Hepatitis E infection among patients with acute febrile jaundice in the Democratic Republic of the Congo: a nationwide cross-sectional study

Hepatitis E virus (HEV) is the leading cause of acute viral hepatitis worldwide, with an estimated 20 million infections yearly. Despite the substantial burden of HEV infections, their prevalence and distribution are poorly documented, especially in resource-limited countries. In the Democratic Republic of the Congo (DRC), surveillance for acute febrile jaundice focuses on yellow fever, while HEV infection can present similar symptoms. However, less than 5% of suspected cases of yellow fever test positive. This study aimed to determine the seroprevalence of HEV infection among suspected yellow fever cases. We conducted a retrospective cross-sectional study using samples collected from suspected yellow fever patients between January 2019 and December 2021. Samples were tested for HEV-specific antibodies (IgM and IgG) and viral RNA. We performed multivariable logistic regression to assess associations between socio-demographic characteristics and HEV antibody positivity. Of the 2,007 serum samples analyzed, 30.8% (28.8–32.8) were positive for HEV total antibodies, while 3.6% were IgM positive. Male participants were nearly 20% more likely to be HEV total antibody-seropositive (AOR: 1.2 [1.0–1.5], p = 0.028) and 40% less likely to be IgM-positive (AOR: 0.6 [0.4–1.1], p = 0.088). There was a trend towards increased HEV seropositivity with age, especially for participants aged 20–29 (AOR: 1.3 [1.0–1.8], p = 0.046). HEV RNA was detected in only one of 72 IgM-positive samples (1.4%). This study provides evidence of HEV circulation in suspected yellow fever patients and highlights the need for dual use of the national yellow fever surveillance system to investigate other causes of acute febrile jaundice.