Abstract
Data on prevalence of hepatitis E virus (HEV) in Malawi is limited. We tested blood samples from HIV-uninfected and -infected populations of women and men enrolled in research studies in Malawi during 1989-2008 to determine the seroprevalence of HEV, hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Samples were tested for IgG against HEV, total antibodies against HAV and HCV, and presence of HBV surface antigens. Of 800 samples tested, 16.5% were positive for HEV IgG, 99.6% were positive for HAV antibodies, 7.5% were positive for HBV surface antigen, and 7.1% were positive for HCV antibodies. No clear trends over time were observed in the seroprevalence of HEV, and HIV status was not associated with hepatitis seroprevalence. These preliminary data suggest that the seroprevalence of HEV is high in Malawi; the clinical effects may be unrecognized or routinely misclassified.
Highlights
hepatitis E virus (HEV) seroprevalence was higher among HIV-uninfected (20.2%) than among HIVinfected (12.9%) persons, and hepatitis C virus (HCV) seroprevalence was higher among male (10.2%) than female (5.6%) (p
Seroprevalence varied by study year and age group; seroprevalence of enteric HEV was 20.8% for a male occupational cohort in the 1994– 1999 Sugar Company of Mulawi (SUCOMA) study(23), and 26.4% for an female urban cohort in the 2003–2005 metronidazole gel (METRO) study (25) in which efficacy of intravaginal metronidazole gel in reducing bacterial vaginosis was assessed
This study provides preliminary estimates of HEV seroprevalence in Malawi, which has a population of ≈12 million, is mostly rural, and has a limited safe water supply and constrained health care services (29)
Summary
Study Design and Populations In a cross-sectional study, we analyzed serum and plasma samples collected during 6 studies in Malawi (Table 1) (21–26). The HEV assays were performed manually following the manufacturer’s instructions in the serology laboratory of the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA. We used the same samples tested for HEV to test for total antibodies (IgG and IgM) against HAV and HCV and for the presence of HBsAg by using commercially available kits from Bio-Rad Laboratories (Hercules, CA, USA). The HAV kits detect both acute and past infection; the HCV assays detect acute, past, and chronic infections; and the HBsAg assay detects acute and chronic infection with HBV These tests were performed by using the automated EVOLIS microplate system from Bio-Rad at the Johns Hopkins Bloomberg School of Public Health in Baltimore. Variables with a statistically significant association with a hepatitis seroprevalence in univariate analysis as well as variables considered epidemiologically important were included in the multivariate logistic
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