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Komas NP, Ghosh S, Abdou-Chekaraou M, Pradat P, Al Hawajri N, Manirakiza A, Laghoe GL, Bekondi C, Brichler S, Ouavéné JO, Sépou A, Yambiyo BM, Gody JC, Fikouma V, Gerber A, Abeywickrama Samarakoon N, Alfaiate D, Scholtès C, Martel N, Le Gal F, Lo Pinto H, Amri I, Hantz O, Durantel D, Lesbordes JL, Gordien E, Merle P, Drugan T, Trépo C, Zoulim F, Cortay JC, Kay AC, Dény P. Hepatitis B and hepatitis D virus infections in the Central African Republic, twenty-five years after a fulminant hepatitis outbreak, indicate continuing spread in asymptomatic young adults. PLoS Negl Trop Dis 2018; 12:e0006377. [PMID: 29698488 PMCID: PMC5940242 DOI: 10.1371/journal.pntd.0006377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 05/08/2018] [Accepted: 03/08/2018] [Indexed: 12/13/2022] Open
Abstract
Hepatitis delta virus (HDV) increases morbidity in Hepatitis B virus (HBV)-infected patients. In the mid-eighties, an outbreak of HDV fulminant hepatitis (FH) in the Central African Republic (CAR) killed 88% of patients hospitalized in Bangui. We evaluated infections with HBV and HDV among students and pregnant women, 25 years after the fulminant hepatitis (FH) outbreak to determine (i) the prevalence of HBV and HDV infection in this population, (ii) the clinical risk factors for HBV and/or HDV infections, and (iii) to characterize and compare the strains from the FH outbreak in the 1980s to the 2010 HBV–HDV strains. We performed a cross sectional study with historical comparison on FH-stored samples (n = 179) from 159 patients and dried blood-spots from volunteer students and pregnant women groups (n = 2172). We analyzed risk factors potentially associated with HBV and HDV. Previous HBV infection (presence of anti-HBc) occurred in 345/1290 students (26.7%) and 186/870 pregnant women (21.4%)(p = 0.005), including 110 students (8.8%) and 71 pregnant women (8.2%), who were also HBsAg-positive (p = 0.824). HDV infection occurred more frequently in pregnant women (n = 13; 18.8%) than students (n = 6; 5.4%) (p = 0.010). Infection in childhood was probably the main HBV risk factor. The risk factors for HDV infection were age (p = 0.040), transfusion (p = 0.039), and a tendency for tattooing (p = 0.055) and absence of condom use (p = 0.049). HBV-E and HDV-1 were highly prevalent during both the FH outbreak and the 2010 screening project. For historical samples, due to storage conditions and despite several attempts, we could only obtain partial HDV amplification representing 25% of the full-length genome. The HDV-1 mid-eighties FH-strains did not form a specific clade and were affiliated to two different HDV-1 African subgenotypes, one of which also includes the 2010 HDV-1 strains. In the Central African Republic, these findings indicate a high prevalence of previous and current HBV-E and HDV-1 infections both in the mid-eighties fulminant hepatitis outbreak and among asymptomatic young adults in 2010, and reinforce the need for universal HBV vaccination and the prevention of HDV transmission among HBsAg-positive patients through blood or sexual routes. In the Central African Republic (CAR), due to 20 years of conflict, the health system has been disorganized. This could contribute to maintenance of high transmission levels of Hepatitis B Virus (HBV) and its satellite Hepatitis Delta Virus (HDV). This work studies the evolution of both infections 25 years after a fulminant hepatitis (FH) outbreak occurring in the mid-1980s associated with HDV superinfection. In young asymptomatic adults, the results show that both HBV and HDV were still actively circulating in CAR in 2010. Indeed, more than one third of HBV-infected individuals were chronic HBV carriers. Furthermore, HDV infection could be spreading among 10% of them through blood and sexual transmission. The past FH outbreak and contemporary infections were both associated with heterogeneous HDV-1 strains, combined with HBV-E. Vaccination against HBV was uncommon among pregnant women and students, even among medical students. The study constitutes warning signals to help CAR health-care reconstruction and underlines the importance of HBV vaccination. The high level of HBV infection creates a background for HDV superinfection. Neonatal HBV vaccination is needed, together with vaccination of unprotected populations. Awareness of health authorities as well as the general public would help reduce HBV and HDV infections.
