Outbreak Of Acute Viral Hepatitis Research Articles

Hepatitis E Genotype 1 Outbreak in Jharkhand, India: A Descriptive Analysis.

A waterborne outbreak of hepatitis E virus occurred in the Jamshedpur city of Jharkhand from March 2018 to October 2018. The aim of the present study is to study the hepatitis E virus outbreak clinically, serologically and etiologically. Five hundred and eighty-four clinically and biochemically documented cases were screened for the hepatotropic viral markers (HepatitisA, B, C, and E) by the ELISA. Demographic data such as gender, age, clinical diagnosis, location, outcome and time of admission were extracted from the online hospital management system. Water samples from the affected area were tested for HEV RNA detection. Genotyping of HEV virus was carried out by sequencing and phylogenetic analysis. Hepatitis E genotype 1 was confirmed as the major etiological agent in this outbreak due to the faecal contamination of drinking water supply while establishing illegal water connections. Mixed infection of HEV-HAV (5.31%) or HEV-HBV (0.91%) was also detected in the present series of acute viral hepatitis. The study highlights the importance of screening for both enterically transmitted hepatotropic viral markers as well as the parenterally transmitted hepatotropic viral markers during the outbreaks of acute viral hepatitis.

Epidemiological investigation of an outbreak of Acute Viral Hepatitis A and E in a semi-urban locality in Chandigarh, North Indian Union Territory, 2016-17.

Context:During ongoing passive surveillance in Burail, Chandigarh an unexpected rise in number of acute viral hepatitis (AVH) was reported during December 2016.Aims:An outbreak of AVH was investigated in an urbanized village, Burail, in Chandigarh, India with an objective of describing its epidemiological features.Settings and Design:A house-to-house survey was conducted in Burail (population 51,958).Subjects and Methods:WHO's standard case definition for AVH was used to identify cases. Suspected cases were tested for hepatitis A virus (HAV) and E virus (HEV) using enzyme-linked immunosorbent assay. Drinking water samples were tested for fecal contamination. Control measures were implemented to contain the outbreak.Statistical Analysis Used:Descriptive analysis was done as per time, person, and place.Results:Out of 141 confirmed cases of AVH, 85.1% were positive for HEV, 12.8% for HAV, and 2.1% for both HAV and HEV. The attack rate was 27.1 per 10,000 in a population. Males were affected more than females (P < 0.05). One of the areas reported a leakage in drinking water pipeline and had highest attack rate (36.8/10000 population). Drinking water samples were found negative for contamination. Around 27% of confirmed cases reported history of taking food from local vendors in Burail 2–6 weeks prior to the onset of symptoms.Conclusion:This study described the epidemiological features of dual hepatitis outbreak due to HAV and HEV from Chandigarh, Union Territory, north India.

Variable Outcome of Acute Viral Hepatitis in Diabetic and Nondiabetic Patients in Bangladesh.

ABSTRACTDiabetes mellitus (DM) are common in Bangladesh, and this country is also well-known for frequent outbreaks of acute viral hepatitis (AVH). The study presented here was designed for the clinical courses of acute hepatitis with and without DM. A total of 300 patients with AVH were enrolled into two groups; group A; patients of AVH with DM (N = 140) and group B; patients with AVH without DM (N = 160). There was no significant difference regarding age, sex, and levels of alanine aminotransferase (ALT) between the two groups. The main cause of AVH was hepatitis E virus (HEV) in 100 and 112 patients of groups A and B, respectively. Jaundice persisted for more than 6 months in 68 of 140 (49%) patients of group A, whereas, this was found in only 11 of 160 patients of group B. Forty-two patients of group A showed evidence of esophageal varices; however, the endoscopic assessment did not reveal any abnormality in patients with group B. Moderate to several hepatic fibrosis was seen in 19 of 140 patients with group A, however, these were not detected in any patient of group B (patient with AVH without DM). Even more important is the fact that four patients of group A died of liver failure, whereas there was no mortality in any patient of group B. The study presented here indicates that all patients with DM with superimposed AVH should be carefully followed up with the possibility of development of severe liver diseases and even mortality.How to cite this article: Harun-or-Rashid, Khan MR, et al. Variable Outcome of Acute Viral Hepatitis in Diabetic and Nondiabetic Patients in Bangladesh. Euroasian J Hepatogastroenterol 2019;9(1): 20-22.

