High Mortality Associated with an Outbreak of Hepatitis E among Displaced Persons in Darfur, Sudan

• Published in: Clinical infectious diseases 2006-06, Vol.42 (12), p.1679-1684
• Main Authors: Boccia, Delia, Guthmann, Jean-Paul, Klovstad, Hilde, Hamid, Nuha, Tatay, Mercedes, Ciglenecki, Iza, Nizou, Jacques-Yves, Nicand, Elisabeth, Guerin, Philippe Jean
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antibodies, Viral - blood; Articles and Commentaries; Biological and medical sciences; Child; Child, Preschool; Disease control; Disease Outbreaks; Displaced persons; Drinking water; Epidemics; Female; Hepatitis; Hepatitis E; Hepatitis E - mortality; Hepatitis E virus; Hospital admissions; Hospitals; Human viral diseases; Humans; Immunoglobulin G - blood; Immunoglobulin M - blood; Infections; Infectious diseases; Jaundice; Male; Medical sciences; Middle Aged; Mortality; Polls & surveys; Pregnancy; Refugees; Retrospective Studies; RNA, Viral - blood; Samples; Sudan - epidemiology; Tropical diseases; Vaccination; Viral diseases; Viral hepatitis; Womens health
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/504322

Background. Hepatitis E virus (HEV) causes acute onset of jaundice and a high case-fatality ratio in pregnant women. We provide a clinical description of hospitalized case patients and assess the specific impact on pregnant women during a large epidemic of HEV infection in a displaced population in Mornay camp (78,800 inhabitants), western Darfur, Sudan. Methods. We reviewed hospital records. A sample of 20 clinical cases underwent laboratory confirmation. These patients were tested for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody to HEV (serum) and for amplification of the HEV genome (serum and stool). We performed a cross-sectional survey in the community to determine the attack rate and case-fatality ratio in pregnant women. Results. Over 6 months, 253 HEV cases were recorded at the hospital, of which 61 (24.1%) were in pregnant women. A total of 72 cases (39.1% of those for whom clinical records were available) had a diagnosis of hepatic encephalopathy. Of the 45 who died (case-fatality ratio, 17.8%), 19 were pregnant women (specific case-fatality ratio, 31.1%). Acute hepatitis E was confirmed in 95% (19/20) of cases sampled; 18 case-patients were positive for IgG (optical density ratio ⩾3), for IgM (optical density ratio >2 ), or for both, whereas 1 was negative for IgG and IgM but positive for HEV RNA in serum. The survey identified 220 jaundiced women among the 1133 pregnant women recorded over 3 months (attack rate, 19.4%). A total of 18 deaths were recorded among these jaundiced pregnant women (specific case-fatality ratio, 8.2%). Conclusions. This large epidemic of HEV infection illustrates the dramatic impact of this disease on pregnant women. Timely interventions and a vaccine are urgently needed to prevent mortality in this special group.