Prevalence, risk factors, and viral load quantification of HBV infection among hospital patients: A cross-sectional investigation in Mogadishu, Somalia

Bashiru Garba; Amino Adan Mohamud; Fartuun Hassan Mohamed; Ayan Aden Moussa; Yusuf Yakubu; Najib Isse Dirie; Aya Muktar Abdulatif; Jamal Hassan Mohamoud; Abdirasak Sharif Ali; Abdurrahman Hassan Jibril

doi:10.1371/journal.pone.0340800

Peer Review History

Original SubmissionNovember 8, 2025
1 Dec 2025 Decision Letter - Ashraf Elbahrawy, Editor Dear Dr. Garba, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 15 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. 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[Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: No Reviewer #2: Yes ****** Reviewer #1: This was a well-designed study that showed the prevalence and molecular detection of HBV among hospital patients in Mogadishu, Somalia. The authors clearly stated the problem and the aim of the study. The methodology used was standard for this type of study. However, some issues need to be addressed: 1) HBsAg was positive in 31 patients, and HBV DNA was detected in 6 patients. It means 25 HBsAg-positive patients did not have detectable HBV DNA. Considering the high sensitivity and specificity of HBsAg rapid test kit (100% and 99.43%), it seems real-time PCR was not sensitive enough to detect low copy numbers of HBV DNA. This issue should be discussed in the discussion section. 2) Kindly clarify in the manuscript whether participants’ vaccination history was self-reported only or confirmed using clinical records. The limitations of relying on self-reported clinical history/patient recall should be adequately addressed in the manuscript where appropriate. 3) Information on vaccination in the study area has not been mentioned in the introduction section. Vaccination coverage, when did the vaccination start, which age group is targeted, these are missing in the introduction section. These inform the readers about the situation in the study area and support why the study was conducted. 4) The limitations of the study are not sufficiently discussed. 5) I would recommend a linguistic revision of the manuscript by a native speaker as some parts do not read very well. Reviewer #2: This study looks at the Prevalence, risk factors, and viral load quantification of HBV infection among hospital patients: A cross-sectional investigation in Mogadishu, Somalia. It is well written but I have a few concerns for the authors to address. 1. 60…. Kindly clarify the body fluids through which transmission can occur since is not all body fluids 2. 214….. Kindly clarify what Dugsi/Madrasa is 3. 229…… 14.1% indicated they have chronic liver disease, what type of chronic liver disease. Does that mean some of the patients were aware of their hepatitis B status? Did you exclude patient who have screen for HBV already? 4. 245 – 246…….In the methods, you subjected only the 31 samples to RT-PCR test, so you can claim those you did not do RT-PCR were negative. Therefore, this statement ‘’The RT-PCR results showed that 6 samples (2.2%) were confirmed positive for HBV DNA, indicating active viral replication, while 264 samples (97.8%) were negative’’ cannot be true. What about if some of the samples you did not do PCR for have occult hepatitis B infection 5. 371- 378 ….that among the infected individuals in our cohort, the vast majority (80.6%) were likely 371 inactive carriers with no detectable viral replication….. kindly replaced inactive carriers with a correct terminology ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: Yes: Fatemeh Farshadpour Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. https://doi.org/10.1371/journal.pone.0340800.r001
Revision 1
16 Dec 2025 Author Response Response to editorial and reviewer comments PONE-D-25-59057: Prevalence, risk factors, and viral load quantification of HBV infection among hospital patients: A cross-sectional investigation in Mogadishu, Somalia We would like to sincerely thank the Editor and Reviewers for their careful evaluation of our manuscript and for the insightful comments and suggestions provided. Their constructive feedback has helped us to clarify key methodological and interpretive aspects of the study, and we fully appreciate and share many of the concerns and priorities they have highlighted in relation to hepatitis B prevention and control in Somalia. Editorial review/Journal Requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Response: The manuscript has been edited to conform with the journal guidelines 2. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Response: The questionnaire on inclusivity in global research has been filled and submitted as supplimentary document. 3. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. Response: I have added my ORCID to the submission system 4. Please upload a new copy of Figures 1 and 2 as the detail is not clear. Response: An improved figure has been submitted as attachments. 5. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Tables 4 and 5 in your text; if accepted, production will need this reference to link the reader to the Table. Response: Both Tables 4 and 5 has been cited accordingly. Reviewer 1 This was a well-designed study that showed the prevalence and molecular detection of HBV among hospital patients in Mogadishu, Somalia. The authors clearly stated the problem and the aim of the study. The methodology used was standard for this type of study. However, some issues need to be addressed: 1. HBsAg was positive in 31 patients, and HBV DNA was detected in 6 patients. It means 25 HBsAg-positive patients did not have detectable HBV DNA. Considering the high sensitivity and specificity of HBsAg rapid test kit (100% and 99.43%), it seems real-time PCR was not sensitive enough to detect low copy numbers of HBV DNA. This issue should be discussed in the discussion section. Response: Thank you for this critical observation. We have now expanded the Discussion to explain that this pattern likely reflects low level or inactive HBV infection with viral loads below the PCR assay’s limit of detection, rather than suboptimal PCR assay performance, and we have supported this with additional references. We also acknowledge this as a limitation of our virological assessment and recommend future studies using more sensitive molecular assays and longitudinal sampling to better characterise low level viremia in this setting (line 387-403). 