Background Hepatitis delta virus (HDV) can establish a persistent infection in people with chronic hepatitis B, leading to the accelerated progression of liver disease. Our study aimed to establish the prevalence of HDV and update the molecular characterization of HDV in the population carrying hepatitis B surface antigens (HBsAg) in Bangui, the capital of the Central African Republic. Methodology We collected 946 plasma samples from HBsAg-positive patients at the Institut Pasteur de Bangui in the Viral Hepatitis Laboratory from archived samples collected from 2014 to 2017. No information on severe liver disease or treatment history was available. Total anti-HDV antibodies (IgG) were assayed using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Subsequently, the R0 region was amplified by reverse-transcription PCR and sequenced. HDV isolates were genotyped and analyzed statistically. Results Prevalence of anti-HDV antibodies (IgG) was 18.18% (172/946). Of the 172 samples positive for anti-HDV antibodies, 111 HDV-positive samples (64.5%) were from males and 61 were from females (35.46%). The highest HDV prevalence (39.5%) was found in patients over 40 years old, and the lowest (1.1%) was found in the 0–10 years age group. The risk of HDV infection was very high in year 2015 ( p = 0.009). Nucleotide sequences of HDV-RNA were obtained for 61 HDV-IgG positive samples of which 60 isolates belonged to the HDV-1 clade and 1 belonged to HDV-8. Conclusion A high prevalence of HDV was found in the study population, but was not evenly distributed across age groups. Patients over 40 had the highest prevalence of HDV. The study identified a predominance of the HDV-1 clade, but clade HDV-8 was also detected.

Hepatitis B virus (HBV) significantly impacts public health, particularly among individuals with Human Immunodeficiency Virus (HIV). Co-infection can worsen HBV progression and increase chronic liver disease risks. This study assessed HBV marker frequency, viral load (VL), and associated factors in HIV patients in South Kivu province (Democratic Republic of Congo) to understand the health implications of HBV-HIV co-infection. This cross-sectional study, from July 1, 2019, to July 30, 2021, included 864 HIV patients aged 18 to 70 years from General Referral Hospital of Panzi (GRH Panzi), Regional Military Hospital of Bukavu (RMH Bukavu), and Fomulac Hospital. Participants, on antiretroviral therapy, ART (TDF/3TC/DTG or AZT/3TC/LPV/r combinations) or newly diagnosed, consented for blood testing for hepatitis B using enzyme-linked immunosorbent assay (ELISA) and VLs using GeneXpert. Data were analyzed with Stata SE 14.0. The study found 8.0

Background Hepatitis E virus (HEV) is a major cause of enterotropic viral hepatitis, a major public health problem in many developing countries. In Central African Republic (CAR), HEV genotypes 1, 2, and 3 have been found to have an impact on human health. However, data on HEV in animal reservoirs are still lacking for CAR. Here, we investigated the presence of HEV in farmed pigs and goats in Bangui, the capital city of CAR, using molecular methods. Methodology In a prospective study, fecal samples from 61 pigs and 39 goats from farms in five districts (2nd, 4th, 6th, 7th, 8th) of Bangui were collected and tested for HEV RNA by real-time RT-PCR. The samples were further analyzed by nested-PCR and sequenced to determine the genotype and subtype to which the virus belong. Results In total, 22/100 (22.0%) feces samples were successfully amplified for HEV RNA by real time RT-PCR. All positive samples were from pigs (22/61; 36.1%), while all goat samples were negative (0/39). Twelve HEV RNA samples (12/22 or 54.5%) were successfully amplified by nested RT-PCR, and subsequently sequenced. Phylogenetic analysis revealed that the obtained sequences clustered with subtype 3h and were genetically related to the human HEV sequences from CAR. Conclusion This study confirms that pigs constitute an HEV reservoir, with genotype 3 being the major circulating strain. Further studies are needed to investigate other local reservoirs and to improve knowledge of the molecular epidemiology of HEV in CAR.

