A Large Outbreak of Hepatitis E Among a Displaced Population in Darfur, Sudan, 2004: The Role of Water Treatment Methods.

Hdl Handle:
http://hdl.handle.net/10144/17670
Title:
A Large Outbreak of Hepatitis E Among a Displaced Population in Darfur, Sudan, 2004: The Role of Water Treatment Methods.
Authors:
Guthmann, J P; Klovstad, H; Boccia, D; Hamid, N; Pinoges, L; Nizou, J Y; Tatay, M; Diaz, F; Moren, A; Grais, R; Ciglenecki, I; Nicand, E; Guerin, P J
Journal:
Clinical Infectious Diseases
Abstract:
BACKGROUND: The conflict in Darfur, Sudan, was responsible for the displacement of 1.8 million civilians. We investigated a large outbreak of hepatitis E virus (HEV) infection in Mornay camp (78,800 inhabitants) in western Darfur. METHODS: To describe the outbreak, we used clinical and demographic information from cases recorded at the camp between 26 July and 31 December 2004. We conducted a case-cohort study and a retrospective cohort study to identify risk factors for clinical and asymptomatic hepatitis E, respectively. We collected stool and serum samples from animals and performed a bacteriological analysis of water samples. Human samples were tested for immunoglobulin G and immunoglobulin M antibody to HEV (for serum samples) and for amplification of the HEV genome (for serum and stool samples). RESULTS: In 6 months, 2621 hepatitis E cases were recorded (attack rate, 3.3%), with a case-fatality rate of 1.7% (45 deaths, 19 of which involved were pregnant women). Risk factors for clinical HEV infection included age of 15-45 years (odds ratio, 2.13; 95% confidence interval, 1.02-4.46) and drinking chlorinated surface water (odds ratio, 2.49; 95% confidence interval, 1.22-5.08). Both factors were also suggestive of increased risk for asymptomatic HEV infection, although this was not found to be statistically significant. HEV RNA was positively identified in serum samples obtained from 2 donkeys. No bacteria were identified from any sample of chlorinated water tested. CONCLUSIONS: Current recommendations to ensure a safe water supply may have been insufficient to inactivate HEV and control this epidemic. This research highlights the need to evaluate current water treatment methods and to identify alternative solutions adapted to complex emergencies.
Affiliation:
Epicentre, Paris, France. jguthmann@epicentre.msf.org
Publisher:
Published by: Infectious Diseases Society of America
Issue Date:
15-Jun-2006
URI:
http://hdl.handle.net/10144/17670
DOI:
10.1086/504321
PubMed ID:
16705572
Additional Links:
http://www.journals.uchicago.edu/page/cid/brief.html
Language:
en
ISSN:
1537-6591
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorGuthmann, J P-
dc.contributor.authorKlovstad, H-
dc.contributor.authorBoccia, D-
dc.contributor.authorHamid, N-
dc.contributor.authorPinoges, L-
dc.contributor.authorNizou, J Y-
dc.contributor.authorTatay, M-
dc.contributor.authorDiaz, F-
dc.contributor.authorMoren, A-
dc.contributor.authorGrais, R-
dc.contributor.authorCiglenecki, I-
dc.contributor.authorNicand, E-
dc.contributor.authorGuerin, P J-
dc.date.accessioned2008-02-07T12:00:35Z-
dc.date.available2008-02-07T12:00:35Z-
dc.date.issued2006-06-15-
dc.identifier.citationA Large Outbreak of Hepatitis E Among a Displaced Population in Darfur, Sudan, 2004: The Role of Water Treatment Methods. 2006, 42 (12):1685-91 Clin. Infect. Dis.en
dc.identifier.issn1537-6591-
dc.identifier.pmid16705572-
dc.identifier.doi10.1086/504321-
dc.identifier.urihttp://hdl.handle.net/10144/17670-
dc.description.abstractBACKGROUND: The conflict in Darfur, Sudan, was responsible for the displacement of 1.8 million civilians. We investigated a large outbreak of hepatitis E virus (HEV) infection in Mornay camp (78,800 inhabitants) in western Darfur. METHODS: To describe the outbreak, we used clinical and demographic information from cases recorded at the camp between 26 July and 31 December 2004. We conducted a case-cohort study and a retrospective cohort study to identify risk factors for clinical and asymptomatic hepatitis E, respectively. We collected stool and serum samples from animals and performed a bacteriological analysis of water samples. Human samples were tested for immunoglobulin G and immunoglobulin M antibody to HEV (for serum samples) and for amplification of the HEV genome (for serum and stool samples). RESULTS: In 6 months, 2621 hepatitis E cases were recorded (attack rate, 3.3%), with a case-fatality rate of 1.7% (45 deaths, 19 of which involved were pregnant women). Risk factors for clinical HEV infection included age of 15-45 years (odds ratio, 2.13; 95% confidence interval, 1.02-4.46) and drinking chlorinated surface water (odds ratio, 2.49; 95% confidence interval, 1.22-5.08). Both factors were also suggestive of increased risk for asymptomatic HEV infection, although this was not found to be statistically significant. HEV RNA was positively identified in serum samples obtained from 2 donkeys. No bacteria were identified from any sample of chlorinated water tested. CONCLUSIONS: Current recommendations to ensure a safe water supply may have been insufficient to inactivate HEV and control this epidemic. This research highlights the need to evaluate current water treatment methods and to identify alternative solutions adapted to complex emergencies.en
dc.language.isoenen
dc.publisherPublished by: Infectious Diseases Society of America-
dc.relation.urlhttp://www.journals.uchicago.edu/page/cid/brief.html-
dc.rightsArchived on this site with permission and copyright by the Infectious Diseases Society of Americaen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAgingen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshDisease Outbreaksen
dc.subject.meshFemaleen
dc.subject.meshHepatitis Een
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshInfant, Newbornen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshOdds Ratioen
dc.subject.meshRNA, Viralen
dc.subject.meshRisk Factorsen
dc.subject.meshSudanen
dc.subject.meshWater Purificationen
dc.titleA Large Outbreak of Hepatitis E Among a Displaced Population in Darfur, Sudan, 2004: The Role of Water Treatment Methods.en
dc.contributor.departmentEpicentre, Paris, France. jguthmann@epicentre.msf.orgen
dc.identifier.journalClinical Infectious Diseasesen

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