Volume 96, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Although large outbreaks of hepatitis E are regularly identified in south Asia, the majority of south Asian countries lack surveillance systems for this disease, which has hindered burden of disease estimates and prioritization of resources for prevention. Our study aimed to identify small hepatitis E outbreaks through a sentinel private laboratory in Dhaka, Bangladesh. We identified patients with detectable IgM antibody against hepatitis E virus. We defined a small outbreak as at least two laboratory-confirmed cases or ≥ 2 acute jaundice cases from the sentinel cases' family, neighborhood, or workplace. From November 2008 to November 2009, we identified 29 small outbreaks of hepatitis E from one private laboratory. The median number of cases in each outbreak was three. Cases were identified every month. Eighteen outbreaks occurred among families or neighbors, and 11 in the workplace. Among 103 cases identified as part of outbreaks, 31 (30%) sought care for diagnosis. In Bangladesh, collaboration between government public health surveillance and private laboratories can strengthen capacity for outbreak detection and improve estimates of disease burden.


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  1. Reyes GR, Purdy MA, Kim JP, Luk K-C, Young LM, Fry KE, Bradley DW, , 1990. Isolation of a cDNA from the virus responsible for enterically transmitted non-A, non-B hepatitis. Science 247: 13351339.[Crossref]
  2. Viswathanan R, , 1957. Infectious hepatitis in Delhi (1955–56): a critical study; epidemiology. Indian J Med Res 45: 130.
  3. Kane MA, Bradley DW, Shrestha SM, Maynard JE, Cook EH, Mishra RP, Joshi DD, , 1984. Epidemic non-A, non-B hepatitis in Nepal. Recovery of a possible etiologic agent and transmission studies in marmosets. JAMA 252: 31403145.[Crossref]
  4. Labrique AB, Zaman K, Hossain Z, Saha P, Yunus M, Hossain A, Ticehurst J, Nelson KE, , 2009. Population seroprevalence of hepatitis E virus antibodies in rural Bangladesh. Am J Trop Med Hyg 81: 875881.[Crossref]
  5. Gambel JM, Drabick JJ, Seriwatana J, Innis BL, , 1998. Seroprevalence of hepatitis E virus among United Nations Mission in Haiti (UNMIH) peacekeepers, 1995. Am J Trop Med Hyg 58: 731736.
  6. Sheikh A, Sugitani M, Kinukawa N, Moriyama M, Arakawa Y, Komiyama K, Li TC, Takeda N, Ishaque SM, Hasan M, Suzuki K, , 2002. Hepatitis e virus infection in fulminant hepatitis patients and an apparently healthy population in Bangladesh. Am J Trop Med Hyg 66: 721724.
  7. Emerson SU, Purcell RH, , 2003. Hepatitis E virus. Rev Med Virol 13: 145154.[Crossref]
  8. Talukdar PK, Rahman M, Rahman M, Nabi A, Islam Z, Hoque MM, Endtz HP, Islam MA, , 2013. Antimicrobial resistance, virulence factors and genetic diversity of Escherichia coli isolates from household water supply in Dhaka, Bangladesh. PLoS One 8: e61090.[Crossref]
  9. Gurley ES, Hossain MJ, Paul RC, Sazzad HM, Islam MS, Parveen S, Faruque LI, Husain M, Ara K, Jahan Y, Rahman M, Luby SP, , 2014. Outbreak of hepatitis E in urban Bangladesh resulting in maternal and perinatal mortality. Clin Infect Dis 59: 658665.[Crossref]
  10. Murray CJ, Lopez AD, , 1997. Global mortality, disability, and the contribution of risk factors: global burden of disease study. Lancet 349: 14361442.[Crossref]
  11. Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST, , 2012. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology 55: 988997.[Crossref]
  12. Zhu F-C, Zhang J, Zhang X-F, Zhou C, Wang Z-Z, Huang S-J, Wang H, Yang C-L, Jiang H-M, Cai J-P, , 2010. Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet 376: 895902.[Crossref]
  13. World Health Organization, 2016. Hepatitis E vaccine: WHO position paper, May 2015–recommendations. Vaccine 34: 304305.[Crossref]
