A large outbreak of Hepatitis E virus genotype 1 infection in an urban setting in Chad likely linked to household level transmission factors, 2016-2017

Abstract

BackgroundIn September 2016, three acutely jaundiced (AJS) pregnant women were admitted to Am Timan Hospital, eastern Chad. We described the outbreak and conducted a case test-negative study to identify risk factors for this genotype of HEV in an acute outbreak setting.MethodsActive case finding using a community based surveillance network identified suspected AJS cases. Pregnant or visibly ill AJS cases presenting at hospital were tested with Assure® IgM HEV rapid diagnostic tests (RDTs) and some with Polymerase Chain Reaction (PCR) in Amsterdam; confirmed cases were RDT-positive and controls were RDT-negative. All answered questions around: demographics, household makeup, area of residence, handwashing practices, water collection behaviour and clinical presentation. We calculated unadjusted odds ratios (ORs) and 95% confidence intervals (95% CI).ResultsBetween September and April 2017, 1443 AJS cases (1293 confirmed) were detected in the town(attack rate: 2%; estimated 65,000 population). PCR testing confirmed HEV genotype 1e.HEV RDTs were used for 250 AJS cases; 100 (40%) were confirmed. Risk factors for HEV infection, included: having at least two children under the age of 5 years (OR 2.1, 95%CI 1.1–4.3), having another household member with jaundice (OR 2.4, 95%CI 0.90–6.3) and, with borderline significance, living in the neighbourhoods of Riad (OR 3.8, 95%CI 1.0–1.8) or Ridina (OR 3.3, 95%CI 1.0–12.6). Cases were more likely to present with vomiting (OR 3.2, 9%CI 1.4–7.9) than controls; possibly due to selection bias. Cases were non-significantly less likely to report always washing hands before meals compared with controls (OR 0.33, 95%CI 0.1–1.1).DiscussionOur study suggests household factors and area of residence (possibly linked to access to water and sanitation) play a role in HEV transmission; which could inform future outbreak responses. Ongoing sero-prevalence studies will elucidate more aspects of transmission dynamics of this virus with genotype 1e.

The Current Host Range of Hepatitis E Viruses

“…HEV is a substantial human pathogen. In areas where adequate sanitation and clean water are lacking, such as in the developing world or in areas with geopolitical conflicts, there have been numerous instances of large-scale HEV outbreaks involving tens of thousands of individuals [7,8,9]. As our understanding of HEV has expanded, it is now recognized as an emerging zoonotic disease prevalent throughout the world [10,11].…”

People-centred surveillance: a narrative review of community-based surveillance among crisis-affected populations

“… 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 Eight documents were provided by humanitarian organisations (three abstracts, 39 , 40 , 41 two non-indexed articles, 42 , 43 and one thesis 44 ) or by the authors (one older, non-indexed article 45 and one article that did not have MeSH keywords 46 ). The 29 documents retrieved 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 described 25 unique systems in the Central African Republic (two systems), 21 , 33 Chad, 35 Côte d’Ivoire (two systems), 24 , 40 , 43 the Democratic Republic of the Congo (two systems), 26 , 30 Guinea, 37 …”

A bioassay-based protocol for chemical neutralization of human faecal wastes treated by physico-chemical disinfection processes: A case study on benzalkonium chloride

“…In the US and many other high-income countries with presumably adequate treatment facilities, human faecal waste and other potentially infectious bodily fluids from healthcare facilities can be discharged directly into local sewage systems. In situ pre-treatment of such human waste is sometimes encouraged under certain conditions such the introduction of high risk diseases and their pathogens into the population, such as cholera (Ashbolt, 2004) (Centers for Disease and Prevention, 2010), typhoid fever (Murphy et al, 2017), Ebola (CDC, 2014a; and infectious hepatitis (Craun et al, 2010) (Sehulster et al, 2003) (Spina et al, 2017). The World Health Organization (WHO), has https://doi.org/10.1016/j.ijheh.2018.07.002 Received 7 February 2018; Received in revised form 28 June 2018; Accepted 3 July 2018 recommendations for management of such wastes using a disinfection option (Prüss et al, 1999;WHO, 2014;WHO and Unicef, 2014).…”