Infections with the hepatitis B virus associated delta agent in an isolated West-African community

The occurrence of delta agent (delta) infection in the native population of the isolated Gbawein and Wroughbarh Clan region of Grand Bassa County, Liberia was studied. Sera of 97 patients with epilepsy, 73 non-epileptic relatives, and 31 non-epileptic control subjects were tested for hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs) and antibody to delta antigen (anti-delta). Of the 201 individuals tested 76 (37.8%) were HBsAg positive; the overall infection rate (HBsAg and anti-HBs positives) was 68.7%. No correlation with clinical disease could be established. Markers of delta infection were detected in seven index cases. All subjects with anti-delta were HBsAg positive except one, who was anti-HBs positive with a low titre of anti-delta (less than 1:10(2)), which is indicative of a recent delta infection. Mothers of six delta infected index cases were available for testing, one was found HBsAg and anti-delta positive, while the other five were anti-HBs positive and anti-delta negative. No delta infections occurred in children of HBV negative mothers. Presence of delta markers varied significantly (P less than 0.02) among HBsAg carriers of the Kpelle (18%) and the Bassa (2%) language group. A comparable difference in delta markers was observed among HBsAg carriers of the Gbawein (17%) and the Wroughbarh (4%) clans.