Large Outbreak Of Hepatitis Research Articles

Detection of Hepatitis A Virus in Strawberries Implicated in an Outbreak in the USA in 1997.

Hepatitis A virus (HAV) was detected in frozen strawberries which had been implicated in a large outbreak of hepatitis A in 1997. The sample was analysed after over 20years of storage, following a standard method not available at the time of the outbreak. This is the first study in which the HAV associated with the 1997 outbreak of foodborne hepatitis has finally been detected.

Hepatitis A takes hold in the community.

In 2016, large outbreaks of hepatitis A virus (HAV) infection began to occur among high-risk individuals, including those with a history of drug use and those experiencing homelessness. This article focusses on HAV infection among high-risk individuals in the community, including those experiencing homelessness.

Large Outbreak of Hepatitis C Virus Associated With Drug Diversion by a Healthcare Technician.

In May 2012, the New Hampshire (NH) Division of Public Health Services (DPHS) was notified of 4 persons with newly diagnosed hepatitis C virus (HCV) infection at hospital X. Initial investigation suggested a common link to the hospital cardiac catheterization laboratory (CCL) because the infected persons included 3 CCL patients and a CCL technician. NH DPHS initiated an investigation to determine the source and control the outbreak. NH DPHS conducted site visits, case patient and employee interviews, medical record and medication use review, and employee and patient HCV testing using enzyme immunoassay for anti-HCV, reverse-transcription polymerase chain reaction for HCV RNA, nonstructural 5B (NS5B) and hypervariable region 1 (HVR1) sequencing, and quasispecies analysis. HCV HVR1 analysis of the first 4 cases confirmed a common source of infection. HCV testing identified 32 of 1074 CCL patients infected with the outbreak strain, including 3 patients coinfected with >1 HCV strain. The epidemiologic investigation revealed evidence of drug diversion by the HCV-infected technician, evidenced by gaps in controlled medication control, higher fentanyl use during procedures for confirmed cases, and building card key access records documenting the presence of the technician during days when transmission occurred. The employee's status as a traveling technician led to a multistate investigation, which identified additional cases at prior employment sites. This is the largest laboratory-confirmed drug diversion-associated HCV outbreak published to date. Recommendations to reduce drug diversion risk and to conduct outbreak investigations are provided.

Jaundice Outbreak in Biratnagar Municipality of Eastern Nepal: A Microbiological perspective

Background and Objectives: Hepatitis is a common cause of jaundice. Hepatitis A and Hepatitis E are enterically transmitted viral diseases. This study investigated an outbreak of viral hepatitis at Biratnagar, Morang district, Nepal, during April 2014. Materials & Methods: An expert team from Microbiology and Public health of BPKIHS inspected the area and blood samples from 90 suspected cases of jaundice were obtained and subjected for IgM and IgG antibody detection against HAV and HEV. Water samples from 10 different areas of affected region were also collected and checked for presence of coliform by membrane filtration method to confirm the suspicion of fecal contamination of water supply. Results: An outbreak Hepatitis E and Hepatitis A occurred in Biratnagar. Out of 90 blood samples, 45 were reactive for hepatitis E IgM, nine were reactive for Hepatitis A IgM. Three samples among these were reactive for both Hepatitis A and Hepatitis E. The liver function tests of the positive cases were deranged while the negative cases had normal LFT. Among the 10 water samples, five of them grew coliforms which confirmed the fecal contamination of drinking water supply. Conclusion: A large outbreak of Hepatitis A and Hepatitis E occurred in a Biratnagar which had spread through the drinking of contaminated water. The outbreak was confirmed both by Epidemiology and Disease Control Division of Nepal government and BPKIHS which led to the identification of source and control of the outbreak.

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.

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.

Dangerous practices in a hemodialysis unit in Vietnam identify from mixed methods

