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A Cluster of Acute Hepatitis E Infection in United Nations Bangladeshi Peacekeepers in Haiti
Joseph J. Drabick
Joseph J. Drabick
Department of Bacterial Diseases, Division of Preventive Medicine, and Department of Virus Diseases, Walter Reed Army Institute of Research, Washington, District of Columbia
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Jeffrey M. Gambel
Jeffrey M. Gambel
Department of Bacterial Diseases, Division of Preventive Medicine, and Department of Virus Diseases, Walter Reed Army Institute of Research, Washington, District of Columbia
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Vera S. Gouvea
Vera S. Gouvea
Department of Bacterial Diseases, Division of Preventive Medicine, and Department of Virus Diseases, Walter Reed Army Institute of Research, Washington, District of Columbia
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Jeffrey D. Caudill
Jeffrey D. Caudill
Department of Bacterial Diseases, Division of Preventive Medicine, and Department of Virus Diseases, Walter Reed Army Institute of Research, Washington, District of Columbia
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Wellington Sun
Wellington Sun
Department of Bacterial Diseases, Division of Preventive Medicine, and Department of Virus Diseases, Walter Reed Army Institute of Research, Washington, District of Columbia
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Charles H. Hoke Jr.
Charles H. Hoke Jr.
Department of Bacterial Diseases, Division of Preventive Medicine, and Department of Virus Diseases, Walter Reed Army Institute of Research, Washington, District of Columbia
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Bruce L. Innis
Bruce L. Innis
Department of Bacterial Diseases, Division of Preventive Medicine, and Department of Virus Diseases, Walter Reed Army Institute of Research, Washington, District of Columbia
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In the fall of 1995, within a month of deployment to Haiti for peacekeeping duty, four Bangladeshi soldiers developed acute icteric hepatitis in rapid succession. Hepatitis E virus (HEV) was found to be the etiology by demonstrating HEV genomic sequences in serum samples by the polymerase chain reaction (PCR) and serologically by the detection of elevated IgM titers to HEV. No case had serologic evidence of acute hepatitis A or C infection. The soldiers had probably acquired their infection while living in a cantonment area outside Dhaka, Bangladesh for one month prior to deployment. Cloning and sequencing of amplified PCR products demonstrated a single strain suggestive of a common source of infection. Furthermore, high genomic identity with Asian strains of HEV and dissimilarity with the Mexican strain was demonstrated, verifying that the strain had indeed been imported. Human waste management from the Bangladesh camp in Haiti was strictly controlled and no secondary cases were observed. A convenience sample of 105 (12%) soldiers from the Bangladesh battalion (850 men) revealed anicteric or asymptomatic HEV infection in seven (7%) of 105. This report contains the first demonstration of acute hepatitis E in natives of Bangladesh and demonstrates the power of the PCR in the rapid diagnosis and epidemiologic analysis of HEV infection. More importantly, this cluster demonstrates the importation of an important infectious disease by multinational peacekeepers to a potentially susceptible host country.
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