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. 2017 Apr 20;12(4):e0175887.
doi: 10.1371/journal.pone.0175887. eCollection 2017.

Southern Tunisia: A still high endemicity area for hepatitis A

Houcine Neffatti  1   2 , Patricia Lebraud  1 , Corinne Hottelet  1 , Jawher Gharbi  2 , Taieb Challouf  3 , Anne-Marie Roque-Afonso  1   4
Affiliations

Southern Tunisia: A still high endemicity area for hepatitis A

Houcine Neffatti et al. PLoS One. .

Abstract

Background: Hepatitis 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.

Methods: Sera 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.

Results: Among 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.

Conclusion: The 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Phylogenetic analysis of VP1/2A sequences (384 nt-long) recovered from Tunisia.
Reference sequences are indicated with their GenBank accession number. Sequences from this study are indicated by the name of the isolate (GenBank accession numbers KY172049 to KY172068). ● cluster from Gabès, ◆ cluster from Medenine, ◇ unique strains
See this image and copyright information in PMC

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