Abstract Background Hepatitis E virus (HEV) is a major public health disease causing large outbreaks and sporadic cases of acute hepatitis. We investigated an outbreak of HEV infection that occurred in September 2018 in the health district (HD) of Bocaranga-Koui, located in the northwestern part of Central African Republic (CAR). Methods Blood samples were collected from 352 patients aged 0–85 years suspected to be infected with yellow fever (YF), according to the World Health Organization YF case definition. The notification forms from recorded cases were used. Water consumed in the HD were also collected. Human samples found negative for anti-YF IgM were then tested by ELISA for anti-HEV IgM and IgG antibodies. Positive anti-HEV (IgM and/or IgG) samples and collected water were then subjected to molecular biology tests using a real time RT-PCR assay, followed by a nested RT-PCR assay for sequencing and phylogenetic analysis. Results Of the 352 icterus patients included, anti-HEV IgM was found in 142 people (40.3%) and anti-HEV IgG in 175 (49.7%). Although HEV infection was detected in all age groups, there was a significant difference between the 0–10 age groups and others age groups (P = 0.001). Elevated levels of serum aminotransferase were observed in anti-HEV IgM-positive subjects. Phylogenetic analysis showed HEV genotype 1e in infected patients as well as in the contaminated water. Conclusion This epidemic showed that CAR remains an HEV-endemic area. The genotype 1e strain was responsible for the HEV outbreak in Bocaranga-Koui HD. It is necessary to implement basic conditions of hygiene and sanitation to prevent further outbreaks of a HEV epidemics, to facilitate access to clean drinking water for the population, to launch intensive health education for basic hygiene measures, to sett up targeted hygiene promotion activities and, finally, to ensure that formal health care is available.

INTRODUCTION:Limited data are available on the prevalence rates of hepatitis B and acquired immunodeficiency syndrome (AIDS) among women survivors of sexual violence (WSSV) in South Kivu province, in the eastern part of the Democratic Republic of Congo (DRC), where armed conflicts persist. Here, we aimed to assess the prevalence of these two infections in this vulnerable local population. METHODS:A total of 1002 WSSV, aged from 18 to 70 years old were enrolled from May 2018 to May 2020 at three healthcare facilities (Panzi, Mulamba and Bulenga hospitals), which are called "The One-Stop Centre Care Model" for the management of sexual violence in South Kivu. Blood samples were collected and tested for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) antigens and antibodies using enzyme-linked immunoassay (ELISA) methods. Subsequently, viral load quantification for HBV and HIV were performed using the GeneXpert. Univariate and multivariate logistic regression models were used to assess factors associated with HIV-positive and HBV-positive status. RESULTS:For HBV, overall prevalence was 8.9% (95% CI; 7.2-10.8%), 32.1% (95% CI; 29.3-35.0%), and 14.5% (95% CI; 12.3-16.8%) for HBsAg, anti-HBc and anti-HBs antibodies, respectively. Among the 89 HBsAg-positive patients, 17 (19.1%) were HBeAg-positive. The median age of individuals with a positive HBsAg test was higher than those with a negative test (median: 40 years (IQR 30-52) compared to 36 years (IQR 24-48)). Risk factors for HBV infection were age (≥35 years) (AOR = 1.83 [1.02-3.32]; p = 0.041), having no schooling (AOR = 4.14 [1.35-12.62]; p = 0.012) or only primary school-level (AOR = 4.88 [1.61-14.75]; p = 0.005), and multiple aggressors (AOR = 1.76 [1.09-2.84], p = 0.019). The prevalence of HIV was 4.3% [95% CI: 3.1-5.7%]. HIV/HBV co-infection occurred only in 5 individuals (0.5%). The HBV viral load was detectable (> 1 log10 UI/mL) in 61.8% of HBsAg-positive subjects and 64.8% HIV-positive subjects had a high viral load (≥ 3 log10 copies/mL). CONCLUSION:This study revealed a high prevalence of HBV and HIV infections among WSSV in South Kivu. The results generated highlight the urgent need for systematic screening of HBV and HIV by integrating fourth-generation ELISA tests in HIV and HBV control programs.

Background The Central African Republic (CAR) is one of the countries with the highest prevalence of viral hepatitis infection in the world. Coinfection with HIV increases the morbidity and mortality beyond that of mono-infection with either hepatitis or HIV. The present study describes the geographic distribution of viral hepatitis infections and molecular characterization of these viruses in the CAR. Methodology Out of 12,599 persons enrolled during the fourth Multiple Indicator Cluster Survey of 2010 in the CAR, 10,621 Dried Blood Spot (DBS) samples were obtained and stored at -20°C. Of these DBS, 4,317 samples were randomly selected to represent all regions of the CAR. Serological tests for hepatitis B, D, and C viruses were performed using the ELISA technique. Molecular characterization was performed to identify strains. Results Of the 4,317 samples included, 53.2% were from men and 46.8% from women. The HBsAg prevalence among participants was 12.9% and that HBc-Ab was 19.7%. The overall prevalence of HCV was 0.6%. Co-infection of HIV/HBV was 1.1% and that of HBV/HDV was 16.6%. A total of 77 HBV, 6 HIV, and 6 HDV strains were successfully sequenced, with 72 HBV (93.5%) strains belonging to genotype E and 5 (6.5%) strains belonging to genotype D. The 6 HDV strains all belonged to clade 1, while 4 recombinants subtype were identified among the 6 strains of HIV. Conclusion Our study found a high prevalence of HBV, HBV/HDV and HBV/HIV co-infection, but a low prevalence of HCV. CAR remains an area of high HBV endemicity. This study’s data and analyses would be useful for establishing an integrated viral hepatitis and HIV surveillance program in the CAR.

