Leone and demonstrate a low circulation of the virus in these animals to date. Further studies should include an examination of humans, especially those with close contact with pigs and porcine products, as well as environmental sampling to evaluate public health effects within the framework of a One Health approach.

Butchering activity is the main risk factor for hepatitis E virus (Paslahepevirus balayani) infection in southwestern Nigeria: a prospective cohort study

Introduction

Paslahepevirus balayani (Hepatitis E virus; HEV) is an emerging virus that poses as a public health threat. The virus is now reported to be the leading cause of acute viral hepatitis, with a unique impact on African settings. Our aim was to evaluate the prevalence and risk factors for HEV infection in three cohorts (animal handlers, villagers, and students).

Methods

A prospective cross-sectional study was carried out on a total of 752 subjects from southwestern Nigeria. In all individuals, anti-HEV IgG and anti-HEV IgM antibodies were evaluated by using ELISA (confirming positive results via immunoblotting), and serum viral RNA was evaluated by using two RT-PCR assays.

Results

The overall seroprevalence of HEV IgG and HEV IgM was 14.9% (95% CI: 12.5-17.6%) and 1.3% (95% CI: 0.7-2.5%), respectively. We observed the highest seroprevalence among animal contact individuals, with butchers being the population with the highest HEV IgG seroprevalence (31.1%). Similarly, HEV IgM was higher in the animal contact group (2.2%) than in the non-animal contact cohort (0%).

Discussions

Viral RNA was not detected in any of the samples. Butchering was significantly associated with higher HEV prevalence. Although all efforts to prevent HEV in Africa have focused on the chlorination of water, our study suggests that most new infections could currently be linked to animal manipulation. Therefore, education and guidelines must be provided in southwest Nigeria to ensure that animal handling and processing methods are safe.

Seroprevalence, Associated Factors, and Fetomaternal Outcome in Pregnant Women That Tested Positive to Hepatitis E Antibodies in Nigeria

Background

Hepatitis E virus infection is an emerging disease with varied courses in pregnancy. There is a dearth of statistics among pregnant women.

Aim

To evaluate the prevalence, associated factors, and pregnancy outcome in women that tested positive for hepatitis E virus (HEV) antibodies in pregnancy. Research Methods. This was a cross-sectional study conducted among pregnant women at a teaching hospital in Nigeria. Relevant information was collected using a structured questionnaire. Blood was collected from each of the participants, and the serum was used to determine the presence of hepatitis E immunoglobulin M (IgM) and G (IgG). The data were analysed using SPSS version 23. Associations between variables were determined at a p value of <0.05.

Results

A total of 200 pregnant women participated in this study. The prevalence of HEV infection among pregnant women was 28.00% (56/200). The mean age was 30.11 ± 5.88. Hepatitis E infection was significantly associated with age (p value = 0.028), method of faecal disposal (p value = 0.043), and source of drinking water (p value = 0.039). A total of 9/200 (4.50%) stillbirths were recorded with 3/9 (33.33%) in women that tested positive for HEV antibodies. About 4/200(2.00%) miscarriages were recorded, and 2/4 (50.00%) were in women that tested positive for HEV antibodies. Hepatitis E infection was not significantly associated with perinatal outcome (p value = 0.45). Only 1/56 (0.50%) maternal death was recorded among women that tested positive to hepatitis E, and none was recorded among those that tested negative to hepatitis E antibodies.

Conclusion

There was a significant statistical association between HEV infection and age, method of faecal disposal, and source of drinking water. This underscores the importance of the provision of clean water and safe faecal disposal. Hepatitis E virus infection did not significantly affect the foetal and maternal outcomes.