BackgroundNon-compliance with infection control practices poses a serious risk to patients receiving chronic hemodialysis. We aimed to identify the type and frequency of non-compliance with infection control practices in a hemodialysis unit in Vietnam where a large outbreak of hepatitis C infection had occurred.MethodsMixed methods approach included observations and discussions of non-compliance with all 12 nurses at the Hemodialysis Unit, District-6 Hospital in Ho Chi Minh City. Observations of nursing care activities were made between September 2013 and January 2014. Compliance with hand hygiene and glove use during nursing care activities were classified according to the potential for a serious risk of transmission of infection and reported as percentages. Each nurse was expected to provide 11 nursing care activities to three patients assigned per hemodialysis sessions. Activities were to be given on an individual patient-centered care basis, that is, one patient was to receive all 11 activities by their assigned nurse. On completion of the observations all nurses were enrolled in a focus group where observed non-compliance was discussed and transcripts were examined for themes.ResultsHand hygiene compliance rate was low (27%, 95%CI 25%-28%, 1633/6140) regardless of classification of seriousness of risk from this breach. Although glove use (76%, 95%CI 74-78%, 1211/1586) and other personal protective equipment use (81%, 95%CI 78%-83%, 773/959) were high gloves were observed to be reused with multiple patients during a single nursing care activity provided to consecutive patients. Nurses explained the breakdown of providing nursing care activities on an individual patient-centered basis was a response to limited supply of gloves and hand hygiene facilities and was exacerbated by nursing being co-opted by overly demanding patients to provide services without delay.ConclusionsThe adaption by the nurses to provide 11 single care activities to multiple consecutive patients in the absence of changing gloves and low hand hygiene compliance was potentially the central risk factor that facilitated the hepatitis C outbreak. Patient-centered care needs to be enforced to minimize multiple nurse-patient contacts that are associated with non-compliance classified as serious risk of infection transmission. Nurse empowerment to resist unreasonable patient demands may also be pivotal to assisting their compliance with hand hygiene and single patient-centered care. An audit program to measure infection control resources and practices may facilitate enforcement of the guidelines.

Surveillance at Private Laboratories Identifies Small Outbreaks of Hepatitis E in Urban Bangladesh.

Although large outbreaks of hepatitis E are regularly identified in south Asia, the majority of south Asian countries lack surveillance systems for this disease, which has hindered burden of disease estimates and prioritization of resources for prevention. Our study aimed to identify small hepatitis E outbreaks through a sentinel private laboratory in Dhaka, Bangladesh. We identified patients with detectable IgM antibody against hepatitis E virus. We defined a small outbreak as at least two laboratory-confirmed cases or ≥ 2 acute jaundice cases from the sentinel cases' family, neighborhood, or workplace. From November 2008 to November 2009, we identified 29 small outbreaks of hepatitis E from one private laboratory. The median number of cases in each outbreak was three. Cases were identified every month. Eighteen outbreaks occurred among families or neighbors, and 11 in the workplace. Among 103 cases identified as part of outbreaks, 31 (30%) sought care for diagnosis. In Bangladesh, collaboration between government public health surveillance and private laboratories can strengthen capacity for outbreak detection and improve estimates of disease burden.

Advances in Studies on Hepatitis E Virus

Abstract Hepatitis E virus (HEV) is transmitted mainly through food and water sources. HEV is a major public health problem faced by developing countries. HEV causes large outbreaks of hepatitis E (HE) or acute sporadic infection. HEV can also lead to chronic infection. HEV mainly affects the young, middle-aged people, and pregnant women, who especially display high rates of infection. This study reviews HE while considering its biological characteristics, clinical symptoms, epidemic characteristics, vaccine, and detection methods.

A Large Outbreak of Hepatitis C Virus Infections in a Hemodialysis Clinic.

BACKGROUND In November and December 2012, 6 patients at a hemodialysis clinic were given a diagnosis of new hepatitis C virus (HCV) infection. OBJECTIVE To investigate the outbreak to identify risk factors for transmission. METHODS A case patient was defined as a patient who was HCV-antibody negative on clinic admission but subsequently was found to be HCV-antibody positive from January 1, 2008, through April 30, 2013. Patient charts were reviewed to identify and describe case patients. The hypervariable region 1 of HCV from infected patients was tested to assess viral genetic relatedness. Infection control practices were evaluated via observations. A forensic chemiluminescent agent was used to identify blood contamination on environmental surfaces after cleaning. RESULTS Eighteen case patients were identified at the clinic from January 1, 2008, through April 30, 2013, resulting in an estimated 16.7% attack rate. Analysis of HCV quasispecies identified 4 separate clusters of transmission involving 11 case patients. The case patients and previously infected patients in each cluster were treated in neighboring dialysis stations during the same shift, or at the same dialysis station on 2 consecutive shifts. Lapses in infection control were identified. Visible and invisible blood was identified on multiple surfaces at the clinic. CONCLUSIONS Epidemiologic and laboratory data confirmed transmission of HCV among numerous patients at the dialysis clinic over 6 years. Infection control breaches were likely responsible. This outbreak highlights the importance of rigorous adherence to recommended infection control practices in dialysis settings.

