Abstract
BackgroundHepatitis A virus (HAV) infection is one of the major causes of acute viral hepatitis. HAV genotypes and its genetic diversity is rarely investigated in our region as well as worldwide.AimsThe aims of the present study were to determine the HAV genotypes and its risk factors and to investigate the genetic diversity of the HAV isolates in the West Bank, Palestine.Study designA cohort of 161 clinically and laboratory-confirmed HAV (IgM-positive) cases and 170 apparently healthy controls from all the districts of the West Bank, Palestine during the period of 2014 to 2016 were tested for HAV infection using IgM antibodies, RT-PCR and sequence analysis of the VP3/VP1 junction region of the HAV genome. Phylogenetic analysis, genetic diversity and haplotypes analysis were used to characterize the VP3/VP1 sequences.ResultsAll the 34 sequences of the HAV were found to be of HAV-IB sub-genotype. The phylogenetic analysis showed four main clusters with cluster III exclusively consisting of 18 Palestinian isolates (18/23-78%), but with weak bootstrap values. A high haplotype diversity (Hd) and low nucleotide diversity (π) were observed. Cluster III showed high number of haplotypes (h = 8), but low haplotype (gene) diversity (Hd = 0.69). A total of 28 active haplotypes with some consisting of more than one sequence were observed using haplotype network analysis. The Palestinian haplotypes are characterized by closely related viral haplotypes with one SNV away from each other which ran parallel to cluster III in the phylogenetic tree. A smaller Palestinian haplotype (4 isolates) was three SNVs away from the major haplotype cluster (n = 10) and closer to others haplotypes from Iran, Spain, and South Africa. Young age, low level of parent’s education, infrequent hand washing before meals, and drinking of un-treated water were considered the major HAV risk factors in the present study.ConclusionHaplotype network analysis revealed haplotype variation among the HAV Palestinian sequences despite low genetic variation and nucleotide diversity. In addition, this study reconfirmed that age and parent’s level of education as HAV risk factors, while hand washing and treating drinking water as protective factors.
Highlights
Hepatitis A virus (HAV) is “a non-enveloped RNA virus belonging to the family Picornaviridae, genus Hepatovirus”
The Palestinian haplotypes are characterized by closely related viral haplotypes with one single nucleotide variation (SNV) away from each other which ran parallel to cluster III in the phylogenetic tree
This study reconfirmed that age and parent’s level of education as HAV risk factors, while hand washing and treating drinking water as protective factors
Summary
Hepatitis A virus (HAV) is “a non-enveloped RNA virus belonging to the family Picornaviridae, genus Hepatovirus”. HAV is one of the major causes of acute hepatitis worldwide and contributes to substantial morbidity in both developed and developing countries. The incidence rate of the HAV infection is underestimated due to the clinical presentations of this disease, since infection at early childhood is largely passed asymptomatic or has mild forms [2]. Palestine (West Bank, and Gaza Strip) was classified as an area of high endemicity of HAV infection [6]. The Palestinian official figures put the HAV infection incidence rate as high as 9.5–85 per 100,000 during the period between 2000 and 2018 [7]. Hepatitis A virus (HAV) infection is one of the major causes of acute viral hepatitis. HAV genotypes and its genetic diversity is rarely investigated in our region as well as worldwide
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