2. Kindly clarify in the manuscript whether participants’ vaccination history was self-reported only or confirmed using clinical records. The limitations of relying on self-reported clinical history/patient recall should be adequately addressed in the manuscript where appropriate. Response: Thank you once again, we appreciate this comment. We have clarified in the Methods and Limitation that vaccination history and other clinical risk factors were collected by self report only (line 143-146; line 484-487). 3. Information on vaccination in the study area has not been mentioned in the introduction section. Vaccination coverage, when did the vaccination start, which age group is targeted, these are missing in the introduction section. These inform the readers about the situation in the study area and support why the study was conducted. Response: Thank you for this comment. We have revised the Introduction to provide insights into the national HBV vaccination programme in Somalia. 4) The limitations of the study are not sufficiently discussed (line 77-87). 4. The limitations of the study are not sufficiently discussed." Response: Thank you for pointing out the need to expand our study limitations. In the revised manuscript, we have strengthened the Limitations section to provide a more transparent appraisal of the potential biases and interpretive constraints of our findings (474-481; 484-487). 5. I would recommend a linguistic revision of the manuscript by a native speaker as some parts do not read very well. Response: We also appreciate your observation regarding the language and readability of the manuscript. The full text has now undergone thorough language editing, including review by a fluent English speaker. Reviewer 2 This study looks at the Prevalence, risk factors, and viral load quantification of HBV infection among hospital patients: A cross-sectional investigation in Mogadishu, Somalia. It is well written but I have a few concerns for the authors to address. 1. 60…. Kindly clarify the body fluids through which transmission can occur since is not all body fluids Response: Thank you for this important clarification. We have revised the sentence to specify that HBV transmission occurs primarily through infected blood, semen, vaginal secretions (line 59-60). 2. 214….. Kindly clarify what Dugsi/Madrasa is Response: We have explained as footnote that Dugsi/Madrasa means islamic religious school (line 229). 3. 229…… 14.1% indicated they have chronic liver disease, what type of chronic liver disease. Does that mean some of the patients were aware of their hepatitis B status? Did you exclude patient who have screen for HBV already? Response: Thank you once again. In our questionnaire, ‘chronic liver disease’ was captured as a self reported, broad clinical category and was not differentiated into specific aetiologies (HBV related cirrhosis, hepatitis C, or non viral liver disease), and we have now clarified this in the Methods and acknowledged it as a limitation. This variable therefore does not necessarily indicate that participants knew their hepatitis B status. We did not specifically exclude patients with a prior HBV test; however, individuals with a documented previous diagnosis were not systematically identified, and all eligible consenting outpatients were screened irrespective of past testing history. This clarification has been added to the Methods and Limitations sections (line 243-244). 4. 245 – 246…….In the methods, you subjected only the 31 samples to RT-PCR test, so you can claim those you did not do RT-PCR were negative. Therefore, this statement ‘’The RT-PCR results showed that 6 samples (2.2%) were confirmed positive for HBV DNA, indicating active viral replication, while 264 samples (97.8%) were negative’’ cannot be true. What about if some of the samples you did not do PCR for have occult hepatitis B infection Response: Thank you one again for this important observation. We agree that our original phrasing could be misinterpreted as implying that all 264 HBsAg negative samples were PCR negative, although RT PCR was performed only on the 31 HBsAg positive specimens. We have revised the Results to report HBV DNA positivity as 6 of 31 HBsAg positive patients (2.2% of all participants), and we now explicitly state that HBV DNA testing was not done for HBsAg negative samples. In addition, we have added a limitation noting that occult HBV infection among HBsAg negative individuals could not be assessed and that the true burden of HBV infection may therefore be underestimated (line 261-267; line 478-481). 5. 371- 378 ….that among the infected individuals in our cohort, the vast majority (80.6%) were likely 371 inactive carriers with no detectable viral replication….. kindly replaced inactive carriers with a correct terminology Response: Thank you for this important clarification. We agree that the term ‘inactive carriers’ is not strictly appropriate. We have therefore replaced this wording with a more accurate statement that reflects the data without implying a specific disease phase (line 387-403). Attachments Attachment Submitted filename: R1_Response to editorial and reviewer comments.docx https://doi.org/10.1371/journal.pone.0340800.r002
28 Dec 2025 Decision Letter - Ashraf Elbahrawy, Editor Prevalence, risk factors, and viral load quantification of HBV infection among hospital patients: A cross-sectional investigation in Mogadishu, Somalia PONE-D-25-59057R1 Dear Dr. Garba, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Ashraf Elbahrawy Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Thank you to the Authors for addressing the comments and suggestions that I have made to the manuscript. Reviewer #2: The authors have addressed all my concerns raised in my first review. the manuscript is look good for publication. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: Yes: Fatemeh Farshadpour Reviewer #2: Yes: Dr. Amoako Duah ******** https://doi.org/10.1371/journal.pone.0340800.r003
Formally Accepted
Acceptance Letter - Ashraf Elbahrawy, Editor PONE-D-25-59057R1 PLOS One Dear Dr. Garba, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Ashraf Elbahrawy Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0340800.r004

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