Clinical Infectious Diseases
Volume 42, Issue 12, 2006, Pages 1679-1684

High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan (Review) (Open Access)

Boccia D. , Guthmann J.-P.* , Klovstad H. , Hamid N. , Tatay M. , Ciglenecki I. , Nizou J.-Y. , Nicand E. , Guerin P.J.
  • a European Programme for Intervention Epidemiology Training, Stockholm, Sweden, Health Protection Agency-Centre for Infection, London, United Kingdom
  • b Epicentre, Teaching Military Hospital Val de Grâce, Paris, France, 8 rue Saint-Sabin, 75011 Paris, France
  • c Norwegian Institute of Public Health, Oslo, Norway, Norwegian Field Epidemiology Training Programme, Oslo, Norway
  • d World Health Organization, Khartoum, Sudan
  • e Médecins Sans Frontières, Teaching Military Hospital Val de Grâce, Paris, France
  • f Médecins Sans Frontières, Teaching Military Hospital Val de Grâce, Paris, France
  • g National Reference Centre of Enterically Transmitted Hepatitis (Hepatitis E Virus), Teaching Military Hospital Val de Grâce, Paris, France
  • h National Reference Centre of Enterically Transmitted Hepatitis (Hepatitis E Virus), Teaching Military Hospital Val de Grâce, Paris, France
  • i Epicentre, Teaching Military Hospital Val de Grâce, Paris, France

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 ≥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. © 2006 by the Infectious Diseases Society of America. All rights reserved.

Author Keywords

[No Keywords available]

Index Keywords

hospitalization Antibodies, Viral laboratory diagnosis gene amplification human Refugees middle aged Sudan priority journal RNA, Viral Humans jaundice Adolescent male virus genome female Child, Preschool Review pregnancy virus RNA Disease Outbreaks epidemic Retrospective Studies fatality major clinical study adult mortality hepatic encephalopathy immunoglobulin G antibody immunoglobulin M antibody pregnant woman immunoglobulin G Hepatitis E immunoglobulin M Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-33744819698&doi=10.1086%2f504322&partnerID=40&md5=03d95c35c490bbd88fecca1d55e1f2ad
DOI: 10.1086/504322
ISSN: 10584838
Cited by: 115
Original Language: English