An outbreak of fulminant hepatitis delta in the Waorani, an indigenous people of the Amazon basin of Ecuador.

S R Manock Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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P M Kelley Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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K C Hyams Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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R Douce Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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R D Smalligan Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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D M Watts Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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T W Sharp Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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J L Casey Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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J L Gerin Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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R Engle Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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A Alava-Alprecht Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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C M Martínez Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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N B Bravo Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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A G Guevara Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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K L Russell Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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W Mendoza Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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C Vimos Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.

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An outbreak of delta hepatitis occurred during 1998 among the Waorani of the Amazon basin of Ecuador. Among 58 people identified with jaundice, 79% lived in four of 22 Waorani communities. Serum hepatitis B surface antigen (HBsAg) was found in the sera of 54% of the jaundiced persons, and 14% of asymptomatic persons. Ninety-five percent of 105 asymptomatic Waorani had hepatitis B core (HBc) IgG antibody, versus 98% of 51 with jaundice. These data confirm that hepatitis B virus (HBV) infection is highly endemic among the Waorani. Sixteen of 23 (70%) HBsAg carriers identified at the onset of the epidemic had serologic markers for hepatitis D virus (HDV) infection. All 16 were jaundiced, where as only two of seven (29%) with negative HDV serology were jaundiced (P = .0006). The delta cases clustered in families, 69% were children and most involved superinfection of people chronically infected with HBV. The data suggest that HDV spread rapidly by a horizontal mode of transmission other than by the sexual route.

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