Objective : In a context of increasing cases despite vaccination campaigns, a survey was conducted in the Bangui population in January 17 to 26, 2022 to evaluate the strains of Severe Acute Respiratory Infection Coronavirus 2 ( SARS-Cov-2 ) circulating in a healthy population by taking nasopharyngeal samples in 2,554 randomly selected volunteers. Antigen detection was performed systematically and RT-PCR was done on the positive samples. Thirty samples were found RT-PCR positive (1.2%) and sent for viral genome sequencing. Twenty eight SARS-Cov-2 strains belong to Omicron type and solely 2 to Delta type. Thus, infection were uncommon in the tested population but the presence of Omicron and Delta types make fear than vaccination will not be efficient to fight against the virus and newly designed vaccine should be implemented to better protect the population who is at risk of infection and re-infection by these variants.

Background. Large-scale population-based seroprevalence studies of SARS-CoV-2 are essential to characterize the cumulative incidence of SARS-CoV-2 infection and to extrapolate the prevalence of presumptive immunity at the population level. Objective. The objective of our survey was to estimate the cumulative population immunity for COVID-19 and to identify individual characteristics associated with positive serostatus. Materials and Methods. This was a clustered cross-sectional study conducted from July 12 to August 20, 2021, in households in the city of Bangui, the capital of the Central African Republic. Information regarding demographic characteristics (age, gender, and place of residence), and comorbidities (chronic diseases) was collected. A venous blood sample was obtained from each participant to determine the level of total anti-SARS-CoV-2 antibodies using a WANTAI SARS-CoV-2 Ab ELISA kit. Results. All up, 799 participants were surveyed. The average age was 27 years, and 45.8% of the respondents were male (sex ratio: 0.8). The overall proportion of respondents with positive serostatus was 74.1%. Participants over 20 years of age were twice as likely to have positive serostatus, with an OR of 2.2 (95% CI: [1.6, 3.1]). Interpretation. The results of this survey revealed a high cumulative level of immunity in Bangui, thus indicating a significant degree of spread of SARS-CoV-2 in the population. The public health implications of this immunity to SARS-CoV-2 such as the post-vaccination total antibody kinetics remain to be determined.

Context and objective: The COVID-19 pandemic has become a major public health problem and has mobilized many innovative means of diagnosis.The Central African Republic is not spared.The emergence of variants and their impact require health monitoring despite the obligation of vaccination.The purpose of this campaign was to determine the circulation of pending secondwave variants.Patients and Methods: A second mass screening campaign took place from 02 to 22 July 2021 in the main land and river entry points of Bangui (Exit North-PK12, Exit South-PK9, Port Beach) and at the LNBCSP.Antigenic and RT-PCR tests carried out on nasopharyngeal samples made it possible to select strains which were finally sequenced.Results: Of 2687 participants included in the study, 53 (1.97%) were positive for SARS-CoV-2.Thirteen (1.53%) were male and 40 (2.18%) female.The analyses carried out on the LumiraDx analyzer were positive for 109 samples against 53 on the

Urticaria is a common syndrom which is manifested by pruritic edematous erythematous plaques. These plaques have no predilection site. They can migrate during the evolution of urticaria. Their second particularity is their fleeting character for they disapear after few hours without treatment. Urticaria has been associated with psychological, allergic and infectious factors. Among incriminated infections, hepatitis viruses have been cited. We are reporting a case of urticaria revealing an anicteric hepatitis B infection.

