Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2019

Open Access 01-12-2019 | Hepatitis E | Research article

Hepatitis E virus infection among pregnant women in Africa: systematic review and meta-analysis

Authors: Mulat Dagnew, Amare Belachew, Moges Tiruneh, Feleke Moges

Published in: BMC Infectious Diseases | Issue 1/2019

Login to get access

Abstract

Background

There have been a number of studies about seroprevalence of HEV among pregnant women in Africa. However, the finding of seroprevalence of HEV infection among pregnant women is variable and inconsistent. Therefore; this systematic review intended to provide the pooled seroprevalence of HEV among pregnant women in Africa.

Methods

We searched, Pub Med, Science direct, African online journals and Google scholar electronic data bases and all available references until August 30, 2018. We included cross sectional studies and cohort studies. The search was further limited studies done in African pregnant women. Statistical analysis done by using Stata (version 11) software. The overall pooled prevalence of HEV presented by using the forest plot with 95% CI. The methodological qualities of included studies were assessed using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments.

Result

The pooled seroprevalence of HEV among pregnant women in Africa was 29.13% (95% CI 14.63–43.63). The highest seroprevalence was 84.3% in Egypt and the lowest 6.6% reported in Gabon. There was highest heterogeneity level where I2 = 99.7%; P < 0.0001.The observed heterogeneity attributed to geographic location/ region, country, assay method used in each study and year of study published. Moreover, HEV seroprevalence varies between countries and within countries. The HEV infection among African pregnant women seems to have a decreasing trend over time.

Conclusion

The seroprevalence of HEV among pregnant women in Africa is high. The seroprevalence of HEV among pregnant women differ with geographic location and assay method. Therefore, it is recommended to conduct further research on commercial ELISA kit sensitivity and specificity, molecular tests, incidence, morbidity and mortality and vertical transmission of HEV from mother to infant in Africa.

