1. Hepatitis E virus infection and acute-on-chronic liver failure in West Africa: a case-control study from The Gambia
- Author
-
Saydiba Tamba, Harr Freeya Njai, Gibril Ndow, Makie Taal, Maud Lemoine, Simon D. Taylor-Robinson, Mark Thursz, Ramou Njie, Kazuaki Takahashi, A. Ceesay, L. Berg, A. Jeng‐Barry, Yusuke Shimakawa, Umberto D'Alessandro, Shunji Mishiro, Sheikh Mohammad Fazle Akbar, E. Opoku, Masahiro Arai, Medical Research Council Unit The Gambia (MRC), Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Osaka University [Osaka], Toshiba General Hospital [Tokyo, Japan], Department of Hepatology [London], Imperial College London-St Mary's Hospital [London], Ministry of Health and Social Welfare [Banjul, The Gambia] (MOHSW), Gambia Hepatitis Intervention Study, Medical Research Council Unit The Gambia (MRC)-International Agency for Research on Cancer (IARC), The PROLIFICA study was funded by the European Commission's Seventh Framework Program (grant 265994). The study was also supported by the MRC Unit The Gambia, the Gambia Government, International Agency for Research on Cancer (IARC), NIHR Biomedical Facility at the Imperial College London and the Asia‐Africa‐Oceania Hepatitis Experts Linkage Promotion (AAOHELP) project which was funded by the Viral Hepatitis Research Foundation of Japan., The authors thank Debbie Garside, the project manager of the PROLIFICA project, and Abubacarr Kambi, Louise Sarr, Famara Bojang, Lamin Bojang, Deboh Jallow, Abdoulie Jatta, Sheriff Koley, Yamundow‐Jallow Samba, Alagie Sanneh, Demba Sonko and Mavis Foster‐Nyarko for their support, and Vincent Mallet, Jong‐Hon Kang and Patrick Ingiliz for their technical advices. We finally thank all the study participants., European Project: 265994,EC:FP7:HEALTH,FP7-AFRICA-2010,PROLIFICA(2011), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), and HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)
- Subjects
Liver Cirrhosis ,Male ,0301 basic medicine ,Cirrhosis ,viruses ,medicine.disease_cause ,Gastroenterology ,MESH: Liver Cirrhosis / epidemiology ,0302 clinical medicine ,Hepatitis E virus ,Prevalence ,Pharmacology (medical) ,MESH: Hepatitis E / epidemiology ,MESH: Water Supply ,education.field_of_study ,MESH: Acute-On-Chronic Liver Failure / epidemiology ,MESH: Middle Aged ,Transmission (medicine) ,MESH: Hepatitis E virus / genetics ,virus diseases ,Agriculture ,MESH: Hepatitis Antibodies / blood ,Middle Aged ,Hepatitis B ,Hepatitis E ,MESH: Case-Control Studies ,3. Good health ,MESH: RNA, Viral ,RNA, Viral ,Female ,Gambia ,030211 gastroenterology & hepatology ,MESH: Agriculture ,Adult ,medicine.medical_specialty ,MESH: Socioeconomic Factors ,MESH: Gambia / epidemiology ,Population ,Sepsis ,03 medical and health sciences ,Water Supply ,Internal medicine ,medicine ,Humans ,Hepatitis Antibodies ,education ,MESH: Prevalence ,Hepatitis B virus ,MESH: Humans ,Hepatology ,business.industry ,Acute-On-Chronic Liver Failure ,MESH: Adult ,medicine.disease ,digestive system diseases ,MESH: Male ,030104 developmental biology ,Socioeconomic Factors ,Case-Control Studies ,Immunology ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,MESH: Female - Abstract
Summary Background In sub-Saharan Africa, it is unknown whether hepatitis E virus (HEV) infection is a common precipitating event of acute-on-chronic liver failure (ACLF). Aims To estimate the prevalence of HEV infection in general population and assess whether HEV is a common trigger of ACLF in cirrhotic patients in The Gambia, West Africa. Methods We first conducted an HEV sero-survey in healthy volunteers. We then tested cirrhotic patients with ACLF (cases) and compensated cirrhosis (controls) for anti-HEV IgG as a marker of exposure to HEV, and anti-HEV IgA and HEV RNA as a marker of recent infection. We also described the characteristics and survival of the ACLF cases and controls. Results In the healthy volunteers (n = 204), 13.7% (95% CI: 9.6–19.2) were positive for anti-HEV IgG, and none had positive HEV viraemia. After adjusting for age and sex, the following were associated with positive anti-HEV IgG: being a Christian, a farmer, drinking water from wells, handling pigs and eating pork. In 40 cases (median age: 45 years, 72.5% male) and 71 controls (39 years, 74.6% male), ≥70% were infected with hepatitis B virus. Although hepatitis B flare and sepsis were important precipitating events of ACLF, none had marker of acute HEV. ACLF cases had high (70.0%) 28-day mortality. Conclusions Hepatitis E virus infection is endemic in The Gambia, where both faecal-oral route (contaminated water) and zoonotic transmission (pigs/pork meat) may be important. However, acute HEV was not a common cause of acute-on-chronic liver failure in The Gambia.
- Published
- 2016