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Hepatitis D prevalence: problems with extrapolation to global population estimates
  1. Alexander J Stockdale1,2,
  2. Benno Kreuels3,4,
  3. Marc R Y Henrion2,5,
  4. Emanuele Giorgi6,
  5. Irene Kyomuhangi6,
  6. Anna Maria Geretti1
  1. 1 Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  2. 2 Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
  3. 3 Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
  4. 4 Department of Tropical Medicine, 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  5. 5 Liverpool School of Tropical Medicine, Liverpool, UK
  6. 6 Centre for Health Informatics, Computing, and Statistics, University of Lancaster, Lancaster, UK
  1. Correspondence to Professor Anna Maria Geretti, Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK; geretti{at}

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We read the meta-analysis of global hepatitis D prevalence by Chen et al and have some serious concerns relating to the proposed epidemiological estimates.1

Seroprevalence of hepatitis delta virus (HDV) was not adequately defined. In the methods, hepatitis delta antibody (anti-HDV), HDV RNA and HDV antigen (HDAg) were described as markers of HDV infection. In Supplementary Table S8, it is evident that total, IgG and IgM anti-HDV and HDAg were variably used to define HDV infection. HDAg is a transient marker of HDV infection, whereas IgM expression is inconsistently associated with both acute and chronic infection; neither are suitable epidemiological markers of chronic HDV infection.2

A total of 50 cohorts were used to inform the primary outcome, global HDV seroprevalence in the general population; of these, 30 were conducted in the last 20 years. The authors estimated …

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  • Contributors The letter was conceived, coauthored and reviewed by all of the authors.

  • Funding AJS is funded by a Wellcome Trust Clinical PhD Fellowship (grant 109130/Z/15/Z); World Health Organisation (WHO), Geneva, Switzerland.

  • Competing interests The authors are presently working on estimates of global hepatitis D prevalence in collaboration with WHO.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.