Epidemiological data for hepatitis D in Africa
Authors: Edouard Tuaillon, Dramane Kania, Emmanuel Gordien, Philippe Van de Perre, Pierre Dujols
Journal: The Lancet Global Health (2017)

The systematic review on the seroprevalence of hepatitis D virus in sub-Saharan Africa by Alexander Stockdale and colleagues1Stockdale AJ Chaponda M Beloukas A et al.Prevalence of hepatitis D virus infection in sub-Saharan Africa: a systematic review and meta-analysis.Lancet Glob Health. 2017; 5: e992-e1003Summary Full Text Full Text PDF PubMed Scopus (76) Google Scholar is a key contribution to the epidemiology of hepatitis D virus infection, and highlights the scarcity of reliable data from the African continent. Most of the studies included in this meta-analysis were based on convenience sampling, and less than half of these studies include a confirmation of hepatitis D virus infection by a molecular test. The Article concludes that there is a need for reliable epidemiological data that are representative of the general population, that there are localised clusters of hepatitis D virus endemicity, and that there is a need for reliable hepatitis D virus testing methods. The first international assessment of external quality control for hepatitis D virus RNA quantification demonstrated the insufficient performances of several assays to detect viruses circulating in Africa (ie, genotypes 1 and 5–8).2Le Gal F Brichler S Sahli R Chevret S Gordien E First international external quality assessment for hepatitis delta virus RNA quantification in plasma.Hepatology. 2016; 64: 1483-1494Crossref PubMed Scopus (61) Google Scholar Although new, improved assays have been developed,3Le Gal F Dziri S Gerber A et al.Performance characteristics of a new consensus commercial kit for hepatitis D virus RNA viral load quantification.J Clin Microbiol. 2017; 55: 431-441Crossref PubMed Scopus (26) Google Scholar implementation of PCR to detect hepatitis D virus remains challenging in Africa. Collection of dried blood spot (DBS) samples is a promising way to facilitate access to nucleic acid testing. WHO has recently recommended serological and molecular testing on DBS specimens as an alternative to blood samples for the diagnosis of hepatitis B and hepatitis C and for large epidemiological surveillance studies in under-resourced regions and remote areas.4WHOWHO guidelines on hepatitis B and C testing. World Health Organization, Geneva2017Google Scholar From our experience, DBS samples can also be used to detect hepatitis D virus antibodies and RNA in samples over 10 000 IU/mL. In a study supported by the French National Agency for AIDS Research (ANRS 12270), DBS samples collected from more than 15 000 adult volunteers during the 2010 Demographic and Health Survey in Burkina Faso in west Africa were tested for hepatitis D virus infection. Among HBsAg carriers, the seroprevalence estimates of hepatitis D virus were 1·1% (95% CI 0·6–1·6) countrywide, 1·4% (0·7–2·0) in men, and 0·7% (0·1–1·4) in women. Heterogeneous geographical distribution of seroprevalence was observed, with estimates of 5·4% (2·2–8·6) in Cascades and 8·7% (2·5–15·0) in Sud-Ouest regions, suggesting local clusters of endemicity (figure). These results highlight that DBS specimens collected during Demographic and Health Surveys and having large samples could be useful for estimating the prevalence of diseases, allowing reliable country-wide and regional distribution of prevalence estimates. We suggest that such surveys might provide opportunities to fill the gaps in the knowledge of epidemic hepatitis infections and to guide national and regional infection control programmes. We declare no competing interests. Prevalence of hepatitis D virus infection in sub-Saharan Africa: a systematic review and meta-analysisFindings suggest localised clusters of hepatitis D virus endemicity across sub-Saharan Africa. Epidemiological data are needed from southern and east Africa, and from patients with established liver disease. Further studies should aim to define the reliability of hepatitis D virus testing methods, identify risk factors for transmission, and characterise the natural history of the infection in the region. Full-Text PDF Open AccessEpidemiological data for hepatitis D in Africa – Authors' replyJose Debes and Shemal Shah highlight the paucity of data from east Africa, one of our major findings. The authors draw attention to a study from Tanzania, where samples that initially tested positive for antibodies against hepatitis D virus by a commercial assay did not test positive on retesting with a second assay.1 The performance of the second assay relative to the first was unknown. Given that the first assay was used widely in the studies included in our analysis without confirmation by a second assay, we elected not to take retesting into account for the study from Tanzania and to maintain consistency with data available from the other studies. Full-Text PDF Open AccessEpidemiological data for hepatitis D in AfricaAlexander Stockdale and colleagues (October, 2017)1 describe the epidemiology of hepatitis D virus in Africa, and conclude that the infection is more common in west Africa than in other regions, particularly east Africa. This epidemiological statement is generally known among practising hepatologists and has important implications when screening for hepatitis D virus. However, a few points should be highlighted from the study. Full-Text PDF Open Access