1921
Volume 83, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

An outbreak of hepatitis E virus (HEV) began in October 2007 in northern Uganda. To determine risk factors and sources for ongoing transmission, we conducted both a case-control study and an environmental investigation. A case patient was defined as having serologic evidence of HEV infection, whereas controls were seronegative. We identified risk factors for infection by univariable and multivariable analyses using conditional logistic regression. Several water sources were tested for HEV RNA. Among 112 cases and 145 controls, storage of drinking water in large-mouthed vessels (adjusted odds ratios [AOR] = 2.83; 95% confidence interval [CI] = 1.16–6.94) and washing hands in a group basin (AOR = 1.90; 95% CI = 1.07–3.38) were associated with HEV infection. HEV RNA was detected from communal hand-rinse and surface-water samples. The epidemiologic and environmental water-testing results suggest that household-level factors played an important role in the transmission of HEV—modalities that have been previously underappreciated.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2010.10-0384
2010-11-05
2017-12-18
Loading full text...

Full text loading...

/deliver/fulltext/14761645/83/5/1170.html?itemId=/content/journals/10.4269/ajtmh.2010.10-0384&mimeType=html&fmt=ahah

References

  1. World Health Organization, 2001. Hepatitis E. Document WHO/CDSCSR/EDC/2002.12. Geneva, Switzerland: World Health Organization.
  2. Labrique AB, Thomas DL, Stoszek SK, Nelson KE, , 1999. Hepatitis E: an emerging infectious disease. Epidemiol Rev 21: 162179.[Crossref]
  3. Centers for Disease Control and Prevention, 1987. Enterically transmitted non-A, non-B hepatitis—East Africa. MMWR Morb Mortal Wkly Rep 36: 241244.
  4. San-Shwe Myint-Myint-Soe, 1985. Epidemiological criteria as indication of non-A, non-B hepatitis in a community. Lancet 2: 828.[Crossref]
  5. Skidmore SJ, , 1999. Factors in spread of hepatitis E. Lancet 354: 10491050.[Crossref]
  6. Skidmore S, , 2002. Overview of hepatitis E virus. Curr Infect Dis Rep 4: 118123.[Crossref]
  7. Shrestha SM, Shikata T, Purcell RH, Uchida T, , 1991. Enteric non-A, non-B hepatitis in Nepal: clinical and epidemiological observation. , eds. Viral Hepatitis C, D, and E: Proceedings of the International Meeting of Non-A, Non-B Hepatitis. Amsterdam, The Netherlands: Elsevier Science Publishers, 265275.
  8. Clayson ET, Shrestha MP, Vaughn DW, Snitbhan R, Shrestha KB, Longer CF, Innis BL, , 1997. Rates of hepatitis E virus infection among adolescents and adults in Katmandu, Nepal. J Infect Dis 176: 763766.[Crossref]
  9. Boccia D, Guthmann JP, Klovstad H, Hamid N, Tatay M, Cigelnecki I, Nizou JY, Nicand E, Guerin PJ, , 2006. High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan. Clin Infect Dis 42: 16791684.[Crossref]
  10. Teshale EH, Howard CM, Grytdal SP, Handzel TR, Barry V, Kamili S, Drobeniuc J, Okware S, Downing R, Tappero JW, Bakamutumaho B, Teo CG, Ward JW, Holmberg SD, Hu DJ, Hepatitis E, , 2010. Epidemic, Uganda. Emerg Infect Dis 16: 126129.[Crossref]
  11. Smith CM, Hill VR, , 2009. Dead-end hollow fiber ultrafiltration for recovery of diverse microbes in water. Appl Environ Microbiol 75: 52845289.[Crossref]
  12. Jothikumar N, Cromeans TL, Robertson BH, Meng XJ, Hill VR, , 2006. A broadly reactive one-step real-time RT-PCR assay for rapid and sensitive detection of hepatitis E virus. J Virol Methods 131: 6571.[Crossref]
  13. Roberts L, Chartier Y, Chartier O, Malenga G, Toole M, Rodka H, , 2001. Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial. Bull World Health Organ 79: 280287.
  14. Vishwanathan R, , 1957. Infectious hepatitis in Delhi (1955–56): a critical study: epidemiology. Indian J Med Res 45 (Suppl 1): 129.
  15. Khuroo MS, , 1991. The enterically transmitted non-A, non-B hepatitis. Indian J Gastroenterol 10: 96100.
  16. Bile K, Isse A, Mohamud O, Allebeck P, Nilsson L, Norder H, Mushahwar I, Magnius L, , 1994. Contrasting roles of rivers and wells as sources of drinking water on attack and fatality rates in a hepatitis E epidemic in Somalia. Am J Trop Med Hyg 51: 466474.
  17. Pina S, Jofre J, Emerson SU, Purcell RH, Girones R, , 1998. Characterization of a strain of infectious hepatitis E virus isolated from sewage in an area where hepatitis E is not endemic. Appl Environ Microbiol 64: 44854488.
  18. Jothikumar N, Aparna K, Kamatchiammal S, Paulmurugan R, Saravanadevi S, Khanna P, , 1993. Detection of hepatitis E virus in raw and treated wastewater with the polymerase chain reaction. Appl Environ Microbiol 59: 25582562.
  19. World Health Organization, 2002. Guidelines for Drinking Water Quality. Addendum. Microbiological Agents in Drinking Water, 2nd ed. Geneva, Switzerland: World Health Organization.
  20. Isaacson M, Frean J, He J, Seriwatana J, Innis BL, , 2000. An outbreak of hepatitis E in Northern Namibia, 1983. Am J Trop Med Hyg 62: 619625.
  21. Guthmann JP, Klovstad H, Boccia D, Hamid N, Pinoges L, Nizou JY, Tatay M, Diaz F, Moren A, Grais RF, Ciglenecki I, Nicand E, Guerin PJ, , 2006. A large outbreak of hepatitis E among a displaced population in Darfur, Sudan, 2004: the role of water treatment methods. Clin Infect Dis 42: 16851691.[Crossref]
  22. Shrestha MP, Scott RM, Joshi DM, Mammen MP, Jr Thapa GB, Thapa N, Myint KS, Fourneau M, Kuschner RA, Shrestha SK, David MP, Seriwatana J, Vaughn DW, Safary A, Endy TP, Innis BL, , 2007. Safety and efficacy of a recombinant hepatitis E vaccine. N Engl J Med 356: 895903.[Crossref]
  23. Zhang J, Liu CB, Li RC, Li YM, Zheng YJ, Li YP, Luo D, Pan BB, Nong Y, Ge SX, Xiong JH, Shih JW, Ng MH, Xia NS, , 2009. Randomized-controlled phase II clinical trial of a bacterially expressed recombinant hepatitis E vaccine. Vaccine 27: 18691874.[Crossref]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2010.10-0384
Loading
/content/journals/10.4269/ajtmh.2010.10-0384
Loading

Data & Media loading...

  • Received : 06 Jul 2010
  • Accepted : 22 Jul 2010

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error