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])
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:
(a)
The seroprevalence of a Zambian population were 42% and 16%, which should be 40.6% and 16.0%, respectively [115]
(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
(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
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Authors’ Affiliations
(1)
International Vaccine Institute
(2)
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
(3)
PATH
Reference
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
