Hospital-based surveillance for viral hemorrhagic fevers and hepatitides in Ghana.
BACKGROUND
Viral hemorrhagic fevers (VHF) are acute diseases associated with bleeding, organ failure, and shock. VHF may hardly be distinguished clinically from other diseases in the African hospital, including viral hepatitis. This study was conducted to determine if VHF and viral hepatitis contribute to hospital morbidity in the Central and Northern parts of Ghana.


RESULTS
From 2009 to 2011, blood samples of 258 patients with VHF symptoms were collected at 18 hospitals in Ashanti, Brong-Ahafo, Northern, Upper West, and Upper East regions. Patients were tested by PCR for Lassa, Rift Valley, Crimean-Congo, Ebola/Marburg, and yellow fever viruses; hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) viruses; and by ELISA for serological hepatitis markers. None of the patients tested positive for VHF. However, 21 (8.1%) showed anti-HBc IgM plus HBV DNA and/or HBsAg; 37 (14%) showed HBsAg and HBV DNA without anti-HBc IgM; 26 (10%) showed anti-HAV IgM and/or HAV RNA; and 20 (7.8%) were HCV RNA-positive. None was positive for HEV RNA or anti-HEV IgM plus IgG. Viral genotypes were determined as HAV-IB, HBV-A and E, and HCV-1, 2, and 4.


CONCLUSIONS
VHFs do not cause significant hospital morbidity in the study area. However, the incidence of acute hepatitis A and B, and hepatitis B and C with active virus replication is high. These infections may mimic VHF and need to be considered if VHF is suspected. The data may help decision makers to allocate resources and focus surveillance systems on the diseases of relevance in Ghana.
Virology Department, Noguchi Memorial Institute of Medical Research, University of Ghana, Legon, Ghana ; Department of Virology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.
Joseph Humphrey Kofi
JH
Bonney
Mubarak
M
Osei-Kwasi
Theophilus Korku
TK
Adiku
Jacob Samson
JS
Barnor
Robert
R
Amesiya
Chrysantus
C
Kubio
Lawson
L
Ahadzie
Stephan
S
Olschläger
Michaela
M
Lelke
Beate
B
Becker-Ziaja
Meike
M
Pahlmann
Stephan
S
Günther
D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D001769:Blood / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000097:blood; D062665:Epidemiological Monitoring; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006482:Hemorrhagic Fevers, Viral / Q000453:epidemiology* / Q000821:virology*; D006525:Hepatitis, Viral, Human / Q000453:epidemiology* / Q000821:virology*; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D008969:Molecular Sequence Data; D012367:RNA, Viral / Q000097:blood; D017422:Sequence Analysis, DNA; D014780:Viruses / Q000302:isolation & purification; D055815:Young Adult
D000914:Antibodies, Viral; D004279:DNA, Viral; D012367:RNA, Viral