The medical humanitarian organization Médecins Sans Frontières (MSF) provides medical care in more than 70 countries and admits more than 7000 cases of snakebite in its facilities each year. We describe our activities against snakebite in three African countries: Central African Republic, South Sudan and Ethiopia, in which different models of care have been developed. A standard protocol using two different antivenoms depending on the patient's syndrome has been introduced, and a simple blood coagulation test is performed to detect venom-induced coagulopathy. Other services, including surgery for necrotizing wounds, are offered in the facilities where MSF admits a large number of snakebite patients. All services, including provision of antivenom, are offered free-of-charge in MSF-supported facilities. Community-based activities focusing on preventive measures and prompt transport to hospital have been developed in a few MSF projects. The provision of quality care and treatment, including effective antivenoms, without out-of-pocket payments by the patients, probably explains why MSF has admitted an increasing number of snakebite victims over the last years. This model requires significant resources and monitoring, including regular training of healthcare workers on treatment protocols and a considerable budget for antivenom procurement.

Significance Transmission of malarial parasites occurs via the bites of Anopheles mosquitoes, whose blood-feeding behavior modulates the risk of infection. In many malaria endemic regions, eradication strategies rely on reducing transmission by targeting nocturnal blood-feeding Anopheles with insecticidal nets. However, a proportion of mosquitoes may naturally feed when humans are not protected by nets, setting a ceiling to the efficacy of massive net-based interventions. In Bangui, Central African Republic, 20 to 30% of daily exposure to indoor bites occurs during daytime, and this fraction may correspond to mosquitoes escaping exposure to current vector control measures. Knowledge about the daily rhythmicity of mosquito biting is therefore crucial to adjust vector control tactics to protect people at places where they spend daytime.

Background: Large-scale population-based seroprevalence studies of SARS-CoV-2 are essential to characterize the cumulative incidence of SARS-CoV-2 infection and to extrapolate the prevalence of presumptive immunity at the population level.Objective: The objective of our survey was to estimate the cumulative population immunity for COVID-19 and to identify individual characteristics associated with a positive serostatus.Method: This was a clustered cross-sectional study conducted from July 12 to August 20, 2021, in households in the city of Bangui, the capital of the Central African Republic. Information regarding demographic characteristics (age, gender, and place of residence), comorbidities (chronic diseases) was collected. A venous blood sample was obtained for each participant to determine the level of total anti-SARS-CoV-2 antibodies using a WANTAI SARS-CoV-2 Ab ELISA kit.Results: All up, 799 participants were surveyed. The average age was 27 years, and 45·8% of the respondents were male (sex ratio: 0.8). The overall proportion of respondents with a positive serostatus was 74·1%. Participants over 20 years of age were twice as likely to have a positive serostatus, with an OR of 2.· ·2 (95% CI: [1·6, 3·1]).Interpretation: The results of this survey revealed a high cumulative level of immunity in Bangui, thus indicating a significant degree of spread of SARS-CoV-2 in the population. The public health implications of this high level of immunity to SARS-CoV-2 in the population remain to be determined.Funding Information: This study was funded by the French Ministry for Europe and Foreign Affairs through the REPAIR COVID-19-Africa project coordinated by the Pasteur International Network association.Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: This study was authorised by the Ministry of Health of the Central African Republic (N° 603/MSPP/DIRCAB/CMRF-21) and by the Ethics and Scientific Committee of the University of Bangui (N°09/UB/FACSS/IPB/CES/20). Informed and signed consent was obtained from each participant.

Hepatitis E virus (HEV) infection is responsible for major endemic outbreaks in developing countries. Human immunodeficiency virus (HIV) and HEV are widespread in the Central African Republic. We report the first documented case of an HEV infection in a 36-month-old child already suffering from HIV and severe acute malnutrition (SAM). The HIV patient was hospitalized for SAM with persistent diarrhea and prolonged fever. The presence of IgG anti-HEV antibodies was noted. Sequencing of the amplified HEV RNA revealed the presence of genotype 3c. The alanine aminotransferase level was slightly above average. The patient died despite being treated by antiretroviral therapy accompanied by probabilistic antibiotic therapy and nutritional rehabilitation. HEV/HIV co-infection in a malnourished patient can accelerate a fatal outcome. In the presence of biological abnormalities in a severe acutely malnourished HIV-infected patient, HEV RNA detection should be added to the standard medical assessment in sub-Saharan African countries.

