A Large Outbreak of Hepatitis E among a Displaced Population in Darfur, Sudan, 2004: The Role of Water Treatment Methods

Background. The conflict in Darfur, Sudan, was responsible for the displacement of 1.8 million civilians. We investigated a large outbreak of hepatitis E virus (HEV) infection in Mornay camp (78,800 inhabitants) in western Darfur. Methods. To describe the outbreak, we used clinical and demographic i...

Full description

Saved in:
Bibliographic Details
Published in:Clinical infectious diseases 2006-06, Vol.42 (12), p.1685-1691
Main Authors: Guthmann, Jean-Paul, Klovstad, Hilde, Boccia, Delia, Hamid, Nuha, Pinoges, Loretxu, Nizou, Jacques-Yves, Tatay, Mercedes, Diaz, Francisco, Moren, Alain, Grais, Rebecca Freeman, Ciglenecki, Iza, Nicand, Elisabeth, Guerin, Philippe Jean
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aging
Articles and Commentaries
Child
Child, Preschool
Chlorine
Disease Outbreaks
Displaced persons
Drinking water
Epidemics
Epidemiology
Female
Hepatitis
Hepatitis E
Hepatitis E - epidemiology
Hepatitis E virus
Hospitals
Humans
Infant
Infant, Newborn
Infections
Jaundice
Male
Medical research
Medical treatment
Middle Aged
Odds Ratio
Patients
Population
Predisposing factors
Risk Factors
River water
RNA, Viral
Sample size
Studies
Sudan - epidemiology
Surface water
Tropical diseases
Water Purification - methods
Water samples
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background. The conflict in Darfur, Sudan, was responsible for the displacement of 1.8 million civilians. We investigated a large outbreak of hepatitis E virus (HEV) infection in Mornay camp (78,800 inhabitants) in western Darfur. Methods. To describe the outbreak, we used clinical and demographic information from cases recorded at the camp between 26 July and 31 December 2004. We conducted a case-cohort study and a retrospective cohort study to identify risk factors for clinical and asymptomatic hepatitis E, respectively. We collected stool and serum samples from animals and performed a bacteriological analysis of water samples. Human samples were tested for immunoglobulin G and immunoglobulin M antibody to HEV (for serum samples) and for amplification of the HEV genome (for serum and stool samples). Results. In 6 months, 2621 hepatitis E cases were recorded (attack rate, 3.3%), with a case-fatality rate of 1.7% (45 deaths, 19 of which involved were pregnant women). Risk factors for clinical HEV infection included age of 15–45 years (odds ratio, 2.13; 95% confidence interval, 1.02–4.46) and drinking chlorinated surface water (odds ratio, 2.49; 95% confidence interval, 1.22–5.08). Both factors were also suggestive of increased risk for asymptomatic HEV infection, although this was not found to be statistically significant. HEV RNA was positively identified in serum samples obtained from 2 donkeys. No bacteria were identified from any sample of chlorinated water tested. Conclusions. Current recommendations to ensure a safe water supply may have been insufficient to inactivate HEV and control this epidemic. This research highlights the need to evaluate current water treatment methods and to identify alternative solutions adapted to complex emergencies.
ISSN:1058-4838
1537-6591
DOI:10.1086/504321