By P. B. Bhattacharya. Second Edition. Revised, Re-written, Enlarged and Brought Up to Date. By J. C. Banerjea, M.B. (Cal.), M.R.C.P. (Lond.) and P. B. Bhattacharya, M.B., D.T.M. (Cal.). Bengal Medical Service, Upper. Pp. I–X. 1–413. U. N Dhur & Co., Calcutta. 1938
by George Cheever Shattuck, M.D., Professor of Tropical Medicine, Emeritus, Harvard Medical School and School of Public Health. 803 pp., illustrated. Cloth. New York: Appleton-Century-Crofts, Ind. 1951. Price $10.00
An outbreak of hepatitis caused by hepatitis E virus (HEV) in Abbottabad, Pakistan was traced to fecal contamination of a water system. Of 109 men hospitalized with hepatitis, 104 (95%) had serologic evidence of acute hepatitis E (IgM antibody to HEV [anti-HEV]), three (3%) probably had acute hepatitis E (high titers of IgG anti-HEV without IgM), and two had acute hepatitis A. Among a subset of 44 men with acute hepatitis E from whom three serum specimens were obtained over a four-month period, the anti-HEV IgG geometric mean titers (GMTs) decreased from 1,519 during the outbreak to 657 at four months. The IgM anti-HEV was detected in 40 (91%) of 44 sera obtained at admission (GMT = 533 during acute disease), but in only six (14%) four months later. The prevalence of anti-HEV in this population before the outbreak was estimated to be 30%. The presence of IgG anti-HEV appeared to protect against clinical hepatitis or development of serologic evidence of new infection with HEV. This is the second major epidemic of hepatitis E in the Pakistani military confirmed by an anti-HEV enzyme-linked immunosorbent assay (ELISA). Evidence that pre-existing antibody as measured by this ELISA protects against disease is important for assessment of vaccine development.