Abstract Background Infection by hepatitis E virus (HEV) can cause a high burden of morbidity and mortality in countries with poor access to clean water and sanitation. Our study aimed to investigate the situation of HEV infections in the Central African Republic (CAR). Methods A retrospective analysis of the blood samples and notification forms collected through the national yellow fever (YF) surveillance program, but for which a diagnosis of YF was discarded, was carried out using an anti-HEV IgM ELISA and a HEV-specific RT-PCR. Results Of 2883 YF-negative samples collected between January 2008 and December 2012, 745 (~ 26%) tested positive by at least either of the 2 tests used to confirm HEV cases. The results revealed that the CAR was hit by a large HEV outbreak in 2008 and 2009. The results also showed a clear seasonal pattern with correlation between HEV incidence and rainfall in Bangui. A phylogenetic analysis showed that the circulating strains belonged to genotypes 1e and 2b. Conclusions Overall, this study provides further evidences that HEV can be a significant cause of acute febrile jaundice, particularly among adults during rainy season or flood, in a country from Sub-Saharan Africa.

BACKGROUND:Previous studies in the Central African Republic (CAR) have reported the presence of hepatitis B virus (HBV) recombinant genotype E/D and a suspicion of immune escape mutants (IEMs), without further investigation into their impact on prevention and diagnosis. Consequently, this study investigated HBV mutations among hepatitis B surface antigen (HBsAg)-positive patients attending Institut Pasteur de Bangui in the CAR. METHODS:Sera from a total of 118 HBsAg-positive patients with no previous history of HBV treatment or vaccination at the Institut Pasteur de Bangui, were sampled between 2017 and 2019. Subsequently, the region spanning the surface and polymerase genes of HBV was amplified by PCR and sequenced. HBV sequences were genotyped/subgenotyped by phylogenetic analysis and serotyped based on predicted amino acid residues at positions s122, s127, s140, s159, and s160. They were then analyzed for HBV IEMs and polymerase mutations. RESULTS:The region spanning the surface and polymerase genes was successfully amplified and sequenced for 51 samples. Of the HBV sequences, 49 were genotype E and two were genotype A subgenotype A1; these were serotyped as ayw4 and ayw1, respectively. Potential IEMs sY100C, sA128V, and sM133T, and several polymerase mutants were identified. CONCLUSIONS:This study raises awareness of the need for further studies to be conducted on a large scale to better understand HBV mutations for improved disease control and prevention strategies in the country.

Background: Little is known about the prevalence of co-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) in the post-conflict South-Kivu Province, Eastern Democratic Republic of the Congo. Therefore, we aimed to determine such data at Panzi Referral Hospital. Methods: We conducted a cross-sectional study of 198 HIV-positive patients seen in consultation from June to 31 November 2017. Socio-demographic and clinical data were collected by interview and clinical examination. Blood sample was taken for serological analyses. The presence of HBV serological markers was determined by enzyme linked immunoassay (ELISA) tests. CD4+ T cell counts were determined for all patients. Data analysis was done using the JMP 7.1 software. Proportions were compared using a Chi-square test or Fisher test. Results: Fourteen of 198 participants (7.07%, 95% confidence interval [CI]: 4.35 - 11.51) were HBsAg-positive. Overall, 33.33% of the subjects had been in contact with HBV and 36.87% were carriers of the immunization marker. Among co-infected patients, 28.57% had a chronic replicative viral B infection, 57.14% a chronic non-replicative infection and 14.29% were inactive carriers. No patient had an acute infection. Co-infection was higher in participants who were aged 55 and over (8.3%), men (12.90%, p = 0.0306), married (12.00%, p = 0.0063), or of Lega ethnicity (14.3%, p = 0.0100). Some clinical signs such as hepatomegaly and jaundice (p < 0.0001), fever (p = 0.0095), splenomegaly (p = 0.0007), ascites (p = 0.0173) and viral encephalitis (p ≤ 0.0001) were associated with co-infection. Severe immunosuppression (50.00%, p = 0.0110) and WHO clinical stage III/IV (10.64%; p = 0.0301) were associated with HIV/HBV co-infection. Conclusions: The relative high prevalence of HIV/HBV co-infection and chronic nature call for the need of integrating HBV screening programs into HIV routine care to reduce morbidity and mortality levels caused by HIV/HBV co-infection.

