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. 2020 Jul 29;20(1):552.
doi: 10.1186/s12879-020-05269-z.

Distribution of hepatitis B virus genotypes in the general population of Myanmar via nationwide study

Yi Yi Kyaw  1   2 , Aye Aye Lwin  3 , Khin Saw Aye  3 , Hlaing Myat Thu  3 , Moh Moh Htun  3 , Hnin Ohmar Soe  1 , Kay Thi Aye  1 , Kyaw Zin Thant  3 , Hyeon Jeong Hwang  2 , JaeHun Cheong  4
Affiliations

Distribution of hepatitis B virus genotypes in the general population of Myanmar via nationwide study

Yi Yi Kyaw et al. BMC Infect Dis. .

Abstract

Background: Hepatitis B virus (HBV) infections are a severe health concern worldwide. HBV is a DNA virus with a rapid rate of mutation. Based on heterogeneity of the nucleotide sequence, the HBV strains are divided into nine genotypes, each with a characteristic geographical distribution. Identifying and tracking alterations of HBV genotypes is important in epidemiological and transmission studies, and contributes to predicting the risk for development of severe liver disease and response to antiviral treatment. The present study was undertaken to detect HBV genotypes and sub-genotypes in the general population of different states and regions in Myanmar.

Methods: In 2015, a total of 5547 adults of the general population, residing in seven states, seven regions and the Nay Pyi Taw Union Territory, were screened for Hepatitis B Surface antigen (HBsAg) by the immunochromatographic test (ICT). Of the 353 HBsAg positive samples, the HBVDNA was identified using polymerase chain reactions (PCR) targeting the DNA sequences encoding the Pre-S region. A total of 153 PCR positive samples were subsequently subjected to genotyping by partial genome sequencing in both directions. The resulting sequences were then edited, aligned, and compared with reference sequences using the National Centre for Biotechnology Information (NCBI) web-based genotyping tool.

Results: Three HBV genotypes (HBV genotype B, genotype C and genotype D) were detected in Myanmar, of which genotype HBV genotype C (66.7%) was the most prevalent, followed by HBV genotype D (32%) and HBV genotype B (1.3%). Sub-genotyping revealed a total of 7 variants within the B, C and D genotypes: 2 (B4 and B5) in HBV genotype B, 3 (C1, C5 and C7) in HBV genotype C, and 2 (D3 and D6) in HBV genotype D.

Conclusion: HBV genotype C, sub-genotype C1 was predominantly distributed in all states and regions of Myanmar. This study is the first report on the nationwide distribution of HBV genotypes and sub-genotypes in Myanmar. We believe our findings will enable huge support for the hepatitis disease surveillance program, since HBV infection is one of the National Priority Diseases in Myanmar.

Keywords: Genotype; Hepatitis B virus; Myanmar; Sub-genotype.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow Chart Diagram of HBV genotyping study
Fig. 2
Fig. 2
HBV genotype distribution in five geographical regions of Myanmar
Fig. 3
Fig. 3
Cladogram of 153 HBV sequences with NCBI major genotype reference sequences. The phylogenetic tree was constructed using 578 bp nucleotide sequences (2860–222) PreS1/ PreS2 region of the reference genome of hepatitis B genotype representing the standard genotypes throughout the world. Phylogenetic analysis by neighbour-joining method with bootstrap test of 1000 replicates and maximum composite likelihood model was applied. Color triangles show the different reference major genotypes from the NCBI GenBank
Fig. 4
Fig. 4
Cladogram of HBV sub-genotypes of genotype D. Phylogenetic tree was constructed using 578 bp nucleotide sequences (2860–222) PreS1/ PreS2 region in the MEGA X, using the Maximum Likelihood method with bootstrap test of 1000 replicates and Kimura two parameter model. GenBank reference sequences are shown as HBV sub-genotype and accession number. Study sequences were designed by study number
Fig. 5
Fig. 5
Cladogram of HBV sub-genotypes of genotypes C. Phylogenetic tree was constructed using 578 bp nucleotide sequences (2860–222) PreS1/ PreS2 region in MEGA X using the neighbor-joining method with bootstrap test of 1000 replicates and maximum composite likelihood model. GenBank reference sequences are shown as HBV sub-genotype and accession number. Study sequences were designed by study number
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