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Aspects épidémiologiques et caractérisation moléculaire des souches du virus de l’hépatite E (VHE) au Burkina Faso

Abstract : The hepatitis E virus (HEV) is causative agent several acute or fulminant hepatitis which mainly occur in developing countries where HEV genotype 1 or 2 appears to have a endemic profile punctuated with epidemic outbreaks (Africa, Asia) (Lui et al., 2013). Genotype 3 and 4 distributed widely in animal reservoirs, were the cause many zoonotic infection in northern and southern countries. In most cases, it is a self-limited infection with rapid viral clearance, but it can evolve into more severe forms with a mortality level ranging from 1 to 4% in the general population to nearly 20% in pregnancy during outbreaks (WHO, 2014). In Burkina Faso, very little epidemiological data are available on HEV. The objective of this work is to improve our understanding of this agent hepatitis. The first part of our study was devoted to the evaluation HEV seroprevalence among blood donors and women attending antenatal care in Ouagadougou. In total more than 1,700 volunteers serum samples were collected in blood banks and medical centers in Burkina Faso. Between 2010 and 2012 on 178 blood donors and 189 pregnant women tested, 19.1% [CI95, 13.3-24.9%] and 11.6% [CI95, 7.1-16.2%], were respectively positive for anti-HEV IgG. These high rates in the general population may be associated a low income and the poor hygienic status (Traoré et al., 2012). In 2014, 3.19% [CI95, 1.70-4.68%] on 525 blood donors tested, were positive for anti-HEV IgM. These results indicate a residual risk for transfusion, probably associated with silent infections and confirm the importance to identify the sources of the virus. The second part of this work was 1) to assess HEV infection among humans in Burkina Faso by exploring the HEV seroprevalence in a high risk population, i.e., butchers; 2) to explore a possible pig-to-human zoonotic transmission cycle by assessing the HEV seroprevalence in slaughter swine; and 3) to identify the genotype of HEV circulating in pigs. The global HEV prevalence among Ouagadougou butchers was estimated to 76%, CI95 [67, 63–84.37%] with a significant risk factor, 3 times higher compared with the general population (OR = 3.46 [95%CI 2.85 - 4.21] p <0.001). IgG anti-HEV in pigs older than 6 months of age were estimated at 80% CI95 [72-87%]. This high prevalence confirms the presence and active circulation HEV among domestic pigs in Burkina Faso as evidenced by the positive sample of liver for HEV RNA which strongly supports the risk of zoonosis. Phylogenetic analyses revealed that genotype 3 HEV is circulating among swine population in Burkina. A similarity >98% was found between swHEV-BF from Yaounde and Madagascar. This data showed for the first time the role of swine in introduction of new HEV in African population. In conclusion, these results latter sign a persistent introduction of HEV infection in the population and hence deserved to be taken in account in transfusion associated risk. Further assessments of the transfusion risk associated require an evaluation of the cost/benefit ratio for the addition of routine HEV RNA screening to the panel of tests on donated blood, to guarantee transfusion safety for the recipient.
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Kuan Abdoulaye Traoré. Aspects épidémiologiques et caractérisation moléculaire des souches du virus de l’hépatite E (VHE) au Burkina Faso. Microbiologie et Parasitologie. Université Paris Sud - Paris XI; Université de Ouagadougou (Burkina-Faso), 2015. Français. ⟨NNT : 2015PA114819⟩. ⟨tel-01249594⟩

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