ArticlePloS one2017
Southern Tunisia: A still high endemicity area for hepatitis A.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 4 of them syntheses that pooled it.
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Who cites it
6 citing papers in PubMed, 4 syntheses or guidelines pooled it, 11 citations in OpenAlex.
- Hepatitis A in the Eastern Mediterranean Region: a comprehensive review.Human vaccines & immunotherapeutics · 2022Pooled it
- Burden of hepatitis E virus infection in pregnancy and maternofoetal outcomes: a systematic review and meta-analysis.BMC pregnancy and childbirth · 2020Pooled it
- A systematic review of the epidemiology of hepatitis A in Africa.BMC infectious diseases · 2019Pooled it
- Seroprevalence of hepatitis E virus infection in pregnant women: a systematic review and meta-analysis.Annals of Saudi medicinePooled it
- Prevalence of Hepatitis E Virus Infection Among Pregnant Women in Tunisia: Findings from a Large Cohort Study.Pathogens (Basel, Switzerland) · 2026Article
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHepatitis A (HAV) and E (HEV) viruses are responsible for enterically transmitted hepatitis. Tunisia is reported to be of intermediate endemicity for HAV and of low seroprevalence for HEV; however, data from rural areas of South Tunisia are lacking.
methodsSera from 216 asymptomatic pregnant women and from 92 patients with acute hepatitis were collected between October 2014 and November 2015. Total and IgM anti-HAV immunoglobulins and anti-HEV IgG and IgM were investigated. Anti-HAV IgM-positive samples were subjected to RT-PCR targeting the VP1/2A region and sequenced. HEV IgM positive samples and all samples from acute hepatitis patients were assessed for HEV RNA.
resultsAmong pregnant women (mean age 32+/-8), HAV seroprevalence was 98.6%, none presented anti-HAV IgM; HEV seroprevalence was 5.1% and three presented weakly reactive anti-HEV IgM without detectable RNA. Among acute hepatitis patients (mean age 18.5 +/- 14), HEV seroprevalence was 19,5%, none presented anti-HEV IgM, nor HEV RNA. HAV seroprevalence exceeded 90% by age 5 and acute HAV infection was detected in 20 patients (21,7%), younger than patients with other hepatitis causes (9,8 years vs. 20,4 years, p = 0,004); 65% were male. Most acute HAV infections were observed in a coastal area where HAV infections represented 52% of hepatitis etiology. Phylogenetic analysis identified genotype IA strains, clustering close to previously published Tunisian sequences.
conclusionThe present study confirmed a low HEV endemicity and evidenced a still high level of HAV circulation in Southern Tunisia, suggesting distinct dissemination patterns for these viruses.
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