Confronting Hepatitis E Virus in Africa: Insights from Nigeria and Pathways for Control

Hepatitis E virus (HEV) is an under-recognized cause of acute viral hepatitis and remains a significant public health issue in Africa. Globally, over 20 million HEV infections and nearly 3 million symptomatic cases happen each year, but the true burden in Africa is poorly understood because of limited surveillance, inconsistent diagnostics, and underreporting. Outbreaks have been reported in several African countries, including Sudan, Uganda, Chad, Ghana, and Nigeria, often linked to floods, displacement, and poor sanitation. Prevalence studies show significant variation, from less than 1% in Tanzania to over 80% in Egypt, indicating different epidemiological situations across the continent. In Nigeria, two major outbreaks have been documented, while seroprevalence studies suggest widespread exposure in humans and high infection rates in pigs. Vulnerable groups include pregnant women, HIV-positive individuals, and livestock handlers; these findings reflect broader trends across Africa where waterborne transmission and zoonotic reservoirs help sustain HEV circulation. The challenges in controlling HEV across Africa include weak surveillance systems, inconsistent diagnostics, limited genetic characterization of circulating strains, inadequate knowledge of risk factors, gaps in blood bank safety, uncertain zoonotic pathways, and low public awareness. Addressing these issues requires a One Health approach that integrates human, veterinary, and environmental health systems, with priority interventions including expanding affordable diagnostics, strengthening WASH infrastructure, routine animal and blood donor screening, targeted education for high-risk groups, and investment in molecular epidemiology. Therefore, this review consolidates current knowledge of HEV in Africa, with insights from Nigeria, and provides recommendations for control through a coordinated One Health approach, essential to reduce transmission, protect vulnerable groups, and build resilient surveillance systems capable of preventing future outbreaks.