High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan
Guerin, Philippe Jean
AffiliationEuropean 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
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JournalClinical Infectious Diseases : an official publication of the Infectious Diseases Society of America
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.
- A large outbreak of hepatitis E among a displaced population in Darfur, Sudan, 2004: the role of water treatment methods.
- Authors: Guthmann JP, Klovstad H, Boccia D, Hamid N, Pinoges L, Nizou JY, Tatay M, Diaz F, Moren A, Grais RF, Ciglenecki I, Nicand E, Guerin PJ
- Issue date: 2006 Jun 15
- [Serological antibodies comparison of a hepatitis E outbreak].
- Authors: Tan CR, Bao ZY, Sun HY, Hu M, Chen Y, Chen M, Zhang M
- Issue date: 2005 Mar
- Virological investigation of a hepatitis E epidemic in North India.
- Authors: Kumar S, Ratho RK, Chawla YK, Chakraborti A
- Issue date: 2006 Sep
- Role of travel as a risk factor for hepatitis E virus infection in a disease-endemic area.
- Authors: Aggarwal R, Kumar R, Pal R, Naik S, Semwal SN, Naik SR
- Issue date: 2002 Jan-Feb
- [Serological characteristics of a hepatitis E outbreak].
- Authors: Tan CR, Chen M, Ge SX, Zhang J, Hu M, Sun HY, Chen Y, Peng G, Shen W, Zhang M, Xia NS
- Issue date: 2003 Dec