Laboratoire des hépatites virales, Institut Pasteur de Bangui, Bangui, Central African Republic.
INSERM, U1052, UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France.
PLoS Negl Trop Dis. 2018 Apr 26;12(4):e0006377. doi: 10.1371/journal.pntd.0006377. eCollection 2018 Apr.
Hepatitis delta virus (HDV) increases morbidity in Hepatitis B virus (HBV)-infected patients. In the mid-eighties, an outbreak of HDV fulminant hepatitis (FH) in the Central African Republic (CAR) killed 88% of patients hospitalized in Bangui. We evaluated infections with HBV and HDV among students and pregnant women, 25 years after the fulminant hepatitis (FH) outbreak to determine (i) the prevalence of HBV and HDV infection in this population, (ii) the clinical risk factors for HBV and/or HDV infections, and (iii) to characterize and compare the strains from the FH outbreak in the 1980s to the 2010 HBV-HDV strains. We performed a cross sectional study with historical comparison on FH-stored samples (n = 179) from 159 patients and dried blood-spots from volunteer students and pregnant women groups (n = 2172). We analyzed risk factors potentially associated with HBV and HDV. Previous HBV infection (presence of anti-HBc) occurred in 345/1290 students (26.7%) and 186/870 pregnant women (21.4%)(p = 0.005), including 110 students (8.8%) and 71 pregnant women (8.2%), who were also HBsAg-positive (p = 0.824). HDV infection occurred more frequently in pregnant women (n = 13; 18.8%) than students (n = 6; 5.4%) (p = 0.010). Infection in childhood was probably the main HBV risk factor. The risk factors for HDV infection were age (p = 0.040), transfusion (p = 0.039), and a tendency for tattooing (p = 0.055) and absence of condom use (p = 0.049). HBV-E and HDV-1 were highly prevalent during both the FH outbreak and the 2010 screening project. For historical samples, due to storage conditions and despite several attempts, we could only obtain partial HDV amplification representing 25% of the full-length genome. The HDV-1 mid-eighties FH-strains did not form a specific clade and were affiliated to two different HDV-1 African subgenotypes, one of which also includes the 2010 HDV-1 strains. In the Central African Republic, these findings indicate a high prevalence of previous and current HBV-E and HDV-1 infections both in the mid-eighties fulminant hepatitis outbreak and among asymptomatic young adults in 2010, and reinforce the need for universal HBV vaccination and the prevention of HDV transmission among HBsAg-positive patients through blood or sexual routes.
乙型肝炎 delta 病毒（HDV）可增加乙型肝炎病毒（HBV）感染者的发病率。20 世纪 80 年代中期，在中非共和国（CAR）爆发的乙型肝炎 delta 病毒暴发性肝炎（FH）中，88%的班吉住院患者死亡。我们评估了学生和孕妇中 HBV 和 HDV 的感染情况，这是 FH 爆发 25 年后进行的，目的是确定：（i）该人群中 HBV 和 HDV 感染的流行率；（ii）HBV 和/或 HDV 感染的临床危险因素；（iii）1980 年代 FH 爆发的毒株与 2010 年 HBV-HDV 毒株的特征和比较。我们对 FH 储存样本（n=179）进行了具有历史比较的横断面研究，这些样本来自 159 名患者，以及志愿者学生和孕妇组的干血斑（n=2172）。我们分析了可能与 HBV 和 HDV 相关的危险因素。以前的 HBV 感染（抗-HBc 存在）发生在 1290 名学生中的 345 名（26.7%）和 870 名孕妇中的 186 名（21.4%）（p=0.005），包括 110 名学生（8.8%）和 71 名孕妇（8.2%），他们也为 HBsAg 阳性（p=0.824）。孕妇中 HDV 感染的发生率（n=13；18.8%）高于学生（n=6；5.4%）（p=0.010）。HBV 感染的主要危险因素可能是儿童时期的感染。HDV 感染的危险因素是年龄（p=0.040）、输血（p=0.039）和纹身倾向（p=0.055）以及缺乏安全套使用（p=0.049）。HBV-E 和 HDV-1 在 FH 爆发和 2010 年筛查项目期间均高度流行。对于历史样本，由于储存条件的原因，尽管我们进行了多次尝试，但仅获得了代表全长基因组 25%的部分 HDV 扩增。1980 年代中期 FH 株的 HDV-1 并未形成特定的分支，而是属于两种不同的非洲 HDV-1 亚群，其中一种还包括 2010 年的 HDV-1 株。在中非共和国，这些发现表明，1980 年代中期 FH 爆发和 2010 年无症状青年中均存在高流行率的 HBV-E 和 HDV-1 感染，这加强了通过血液或性途径对 HBsAg 阳性患者进行普遍 HBV 接种和预防 HDV 传播的必要性。