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Affiliation(s)
- Narcisse Patrice Komas
- Laboratoire des hépatites virales, Institut Pasteur de Bangui, Bangui, Central African Republic
- * E-mail: (NPK); (PD)
| | - Sumantra Ghosh
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Mariama Abdou-Chekaraou
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
| | - Pierre Pradat
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Center for Clinical Research, Croix-Rousse Hospital, Lyon, France
- Hospices Civils de Lyon, Lyon, France/Université de Lyon I, Lyon, France
| | | | - Alexandre Manirakiza
- Service d’Épidémiologie, Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Gina Laure Laghoe
- Laboratoire des hépatites virales, Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Claudine Bekondi
- Laboratoire des hépatites virales, Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Ségolène Brichler
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
| | - Jean-Omer Ouavéné
- Service de Médecine Interne, Hôpital de l’Amitié, Avenue Indépendance, Bangui, Central African Republic
| | - Abdoulaye Sépou
- Service de Gynécologie Obstétrique, Hôpital Communautaire de Bangui, Avenue des Martyrs, Bangui, Central African Republic
| | - Brice Martial Yambiyo
- Service d’Épidémiologie, Institut Pasteur de Bangui, Bangui, Central African Republic
| | | | - Valentin Fikouma
- Centre de Traitement Ambulatoire de l’Hôpital Communautaire de Bangui, Bangui, Central African Republic
| | - Athénais Gerber
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
| | | | - Dulce Alfaiate
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Caroline Scholtès
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Hospices Civils de Lyon, Lyon, France/Université de Lyon I, Lyon, France
- Laboratoire de Virologie, Croix-Rousse Hospital, Lyon, France
| | - Nora Martel
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Frédéric Le Gal
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
| | - Hugo Lo Pinto
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Ikram Amri
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Olivier Hantz
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - David Durantel
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Jean-Louis Lesbordes
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Emmanuel Gordien
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
| | - Philippe Merle
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Hospices Civils de Lyon, Lyon, France/Université de Lyon I, Lyon, France
| | - Tudor Drugan
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Trépo
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Hospices Civils de Lyon, Lyon, France/Université de Lyon I, Lyon, France
| | - Fabien Zoulim
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Hospices Civils de Lyon, Lyon, France/Université de Lyon I, Lyon, France
| | - Jean-Claude Cortay
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Alan Campbell Kay
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Paul Dény
- INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Service de Microbiologie Clinique, Hôpital Avicenne, Groupe des Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique–Hôpitaux de Paris, Bobigny, France, Université Paris 13/Sorbonne Paris Cité, UFR Santé Médecine Biologie Humaine, Bobigny, France
- * E-mail: (NPK); (PD)
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Le Gal F, Badur S, Hawajri NA, Akyüz F, Kaymakoglu S, Brichler S, Zoulim F, Gordien E, Gault E, Dény P. Current hepatitis delta virus type 1 (HDV1) infections in central and eastern Turkey indicate a wide genetic diversity that is probably linked to different HDV1 origins. Arch Virol 2012; 157:647-59. [PMID: 22241621 DOI: 10.1007/s00705-011-1212-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 11/28/2011] [Indexed: 02/07/2023]
Abstract
Hepatitis delta virus (HDV) is a subviral pathogen of humans, a satellite of hepatitis B virus (HBV) that induces severe acute and chronic liver diseases. The genus Deltavirus consists of eight clades or genotypes, with HDV1 being ubiquitous and frequently characterized. In Turkey, HDV1 infection is highly endemic among HBsAg carriers, especially in the southeastern region. In this study, we analyzed 34 samples from patients who were chronically infected with HBV/HDV, originating from 22 cities of rural regions in the central and eastern parts of Turkey, in order to determine the levels of viral replication and genetic diversity. HDV RNA levels ranged between 3.02 and 8.75 Log copies/mL, and HBV DNA was detected in 25 samples (73.5%), with values ranging from 2.53 to 5.30 Log copies/mL. Analysis of nucleotides 900-1280 of HDV genomes (n = 34) and full-length (n = 17) sequences indicated that all of the strains belonged to genotype HDV1. However, a high genetic diversity was observed among the isolates, with a mean full-length dissimilarity score of 13.05%. HDV sequences clustered with sequences from Western Europe (n = 11), Eastern Europe and Asia (n = 19) or Africa (n = 4). HDV1 isolates related to strains of African origin had a serine residue instead of an alanine at position 202 of the large delta protein. HBV preS1 sequences obtained for 34 isolates indicated an HBV/D genotype in all cases. Taken together, our results indicate that in Turkey, where HBV-HDV dual infection is highly endemic, both viruses have high levels of replication, and HDV strains exhibit wide genetic diversity, which might reflect ancient evolution and/or successive outbreaks.
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Affiliation(s)
- Frédéric Le Gal
- Service de Bactériologie, Virologie-Hygiène, Hôpital Avicenne, Assistance Publique, Hôpitaux de Paris, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Université Paris 13, Bobigny, France
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Ganne-Carrié N, Williams V, Kaddouri H, Trinchet JC, Dziri-Mendil S, Alloui C, Hawajri NA, Dény P, Beaugrand M, Gordien E. Significance of hepatitis B virus genotypes A to E in a cohort of patients with chronic hepatitis B in the Seine Saint Denis District of Paris (France). J Med Virol 2006; 78:335-40. [PMID: 16419113 DOI: 10.1002/jmv.20545] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The aim of this study was to examine the genetic variability of the hepatitis B virus (HBV) and its significance. HBV genotypes, core promoter and precore mutants were characterized in 109 consecutive patients with biopsy-proven HBV chronic hepatitis. Genotypes A (26.6%), B (12.8%), C (18.3%), D (18.3%), and E (14.7%) indicate a wide genotypic distribution. Patients were from Asia (30.3%), Europe (28.4%), Sub Saharan Africa (23.9%), the Caribbean (10.1%), North Africa (5.5%), and Madagascar (1.8%). HBV genotypes A and D (HBV/A and /D) infected all subgroups except Asian patients. HBV/B or /C were found in 97% of Asian patients, whereas HBV/E only infected sub-Saharan African and Caribbean patients. Differences according to genotypes were: an increased prevalence of anti-HBe antibodies in patients infected with HBV/D (P = 0.003), higher serum transaminases in patients infected with HBV/A and/D (P = 0.043), more severe liver fibrosis in patients infected with HBV/A, /C and/D (P = 0.02). Precore and core promoter mutants were found in 87% of anti-HBe positive patients, and were associated with HBV/D (P = 0.04) and severe liver fibrosis (P = 0.002). It is concluded that HBV genotypes A, B, C, D, and E circulate in the Seine Saint Denis District, reflecting the geographical origin of patients. HBV/A, /C and/D seem to be associated with more severe hepatic disease.
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Affiliation(s)
- Nathalie Ganne-Carrié
- Service d'Hépato-Gastroentérologie, Hôpital Jean Verdier (Bondy), Assistance Publique-Hôpitaux de Paris, UPRES 3409, UFR Santé Médecine Biologie Humaine, Université Paris 13, France.
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