Epidemiological investigation of an acute viral hepatitis outbreak in an urbanized rural area in a North Indian Union Territory

Purpose: A waterborne outbreak of acute viral hepatitis (AVH) was reported in an congested and overcrowded urbanized rural area, known as Burail, in Chandigarh, during January to December, 2017. This outbreak was investigated with an objective of describing its epidemiological features, identify the source of contamination and implement the containment measures. Methods & Materials: A house-to-house survey was conducted to identify symptomatic cases, defined as per WHO's standard case definition for acute viral hepatitis, using standard case record form. Laboratory investigation of all the suspected cases was done for Hepatitis A and E virus (HAV & HEV) by enzyme-linked immunosorbent assay method. Environmental investigation included water testing of all the tube wells supplying water in the study area for chlorination and faecal contamination. The outbreak was described in terms of time, person, and place analysis to generate the hypothesis and implement control measures to contain the outbreak. Results: A total of 34,542 individuals were contacted and screened for symptoms of acute viral hepatitis. Hundred fifty four cases of AVH were laboratory confirmed. Out of these, 128 (83.1%) cases were positive for HEV, 21 (13.7%) for HAV, and 5 (3.2%) for both HAV & HEV IgM antibodies. Overall attack rate (AR) was 0.49%. It was highest among the age group of 16-20 years (0.98%), followed by 11-15 years (0.79%). However, all the age groups were affected. The AR among males (0.52%) was higher as compared to the females (0.43%). There were no deaths reported. Environmental investigation confirmed the sewage contamination of drinking water in the distribution system of one of the tube well, where clustering of cases was observed. Conclusion: Dual HAV and HEV outbreak was confirmed that was transmitted by contaminated drinking water in the study area. HEV was the major etiological agent. The recognition of early warning signals, timely investigation, and surveillance of water quality can contain the outbreak.

An outbreak of hepatitis A virus among children in a flood rescue camp: A post-disaster catastrophe

We report an outbreak of acute viral hepatitis among children in a flood rescue camp at Rudraprayag district of Uttarakhand State, India. In May 2013, there was a disastrous natural calamity, The Himalayan Tsunami in Himalayan and Sub-Himalayan region of Uttarakhand. More than 5700 people were feared dead, and thousands were sheltered in different rescue camps. A linkage was hypothesised between the infected individuals and the common water sources feared of being contaminated faecally. Aetiological agent of the present outbreak was HAV that is emerging in an outbreak form in India, emphasizing a definite need for formulating mandatory vaccination and proper control strategies. The report exemplifies the basic problems encountered after a natural calamity.

Assessment of timeliness, representativeness and quality of data reported to Italy's national integrated surveillance system for acute viral hepatitis (SEIEVA)

ObjectivesPeriodic assessment of surveillance systems is recommended to verify whether they are appropriately monitoring the public health problem under surveillance. The aim of this study was to evaluate timeliness, data quality and representativeness of data reported to the Italian Integrated Epidemiological System for Acute Viral Hepatitis (SEIEVA). Study designCross-sectional analysis of surveillance data. MethodsQuantitative indicators were used to evaluate representativeness of reported cases, data quality, and timeliness between surveillance steps, for reports of acute viral hepatitis cases with date of onset of symptoms from 2009 to 2012 (N = 4516). ResultsRepresentativeness was 75%. Over 95% of records reported information on age, sex, city of residence, risk factors for hepatitis A and vaccination status. Information on risk factors for hepatitis B and C were reported less consistently (83%), as was information on early outcome (60%). Wide delays were found between surveillance steps. ConclusionsThe system collects high quality data on acute viral hepatitis cases in Italy. Timeliness was found to be the main limit and needs to be improved by optimizing web-based reporting procedures, increasing communication with participating centres, improving feedback and increasing dissemination of surveillance results. The study highlights the importance of reporting timeliness to detect outbreaks of acute viral hepatitis.

Erratum to “Investigating an outbreak of acute viral hepatitis caused by hepatitis E virus variants in Karachi, South Pakistan” Khan A, Tanaka Y, Kurbanov F, Elkady A, Abbas Z, Azam Z, Subhan A, Razza S, Hamid S, Jafri W, Shih J, Xia N, Takahashi K, Mishiro S, Mizokami M. J Med Virol 2011;83:622–629

Erratum to “Investigating an outbreak of acute viral hepatitis caused by hepatitis E virus variants in Karachi, South Pakistan” Khan A, Tanaka Y, Kurbanov F, Elkady A, Abbas Z, Azam Z, Subhan A, Razza S, Hamid S, Jafri W, Shih J, Xia N, Takahashi K, Mishiro S, Mizokami M. J Med Virol 2011;83:622–629

Investigating an outbreak of acute viral hepatitis caused by hepatitis E virus variants in Karachi, South Pakistan

