Abstract
Yellow fever (YF) is a vector-borne disease transmitted to humans by infected Aedes mosquitoes, while hepatitis E virus (HEV) is a waterborne disease that is transmitted through the fecal-oral route. Both diseases have very close clinical presentation, namely fever, jaundice, malaise, and dark urine; they differ in severity and outcome. In this cross-sectional, laboratory-based study, an attempt was made to measure the correlation of concomitant YF and HEV infection in Darfur States during the previous YF outbreak in 2012. Results found concomitant outbreaks of YF and HEV at the same time with very weak statistical correlation between the two infections during the outbreak period, with Cramer's V correlation 0.05 and insignificant p value of 0.86. This correlation indicates that clinicians and care providers in tropical areas have to deal with clinical case definitions used for disease surveillance very carefully since prevalence of HEV infection is relatively common and this increases the possibility of misclassification and missing YF cases, particularly initial index cases, in a season or outbreak.
Highlights
Yellow fever (YF) is a vector-borne disease transmitted to humans by infected Aedes mosquitoes, while hepatitis E virus (HEV) is a waterborne disease that is transmitted through the fecal-oral route
Its clinical presentation varies from mild flu-like illness to hemorrhagic fever and may lead to death, with a case fatality rate ranging between 20% and 50% [2]
This study reports the co-existence of YF and HEV infections in Darfur region during the last YF outbreak season and highlights the potentiality of clinical misclassifications when referring to a clinical standard case definition
Summary
Yellow fever (YF) is a vector-borne disease transmitted to humans by infected Aedes mosquitoes, while hepatitis E virus (HEV) is a waterborne disease that is transmitted through the fecal-oral route. Both diseases have very close clinical presentation, namely fever, jaundice, malaise, and dark urine; they differ in severity and outcome. Its urban cycle occurs with the presence of relatively large population living in close proximity to mosquito species (Aedes aegypti) capable of virus transmission and outbreak propagation [1,3]. More recently in 2012 and 2013, a major outbreak occurred in the Darfur region in the western part of Sudan, a region that had never been covered by YF vaccination before [7]
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