Talk:WikiJournal of Medicine/Epidemiology of the Hepatitis D virus

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WikiJournal of Medicine
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<meta name='citation_doi' value='10.15347/wjm/2020.001.2'>

Article information

Mario Rizzetto (2020), "Epidemiology of the Hepatitis D virus", WikiJournal of Medicine, 7 (1): 1, doi:10.15347/WJM/2020.001.2, ISSN 2002-4436, Wikidata Q89093122




This article has been updated since its initial publication on 29 Mar 2020. (summary of changes). The previous version is archived at this link as a record.


Plagiarism check

  Pass. Report from WMF copyvios tool found only trivial duplications such as reference names, not considered plagiarism. T.Shafee(Evo﹠Evo)talk 21:33, 19 November 2019 (UTC)

First peer review

Review by anonymous peer reviewer , Long-standing expert in hepatitis Delta virology, experimental models and clinical aspects
This review was submitted on , and refers to this previous version of the article


Nice text written by the discoverer of the hepatitis Delta virus, and still passionately working on it after more than 40 years. I have some minor comments to add:

  1. Line 2, "a recent systematic review suggests that up to 60 million individuals could be infected": this statement must be nuanced since the article by Chen has been criticized. I would suggest to add a short sentence as follows: "a recent systematic review suggests that up to 60 million individuals could be infected, although these figures were later disputed (REF: Stockdale AJ, Kreuels B, Henrion MRY, Giorgi E, Kyomuhangi I, Geretti AM. Hepatitis D prevalence: problems with extrapolation to global population estimates. Gut. 2018 Dec 19. pii: gutjnl-2018-317874. doi:10.1136/gutjnl-2018-317874. [Epub ahead of print])
  2. Line 20: the sentence "therefore patients with advanced HBsAg liver disease are the most suitable category of HBsAg carriers to determine the epidemiology of HDV" should read "therefore patients with advanced HBsAg liver disease are the most suitable category of HBsAg carriers to determine the epidemiology and real health burden of HDV";
  3. A concluding statement is lacking: what is the take-home message of this article, in summary?
Response

I agree with both the points raised by the referee at line 2 and line 20

In addition:

  • Line 10 from bottom, delete …poor…
  • Line 16 from bottom, add 'and poor' after 'developing' = …developing and poor countries of…

A conclusive statement may be repetitive with the text. However, if one is needed, it could be:

Chronic hepatitis D represents the most ominous form of chronic viral liver disorders and the one for which there is at present no efficacious therapy. Control of the HBV by the implementation of HBV vaccination programs is bound to diminish and ultimately eradicate HDV infection

Second peer reviewer

Review by William L Irving , University of Nottingham
This review was submitted on , and refers to this previous version of the article


This is a concise and readable summary of the literature describing prevalence and significance of HDV infection. I have only 2 very minor comments to make:

(1) I'm not sure that the word "perdures" (final sentence of the summary) is appropriate. I've not come across it before, so I can't really make a definitive suggestion as to an alternative. Possibilities would be "remains" or "persists" but I can't be sure that isn't changing the intended meaning.

Response

Changed perdures with is

(2) There is a statement "The majority of the afflicted are carriers of the hepatitis B surface antigen". This implies that at least in a minority of cases, HDV infection has been reported in patients who are NOT HBsAg positive. Is this the case? - it isn't something I have come across, but it would be of great interest. If not, then I think the statement should be revised to say that HDV infection only occurs in patients who are HBsAg positive.

Response

It is a matter of wording. Normal individuals who are not HBsAg carriers can become infected by HDV by simultaneous coinfection with HBV/HDV; this results in an acute self-limited HDV infection and hepatitis. Obviously they became temporarily HBsAg positive but are not preexisting "carriers" of the HBsAg. This point is further explained in the text. I admit that it may be confusing. It would perhaps be clearer if "the majority of the afflicted..." is changed into "The major victims are the carriers of the hepatitis B surface antigen"

Third peer review

Review by anonymous peer reviewer , MD
This review was submitted on , and refers to this previous version of the article


This is a comprehensible overview of the HDV infection. The author described the prevalence of chronic hepatitis D in different geographical regions. The effectiveness of HBV vaccination in reducing HDV transmission and the high rate of HDV infection among injection drug users in the developed countries were highlighted.

1) In the conclusion, besides emphasizing on universal HBV vaccination programs, it would be meaningful to recommend other strategies to break the chain of HDV transmission among high risk patients such as injection drug users. The importance of HDV screening, prevention and education for the at-risk populations should also be discussed

Response

The only really effective way of breaking the chain transmission between injection drug users is HBV vaccinatiion.The screening, prevention and education for populations at risk of HDV are the same as for the HBV; it is not conceivable that drug addicts that do not follow preacautions or cannot be educated against the HBV, can be educated to follow precautions against the HDV (i.e.avoid to inject..). If you wish you can add in Conclusions, after therapy: Limitations of interpersonal contacts, use of condoms, avoidance of direct contact with blood and of the sharing of sharp items between HDV-infected and non infected HBsAg carriers, whenever feasible, may help to diminish the risk. However I believe that this may be superfluous as they are the same precautions recommended to prevent Hepatitis B Virus infection

2) The Figure indicated the different HDV genotypes globally including the novel genotype 6,7,8 present in Africa. It would be more informative to concisely mention HDV genotype distribution in the context of epidemiology.

Response

In figure 1, delete.:. and HDV genotypes … and add in it after... in 2015.: Eight genotypes have been identified worldwide by comparative phylogenetic analysis. Genotype 1 is the most frequent and has variable pathogenicity, Genotypes 2 and 4 are found in East Asia causing relatively mild disease. Genotype 3 is found in South America in association with severe hepatitis. Genotypes 5 6,7,8 have been found only in Africa.

3) In paragraph 3 line 4 and 5: the sentence “patients with advanced HBsAg liver disease are the most suitable category of HBsAg carriers to determine the epidemiology and real health burden of HDV” needs to clarified. While this measure might identify those with advanced hepatitis D and its health burden, it likely would under estimate the true prevalence of HDV infection

Response

After..mono-infected patients, delete; therefore and add the sentence: As the probability of finding anti-HD throughout the clinical spectrum of HBsAg liver disorders increases in parallel with the severity of the liver disease, patients with HBsAg cirrhosis are the most suitable to determine the burden of HDV.

Most people still perform convenience HDV screening in asymptomatic HBsAg carriers at blood banks, pregnancy centers, general populations etc. i.e. in populations where the risk of HDV is much lower than in cirrhotics, obtaining low prevalence rates for anti-HD which are then extrapolated to conclude that HDV infection is irrelevant. Therefore the most reliable data on the impact of HDV come from cirrhotics, because screening in other clinical categories of HBsAg carriers underestimate the burden of HDV; I understand that this is not a true epidemiological data in the ordinary sense of the word but still it is the only reliable index on the true medical presence of HDV in a country.

Minor comments:


Attention to spelling and English grammar

Summary of edits during review

Copyright issues

Comments by Thomas Shafee
These comments were submitted on , and refer to this previous version of the article

It was brought to our attention that this article contains self-plagiarism (from this source) that was added to the abstract after the initial plagiarism check. Unfortunately, although written by the same author, the 2015 article's copyright is owned by Cold Spring Harbor Laboratory Press, who reserve all rights and do not permit reuse. After asking the author whether they would prefer to rewrite the abstract or have us do so, the requested that we do. The article has therefore been updated via this diff and assigned a new doi.

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