Trial registration

Appendix
Available only for authorised users
Literature
1.
Khuroo MS. Discovery of hepatitis E: the epidemic non-a, non-B hepatitis 30 years down the memory lane. Virus Res. 2011;161:3–14.PubMedCrossRef
2.
3.
Tam AW, Smith MM, Guerra ME, et al. Hepatitis E virus (HEV): molecular cloning and sequencing of the full-length viral genome. Virology. 1991;185:120–31.PubMedCrossRef
4.
Ruggeri FM, Di Bartolo I, Ponterio E, Angeloni G, Trevisani M, Ostanello F. Zoonotic transmission of hepatitis E virus in industrialized countries. New Microbiol. 2013;36(4):331-44.
5.
6.
Pérez-Gracia MT, Suay B, Mateos-Lindemann ML. Hepatitis E: an emergingdisease. Infect Genet Evol. 2014;22:40–59.PubMedCrossRef
7.
8.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2095–128.CrossRef
9.
10.
Rein DB, Stevens GA, Theaker J, et al. The global burden of hepatitis E genotypes 1 and 2 in 2005. Hepatology. 2012;55(4):988–97.PubMedCrossRef
11.
Aggarwal R. Hepatitis and pregnancy. Indian J Gastroenterol. 2005;26:3–5.
12.
Kumar A, Beniwal M, Kar P, Sharma JB, Murthy NS. Hepatitis E in pregnancy. Int J Gynaecol Obstet. 2004;85:240–4.PubMedCrossRef
13.
Tsega E, Krawczynski K, Hansson BG, Nordenfelt E, Negusse Y, Alemu W, et al. Outbreak of acute hepatitis E virus infection among military personnel in northern Ethiopia. J Med Virol. 1991;34:232–6.PubMedCrossRef
14.
Mushahwar IK, Dawson GJ, Bile KM, Magnius LO. Serological studies of an enterically transmitted non-a, non-B hepatitis in Somalia. J Med Virol. 1993;40:218–21.PubMedCrossRef
15.
Benjelloun S, Bahbouhi B, Bouchrit N, Cherkaoui L, Hda N, Coursaget P, et al. Outbreak of enterically-transmitted hepatitis due to hepatitis a and hepatitis E viruses. J Hepatol. 1998;28:745–50.CrossRef
16.
Nicand E, Armstrong GL, Enouf V, Guthmann JP, Guerin JP, Caron M, et al. Genetic heterogeneity of hepatitis E virus in Darfur, Sudan, and neighboring Chad. J Med Virol. 2005;77:519–21.PubMedCrossRef
17.
Kim JH, Nelson KE, Panzner U, Kasture Y, Labrique AB, Wierzba TF. A systematic review of the epidemiology of hepatitis E virus in Africa. BMC Infect Dis. 2014;14:308.PubMedPubMedCentralCrossRef
18.
Joanna Briggs Institute. Critical appraisal tools. 2005.
19.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.CrossRef
20.
Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J Epidemiol Community Health. 2013;67(11):974–97.PubMedCrossRef
21.
Rücker G, Schwarzer G, Carpenter JR, Schumacher M. Undue reliance on I(2) in assessing heterogeneity may mislead. BMC Med Res Methodol. 2008;8:7.CrossRef
22.
Ioannidis J. Interpretation of tests of heterogeneity and bias in meta-analysis. J Eval Clin Pract. 2008;14(5):951–7.PubMedCrossRef
23.
24.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.PubMedCrossRef
25.
De Paschale M, Ceriani C, Roman L, Cerulli T, Cagnin D, Ndayake J, et al. Epidemiology of hepatitis E virus infection during pregnancy in Benin. Tropical Med Int Health. 2016;21(1):108–13.CrossRef
26.
27.
Florence K, Djeneba O, Charlemagne G, Florencia DW, Dorcas OY, Rebeca CT, et al. Hepatitis e in pregnant women at the saint Camille Hospital of Ouagadougou in Burkina Faso: prevalence and infection risk factors. Int J Recent Adv Multidiscip Res. 2016;3(10):1885–8.
28.
Noufensi MRY, Kengne M, Njukeng PA, Anong DN, Masebe TM, Tamoufe U, Echelibe H, Ter Goon D, Nwobegahay JM. Seroprevalence and risk factors of hepatitis E virus infection among pregnant women at the Yaounde central hospital, Cameroon. Microbiol Res Int. 2016;4(4):50–4.
29.
Gad YZ, Mousa N, Shams M, Elewa A. Seroprevalence of subclinical HEV infection in asymptomatic, apparently healthy, pregnant women in Dakahlya governorate, Egypt. Asian J Transfus Sci. 2011;5:136–9.PubMedPubMedCentralCrossRef
30.
