Southern Tunisia: A still high endemicity area for hepatitis A

Abstract

BackgroundHepatitis A (HAV) and E (HEV) viruses are responsible for enterically transmitted hepatitis. Tunisia is reported to be of intermediate endemicity for HAV and of low seroprevalence for HEV; however, data from rural areas of South Tunisia are lacking.MethodsSera from 216 asymptomatic pregnant women and from 92 patients with acute hepatitis were collected between October 2014 and November 2015. Total and IgM anti-HAV immunoglobulins and anti-HEV IgG and IgM were investigated. Anti-HAV IgM-positive samples were subjected to RT-PCR targeting the VP1/2A region and sequenced. HEV IgM positive samples and all samples from acute hepatitis patients were assessed for HEV RNA.ResultsAmong pregnant women (mean age 32+/-8), HAV seroprevalence was 98.6%, none presented anti-HAV IgM; HEV seroprevalence was 5.1% and three presented weakly reactive anti-HEV IgM without detectable RNA. Among acute hepatitis patients (mean age 18.5 +/- 14), HEV seroprevalence was 19,5%, none presented anti-HEV IgM, nor HEV RNA. HAV seroprevalence exceeded 90% by age 5 and acute HAV infection was detected in 20 patients (21,7%), younger than patients with other hepatitis causes (9,8 years vs. 20,4 years, p = 0,004); 65% were male. Most acute HAV infections were observed in a coastal area where HAV infections represented 52% of hepatitis etiology. Phylogenetic analysis identified genotype IA strains, clustering close to previously published Tunisian sequences.ConclusionThe present study confirmed a low HEV endemicity and evidenced a still high level of HAV circulation in Southern Tunisia, suggesting distinct dissemination patterns for these viruses.

Prevalence of hepatitis A virus in patients attending a referral hospital in Bubanza Province, Northwest Burundi

“…6 In a study conducted among acute hepatitis patients at Kenyatta National Hospital in Nairobi, Kenya, it was found that all those positive for anti-HAV and anti-HEV antibodies used pit latrines in their households. 16 This has been also reported previously in Northern Africa and elsewhere. 18 Hepatitis A virus is spread through food and water contaminated by the feces of people infected with hepatitis A virus.…”

“…These results are in agreement with what has been reported in south Tunisia in 2017 and elsewhere. 16 Improvement in hygienic and good sanitation practices would reduce the transmission of the virus from person-to-person. On the contrary, developed countries are characterized by low antibody seroprevalence of HAV during childhood.…”

Epidemiological Aspects of Hepatitis A: Endemicity Patterns and Molecular Epidemiology

“…All clinical HAV strains from different regions of Sfax Governorate belonged to genotype IA [10]. This result is in an agreement with those of other Tunisian studies, which demonstrated that the predominant genotype still continues to be IA [15][16][17]. In addition, HAV sequences were closer to GBM reference strain (isolated in Germany) than to Asian sequences, suggesting a close genetic relatedness with HAV strains isolated in Mediterranean countries.…”

Sero-prevalence and Risk Factors for Hepatitis A Virus Infection among Pregnant Women at the Samandin Medical Center, Ouagadougou, Burkina Faso

“…Nevertheless, Israeli researchers claim that the occurrence of acute hepatitis A in a pregnant woman is associated with high rates of gestational complications and premature delivery [41]. A few cases of mother-to-child transmission of hepatitis A that is responsible for neonatal hepatitis or in utero complications [42,43] have also been published, but which we have not explored and which could be a subject of future research.…”