Hepatitis E is a classic water-borne disease in developing countries. Detection of anti-HEV IgM and IgG antibodies, in addition to HEV RNA are useful epidemiological markers in diagnosis of hepatitis E. This study was conducted to investigate an outbreak of acute viral hepatitis in South-Pakistan. Anti-HEV IgM and IgG were assessed comparatively with serological kits manufactured by Abbott, Cosmic, TGH, and Wantai, selecting HEV RNA as reference assay. Molecular evolutionary analysis was performed by phylogeny and HEV spread time analysis by Bayesian Coalescent Theory approach. Of the 89 patients, 24 (26.9%) did not have acute hepatitis viral marker. Of the remaining 65 cases, 4 (6.1%) were positive for anti-HAV IgM, one (1.5%) for anti-HBc IgM, 2 (3%) for HCV, 53 (81.5%) for anti-HEV IgM, and 5 (7.7%) were hepatitis-negative. The Wantai test was 100% sensitive and specific followed by Cosmic (98.1% and 100%), TGH (98.1% and 97.2%) and Abbott (79.2% and 83.3%). Two HEV variant strains were detected by phylogeny responsible for this acute hepatitis outbreak. Estimates on demographic history of HEV showed that HEV in Pakistan has remained at a steady nonexpanding phase from around 1970 to the year 2005, in which it expanded explosively with the emergence of new HEV variants. In conclusion, the limited sensitivity of available assay (Abbott anti-HEV EIA) may be a concern in HEV diagnosis in Pakistan. This study cautions that the dissemination of the variant strains to other areas of Pakistan may lead to explosive HEV outbreaks.

Investigation of an epidemic of Hepatitis E in Nellore in south India

To determine the incidence of acute hepatitis because of hepatitis E virus (HEV) and the source of the epidemic in Nellore in south India in 2008. Anti-HEV IgM ELISA and RT-PCR for HEV-RNA were carried out on blood and stool samples from patients with acute hepatitis presenting to different hospitals in the city. The city was divided into 33 clusters, and 20 families from each cluster were systematically interviewed to determine the incidence of hepatitis E in the city. The survey was conducted on 2685 residents of 673 households from 24th November to 4th December 2008. The overall incidence of hepatitis was 5.7% (152/2685), i.e. an estimated 23,915 persons in the city were affected. There were two deaths because of acute hepatitis in the population surveyed translating to an estimated 315 deaths. Men had higher attack rates than women (7.8%vs. 3.5%) and young adults compared to children under 5 years (6.9%vs. 2.9%). Families drinking water from the pumping station at Bujjamarevu had the highest attack rate of 54.5% (39.8-69.2%). HEV IgM antibodies were present in 80/100 plasma samples tested. HEV-RNA was detected in 43/100 individuals tested, and isolates were characterized as genotype 1 by sequencing. Sewage draining into the river close to the pumping stations and broken pipelines crossing sewage drains may have triggered this large outbreak.

Morbidity associated with hepatitis E virus infection in endemic setting

Background To determine the groups most affected by hepatitis E virus (HEV) during documented acute viral hepatitis (AVH) epidemics, trends in AVH-associated mortality rate (MR) per 100,000 over a 35-year period were examined. Methods Reported AVH incidence data from 1971 to 2005 and AVH-associated mortality data from 1981 to 1995 were examined. Serologic markers for infection with hepatitis viruses A, B, D, and E were determined from a sample of hospitalized patients with AVH from an epidemic period (1987) and from a sample of pregnant women with AVH from a non-epidemic period (1992). Results Two multi-year AVH outbreaks were identified: one during 1975-1976, and one during 1985-1987. During 1985-1987, AVH-associated MRs were 12.3-17.8 for the general population. Highest AVH-associated MRs occurred among children in the first 3 years of life (40-190 per 100,000) and among women aged 20-29 (15-21 per 100,000). During 1988-1995 when reported AVH morbidity was much lower in the general population, AVH-associated MRs were markedly lower among these same age groups. In 1988, AVH-associated MRs were higher in rural (21 per 100,000) than in urban (8 per 100,000) populations (RR 2.6; 95% CI 1.16-5.93; p < 0.05). Serologic evidence of acute HEV infection was found in 280 of 396 (71%) patients with AVH in 1987 and 12 of 99 (12%) pregnant patients with AVH in 1992. Discussion In the absence of the availability of confirmatory testing, inferences regarding probable hepatitis epidemic etiologies can sometimes be made using surveillance data, comparing AVH incidence with AVH-associated mortality with an eye to population-based viral hepatitis control measures. Data presented here implicate HEV as the probable etiology of high mortality observed in pregnant women and in children <3 years. High mortality among pregnant women but not among children <3 years has been observed in previous descriptions of epidemic hepatitis E. The high mortality among younger children observed in an outbreak of acute viral hepatitis associated with hepatitis E merits corroboration in future outbreaks.