Stoszek SK, Abdel-Hamid M, Saleh DA, El Kafrawy S, Narooz S, Hawash Y, et al. High prevalence of hepatitis E antibodies in pregnant Egyptian women. Trans R Soc Trop Med Hyg. 2006;100:95–101.PubMedCrossRef
31.
El-Shety AG, Ali AI, Soliman K, Yasser H, Kelany F, Mostafa TM. Seroprevalence of subclinical hepatitis e infection among pregnant women in rural Egyptian areas. AAMJ. 2014;12(4):162–78.
32.
Tekeste TG, Abakar AD, Talha AA, Khalid AM. Seroprevalence of hepatitis E amongst pregnant women in Asmara, Eritrea. Eur Acad Res. 2017;5(1):607–17.
33.
Abebe M, Ali I, Ayele S, Overbo J, Aseffa A, Mihret A. Seroprevalence and risk factors of hepatitis E virus infection among pregnant women in Addis Ababa, Ethiopia. PLoS One. 2017;12(6):1–9.CrossRef
34.
Niguse S, Hailekiros H, Buruh G, Dejene T, Berhe N, Asmelash T. Seroprevalence and risk factors of hepatitis E virus infection among pregnant women attending antenatal care in health facilities of Tigray, northern Ethiopia. J Med Virol. 2018;90(8):1364–9.PubMedCrossRef
35.
Tsega E, Krawczynski K, Hansson BG, Nordenfelt E. Hepatitis E virus infection in pregnancy in Ethiopia. Ethiop Med J. 1993;31:173–18.PubMed
36.
Caron M, Kazanji M. Hepatitis E virus is highly prevalent among pregnant women in Gabon, Central Africa, with different patterns between rural and urban areas. Virol J. 2008;5:158.PubMedPubMedCentralCrossRef
37.
Caron M, Bouscaillou J, Kazan M. Acute risk for hepatitis E virus infection among HIV-1-positive pregnant women in Central Africa. Virol J. 2012;9:254.PubMedPubMedCentralCrossRef
38.
Adjei AA, Yao T, John TA, Clement AG, Obed S, Julius A, et al. Hepatitis E virus infection is highly prevalent among pregnant women in Accra, Ghana. J Virol. 2009;6:108.CrossRef
39.
Obiri-Yeboah D, Asante Awuku Y, Adu J, Pappoe F, Obboh E, Nsiah P, Amoako-Sakyi D, Simpore J. Sero-prevalence and risk factors for hepatitis E virus infection among pregnant women in the Cape Coast Metropolis, Ghana. PLoS ONE. 2018;13(1):e0191685.PubMedPubMedCentralCrossRef
40.
Junaid SA, Agina SE, Abubakar KA. Epidemiology and associated risk factors of hepatitis E virus infection in plateau state, Nigeria. Virol Res Treat. 2014;5:15–26.
41.
Alkali BR, Bello M, Kabiru M, Shu’aibu AB, A’isha BI, Firdausi A. Seroprevalence of hepatitis E virus (HEV) infection in pregnant women in Sokoto state, Nigeria. J Adv Microbiol. 2016;1(3):1–5.CrossRef
42.
Harritshøj LH, Theilgaard ZP, Mannheimer E, Midgley SE, Chiduo M, Ullum H Katzenstein TL. Hepatitis e virus epidemiology among HIV infected women in an urban area in Tazania. Int J Infect Dis. 2018;73:7-9.PubMedCrossRef
43.
Hannachi N, Hidar S, Harrabi I, Mhalla S, Marzouk M, Ghzel H, Ghannem H, Khairi H, Boukadida J. Seroprevalence and risk factors of hepatitis E among pregnant women in central Tunisia. Pathol Biol. 2011;59(5):e115-8.
44.
Al-Tayeb ZA, Nafi M, Yassin MEM. Frequency of hepatitis E virus among pregnant women attending Khartoum hospitals. Am J Res Commun. 2014;2(4):241–7.
45.
Eltayeb R, Gasim IG, Elhassan ME, Abdullahi H, ARayis D. Maternal and newborn Seroprevalence of hepatitis E virus at Medani Hospital, Sudan. F1000Research. 2015;1:4–823.
46.
Ao M, Osman OH, Jaffer A, Ali AA, Elfatih M, Ibrahim A, Abuzeid N. Seroprevalence of HEV infection and risk factors among Sudanese pregnant women in Khartoum state. Mediterranean J Biosci. 2016;1(2):83–91.
47.
Begum N, Polipalli SK, Husain SA, Kumar A, Kar P. Duration of hepatitis E viremia in pregnancy. Int J Gynecol Obstet. 2010;108:207–10.CrossRef
48.
Khuroo MS, Kamili S, Khuroo MS. Clinical course and duration of viremia in vertically transmitted hepatitis E virus (HEV) infection in babies born to HEV-infected mothers. J Viral Hepat. 2009;16:519–23.PubMedCrossRef
49.
