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Original research
The epidemiology of hepatitis delta virus infection in Cameroon
  1. Camille Besombes1,
  2. Richard Njouom2,
  3. Juliette Paireau3,
  4. Guillaume Lachenal4,
  5. Gaëtan Texier5,
  6. Mathurin Tejiokem5,
  7. Simon Cauchemez3,6,
  8. Jacques Pépin7,
  9. Arnaud Fontanet1,8
  1. 1 Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
  2. 2 Department of Virology, Centre Pasteur du Cameroun, Yaounde, Cameroon
  3. 3 Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
  4. 4 Sciences Po, Paris, France
  5. 5 Department of Epidemiology and Public Health, Centre Pasteur du Cameroun, Yaounde, Cameroon
  6. 6 UMR2000, CNRS, Paris, France
  7. 7 Department of Microbiology and Infectious Diseases, Sherbrooke University, Sherbrooke, Quebec, Canada
  8. 8 PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France
  1. Correspondence to Prof Arnaud Fontanet, Epidemiology of Emerging Diseases, Institut Pasteur, 75015 Paris, France; fontanet{at}


Objective To investigate the distribution and risk factors of hepatitis delta virus (HDV) infection in Cameroon.

Design We tested for hepatitis B virus (HBV) surface antigen (HBsAg) and anti-HDV antibody 14 150 samples collected during a survey whose participants were representative of the Cameroonian adult population. The samples had already been tested for hepatitis C virus and HIV antibodies.

Results Overall, 1621/14 150 (weighted prevalence=11.9%) participants were HBsAg positive, among whom 224/1621 (10.6%) were anti-HDV positive. In 2011, the estimated numbers of HBsAg positive and HDV seropositives were 1 160 799 and 122 910 in the 15–49 years age group, respectively. There were substantial regional variations in prevalence of chronic HBV infection, but even more so for HDV (from 1% to 54%). In multivariable analysis, HDV seropositivity was independently associated with living with an HDV-seropositive person (OR=8.80; 95% CI: 3.23 to 24.0), being HIV infected (OR=2.82; 95% CI: 1.32 to 6.02) and living in the South (latitude <4°N) while having rural/outdoor work (OR=15.2; 95% CI: 8.35 to 27.6, when compared with living on latitude ≥4°N and not having rural/outdoor work).

Conclusion We found evidence for effective intra-household transmission of HDV in Cameroon. We also identified large differences in prevalence between regions, with cases concentrated in forested areas close to the Equator, as described in other tropical areas. The reasons underlying these geographical variations in HDV prevalence deserve further investigation.

  • hepatitis D
  • epidemiology

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  • CB and RN contributed equally.

  • Contributors AF and RN obtained funding for the study. AF, RN and JPé designed the study. RN was responsible for laboratory analyses. CB, AF, JPa and JPé carried out statistical analyses and were responsible for data interpretation. CB, JPé and AF wrote the first draft of the manuscript. All authors contributed to revisions of the manuscript and made important intellectual contributions.

  • Funding This study was funded by the Agence Nationale de Recherche sur le Sida et les Hépatites Virales (grant ANRS 12289) and got support from the INCEPTION project (PIA/ANR-16-CONV-0005). The funding agencies played no role in study design, data collection or analysis, writing the manuscript or decision to submit. The corresponding author had full access to all the data in the study, and had final responsibility for the decision to submit the publication. The Demographic and Health Survey around which this study was organised had been funded by the United States Agency for International Development.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Cameroonian National Ethics Committee and the Ministry of Health.

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

  • Data availability statement Data are available upon reasonable request. The DHS data are available from the DHS Program website at The virological data used in this manuscript are available in a deidentified manner upon reasonable request from RN, Virology laboratory, Centre Pasteur du Cameroun,

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