Kuodi Paul, Patterson Jenna, Silal Sheetal, Hussey Gregory D, Kagina Benjamin M
Faculty of Health Sciences, Department of Public Health, Lira University, Lira, Uganda
School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa.
BMJ Open. 2020 Sep 28;10(9):e036407. doi: 10.1136/bmjopen-2019-036407.
To characterise the environmental presence of hepatitis A virus (HAV) in low- and middle-income countries (LMICs).
Systematic review and meta-analysis.
EBSCOhost, PubMed, Scopus, ScienceDirect, Clinical Key and Web of Science were searched. Grey literature was sourced by searching the following electronic databases: Open Grey, National Health Research Database and Mednar.
Cross-sectional and ecological studies reporting HAV environmental presence and conducted in LMICs between January 2005 and May 2019, irrespective of language of publication.
Relevant data were extracted from articles meeting the inclusion criteria, and two reviewers independently assessed the studies for risk of bias. High heterogeneity of the extracted data led to the results being reported narratively.
A total of 2092 records were retrieved, of which 33 met the inclusion criteria. 21 studies were conducted in Tunisia, India and South Africa, and the rest were from Philippines, Pakistan, Morocco, Chad, Mozambique, Kenya and Uganda. In Tunisian raw sewage samples, the prevalence of HAV ranged from 12% to 68%, with an estimated average detection rate of 50% (95% CI 25 to 75), whereas HAV detection in treated sewage in Tunisia ranged from 23% to 65%, with an estimated average detection rate of 38% (95% CI 20 to 57). The prevalence of HAV detection in South African treated sewage and surface water samples ranged from 4% to 37% and from 16% to 76%, with an estimated average detection rates of 15% (95% CI 1 to 29) and 51% (95% CI 21 to 80), respectively. Over the review period, the estimated average detection rate of environmental HAV presence appeared to have declined by 10%.
The quality of included studies was fair, but sampling issues and paucity of data limited the strength of the review findings.
CRD42019119592.
描述甲型肝炎病毒（HAV）在低收入和中等收入国家（LMICs）环境中的存在情况。
系统评价和荟萃分析。
检索了EBSCOhost、PubMed、Scopus、ScienceDirect、Clinical Key和Web of Science。通过检索以下电子数据库获取灰色文献：Open Grey、国家卫生研究数据库和Mednar。
2005年1月至2019年5月期间在LMICs进行的报告HAV环境存在情况的横断面研究和生态学研究，无论出版物语言如何。
从符合纳入标准的文章中提取相关数据，两名评审员独立评估研究的偏倚风险。提取数据的高度异质性导致结果以叙述方式报告。
共检索到2092条记录，其中33条符合纳入标准。21项研究在突尼斯、印度和南非进行，其余来自菲律宾、巴基斯坦、摩洛哥、乍得、莫桑比克、肯尼亚和乌干达。在突尼斯的未经处理污水样本中，HAV的流行率在12%至68%之间，估计平均检出率为50%（95%CI 25至75），而突尼斯处理后污水中的HAV检出率在23%至65%之间，估计平均检出率为38%（95%CI 20至57）。南非处理后污水和地表水样本中HAV的检出率在4%至37%和16%至76%之间，估计平均检出率分别为15%（95%CI 1至29）和51%（95%CI 21至80）。在审查期间，环境中HAV存在的估计平均检出率似乎下降了10%。
纳入研究的质量尚可，但抽样问题和数据匮乏限制了综述结果的说服力。
PROSPERO注册号：CRD42019119592。