Kumar RM, Udumann S, Rana S, Kochiyil JK, Usmani A, Thomas L. Seroprevalence and mother-to-infant transmission of hepatitis E virus among pregnant women in the United Arab Emirates. Eur J Obstet Gynecol Reprod Biol. 2001;100(1):9–15.PubMedCrossRef
50.
Wang M, Fu P, Yin Y, He M, Acute LY. Recent and past HEV infection among voluntary blood donors in China: a systematic review and Meta-analysis. PLoS One. 2016;11(9):1–12.
51.
52.
Gu G, Huang H, Zhang L, Bi Y, Hu Y, Zhou YH. Hepatitis E virus seroprevalence in pregnant women in Jiangsu, China, and postpartum evolution during six years. BMC Infect Dis. 2015;15:560.PubMedPubMedCentralCrossRef
53.
Alvarado-Esquevil C, Sanchez-Anguiano LF. Hernandaze -Tinoco Hepatitis e virus exposure in pregnant mother in rural Durango, Mexico. J Ann Hepatol. 2014;13:510–7.CrossRef
54.
Renou C, Gobert V, Locher C, Moumen A, Savary J, Roque-Afonso AM, Timbely O. Prospective study of hepatitis E virus infection among pregnant women in France. Virol J. 2014;11(68):1–3.
55.
Patra S, Kumar A, Trivedi SS, Puri M, Sarin KS. Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection. Ann Intern Med. 2007;147:28–33.PubMedCrossRef
56.
57.
Matsubayashi K, Nagaoka Izopet J, Kamar N. Hepatitis E: from zoonotic transmission to chronic infection in immunosuppressed patients. Med Sci (Paris). 2008;24:1023–5.CrossRef
58.
Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J, Dalton HR. Hepatitis E. Lancet. 2012;379(9835):2477–88.PubMedCrossRef
59.
60.
Kamar N, Izopet J, Rostaing L. Hepatitis E virus infection. Curr Opin Gastroenterol. 2013;29:271–8.PubMedCrossRef
61.
Hartl J, Otto B, Madden RG, Webb G, Woolson KL, Kriston L, Vettorazzi E, Lohse AW, Dalton HR, Pischke S. Hepatitis E Seroprevalence in Europe: a meta-analysis. Viruses. 2016;8(211):1–14.
62.
Rossi-Tamisier M, Moal V, Gerolami R, Colson P. Discrepancy between anti-hepatitis E virus immunoglobulin G prevalence assessed by two assays in kidney and liver transplant recipients. J Clin Virol. 2013;56:62–4.PubMedCrossRef
63.
Hartl J, Kreuels B, Polywka S, Addo M, Luethgehetmann M, Dandri M, Dammermann W, Sterneck M, Lohse AW, Pischke S. Comparison of autochthonous and imported cases of hepatitis a or hepatitis E. Z Gastroenterol. 2015;53:639–43.PubMedCrossRef
64.
Khudyakov Y, Kamili S. Serological diagnostics of hepatitis E virus infection. Virus Res. 2011;161:84–92.PubMedCrossRef
65.
Bendall R, Ellis V, Ijaz S, Ali R, Dalton H. A comparison of two commercially available anti-HEV IgG kits and a re-evaluation of anti-HEV IgG seroprevalence data in developed countries. J Med Virol. 2010;82:799–805.PubMedCrossRef
66.
Metadata
Title
Hepatitis E virus infection among pregnant women in Africa: systematic review and meta-analysis
Authors
Mulat Dagnew
Amare Belachew
Moges Tiruneh
Feleke Moges
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Hepatitis E
Published in
BMC Infectious Diseases / Issue 1/2019
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-019-4125-x

Other articles of this Issue 1/2019

BMC Infectious Diseases 1/2019 Go to the issue

Research article

Chlorhexidine-impregnated dressing for the prophylaxis of central venous catheter-related complications: a systematic review and meta-analysis

Research article

Surveillance and characterisation of influenza viruses among patients with influenza-like illness in Bali, Indonesia, July 2010–June 2014

Research article

Seasonality and the effects of weather on Campylobacter infections

Case report

Severe chest allodynia as an unusual first presentation of hydatid disease: a case report

Research article

Rates and predictors of switching to tenofovir alafenamide-containing ART in a nationwide cohort

Research article

Mycoplasma Genitalium and Mycoplasma Hominis are prevalent and correlated with HIV risk in MSM: a cross-sectional study in Shenyang, China

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits