Open Access

Erratum to: A systematic review of the epidemiology of hepatitis E virus in Africa

  • Jong-Hoon Kim1Email author,
  • Kenrad E. Nelson2,
  • Ursula Panzner1,
  • Yogita Kasture1,
  • Alain B. Labrique2 and
  • Thomas F. Wierzba3
BMC Infectious DiseasesBMC series – open, inclusive and trusted201717:187

https://doi.org/10.1186/s12879-017-2274-3

Received: 21 February 2017

Accepted: 21 February 2017

Published: 3 March 2017

The original article was published in BMC Infectious Diseases 2014 14:308

Erratum

In this letter, we wish to correct errors in the previously published article [1]. Although the errors do not change the main results and conclusions described in the abstract of the original article, we believe providing the correct information is important. The major correction is about the genotype distribution of HEV in Africa. In the original article, we indicated that genotype 3 is rare and less commonly found than genotype 2 while genotype 1 is the most prevalent. The correct information is, however, that genotypes 2 and 3 were identified at a similar frequency while genotype 1 was the most prevalent. This error arose because the genotypes of HEV identified in seven Nigerian adults [89] were mistaken to be 2, when their actual genotype was 3. In what follows, we revised the relevant section named “Genotype prevalence” on page 5 of the original article and the relevant table and figure (i.e., Table 5 and Fig. 2).
Table 1

Seroprevalence of anti-HEV antibodies in Africa. Seroprevalence varies by country and by subpopulation and studies were done under different conditions (e.g., sample size, demographics, and different diagnostic methods). Age of the sample is provided as mean (range or ± standard deviation, if available)

Country

% sero-prevalence

Sample demographics

Sample size

Year of sampling

Diagnostic methods

Source

Burkina Faso

19.1

Blood donors

178

2010-12

IgG

[29]

 

11.6

Pregnant women

189

2010-12

IgG

[29]

Burundi

14.0

Adults without chronic liver disease, 44.7 yrs old (±13.5)

129

1986

Total Ig

[30]

Cameroon

14.2

HIV-infected adults, 38.1 yrs old (±11.3)and

289

2009-10

IgG

[32]

 

2.0

HIV-infected children, 8.3 yrs old (±7.5)

100

2009-10

IgG

[32]

CARa

24.2

Patients attending the center for sexually transmitted diseases

157

1995b

Total Ig

[33]

Djibouti

13.0

Male peacekeepers in Haiti, 31.2 yrs old

112

1998b

Total Ig

[42]

Egypt

84.3

Pregnant women, 24 yrs old (16-48)

2,428

1997-2003

Total Ig

[55]

 

80.1

Patients with chronic liver disease, 48 yrs old (23-62)

518

2000-2

IgG

[57]

 

67.6

Residents of two rural villages, 24.5 and 26.5 yrs, respectively

10,156

1997

Total Ig

[54]

 

58.6

Asymptomatic pregnant women, ~33 yrs old

116

2009

IgG

[58]

 

56.4

Residents of a semi-urban village, 1-67 yrs old

140

1993

Total Ig

[51]

 

54.1

Four waste water treatment plant male workers, 20-60 yrs old

205

1998-9

IgG

[116]

 

51.2

Waste water treatment plant workers, 47.1 yrs old

43

2011b

Total Ig

[60]

 

50.6

Waste water treatment plant workers, 20-60 yrs old

233

2000b

Total Ig

[61]

 

45.3

Blood donors, 18-45 yrs old

95

1998b

IgG

[52]

 

39.6

Haemodialysis patients, 8-20 yrs old

96

1998b

IgG

[52]

 

38.9

Healthy females, 21.8 yrs old (16-25)

95

1995

IgG

[50]

 

17.2

Residents of a hamlet, 20.9 yrs old (<1-95)

1259

1992

IgG

[49]

 

0.0

Healthy controls, 20–60 yrs old

96

1998-9

IgG

[116]

Gabon

14.2

Pregnant women, 24.6 yrs old (14-44)

840

2005, 2007

IgG

[73]

 

0.0

Villagers, 29 yrs old (2-80)

35

1991-2

Total Ig

[72]

Ghana

45.3

Adult HIV patients, 40 yrs old (±9.6)

402

2008-10

IgG

[32]

 

38.1

Pig handlers, 36.5 yrs old (12-65)

105

2009b

Total Ig

[77]

 

34.8

Pig handlers, 32.9 yrs old (15-70)

353

2008

Total Ig

[75]

 

28.7

Pregnant women, 28.9 yrs old (13-42)

157

2008

Total Ig

[78]

 

4.6

Blood donors

239

2012b

IgG

[76]

 

4.4

6-18 yr olds

803

1993

Total Ig

[74]

Madagascar

14.1

Slaughterhouse workers

427

2008-9

Total Ig

[81]

Morocco

8.5

Blood donors

200

2000-1

IgG

[85]

 

2.2

men (n = 232) and women (n = 259), 27.7 yrs old (±5.9)

491

1995b

IgG

[84]

Nigeria

94.0

Control healthy adults (n = 44)

44

2008-9

Total Ig

[90]

 

43.0

Health care workers

88

2008-9

Total Ig

[90]

 

13.4

Healthy and sick people, 29.8 yrs old (3-72)

186

2007

Total Ig

[91]

Sierra Leone

7.6

Primary school children, 6-12 yrs old

66

1998b

IgG

[139]

South Africa

10.7

Urban (n = 407) and rural (n = 360) blacks, 42 yrs old (18-85)

767

1996b

Total Ig

[98,117]

 

2.6

Medical students

227

1992

Total Ig

[97]

 

1.8

Canoeists who have been regularly exposed to waste water

555

1992

Total Ig

[97]

Tanzania

6.6

Women, 32.1 yrs old (15-45)

212

1996

Total Ig

[114]

 

0.2

Healthy adults, 30.3 yrs old

403

1992

Total Ig

[112]

 

0.0

Women

180

1995

Total Ig

[113]

Tunisia

46.0

Healthy persons, > 60 yrs old

100

1991

IgG

[106]

 

29.5

Children with chronic haematological diseases

34

1996

IgG

[106]

 

28.9

Polytransfused patients; adults (n = 59, 34.8 yrs old [20-61]) and children (n = 48, 7.3 yrs old [1-15])

107

2008-9

IgG

[107]

 

22.0

Healthy blood donors, < 40 yrs old

100

1996

IgG

[106]

 

12.1

Pregnant women, 30.1 yrs old (17-52)

404

2008-9

IgG

[108]

 

10.0

Healthy controls; blood donors (n = 100, 31.3 yrs old [20–58])

and children, (n = 60, 7.9 yrs old [1–15])

160

2008-9

IgG

[107]

 

5.4

Blood donors, 32.6 yrs old (± 8.6)

687

2007-8

Total Ig

[109]

 

4.3

Healthy persons, 20.7 yrs old (16-25)

1,505

2008b

IgG

[110]

Zambia

40.6c

Urban adults, 18–64 yrs old

106

1999

IgG

[115]

 

16.0

Urban children, 1–15 yrs old

194

2011

IgG

[115]

aCAR; Central African Republic

bThe year of the publication

cThe original study reports 42%, but the actual figures indicate that 43 out of 106 specimens are positive; 43/106 = 0.4056

Table 2

Sporadic cases caused by hepatitis E virus in Africa. Proportion of sporadic hepatitis cases attributable to HEV varies by country and by subpopulation and studies were done under different conditions (e.g., sample size, demographics, and different diagnostic methods). Age of the sample is provided as mean (range or ± standard deviation, if available)

Country

% sero-positivity

Case demographics

No. of cases

Year of sampling

Diagnostic methods

Source

Chad

48.8

Acute or fulminant hepatitis patients, 4-64 yrs old

41

1993

IgM

[36]

 

20.0a

Sporadic cases

17

1994

RT-PCRb

[27]

Djibouti

58.5

Acute hepatitis patients, 21.8 yrs old (2-65)

65

1992-3

IgM

[41]

Egypt

24.2

Jaundiced patients, 1-73 yrs old

202

1993

IgM

[46]

 

22.2

Jaundiced children, 5 yrs old (1-11)

261

1990

IgM

[70]

 

21.7

Acute hepatitis patients, 26.6 yrs old (18-60)

143

1993-4

IgM

[71]

 

20.2

Acute viral hepatitis patients, 8 yrs old

287

2006-8

IgM

[62]

 

17.9

Acute hepatitis patients, 15.7 (± 14.9) yrs old

235

2007-8

IgM or > = 3-fold rise in IgG

[69]

 

17.2

Children with elevated level (two-fold or more) of AST and ALT

64

2006d

IgM

[47]

 

15.7

Acute hepatitis patients, 15.9 yrs old (1-65)

235

2007-8

IgM

[63]

 

15.1

Children with acute jaundice, 6.4 yrs old (1-13)

73

1987-8

IgM

[45]

 

12.5

Patients with acute hepatitis, 20.2 yrs old (4-65)

200

2001-2

IgM

[64]

 

6.0

Children with minor hepatic ailments, 6 mo-10 yrs

100

2004-5

IgM

[65]

 

5.0

Patients with acute on chronic liver failure, 46.4 yrs old

100

2009-10

IgM

[66]

 

2.1

Acute viral hepatitis patients, 25 yrs old (2-77)

47

2002-5

IgM

[76]

 

2.0

Hepatitis patients, 5.4 yrs old (1.5-15)

50

2007

RT-PCR

[48]

Ethiopia

45.6

Acute viral hepatitis patients with NANB

79

1988-91

FABAd

[43]

 

31.8

Non-pregnant women with acute viral hepatitis, 30 yrs old

22

1988-91

FABA

[6]

 

67.9

Pregnant women with acute viral hepatitis, 26 yrs old

28

1988-91

FABA

[6]

Mayotte

100.0

Patients with acute jaundice, 46 yrs old

1

2009

IgM

[82]

Nigeria

70.0

Male patients with acute hepatitis, 25-33 yrs old

10

1997-8

RT-PCR

[89]

Senegal

20.0

Patients with jaundice

30

1992c

IgM

[93]

 

10.2

Patients with viral hepatitis

49

1993c

IgM

[92]

Somalia

61.1

Native Somalis and displaced Ethiopian patients with acute hepatitis, 7-90 yrs old

36

1992-3

IgM

[96]

Sudan

5.4

Patients with fulminant hepatic failure, 38 yrs old (19-75)

37

2003-4

IgM

[103]

 

59.0

Children with acute clinical jaundice, ≤14 yrs old

39

1987-8

IgM

[118]

a20% was extrapolated from the results of RT-PCR of 5 samples out of total 17 cases

bReverse transcription polymerase chain reaction

cThe year of the publication

dFABA; fluorescent antibody blocking assay, which is claimed to detect acute infection, not but past infection

Table 5

Genotype distribution from African HEVs

Genotype

Country

Year of sampling

Sample

RNA region tested

Source

1

CARa

2002

One fecal sample from an outbreak

NAb

[34]

 

Chad

1984

A patient with hepatitis E

Complete genome

[28]

  

2004

Five isolates from an outbreak

ORFc2 (363 ntd)

[35]

 

Egypt

1993

Acute hepatitis patients

ORF1 (location: 55-320)

[46]

  

2006-8

Acute hepatitis patients

ORF1

[62]

  

2012e

Sixteen isolates from acute hepatitis patients

ORF2 (189 nt)

[124]

 

Namibia

1983

Nine isolates from an outbreak in Kavango

ORF2 (296 nt), 3 (188 nt)

[88]

 

Sudan

2004

Twenty three isolates from an outbreak

ORF2 (363 nt)

[35]

 

Uganda

2007

Internally displaced persons camp

NA

[123]

  

2008

Twenty four isolates from an outbreak

NA

[119]

2

CAR

2002

Three fecal samples from an outbreak

NA

[34]

 

Chad

2004

Four isolates from an outbreak

ORF2 (363 nt)

[35]

 

Namibia

1995

Four isolates from NANB outbreak in Rundu

ORF2 (451 nt near 3'-end)

[87]

3

Nigeria

2000e

Ten adult acute hepatitis patients

ORF1, 2 (3'-end)

[89]

 

Egypt

2007

One 9 year-old acute hepatitis patient

ORF1, 2, 2/3

[48]

 

Mayotte

2009

One French acute hepatitis patient (46 yr old)

ORF2 (288 nt)

[82]

 

Madagascar

2009

Slaughter house workers

ORF2,3 (1000 nt)

[81]

aCAR; Central African Republic

bNA; not available

cORF; open reading frame

dnt; nucleotides

ePublication year

Fig. 2

Map of Africa. Colored areas represent countries where HEV is endemic at least for some subpopulations or sporadic HEV cases or outbreaks have been detected. Circles indicate HEV outbreaks with centers and areas indicating the location and outbreak size, respectively. Different colors represent different genotypes. White areas indicate countries where no data is available

Genotype prevalence

Data on the genotypes of circulating HEV’s are available for 9 countries (16 studies). Table 5 presents a summary sorted by genotype and also provides characteristics of the sample, genomic regions tested. Genotype 1 seems to be most prevalent as it was found in Central African Republic [34], Sudan [35], Chad [28, 35], Egypt [46, 62, 124], and Namibia [88] followed by genotype 2 and 3, of which both were observed at a similar frequency. Genotype 2 was found in Central African Republic [34], Chad [35], and Namibia [87]. Genotype 3 was observed in one Egyptian child [48], one acute hepatitis patient in Mayotte (originally from France) [82], seven Nigerian adults with acute hepatitis E [89], and slaughter house workers in Madagascar [81]. Genotype prevalence can differ in neighboring countries as was demonstrated by one study in Sudan and Chad where genotype 1 was more common in Sudan and genotype 2 was more common in Chad [35]. Figure 2 shows a map of Africa where countries in which HEV infections were observed are differently colored according to HEV genotype.

We corrected additional minor errors in Tables 1 and 2 although these corrections do not cause any changes in the main text. We have made three revisions to Table 1 of the original article:
  1. (a)

    The seroprevalence of a Zambian population were 42% and 16%, which should be 40.6% and 16.0%, respectively [115]

     
  2. (b)

    The sample size, (n = 402), in the description of the study conducted in Ghana (the first row of Ghana) was removed to avoid duplication

     
  3. (c)

    The study of HEV in Sierra Leone was mistaken to be omitted in the original article with no reference included. It is now included in the revised Table 1 with the full reference [139]

     

The order of table cells was rearranged for Egyptian data by descending seroprevalence to make it consistent across countries. For Table 2, some of decimal points appear as middle dots in the original article, which were revised to be the same as other decimal points (i.e., periods) in the revised Table 2.

139. Hodges M, Sanders E, Aitken C. Seroprevalence of hepatitis markers; HAV, HBV, HCV and HEV amongst primary school children in Freetown, Sierra Leone. West Afr J Med. 1998; 17(1): 36-7.

Notes

Declarations

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
International Vaccine Institute
(2)
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
(3)
PATH

Reference

  1. Kim J-H, Nelson KE, Panzner U, Kasture Y, Labrique AB, Wierzba TF. A systematic review of the epidemiology of hepatitis E virus in Africa. BMC Infectious Diseases. 2014;14:308.View ArticlePubMedPubMed CentralGoogle Scholar

Copyright

© The Author(s). 2017

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