High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan

Hdl Handle:
http://hdl.handle.net/10144/116354
Title:
High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan
Authors:
Boccia, Delia; Guthmann, Jean-Paul; Klovstad, Hilde; Hamid, Nuha; Tatay, Mercedes; Ciglenecki, Iza; Nizou, Jacques-Yves; Nicand, Elisabeth; Guerin, Philippe Jean
Journal:
Clinical Infectious Diseases : an official publication of the Infectious Diseases Society of America
Abstract:
BACKGROUND: Hepatitis E virus (HEV) causes acute onset of jaundice and a high case-fatality ratio in pregnant women. We provide a clinical description of hospitalized case patients and assess the specific impact on pregnant women during a large epidemic of HEV infection in a displaced population in Mornay camp (78,800 inhabitants), western Darfur, Sudan. METHODS: We reviewed hospital records. A sample of 20 clinical cases underwent laboratory confirmation. These patients were tested for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody to HEV (serum) and for amplification of the HEV genome (serum and stool). We performed a cross-sectional survey in the community to determine the attack rate and case-fatality ratio in pregnant women. RESULTS: Over 6 months, 253 HEV cases were recorded at the hospital, of which 61 (24.1%) were in pregnant women. A total of 72 cases (39.1% of those for whom clinical records were available) had a diagnosis of hepatic encephalopathy. Of the 45 who died (case-fatality ratio, 17.8%), 19 were pregnant women (specific case-fatality ratio, 31.1%). Acute hepatitis E was confirmed in 95% (19/20) of cases sampled; 18 case-patients were positive for IgG (optical density ratio > or =3), for IgM (optical density ratio >2 ), or for both, whereas 1 was negative for IgG and IgM but positive for HEV RNA in serum. The survey identified 220 jaundiced women among the 1133 pregnant women recorded over 3 months (attack rate, 19.4%). A total of 18 deaths were recorded among these jaundiced pregnant women (specific case-fatality ratio, 8.2%). CONCLUSIONS: This large epidemic of HEV infection illustrates the dramatic impact of this disease on pregnant women. Timely interventions and a vaccine are urgently needed to prevent mortality in this special group.
Affiliation:
European Programme for Intervention Epidemiology Training, Stockholm, Sweden; Health Protection Agency–Centre for Infection, London, United Kingdom; Epicentre, Paris, France; Medecins Sans Frontieres, Paris, France; National Reference Centre of Enterically Transmitted Hepatitis (Hepatitis E Virus), Teaching Military Hospital Val de Grace, Paris, France; Norwegian Institute of Public Health, Oslo, Norway; Norwegian Field Epidemiology Training Programme, Oslo, Norway; World Health Organization, Khartoum, Sudan
Issue Date:
12-May-2006
URI:
http://hdl.handle.net/10144/116354
DOI:
10.1086/504322
PubMed ID:
16705571
Additional Links:
http://www.journals.uchicago.edu/doi/abs/10.1086/504322?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
Type:
Article
Language:
en
ISSN:
1537-6591
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorBoccia, Deliaen
dc.contributor.authorGuthmann, Jean-Paulen
dc.contributor.authorKlovstad, Hildeen
dc.contributor.authorHamid, Nuhaen
dc.contributor.authorTatay, Mercedesen
dc.contributor.authorCiglenecki, Izaen
dc.contributor.authorNizou, Jacques-Yvesen
dc.contributor.authorNicand, Elisabethen
dc.contributor.authorGuerin, Philippe Jeanen
dc.date.accessioned2010-11-25T19:26:16Z-
dc.date.available2010-11-25T19:26:16Z-
dc.date.issued2006-05-12-
dc.identifier.citationClin. Infect. Dis. 2006;42(12):1679-84en
dc.identifier.issn1537-6591-
dc.identifier.pmid16705571-
dc.identifier.doi10.1086/504322-
dc.identifier.urihttp://hdl.handle.net/10144/116354-
dc.description.abstractBACKGROUND: Hepatitis E virus (HEV) causes acute onset of jaundice and a high case-fatality ratio in pregnant women. We provide a clinical description of hospitalized case patients and assess the specific impact on pregnant women during a large epidemic of HEV infection in a displaced population in Mornay camp (78,800 inhabitants), western Darfur, Sudan. METHODS: We reviewed hospital records. A sample of 20 clinical cases underwent laboratory confirmation. These patients were tested for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody to HEV (serum) and for amplification of the HEV genome (serum and stool). We performed a cross-sectional survey in the community to determine the attack rate and case-fatality ratio in pregnant women. RESULTS: Over 6 months, 253 HEV cases were recorded at the hospital, of which 61 (24.1%) were in pregnant women. A total of 72 cases (39.1% of those for whom clinical records were available) had a diagnosis of hepatic encephalopathy. Of the 45 who died (case-fatality ratio, 17.8%), 19 were pregnant women (specific case-fatality ratio, 31.1%). Acute hepatitis E was confirmed in 95% (19/20) of cases sampled; 18 case-patients were positive for IgG (optical density ratio > or =3), for IgM (optical density ratio >2 ), or for both, whereas 1 was negative for IgG and IgM but positive for HEV RNA in serum. The survey identified 220 jaundiced women among the 1133 pregnant women recorded over 3 months (attack rate, 19.4%). A total of 18 deaths were recorded among these jaundiced pregnant women (specific case-fatality ratio, 8.2%). CONCLUSIONS: This large epidemic of HEV infection illustrates the dramatic impact of this disease on pregnant women. Timely interventions and a vaccine are urgently needed to prevent mortality in this special group.en
dc.language.isoenen
dc.relation.urlhttp://www.journals.uchicago.edu/doi/abs/10.1086/504322?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmeden
dc.rightsArchived with thanks to Clinical Infectious Diseases : an official publication of the Infectious Diseases Society of Americaen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAntibodies, Viralen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshDisease Outbreaksen
dc.subject.meshFemaleen
dc.subject.meshHepatitis Een
dc.subject.meshHumansen
dc.subject.meshImmunoglobulin Gen
dc.subject.meshImmunoglobulin Men
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshPregnancyen
dc.subject.meshRNA, Viralen
dc.subject.meshRefugeesen
dc.subject.meshRetrospective Studiesen
dc.subject.meshSudanen
dc.titleHigh mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudanen
dc.typeArticleen
dc.contributor.departmentEuropean Programme for Intervention Epidemiology Training, Stockholm, Sweden; Health Protection Agency–Centre for Infection, London, United Kingdom; Epicentre, Paris, France; Medecins Sans Frontieres, Paris, France; National Reference Centre of Enterically Transmitted Hepatitis (Hepatitis E Virus), Teaching Military Hospital Val de Grace, Paris, France; Norwegian Institute of Public Health, Oslo, Norway; Norwegian Field Epidemiology Training Programme, Oslo, Norway; World Health Organization, Khartoum, Sudanen
dc.identifier.journalClinical Infectious Diseases : an official publication of the Infectious Diseases Society of Americaen

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