  14. Bangladesh Bureau of Statistics, 2011. Bangladesh Population and Housing Census 2011. Dhaka, Bangladesh: Bangladesh Bureau of Statistics.
  15. Drobeniuc J, Meng J, Reuter G, Greene-Montfort T, Khudyakova N, Dimitrova Z, Kamili S, Teo CG, , 2010. Serologic assays specific to immunoglobulin M antibodies against hepatitis E virus: pangenotypic evaluation of performances. Clin Infect Dis 51: e24e27.[Crossref]
  16. Panda SK, Thakral D, Rehman S, , 2006. Hepatitis E virus. Rev Med Virol 17: 151180.[Crossref]
  17. Singh V, Singh V, Raje M, Nain CK, Singh K, , 1998. Routes of transmission in the hepatitis E epidemic of Saharanpur. Trop Gastroenterol 19: 107109.
  18. Swain SK, Baral P, Hutin YJ, Rao TV, Murhekar M, Gupte MD, , 2010. A hepatitis E outbreak caused by a temporary interruption in a municipal water treatment system, Baripada, Orissa, India, 2004. Trans R Soc Trop Med Hyg 104: 6669.[Crossref]
  19. Islam S, Begum HA, Nili NY, , 2010. Bacteriological safety assessment of municipal tap water and quality of bottle water in Dhaka city: health hazard analysis. Bangladesh Journal of Medical Microbiology 4: 913.
  20. Nahar A, Ahmed M, Chakraborty A, , 2011. A quality analysis of Dhaka WASA drinking water: detection and biochemical characterization of the isolates. J Environ Sci Nat Resour 4: 4149.
  21. Kumpel E, Nelson KL, , 2013. Comparing microbial water quality in an intermittent and continuous piped water supply. Water Res 47: 51765188.[Crossref]
  22. Gupta SK, Sheikh MA, Islam MS, Rahman KS, Jahan N, Rahman MM, Hoekstra RM, Johnston R, Ram PK, Luby S, , 2007. Usefulness of the hydrogen sulfide test for assessment of water quality in Bangladesh. J Appl Microbiol 104: 388395.
  23. Hughes JM, Wilson ME, Teshale EH, Hu DJ, Holmberg SD, , 2010. The two faces of hepatitis E virus. Clin Infect Dis 51: 328334.[Crossref]
  24. World Health Organization, 2010. The global prevalence of hepatitis E virus infection and susceptibility: a systematic review. Geneva, Switzerland: World Health Organization.
  25. Bangladesh Bureau of Statistics, 2011. Bangladesh Bureau of Statistics. Dhaka, Bangladesh: Bangladesh Bureau of Statistics.
  26. Director General Health Services Bangladesh, 2012. Health Bulletin 2012. Bangladesh: Director General Health Services, 5360.
  27. Khan FU, Bedi AS, Sparrow R, , 2014. Sickness and death: economic consequences and coping strategies of the urban poor in Bangladesh. World Dev 72: 255266.[Crossref]
  28. Hossain MZ, Sikder SS, Zaman K, Saha P, Yunus M, Nelson KE, Labrique AB, , 2013. Screening utility, local perceptions, and care-seeking for reported jaundeesh among respondents lacking signs of icterus in rural Bangladesh. J Health Popul Nutr 31: 367.[Crossref]
  29. Johnson MG, Williams J, Lee A, Bradley KK, , 2014. Completeness and timeliness of electronic vs. conventional laboratory reporting for communicable disease surveillance-Oklahoma, 2011. Public Health Rep 129: 261266.
  30. Widdowson M-A, Bosman A, van Straten E, Tinga M, Chaves S, van Eerden L, van Pelt W, , 2003. Automated, laboratory-based system using the internet for disease outbreak detection, The Netherlands. Emerg Infect Dis 9: 1046.[Crossref]
  31. Ahmed T, Lucas H, Khan AS, Islam R, Bhuiya A, Iqbal M, , 2014. eHealth and mHealth initiatives in Bangladesh: a scoping study. BMC Health Serv Res 14: 260.[Crossref]
  32. Asian Development Bank, 2016. Bangladesh: Dhaka Water Supply Sector Development Program. Available at: http://www.adb.org/projects/39405-013/main. Accessed May 20, 2016.
  33. World Health Organization, 2014. Draft Recommendations of the SAGE Working Group on Hepatitis E. Geneva, Switzerland: World Health Organization.

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  • Received : 20 May 2016
  • Accepted : 26 Oct 2016

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