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. 2024 Feb 19;24(1):215.
doi: 10.1186/s12879-024-09116-3.

Hepatitis E outbreak in the health district of Bocaranga-Koui, Central African Republic, 2018-2019

Marina Prisca de Marguerite Nombot-Yazenguet  1 , Joël Wilfried Doté  2 , Giscard Wilfried Koyaweda  3 , Philippe Armand Zemingui-Bembete  1 , Benjamin Selekon  4 , Ulrich Vickos  5 , Alexandre Manirakiza  6 , Emmanuel Nakoune  4 , Ionela Gouandjika-Vasilache  2 , Narcisse Patrice Joseph Komas  7
Affiliations

Hepatitis E outbreak in the health district of Bocaranga-Koui, Central African Republic, 2018-2019

Marina Prisca de Marguerite Nombot-Yazenguet et al. BMC Infect Dis. .

Abstract

Background: Hepatitis E virus (HEV) is a major public health disease causing large outbreaks and sporadic cases of acute hepatitis. We investigated an outbreak of HEV infection that occurred in September 2018 in the health district (HD) of Bocaranga-Koui, located in the northwestern part of Central African Republic (CAR).

Methods: Blood samples were collected from 352 patients aged 0-85 years suspected to be infected with yellow fever (YF), according to the World Health Organization YF case definition. The notification forms from recorded cases were used. Water consumed in the HD were also collected. Human samples found negative for anti-YF IgM were then tested by ELISA for anti-HEV IgM and IgG antibodies. Positive anti-HEV (IgM and/or IgG) samples and collected water were then subjected to molecular biology tests using a real time RT-PCR assay, followed by a nested RT-PCR assay for sequencing and phylogenetic analysis.

Results: Of the 352 icterus patients included, anti-HEV IgM was found in 142 people (40.3%) and anti-HEV IgG in 175 (49.7%). Although HEV infection was detected in all age groups, there was a significant difference between the 0-10 age groups and others age groups (P = 0.001). Elevated levels of serum aminotransferase were observed in anti-HEV IgM-positive subjects. Phylogenetic analysis showed HEV genotype 1e in infected patients as well as in the contaminated water.

Conclusion: This epidemic showed that CAR remains an HEV-endemic area. The genotype 1e strain was responsible for the HEV outbreak in Bocaranga-Koui HD. It is necessary to implement basic conditions of hygiene and sanitation to prevent further outbreaks of a HEV epidemics, to facilitate access to clean drinking water for the population, to launch intensive health education for basic hygiene measures, to sett up targeted hygiene promotion activities and, finally, to ensure that formal health care is available.

Keywords: Bocaranga-Koui health district; Central African Republic; Hepatitis E outbreak; Molecular characterization.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Map showing districts reporting suspect cases, northwestern Central African Republic, 2018–2019
Fig. 2
Fig. 2
Flow chart of HEV detection in blood samples
Fig. 3
Fig. 3
Distribution of anti-HEV IgM per month (From September 2018 to July 2019)
Fig. 4
Fig. 4
Phylogenetic analysis of sequences obtained in the study in comparison to reference sequences from GenbanK. Strains isolated from the Bocaranga and Koui patients samples during the 2018 epidemic are indicated by a red circle formula image and from the water well sample by a blue triangle  formula image . HEV genotype 1e sequences obtained in the present study were deposited in the NCBI GenBank database on the accession numbers MN901844 to MN901869 and MW258967 to MW258978. Bootstrap values are indicated when > 70% as a percentage obtained from 1000 re-samplings of the data
See this image and copyright information in PMC

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