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J Med Virol. 2017 Mar;89(3):469-475. doi: 10.1002/jmv.24665. Epub 2016 Aug 24.

Evolutionary dynamics of HBV-D7 subgenotype in Tunisia.

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Department of Infectious, Parasitic and Immune-Mediated Diseases, Epidemiology Unit, Istituto Superiore di Sanità, Rome, Italy.
University Hospital Campus Bio-Medico, Rome, Italy.
Department of Infectious Diseases, Viral Hepatitis Research Unit (UR12SP35), University Hospital Farhat Hached, Sousse, Tunisia.
Faculty of Pharmacy, Laboratory of Infectious Diseases and Biological Agents, University of Monastir, Monastir, Tunisia.
Department of Infectious, Parasitic and Immune-Mediated Diseases, Viral Hepatitis Unit, Istituto Superiore di Sanità, Rome, Italy.
Department of Cell Biology and Neurosciences, Clinical Diagnostics and Therapy of Degenerative Diseases of the Central Nervous System Unit, Istituto Superiore di Sanità, Rome, Italy.
Public Health and Infectious Diseases, Sapienza University, Rome, Italy.


Hepatitis B virus (HBV) is the main cause of diseases liver related infecting more than 200 milion persons worldwide. HBV infection shows high level of prevalence in South-East Europe and in Mediterranean basin. In Tunisia, a country with an intermediate level endemicity, HbsAg prevalence ranges from 2 to 5%. Most of the HBV isolates from Tunisia were classified as subgenotype D7 whose circulation is restricted to a specific area of North Africa including Maghreb region. In this paper, the phylogeny of HBV-D7 isolated from 38 Tunisian patients was investigated by analyzing the S gene region of HBV. A Bayesian coalescent-based framework was used to estimate the origin of the HBV-D7 in the country. The Tunisian D7 isolates were found to share a common ancestor whose origin was traced back to 1958. Population dynamics indicated that HBV-D7 epidemic in Tunisia grew exponentially from 1960s to 1990s. After that, the curve reached a plateau around the years 2000 likely due to the implementation of the infant vaccination program in 1996. Epidemiological data suggested that the exponential growth phase was likely sustained by intra-familial transmission events occurring during infancy. Further characterization of HBV-D7 isolates should be performed to evaluate, in the post-vaccination era, the emergence of new transmission routes, and to monitor the efficacy of the vaccination program. J. Med. Virol. 89:469-475, 2017.


epidemiology; evolution; hepatitis B virus

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