First documented outbreak of hepatitis E virus transmission in Java, Indonesia

Abstract

A suspected hepatitis outbreak occurred in Bondowoso District, East Java Province, Indonesia, in March-May 1998. An investigation was initiated in April 1998, involving a retrospective review of hospital records, a community-based cross-sectional study, and a health service-based case detection and household follow-up. Sera and epidemiological information were collected from 962 individuals: 235 from 3 outbreak-affected communities along the same rural stretch of river, 101 from community controls living distant from the river, 151 cases detected in health centres, 141 family members of the cases, and 334 subjects from neighbouring families. The prevalence of acute hepatitis E virus (HEV), based on anti-HEV IgM, total antibody (Ig) to HEV and polymerase chain reaction (PCR), was significantly (P < 0.00001) higher (52.4%) among the outbreak communities than among the community controls (3%). The background prevalence of HEV, based on anti-HEV IgG, was also significantly (P < 0.00001) higher (47%) among the outbreak communities than among the community controls (3%). None of the 476 sera screened for anti-HAV (hepatitis A virus) IgM was positive. These results indicate that HEV was the aetiological agent responsible for the outbreak. The overall attack rate (AR) for the 3 outbreak-affected communities surveyed was 19%, with AR determined on the basis of clinically recognized, acute jaundice illness. The usage of river water as primary source for bathing, human-waste disposal, and drinking purposes differed significantly (P < 0.00001) between the communities in outbreak areas and those in non-outbreak areas. There is no significant influence attributed to 'boiling water' on acute HEV. No climatic influences (flooding or drought) predisposed this instance of epidemic HEV transmission. This outbreak represents the first documented evidence of epidemic HEV transmission in Java, Indonesia.

Investigating the Seroprevalence of Hepatitis E Among Blood Donors Referring to Blood Donation Centers in Birjand County in Iran

“…Moreover, sewage disposal systems in rural areas are not effective. The results of a study in Sudan also showed that a healthy source of water can play a significant role in preventing hepatitis E. It is worth noting that water chlorination is not adequate for preventing hepatitis E; rather, modern approaches are needed for effective water treatment (24). The results of a study in Indonesia also illustrated that hepatitis E was more prevalent among people who lived alongside rivers (24).…”

“…The results of a study in Sudan also showed that a healthy source of water can play a significant role in preventing hepatitis E. It is worth noting that water chlorination is not adequate for preventing hepatitis E; rather, modern approaches are needed for effective water treatment (24). The results of a study in Indonesia also illustrated that hepatitis E was more prevalent among people who lived alongside rivers (24). Moreover, Gajjar et al (2014) reported that hepatitis E is more prevalent in developing countries where people suffer from the shortage of healthy drinking water and environmental sanitation (25).…”

From barnyard to food table: The omnipresence of hepatitis E virus and risk for zoonotic infection and food safety

“…Consumption of contaminated shellfish has been implicated in sporadic cases of acute hepatitis E (Cacopardo et al 1997; Koizumi et al 2004). It has also been shown that, in HEV endemic regions, the use of river water for bathing, waste disposal, and drinking purposes is a significant risk factor (Sedyaningsih-Mamahit et al, 2002; Toole et al, 2006). For instance, a unique riverine transmission of HEV has been reported in Southeast Asia: epidemic foci centered in riverine environments (Corwin et al 1999) and peaked with heavy rains and flooding, and the hepatitis E attack rate was significantly higher in villages using river water than in those using wells or ponds (Bile et al 1994).…”

Evaluation of Diagnostic Assays for Hepatitis E Virus in Outbreak Settings

“…Investigations included a retrospective review of hospital records, a cross-sectional study, and case detection with household contact follow-up (19). Sera from 82 symptomatic and 174 asymptomatic individuals from the four affected villages and the local health centers and from 496 subjects from an unaffected village with no acute illness in the prior 30 days were used for this study.…”