New Insights into Hepatitis E Virus Virus–Host Interaction: Interplay with Host Interferon Induction

ABSTRACT Hepatitis E virus (HEV) is a fecal–oral-transmitted viral pathogen causing several large outbreaks of hepatitis across the world. HEV-mediated hepatitis has a mortality rate from 0.5 to 3% in young adults but is up to 30% in pregnant women. HEV is also a zoonotic pathogen as it has been isolated from different mammalian hosts including the pig, rabbit, rat, ferret, bat and deer. As an invading pathogen, HEV needs to overcome the host innate immune response to establish infection. Notable progress has been recently made in HEV mechanisms of antagonizing the host innate immune responses. In this review, we elaborate on the HEV interplay with host interferon induction while briefly summarizing the major aspects of HEV biology and host interferon induction to assist the understanding of the virus–host interaction.

Hepatitis E as a cause of acute jaundice syndrome in northern Uganda, 2010-2012.

Hepatitis E virus (HEV) is a common cause of acute viral hepatitis in developing countries; however, its contribution to acute jaundice syndrome is not well-described. A large outbreak of hepatitis E occurred in northern Uganda from 2007 to 2009. In response to this outbreak, acute jaundice syndrome surveillance was established in 10 district healthcare facilities to determine the proportion of cases attributable to hepatitis E. Of 347 acute jaundice syndrome cases reported, the majority (42%) had hepatitis E followed by hepatitis B (14%), malaria (10%), hepatitis C (5%), and other/unknown (29%). Of hepatitis E cases, 72% occurred in Kaboong district, and 68% of these cases occurred between May and August of 2011. Residence in Kaabong district was independently associated with hepatitis E (adjusted odds ratio = 13; 95% confidence interval = 7-24). The findings from this surveillance show that an outbreak and sporadic transmission of hepatitis E occur in northern Uganda.

A Multistate Outbreak of Hepatitis A Associated With Semidried Tomatoes in Australia, 2009

A large outbreak of hepatitis A affected individuals in several Australian states in 2009, resulting in a 2-fold increase in cases reported to state health departments compared with 2008. Two peaks of infection occurred (April-May and September-November), with surveillance data suggesting locally acquired infections from a widely distributed food product. Two case-control studies were completed. Intensive product trace-back and food sampling was undertaken. Genotyping was conducted on virus isolates from patient serum and food samples. Control measures included prophylaxis for close contacts, public health warnings, an order by the chief health officer under the Victorian Food Act 1984, and trade-level recalls on implicated batches of semidried tomatoes. A multijurisdictional case-control study in April-May found an association between illness and consumption of semidried tomatoes (odds ratio [OR], 3.0; 95% CI 1.4-6.7). A second case-control study conducted in Victoria in October-November also implicated semidried tomatoes as being associated with illness (OR, 10.3; 95% CI, 4.7-22.7). Hepatitis A RNA was detected in 22 samples of semidried tomatoes. Hepatitis A virus genotype IB was identified in 144 of 153 (94%) patients tested from 2009, and partial sequence analysis showed complete identity with an isolate found in a sample of semidried tomatoes. The results of both case-control studies and food testing implicated the novel vehicle of semidried tomatoes as the cause of this hepatitis A outbreak. The outbreak was extensive and sustained despite public health interventions, the design and implementation of which were complicated by limitations in food testing capability and complex supply chains.

Molecular epidemiology of a large community-based outbreak of hepatitis B in Bristol, UK

Background A large outbreak of hepatitis B virus (HBV) infection in the UK occurred between 2001 and 2005 in Bristol, UK. Objectives To identify HBV strains circulating amongst risk groups in the HBV outbreak cohort. Study design Cross-sectional study of acute HBV outbreak cases in Bristol. Results HBV sequences from sera of 95 of the 237 cases (40%) were characterised. The majority of cases (77%) were found to carry an HBV variant belonging to genotype D, designated HBV BV. Eighty-eight percent (36/41) of sequences from injection drug users were HBV BV as were 70% (19/27) from those with heterosexual intercourse as the primary identified risk factor. Of 15 sequences characterised from cases of pre-outbreak acute or chronic hepatitis B residing in Bristol, 40% also carried HBV BV; the earliest was from a case identified in 1994. Conclusion The findings from this study link the spread of HBV BV from injecting drug users to the general population through heterosexual intercourse during the outbreak. The molecular sequencing of specimens from this outbreak reports the emergence of HBV BV, a HBV strain circulating in Bristol and South West England, as the cause of one of the largest outbreaks of acute hepatitis B in the UK.

Delayed HCV Antibody Responses in HIV-Infected Patients

Large outbreaks of hepatitis C virus (HCV) infection have occurred among HIV-positive men who have sex with men (MSM) in Europe and the U.S. Prompt diagnosis and treatment of acute HCV infection can lead to improved outcomes. Antibody screening is frequently used to diagnose HCV infection in HIV-positive patients, but is this method adequate to detect …

Hepatitis E Vaccine — Ready for Prime Time?

