A Waterborne Outbreak of Hepatitis E Virus Transmission in Southwestern Vietnam

Andrew Lee CorwinU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Ha Ba KhiemU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Edward T. ClaysonU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Pham Kim SacU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Vo Thi Tuyet NhungU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Vu Thuy YenU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Cao Thi Thu CucU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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David VaughnU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Janick MervenU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Thomas L. RichieU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Maidy Pranata PutriU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Junkun HeU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Robert GrahamU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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F. Stephen WignallU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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Kenneth C. HyamsU.S. Naval Medical Research Unit No. 2, Pasteur Institute, Armed Forces Research Institute of Medical Sciences, Abbott Laboratories, U.S. Naval Medical Research Institute, Jakarta, Indonesia

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A hepatitis outbreak affecting primarily adults occurred in southwestern Vietnam, along the Hau river bordering Cambodia, in June and July 1994. One month after the outbreak, sera and epidemiologic information were collected from 150 subjects: 50 patient cases, 50 matched, healthy community controls, and 50 geographic controls living 50 km upriver. The prevalence of immunoglobulin G (IgG) to hepatitis E virus (HEV) was significantly (P < 0.001) higher (76%) among cases than among the matched (38%) and geographic (38%) control populations. Immunoglobulin M to HEV was detected by enzyme-linked immunosorbent assay and Western blot in 16% of sera collected from patients one month after the outbreak. Hepatitis E virus RNA was detected with the polymerase chain reaction in 6% of sera from patients; RNA was not detected in either control group. These results indicate that HEV was the etiologic agent responsible for the outbreak. Children were under-represented among clinical cases. River water served as the principal source for drinking and bathing among most (96%) of the case and control study populations. Boiling of drinking water was negatively associated (P < 0.05) with IgG anti-HEV seropositivity. Unusually heavy rainfall likely contributed to conditions that favored the outbreak. This is the first recognized outbreak of epidemic HEV transmission in Indo-China.

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