Background. Hepatitis E virus (HEV) is a waterborne virus that causes acute hepatitis in immunocompromised patients and those who are immunocompetent. Few cases of chronic HEV have been described in industrialized countries. The Central African Republic is 1 of the few countries in the world that is endemic for both HIV and HEV. The prevalence of HIV infection is estimated to be 4.9% among adults aged 15-49 years, and hepatitis E is epidemo-endemic. The aim of this study was to characterize the epidemiology of HEV infection in people living with HIV (PLHIV) in Bangui. Methods. A cross-sectional study was conducted between April and September 2015 based on answers to a questionnaire, and blood samples were collected for determination of immunological markers by enzyme-linked immunosorbent assay and molecular tests. Results. Of the 200 PLHIV included, 15 (7.5%) had the IgM that characterizes acute HEV infection; 8.9% were women, and 2.2% were men. The overall seroprevalence of IgG was 68% (48% women and 70.4% men), indicating that men are statistically significantly more exposed to HEV than women. HEV infection had no effect on transaminase or T-CD4+ lymphocyte cell levels. The origin of infection could not be identified. Conclusions. The seroprevalence of HEV is very high among PLHIV and in the general population of Bangui. This must be taken into account in studies of the risk factors of PLHIV infected with HEV.

Hepatocellular carcinoma (HCC) is still a major killing malignancy in sub-Saharan Africa. Lifelong intoxication with aflatoxin B1 is considered as one of the primary causes of this situation. The role of aflatoxin in HCC from a given population is commonly estimated through the prevalence of R249S mutation of TP53 , a hallmark for previous exposure to the mycotoxin. However, the role of AFB1 is barely known in large part of Africa. We conducted a survey on circulating cell-free DNA from 149 patients with HCC and 213 control subjects with and without liver diseases from Cameroon and Central African Republic using droplet digital PCR technique. We observed a mutation prevalence of 24.8% ( n = 37/149) in patients with tumor and 5.6% ( n = 12/213) in controls ( P = 2.2E−07). Patients with mutations usually displayed significantly increased circulating alpha-fetoprotein (AFP) values, high hepatitis B virus (HBV) DNA loads as well as worsened values of blood cells count. Interestingly, the fraction of droplets positive for R249S was significantly larger in patients with liver cancer (15.3 ± 3.7%) than in controls (0.5 ± 0.3%, P = 7.1E−04). Our survey indicates that AFB1 is instrumental for HCC development in Middle Africa and that droplet digital PCR might be used in the region both to diagnose HCC and to conduct public health surveys on populations at risk of chronic aflatoxin intoxication.

Hepatitis delta virus (HDV) increases morbidity in Hepatitis B virus (HBV)-infected patients. In the mid-eighties, an outbreak of HDV fulminant hepatitis (FH) in the Central African Republic (CAR) killed 88% of patients hospitalized in Bangui. We evaluated infections with HBV and HDV among students and pregnant women, 25 years after the fulminant hepatitis (FH) outbreak to determine (i) the prevalence of HBV and HDV infection in this population, (ii) the clinical risk factors for HBV and/or HDV infections, and (iii) to characterize and compare the strains from the FH outbreak in the 1980s to the 2010 HBV-HDV strains. We performed a cross sectional study with historical comparison on FH-stored samples (n = 179) from 159 patients and dried blood-spots from volunteer students and pregnant women groups (n = 2172). We analyzed risk factors potentially associated with HBV and HDV. Previous HBV infection (presence of anti-HBc) occurred in 345/1290 students (26.7%) and 186/870 pregnant women (21.4%)(p = 0.005), including 110 students (8.8%) and 71 pregnant women (8.2%), who were also HBsAg-positive (p = 0.824). HDV infection occurred more frequently in pregnant women (n = 13; 18.8%) than students (n = 6; 5.4%) (p = 0.010). Infection in childhood was probably the main HBV risk factor. The risk factors for HDV infection were age (p = 0.040), transfusion (p = 0.039), and a tendency for tattooing (p = 0.055) and absence of condom use (p = 0.049). HBV-E and HDV-1 were highly prevalent during both the FH outbreak and the 2010 screening project. For historical samples, due to storage conditions and despite several attempts, we could only obtain partial HDV amplification representing 25% of the full-length genome. The HDV-1 mid-eighties FH-strains did not form a specific clade and were affiliated to two different HDV-1 African subgenotypes, one of which also includes the 2010 HDV-1 strains. In the Central African Republic, these findings indicate a high prevalence of previous and current HBV-E and HDV-1 infections both in the mid-eighties fulminant hepatitis outbreak and among asymptomatic young adults in 2010, and reinforce the need for universal HBV vaccination and the prevention of HDV transmission among HBsAg-positive patients through blood or sexual routes.