Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2016; 22(44): 9853-9859
Published online Nov 28, 2016. doi: 10.3748/wjg.v22.i44.9853
Hepatitis E virus: Western Cape, South Africa
Richie G Madden, Sebastian Wallace, Mark Sonderup, Stephen Korsman, Tawanda Chivese, Bronwyn Gavine, Aniefiok Edem, Roxy Govender, Nathan English, Christy Kaiyamo, Odelia Lutchman, Annemiek A van der Eijk, Suzan D Pas, Glynn W Webb, Joanne Palmer, Elizabeth Goddard, Sean Wasserman, Harry R Dalton, C Wendy Spearman
Richie G Madden, Sebastian Wallace, Glynn W Webb, Joanne Palmer, Harry R Dalton, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom
Mark Sonderup, C Wendy Spearman, Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Anzio Road, Cape Town 7925, South Africa
Stephen Korsman, National Health Laboratory Service, Groote Schuur Hospital, Cape Town and Division of Medical Virology, Anzio Road, Cape Town 7925, South Africa
Tawanda Chivese, Bronwyn Gavine, Aniefiok Edem, Roxy Govender, Nathan English, Christy Kaiyamo, Odelia Lutchman, University of Cape Town Faculty of Health Sciences, Anzio Road, Observatory, Cape Town 7935, South Africa
Annemiek A van der Eijk, Suzan D Pas, Department of Viroscience, Erasmus Medical Centre, Medical Center Rotterdam, Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
Elizabeth Goddard, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town and Red Cross Children’s Hospital, Cnr of Klipfontein and Milner Road, Rondebosch, Cape Town 7700, South Africa
Sean Wasserman, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Anzio Road, Cape Town 7925, South Africa
Author contributions: Madden RG, Wallace S, Sonderup M, Dalton HR and Spearman CW conceived the study and wrote the paper; Chivese T, Gavine B, Edem A, Govender R, English N, Kaiyamo C, Lutchman O and Webb G collected the data and reviewed the drafts; Palmer J did the statistical analysis; and van der Eijk AA, Pas SD, Wasserman S and Goddard E reviewed the drafts; Spearman CW is the guarantor.
Institutional review board statement: Ethics approval was granted by the Faculty of Health Sciences Human Research Ethics Committee of the University of Cape Town, reference HREC 018/2014.
Informed consent statement: All participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: Dalton HR has had travel and accommodation costs and consultancy fees from GlaxoSmithKline, Wantai and Gilead; and travel, accommodation and lecture fees from Merck, GFfe Blut GmBh and the Gates foundation. Sonderup M has received travel awards and consultancy fees from AbbVie, Gilead and Roche.
Data sharing statement: There is no additional data to share.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Richie G Madden, Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, TR1 3LJ Truro, United Kingdom. richie@forfey.com
Telephone: +44-77-36335924 Fax: +44-18-72252794
Received: July 8, 2016
Peer-review started: July 12, 2016
First decision: July 29, 2016
Revised: September 16, 2016
Accepted: October 19, 2016
Article in press: October 19, 2016
Published online: November 28, 2016
Processing time: 141 Days and 2.2 Hours
Abstract
AIM

To conduct a prospective assessment of anti-hepatitis E virus (HEV) IgG seroprevalence in the Western Cape Province of South Africa in conjunction with evaluating risk factors for exposure.

METHODS

Consenting participants attending clinics and wards of Groote Schuur, Red Cross Children’s Hospital and their affiliated teaching hospitals in Cape Town, South Africa, were sampled. Healthy adults attending blood donor clinics were also recruited. Patients with known liver disease were excluded and all major ethnic/race groups were included to broadly represent local demographics. Relevant demographic data was captured at the time of sampling using an interviewer-administered confidential questionnaire. Human immunodeficiency virus (HIV) status was self-disclosed. HEV IgG testing was performed using the Wantai® assay.

RESULTS

HEV is endemic in the region with a seroprevalence of 27.9% (n = 324/1161) 95%CI: 25.3%-30.5% (21.9% when age-adjusted) with no significant differences between ethnic groups or HIV status. Seroprevalence in children is low but rapidly increases in early adulthood. With univariate analysis, age ≥ 30 years old, pork and bacon/ham consumption suggested risk. In the multivariate analysis, the highest risk factor for HEV IgG seropositivity (OR = 7.679, 95%CI: 5.38-10.96, P < 0.001) was being 30 years or older followed by pork consumption (OR = 2.052, 95%CI: 1.39-3.03, P < 0.001). A recent clinical case demonstrates that HEV genotype 3 may be currently circulating in the Western Cape.

CONCLUSION

Hepatitis E seroprevalence was considerably higher than previously thought suggesting that hepatitis E warrants consideration in any patient presenting with an unexplained hepatitis in the Western Cape, irrespective of travel history, age or ethnicity.

Keywords: Hepatitis E; Seroprevalence; South Africa; Pork consumption; Genotype

Core tip: This is a prospective seroprevalence study of 1161 participants assessing anti-hepatitis E virus (HEV) IgG seroprevalence in the Western Cape Province of South Africa. The only risk factors for seropositivity are pork consumption and individuals over 30 years of age. A recent clinical case suggests HEV genotype 3 may be circulating in South Africa.