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Surveillance at Private Laboratories Identifies Small Outbreaks of Hepatitis E in Urban Bangladesh
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.
Author Notes
Financial support: The study was funded by CDC Atlanta, cooperative agreement number 5U01CI000628-01. icddr,b acknowledges with gratitude the commitment of the U.S. CDC and the Government of Bangladesh to its research effort and is thankful to the governments of Australia, Bangladesh, Canada, Sweden, and the United Kingdom for providing core/unrestricted support.
Authors' addresses: Hossain M. S. Sazzad and Emily S. Gurley, Program on Emerging Infection, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh, E-mails: sazzad@icddrb.org and egurley@icddrb.org. Alain B. Labrique, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, and Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, E-mail: alabriq1@jhu.edu. Chong-Gee Teo, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: enz0@cdc.gov. Stephen P. Luby, Department of Medicine, Stanford University, Stanford, CA, E-mail: sluby@stanford.edu.