Water-Borne Hepatitis E Virus Epidemic in Islamabad, Pakistan: A Common Source Outbreak Traced to the Malfunction of a Modern Water Treatment Plant

Rab, Mohammad Abdur; Bile, Mohamud Khalif; Mubarik, Mohammad Mohsin; Asghar, Humayun; Sami, Z; Siddiqi, Sameen; Dil, A S; Barzgar, Mohammad Ali; Chaudhry, Mushtaq Ahmed; Burney, Mohammad Ilyas

doi:10.4269/ajtmh.1997.57.151

Cited by 117 publications

(90 citation statements)

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“…Lower infection rates with HEV has been reported from HEV outbreaks in Nepal, Pakistan, and India, where women were 2-fold less likely to report clinical illness during outbreaks. 32,34 In much of rural Bangladesh, conservative norms often restrict the mobility and employment of women outside of the home or neighborhood, which may, in turn, limit their exposures to potential sources of HEV. Women in the higher income category were also less likely to be seropositive, possibly because of better sanitary conditions and limited exposures to contaminated water.…”

Section: Discussionmentioning

confidence: 99%

Population Seroprevalence of Hepatitis E Virus Antibodies in Rural Bangladesh

Labrique¹,

Zaman²,

Hossain³

et al. 2009

The American Journal of Tropical Medicine and Hygiene

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Abstract. Hepatitis E virus (HEV) causes a substantial burden of sporadic and epidemic disease worldwide. HEV infections result in serious morbidity and mortality, especially among pregnant women, and have significant economic costs. Few population-based studies have characterized the epidemiology of HEV. A rural Bangladeshi population was studied to determine the age-and gender-specific population seroprevalence of antibodies to HEV. Of 1,134 specimens tested from a representative, random population sample, 255 (22.5%) were anti-HEV IgG seropositive. Seroprevalence was lower among women (19.7%) than among men (25.8%). We found anti-HBc (hepatitis B core) in 380 of 1080(35.2%) tested, anti-HCV (hepatitis C) in 14 of 917(1.5%) tested, and anti-HAV (hepatitis A) in 116 of 124(93.5%) tested individuals. Our data suggest that viral hepatitis, especially HEV, remains an under-recognized and significant public health problem in rural Bangladeshi populations, warranting further attention.

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Section: Discussionmentioning

confidence: 99%

Population Seroprevalence of Hepatitis E Virus Antibodies in Rural Bangladesh

Labrique¹,

Zaman²,

Hossain³

et al. 2009

The American Journal of Tropical Medicine and Hygiene

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“…36 Newborns whose mothers had acute hepatitis at the time of delivery comprised one-half (4/8) of the fatalities in a 1993-1994 outbreak in Islamabad, Pakistan. 21 Pregnant women with jaundice during a 2008-2009 hepatitis E outbreak in Tongi, Bangladesh were more than two times as likely as non-jaundiced pregnant women to miscarry or deliver a stillborn baby. 37 In two separate hospital-based prospective studies in New Delhi and Chennai, India,~15% to 50% of the live-born infants of mothers with hepatitis E died within the first 1 week post-partum.…”

Section: Hepatitis E and Maternal-child Healthmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11][12][13][14] High case-fatality ratios among pregnant women, particularly during the third trimester of pregnancy, remain an almost pathognomonic feature of hepatitis E epidemics caused by HEV genotype 1. [15][16][17][18][19][20][21] There is mounting evidence that hepatitis E is an important contributor to maternal morbidity and mortality in south Asia, even outside of periodic large outbreaks. [22][23][24][25][26] In the early literature on hepatitis E, there was much conjecture about the extent to which maternal hepatitis E threatened fetal and neonatal health beyond catastrophic maternal illness or death.…”

Section: Introductionmentioning

confidence: 99%

Fetal and Neonatal Health Consequences of Vertically Transmitted Hepatitis E Virus Infection

Krain

Atwell

Nelson

et al. 2014

The American Journal of Tropical Medicine and Hygiene

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Abstract. Hepatitis E virus (HEV) infections lead to tens of thousands of deaths annually, mostly in developing countries. Hepatitis E poses a significant threat to the health of expectant mothers, a well-noted epidemiologic feature of the disease, but the contribution of vertically transmitted HEV infection to fetal and neonatal morbidity and mortality has received limited attention. Evidence assembled to date suggests that mother-to-child HEV transmission may be frequent and deleterious to the fetus and newborn in pregnancies affected by hepatitis E. Additional work is required to resolve key questions. (1) What risks do subclinical maternal HEV infections and infections early in pregnancy pose to fetal health and development? (2) Does vertical transmission occur during labor and/or breastfeeding and contribute appreciably to neonatal morbidity and mortality? (3) How do treatment decisions for severely ill mothers affect fetal and neonatal outcomes? (4) Can maternal vaccination effectively prevent vertical transmission of HEV?

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“…7,24,25,43,45 Tables 3 and 4 7,11,12,[42][43][44][45][46][48][49][50] highlight the sporadic and epidemic studies of HEV induced AVH/ALF reported in pregnant females.…”

Section: Pregnant Females Are More Susceptible To Contract Hepatitis mentioning

confidence: 99%

“…52 Further, certain studies have also documented that However, the above mentioned facts have emanated predominantly from the Indian subcontinent Northern India and Pakistan, Somalia, Sudan and Nepal. 7,11,12,50 The information of HEV and its relation to pregnancy in southern India needs appropriate prospective evaluation.…”

Section: Pregnant Females Are More Susceptible To Contract Hepatitis mentioning

confidence: 99%