Genetic heterogeneity of hepatitis E virus in Darfur, Sudan, and neighboring Chad.

The within-outbreak diversity of hepatitis E virus (HEV) was studied during the outbreak of hepatitis E that occurred in Sudan in 2004. Specimens were collected from internally displaced persons living in a Sudanese refugee camp and two camps implanted in Chad. A comparison of the sequences in the ORF2 region of 23 Sudanese isolates and five HEV samples from the two Chadian camps displayed a high similarity (>99.7%) to strains belonging to Genotype 1. But four isolates collected in one of the Chadian camps were close to Genotype 2. Circulation of divergent strains argues for possible multiple sources of infection

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

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

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

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

Trans R Soc Trop Med Hyg

BACKGROUND: Endemic hepatitis E in Southeast Asia increases the risk of death in pregnant women. In Lao People's Democratic Republic, infection with hepatitis E virus (HEV) is widespread in pig farms. No human data are available yet. This study determined the prevalence and risk factors for HEV infection among women of reproductive age living in urban and rural areas. METHODS: A cross-sectional study was conducted in Xieng Khouang province, selected for its high prevalence of HEV in pig farms, after a two-stage random sampling. Blood eluates of filter paper samples were tested by enzyme-linked immunosorbent assay for anti-HEV immunoglobulin G (IgG). Risk factors were investigated by bivariate and multivariate analyses. RESULTS: Of 226 women (112 rural and 114 urban), anti-HEV IgG was detected in 66 (29.2%), with more in rural than in urban areas (38.4% vs 20.2%; p=0.005). Age (25-29 y) and farming profession were associated with HEV positivity. Living in an urban area, a supply of clean drinking water and raw duck blood consumption were protective. CONCLUSIONS: Risks of HEV infection are more related to lack of drinking water resources than to promiscuity with pigs. Women of childbearing age could be targeted by future vaccination programs. Consumption of drinking water should be recommended during pregnancy

Outbreak of hepatitis E virus infection in Darfur, Sudan: effectiveness of real-time reverse transcription-PCR analysis of dried blood spots.

Biological samples collected in refugee camps during an outbreak of hepatitis E were used to compare the accuracy of hepatitis E virus RNA amplification by real-time reverse transcription-PCR (RT-PCR) for sera and dried blood spots (concordance of 90.6%). Biological profiles (RT-PCR and serology) of asymptomatic individuals were also analyzed

Identification of Genotype 1 Hepatitis E Virus in Samples from Swine in Cambodia

Hepatitis E virus (HEV) is a major enterically transmitted pathogen in many developing countries, where it causes outbreaks and sporadic cases of acute hepatitis. A study conducted with pigs from several livestock farms in Cambodia identified one swine genotype 1 HEV isolate as being associated with prevalent swine genotype 3 HEV

Paludisme des aéroports : particularités thérapeutiques à propos de 6 cas relatés en 1994

Depuis 1977, 44 cas de paludisme des aéroports ont été rapportés en Europe. Cette affection rare reste d'actualité compte tenu de sa gravité et de sa difficulté diagnostique. Au cours du mois d'août 1994, 6 nouveaux cas de paludisme autochtone à #Plasmodium falciparum contractés dans les environs de l'aéroport Roissy-Charles de Gaulle (France) ont été diagnostiqués chez 5 hommes et 1 femme, âgés de 23 à 51 ans. Les signes initiaux à l'admission étaient caractérisés par leur exceptionnelle gravité : fièvre à 40°C (6/6), frissons, céphalées, troubles digestifs (4/6) ; 2 d'entre eux présentaient un accès pernicieux palustre selon les critères de l'Organisation Mondiale de la Santé avec état confusionnel post-critique, syndrome méningé. Sur le plan biologique, ont été observés une thrombopénie de 15 à 50 Gg/l chez tous les patients, des troubles électrolytiques avec hyponatrémie (5/6), hypocalcémie de 1,5 mmol/l à 1,89 mmol/l (4/6), hypoprotidémie (4/6), tableau de coagulation intra-vasculaire disséminée (1/6). L'examen parasitologique du sang met en évidence la présence de trophozoïtes intra-érythrocytaires de #Plasmodium falciparum avec une parasitémie variant de 1,1 à 50%. Devant la gravité de la symptomatologie, tous les patients ont été traités par quinine IV (1,6 g/j) pendant 48 heures à 7 jours puis relais par halofantrine (4/6) ou association avec la doxycycline (1/6). L'évolution favorable sur le plan clinique et biologique dans les premiers jours du traitement (avec négativation de la parasitémie en 3 à 5 jours pour 5 des 6 patients) a été suivie pour 5 d'entre eux par une aggravation secondaire avec réapparition de la fièvre (3/6), encéphalopathie (2/6), décès (1/6). Le paludogramme de 3 isolats a montré la chloroquinorésistance d'une des souches, la sensibilité vis à vis de la quinine, la mefloquine et l'halofantrine. En l'absence d'antécédent de séjour en zone d'endémie palustre, 3 modes de contamination ont été identifiés, piqûre sur l'aéroport par des anophèles infectées (3/6), piqûre au cours de l'ouverture de conteneur à la poste de l'aéroport (1/6), piqûre par des anophèles transportées par les véhicules d'employés de l'aéroport (2/6). Cette étude souligne l'efficacité de la quinine à dose optimale et prolongée ainsi que l'importance du suivi des recommandations de l'Organisation Mondiale de la Santé sur la désinsectisation des avions en provenance de zones d'endémie. (Résumé d'auteur