J Desramé | PubMed Health

PubMed1998

Outbreak of enterically-transmitted hepatitis due to hepatitis A and hepatitis E viruses.

BACKGROUND/AIMS: One hundred and eleven patients with acute hepatitis and 61 controls were investigated for hepatitis serological markers in order to determine the viral etiology of cases involved in a waterborne epidemic of hepatitis observed in 1993 in Djibouti, Republic of Djibouti (East Africa). These cases occurred both in indigenous Djiboutians, and in French soldiers and their families in Djibouti. A retrospective study of the viral etiology of acute hepatitis cases observed in French soldiers and relatives living in Djibouti during the 3-year period preceding the epidemic was also undertaken. METHODS: HAV, HBV and HCV infections were investigated using commercial ELISA tests. HEV infections were investigated by testing IgG and IgM-specific antibodies by means of three different ELISA tests using recombinant proteins or synthetic peptides. RESULTS: Hepatitis A was observed in 37 (33%) and hepatitis E in 43 (39%) of the 111 cases of acute hepatitis recorded during this epidemic. Hepatitis B represented only 6% of the indigenous cases and hepatitis C was not observed among the cases investigated. Anti-HEV IgG antibodies were also detected in 19% of the indigenous control group. CONCLUSION: These results suggest that both HAV and HEV were responsible for this waterborne epidemic of acute hepatitis. However, HAV and HEV infections were not equally distributed between French expatriates and Djibouti residents. Whereas HAV infections were mainly observed in French patients, HEV was almost exclusively found in indigenous patients. This study reports for the first time a waterborne outbreak of acute hepatitis simultaneously due to HAV and HEV.

Adolescent↗

PubMed1996

[Viral hepatitis E].

Thanks to progress in serologic techniques evidence was obtained in 1980 showing that acute hepatitis epidemics observed in India were due to neither virus A nor virus B. The presence of another virus was confirmed and its genome was cloned and sequenced in 1991. Hepatitis virus E is a small RNA virus that differs from other known human viruses. Man and probably a few animal species maintain dissemination by the fecal route. Subjects not previously contaminated are susceptible and produce protective antibodies. Contamination occurs by the fecal-oral route general from water or tainted food. Direct contamination is rare. Vertical transmission from mother to fetus can also be observed. Outbreaks of the disease are characterized by epidemic proportions, preferential involvement of adolescent and young adults, and high incidence of fulminant cases especially in pregnant women. Outbreaks have been observed in endemic settings in southern Asia, Africa, and Mexico where sporadic cases are observed. Endemic areas are found in all developing countries. Hepatitis E is not clinically different from other acute viral hepatitis. Asymptomatic forms are common especially in children. The course of the disease is usually benign with little risk of development of chronic symptoms and cirrhosis. However hepatitis E is associated with a high incidence of severe cases with a mortality of 1 to 2% from icteric forms which occur in 15 to 20% of cases involving women contaminated during the last three months of pregnancy. Diagnosis can be made using either synthetic proteins or recombinant peptides. for the epitopes of the virus. Prevention depends on protection of the water supply and proper sewage disposal. Successful active immunization of monkeys holds promise for development of a vaccine. Due to its magnitude and high mortality rate hepatitis E is a major health problem for numerous regions around the world including Southeast Asia.

Adolescent↗