Hepatitis A and E virus infections have different epidemiological patterns in Rwanda

Abstract

Objectives: To investigate the prevalence of anti-HAV and HEV markers in order to better understand spread of these two viruses among adults in Rwanda. Methods: Samples from 1045 and 1133 blood donors, healthy adults and liver disease patients were analysed for anti-HAV IgG and HEV markers respectively. Results: Anti-HAV was present in 96.9% (1013/1045), with proportions of immune persons increasing with age. HEV infection markers were detected in 11.9% (135/1133) without differences between the three categories. Seven persons had low levels of HEV RNA including four blood donors but none of the HEV strains could be sequenced. The highest prevalence of HEV markers was in farmers and persons from the Southern (17.3%) and Western regions (18.6%), which have the national highest density of pigs. This may indicate that pigs constitute an important source of HEV infection for humans in Rwanda. Conclusion: HAV remains highly endemic in Rwanda, but there may now be a decline of exposure during childhood. HEV is also endemic in Rwanda, but has a moderate spread and may be transmitted by blood transfusion. Based on the geographical and occupational differences in HEV prevalence, a possible zoonotic transmission from pigs should be further explored. Keywords: HEV, HAV, Epidemiology, Seroprevalence, Africa