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.
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.
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.
Ghana is endemic for yellow fever and lies between two Lassa fever endemic areas — Guinea, Liberia, Sierra Leone, and Mali in the West, and Nigeria in the East. Ebola hemorrhagic fever has been documented in the neighboring Cote d'Ivoire. Thus, it is plausible that the latter VHFs also occur in Ghana, and there have been rumors of cases, which present like VHF in the north of the country. Our study aimed at verifying or disproving this suspicion. At 18 hospital-based study sites in the Central and Northern part of the country, samples from 258 patients with VHF symptoms were collected and tested for various VHF by PCR. As viral hepatitis is an important differential diagnosis of yellow fever, we also tested for several serological and molecular hepatitis markers. Rather surprisingly, VHFs were not detected, indicating that, even if they are endemic in the North of Ghana, they do not significantly contribute to hospital morbidity. However, a large fraction of patients showed markers of acute hepatitis A, and active hepatitis B and C. Children were mainly affected by hepatitis A, while adults were affected by hepatitis B and C. Hepatitis A and B are vaccine-preventable, and chronic hepatitis B and C are treatable diseases. Further efforts are needed to reduce the burden of these diseases in Ghana.