Editorial Commentary:The Mystery of Hepatitis E Seroprevalence in Developed Countries: Is There Subclinical Infection due to Hepatitis E Virus?

<i>Editorial Commentary:</i>The Mystery of Hepatitis E Seroprevalence in Developed Countries: Is There Subclinical Infection due to Hepatitis E Virus?

Recovery and Sequence Analysis of Hepatitis A Virus from Springwater Implicated in an Outbreak of Acute Viral Hepatitis

An outbreak of acute hepatitis A virus in North Carolina was linked to drinking water from a contaminated shallow spring by phylogenetic analysis of hepatitis A virus (HAV) genomic sequences. Detection of HAV and fecal indicators in the water provided useful and timely information to assist with public health prevention and control measures.

Dual infection with hepatitis A and E viruses in outbreaks and in sporadic clinical cases: Cuba 1998–2003

Viral hepatitis ranks as the fifth cause of morbidity for infectious diseases in Cuba. Epidemics are observed frequently in the population, the hepatitis A virus being the main agent responsible for such epidemics. Previous reports also confirmed the circulation of the hepatitis E virus. From 1998 to 2003, 258 serum samples were collected by the Reference Laboratory on Viral Hepatitis during 33 outbreaks of acute viral hepatitis as well as from 39 sporadic clinical cases. Sera were tested for anti-HAV and anti-HEV IgM by EIA. Overall of the 33 outbreaks studied sera from 12 (36.4%) were positive for anti-HAV IgM only, from 7 (21.2%) were positive for anti-HEV IgM only, and from 14 (42.4%) were positive for antibodies to both viruses. Individually of the 258 sera collected, 137 (53.1%) were positives for anti-HAV IgM, 20 (7.8%) were positives for anti-HEV IgM, 33 (12.8%) were positives for both markers and 68 (26.4%) were negative to both. Of the clinical cases, 4 (10.3%) were positives for anti-HAV IgM, 13 (33.3%) were positives for anti-HEV IgM and 5 (12.8%) were positives for both markers. Seventeen (43.6%) sera were negatives for all viral hepatitis markers available (A-E). A high positivity for HEV was found in outbreaks tested with the kit produced by CIGB. In particular HEV seems to infect individuals of all ages. The results demonstrate the co-circulation of and co-infection with two enterically transmitted viruses; however a higher positivity was observed for anti-HAV than to anti-HEV (53.1% vs. 7.8%) in outbreaks.

Recovery and Sequence Analysis of Hepatitis A Virus from Springwater Implicated in an Outbreak of Acute Viral Hepatitis

Recovery and Sequence Analysis of Hepatitis A Virus from Springwater Implicated in an Outbreak of Acute Viral Hepatitis

OUTBREAK OF ACUTE VIRAL HEPATITIS DUE TO HEPATITIS E VIRUS IN HYDERABAD

Purpose: A waterborne outbreak of viral hepatitis occurred in the old city of Hyderabad from March through August 2005. An attempt was made to study the outbreak clinically, serologically, and etiologically. Methods: Five hundred and forty-six clinically and biochemically documented cases were screened for the hepatotropic viral markers, hepatitis A, B, C, and E by the ELISA method. Their demographic characteristics and outcomes were analyzed. Point source contamination of the water supply with sewerage was identified. Result: Our data confirms hepatitis E as the major cause of the outbreak (78.57%). Occasionally, mixed infection of HEV-HAV (5.31%) or HEV-HBV (0.91%) was detected in the present series of acute viral hepatitis. Conclusions: HEV was confirmed as the major etiological agent in this outbreak that was transmitted by contaminated drinking water. The study highlights the importance of screening for both enterically transmitted hepatotropic viral markers as well as the parenterally transmitted hepatotropic viral markers during outbreaks of acute viral hepatitis.

Outbreak of acute viral hepatitis due to hepatitis E virus in Hyderabad

A waterborne outbreak of viral hepatitis occurred in the old city of Hyderabad from March through August 2005. An attempt was made to study the outbreak clinically, serologically, and etiologically. Five hundred and forty-six clinically and biochemically documented cases were screened for the hepatotropic viral markers, hepatitis A, B, C, and E by the ELISA method. Their demographic characteristics and outcomes were analyzed. Point source contamination of the water supply with sewerage was identified. Our data confirms hepatitis E as the major cause of the outbreak (78.57%). Occasionally, mixed infection of HEV-HAV (5.31%) or HEV-HBV (0.91%) was detected in the present series of acute viral hepatitis. HEV was confirmed as the major etiological agent in this outbreak that was transmitted by contaminated drinking water. The study highlights the importance of screening for both enterically transmitted hepatotropic viral markers as well as the parenterally transmitted hepatotropic viral markers during outbreaks of acute viral hepatitis.