Hepatitis E virus infection among pregnant women in Africa: systematic review and meta-analysis

Abstract

Background There have been a number of studies about seroprevalence of HEV among pregnant women in Africa. However, the finding of seroprevalence of HEV infection among pregnant women is variable and inconsistent. Therefore; this systematic review intended to provide the pooled seroprevalence of HEV among pregnant women in Africa. Methods We searched, Pub Med, Science direct, African online journals and Google scholar electronic data bases and all available references until August 30, 2018. We included cross sectional studies and cohort studies. The search was further limited studies done in African pregnant women. Statistical analysis done by using Stata (version 11) software. The overall pooled prevalence of HEV presented by using the forest plot with 95% CI. The methodological qualities of included studies were assessed using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments. Result The pooled seroprevalence of HEV among pregnant women in Africa was 29.13% (95% CI 14.63–43.63). The highest seroprevalence was 84.3% in Egypt and the lowest 6.6% reported in Gabon. There was highest heterogeneity level where I 2 = 99.7%; P < 0.0001.The observed heterogeneity attributed to geographic location/ region, country, assay method used in each study and year of study published. Moreover, HEV seroprevalence varies between countries and within countries. The HEV infection among African pregnant women seems to have a decreasing trend over time. Conclusion The seroprevalence of HEV among pregnant women in Africa is high. The seroprevalence of HEV among pregnant women differ with geographic location and assay method. Therefore, it is recommended to conduct further research on commercial ELISA kit sensitivity and specificity, molecular tests, incidence, morbidity and mortality and vertical transmission of HEV from mother to infant in Africa. Trial registration CRD42018084963 . Electronic supplementary material The online version of this article (10.1186/s12879-019-4125-x) contains supplementary material, which is available to authorized users.

A systematic review of the epidemiology of Hepatitis E virus infection in South – Eastern Asia

“…This scenario goes to prove that the endemicity of HEV is no longer restricted to only developing countries, but even developed countries are no exception [ 51 ]. Other factors that may lead to HEV seroprevalence variation in the subregion include study type, sample size or frame [ 18 ], migration, tourism, and proportion of specific ethnic groups in a country [ 19 ]. Studies were conducted among susceptible and non – susceptible groups as well.…”

“…Systematic reviews (SR) are essential tools in human medical research, thus crucial for investigating HEV seroprevalence. SR of HEV epidemiology have been conducted in Africa [ 17 , 18 ], Europe as well as in some selected high – income countries [ 19 ]. However, there is no comprehensive SR of HEV infection in South – eastern Asia (SEA).…”

Innate Immune Responses to Acute Viral Infection During Pregnancy

“…Of its four genotypes, HEV-1 and 2 cause human disease and are spread by feco-oral transmission through contaminated water supply, entering the body via enterocytes and replicating in the liver. This route accounts for the wide geographical variation in disease burden of hepatitis E, which is concentrated in areas of poor sanitation ( 42 , 49 ). In the general population, hepatitis E is asymptomatic in the vast majority of cases, but still causes 3.3 million symptomatic infections (usually mild, self-limiting and clinically indistinguishable from hepatitis A) and 56,000–70,000 deaths per year, a mortality rate of <0.5% ( 42 ).…”

Seroprevalence of Dromedary Camel HEV in Domestic and Imported Camels from Saudi Arabia

“…However, the disease is now encountered in developed countries as well through ingestion of infected animal products or close contact with infected animals, especially pigs [9]. Mortality from HEV infection is not high except in pregnant women infected with HEV genotype 1 and 2 [10]. HEV infections cause a number of extra-hepatic manifestations, which include a wide spectrum of neurological syndromes [11,12].…”