Abstract
ABSTRACTThe majority of patients with acute febrile jaundice (>95%) identified through a yellow fever surveillance program in the Democratic Republic of Congo (DRC) test negative for antibodies against yellow fever virus. However, no etiological investigation has ever been carried out on these patients. Here, we tested for hepatitis A (HAV), hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), and hepatitis E (HEV) viruses, all of which can cause acute febrile jaundice, in patients included in the yellow fever surveillance program in the DRC. On a total of 498 serum samples collected from suspected cases of yellow fever from January 2003 to January 2012, enzyme-linked immunosorbent assay (ELISA) techniques were used to screen for antibodies against HAV (IgM) and HEV (IgM) and for antigens and antibodies against HBV (HBsAg and anti-hepatitis B core protein [HBc] IgM, respectively), HCV, and HDV. Viral loads and genotypes were determined for HBV and HVD. Viral hepatitis serological markers were diagnosed in 218 (43.7%) patients. The seroprevalences were 16.7% for HAV, 24.6% for HBV, 2.3% for HCV, and 10.4% for HEV, and 26.1% of HBV-positive patients were also infected with HDV. Median viral loads were 4.19 × 105 IU/ml for HBV (range, 769 to 9.82 × 109 IU/ml) and 1.4 × 106 IU/ml for HDV (range, 3.1 × 102 to 2.9 × 108 IU/ml). Genotypes A, E, and D of HBV and genotype 1 of HDV were detected. These high hepatitis prevalence rates highlight the necessity to include screening for hepatitis viruses in the yellow fever surveillance program in the DRC.
Highlights
Yellow fever is one of the most lethal viral diseases transmitted by infected Aedes mosquitos [1]
The aim of this study was to screen for hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV) in patients included in the yellow fever surveillance program in the Democratic Republic of Congo (DRC) and who tested negative for the yellow fever virus by enzyme-linked immunosorbent assay (ELISA) and PCR
Nearly 10 years of monitoring yellow fever has shown that the large majority of samples collected from patients with acute febrile jaundice in the DRC are not diagnosed with yellow fever
Summary
Yellow fever is one of the most lethal viral diseases transmitted by infected Aedes mosquitos [1]. Yellow fever is often associated with clinical cases of acute febrile jaundice [2] This clinical syndrome is common to several endemic diseases, viral hepatotropic infections [3]. Viral hepatitis prevalence data in the DRC are either absent (HDV), scarce (HEV) [21], old (HAV) [22], or limited to asymptomatic patients in urban areas (HBV and HCV) [23,24,25]. The aim of this study was to screen for HAV, HBV, HCV, HDV, and HEV in patients included in the yellow fever surveillance program in the DRC and who tested negative for the yellow fever virus by ELISA and PCR
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