Prevalence and Phylogenetic Analysis of Hepatitis A Virus in Patients Attending Mpanda General Hospital in Burundi

Abstract

Viral hepatitis is a public health problem worldwide. Hepatitis A, transmitted by fecal-oral route, is an infectious viral disease caused by hepatitis A virus (HAV) and occurs mainly due to poor sanitation. Hepatitis A, the most common cause of acute hepatitis, is wrongly considered a benign disease despite the risk of fulminant hepatic failure. This study aimed to determine the prevalence and phylogenetic characteristics of HAV in patients attending Mpanda General Hospital in Burundi. The association between demographic factors and HAV cases was also established. A cross-sectional study was used. Participants were recruited using a consecutive sampling technique. Data and blood samples took three months (October to December 2017). Data from consented/assented participants were collected using questionnaires. Five milliliters of venous blood were collected from 385 participants and analyzed. Anti-HAV IgM and IgG antibodies were screened using Rapid test and Enzyme Linked Immunosorbent Assay Kits. Anti-HAV IgM positive samples were used for molecular analysis. A nested Reverse Transcription-PCR was performed to detect HAV genome using gene specific primers and the positive samples sequenced for HAV genotype. The prevalence of HAV infection and the 95% CI were calculated. The association between HAV cases and independent variables was assessed by a bivariate logistic regression and p-value ≤ 0.05 was considered significant. The median age was 23 and the range 72 [2-74] years. The overall prevalence of Hepatitis A virus was 60.3% (232/385). There was a significant association between age, lack of clean water, traditional latrines and Hepatitis A Virus cases. Of the 124 cases positive for anti-HAV IgM, nine were positive for HAV RNA. Phylogenetic analysis revealed that all isolates belonged to genotype IB. From findings, good hygienic practices and sanitation would reduce the incidence of the HAV infection. Further research aimed at HAV genotype characterization should be performed in other parts of Burundi to identify the genotype most common in the country. There is need for a nationwide survey of HAV infection in Burundi involving a nationwide sample to determine the overall prevalence and molecular characterization of HAV in the country.