Large outbreaks of hepatitis E virus (HEV) infection were first recognized as a distinct clinical entity in the early 1980s.1,2 Outbreaks continue and involve thousands of patients in certain geographic regions of the world, including the Indian subcontinent, northwest China, and the Central Asian Republics (the former Soviet Union) — areas where HEV infection is endemic.3 HEV is transmitted predominantly through the fecal–oral route, and most reported outbreaks of infection have been related to the consumption of fecally contaminated drinking water; person-to-person transmission of the disease appears to be uncommon. There is a high attack rate in adults and . . .

Molecular epidemiological studies show that hepatitis A virus is endemic among active homosexual men in Europe

Large outbreaks of hepatitis A have occurred in Denmark, Germany, the Netherlands, Norway, Spain, Sweden, and the United Kingdom during the period 1997-2005 affecting homosexual men. A collaborative study was undertaken between these countries to determine if the strains involved in these hepatitis A outbreaks were related genetically. The N-terminal region of VP1 and the VP1/P2A region of the strains were sequenced and compared. The majority of the strains found among homosexual men from the different European countries formed a closely related cluster, named MSM1, belonging to genotype IA. Different HAV strains circulated among other risk groups in these countries during the same period, indicating that specific strains were circulating among homosexual men exclusively. Similar strains found among homosexual men from 1997 to 2005 indicate that these HAV strains have been circulating among homosexual men for a long time. The homosexual communities are probably too small within the individual countries to maintain HAV in their population over time, whereas the homosexual communities across Europe are probably sufficiently large to sustain continued circulation of homologous HAV strains for years resulting in an endemic situation among homosexual men.

Use of Molecular Epidemiology to Confirm a Multistate Outbreak of Hepatitis a Caused by Consumption of Oysters

The 39 oyster consumption-related cases of hepatitis A reported in 2005 represent the first large outbreak of hepatitis A associated with shellfish consumption in the United States in >15 years. This is the first outbreak investigation in which an identical hepatitis A virus sequence was obtained from both the implicated food product and case patients.

A Large Outbreak of Hepatitis B Virus Infections Associated With Frequent Injections at a Physician's Office

To determine whether hepatitis B virus (HBV) transmission occurred among patients visiting a physician's office and to evaluate potential transmission mechanisms. Serologic survey, retrospective cohort study, and observation of infection control practices. Private medical office. Those visiting the office between March 1 and December 26, 2001. We identified 38 patients with acute HBV infection occurring between February 2000 and February 2002. The cohort study, limited to the 10 months before outbreak detection, included 91 patients with serologic test results and available charts representing 18 case-patients and 73 susceptible patients. Overall, 67 patients (74%) received at least one injection during the observation period. Case-patients received a median of 14 injections (range, 2-25) versus 2 injections (range, 0-17) for susceptible patients (P < .001). Acute infections occurred among 18 (27%) of 67 who received at least one injection versus none of 24 who received no injections (RR, 13.6; CI95, 2.4-undefined). Risk of infection increased 5.2-fold (CI95, 0.6-47.3) for those with 3 to 6 injections and 20.0-fold (CI95, 2.8-143.5) for those with more than 6 injections. Typically, injections consisted of doses of atropine, dexamethasone, vitamin B12, or a combination of these mixed in one syringe. HBV DNA genetic sequences of 24 patients with acute infection and 4 patients with chronic infection were identical in the 1,500-bp region examined. Medical staff were seronegative for HBV infection markers. The same surface was used for storing multidose vials, preparing injections, and dismantling used injection equipment. Administration of unnecessary injections combined with failure to separate clean from contaminated areas and follow safe injection practices likely resulted in patient-to-patient HBV transmission in a private physician's office.

Large outbreak of hepatitis A in tourists staying at a hotel in Hurghada, Egypt, 2004 – orange juice implicated

In August and September 2004, a large outbreak of hepatitis A occurred involving tourists staying at a specific hotel in the Egyptian resort of Hurghada. A total of 351 cases associated with this outbreak

Overview of hepatitis E virus

Hepatitis E virus (HEV) is an enterically transmitted virus usually presenting as an acute self-limiting disease. However, mortality increases dramatically from around 1% to 20% in pregnant women. HEV has been the cause of very large outbreaks of hepatitis in developing countries and is also responsible for a significant number of sporadic cases. It is clear that cases occur outside the endemic areas, and new isolates have been identified. HEV-like viruses have also been found in various animal groups, and it is likely that HEV can be regarded as a zoonotic infection. Preventative measures at the moment depend mainly on the provision of clean water supplies, although a vaccine is now undergoing clinical trials.