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Al-Shimari FH, Rencken CA, Kirkwood CD, Kumar R, Vannice KS, Stewart BT. Systematic review of global hepatitis E outbreaks to inform response and coordination initiatives. BMC Public Health 2023; 23:1120. [PMID: 37308896 DOI: 10.1186/s12889-023-15792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/02/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Hepatitis E virus (HEV) is the most common cause of acute hepatitis. While symptoms are generally mild and resolve within weeks, some populations (e.g., pregnant women, immunocompromised adults) are at high-risk of severe HEV-related morbidity and mortality. There has not been a recent comprehensive review of contemporary HEV outbreaks, which limits the validity of current disease burden estimates. Therefore, we aimed to characterize global HEV outbreaks and describe data gaps to inform HEV outbreak prevention and response initiatives. METHODS We performed a systematic review of peer-reviewed (PubMed, Embase) and gray literature (ProMED) to identify reports of outbreaks published between 2011 and 2022. We included (1) reports with ≥ 5 cases of HEV, and/or (2) reports with 1.5 times the baseline incidence of HEV in a specific population, and (3) all reports with suspected (e.g., clinical case definition) or confirmed (e.g., ELISA or PCR test) cases if they met criterium 1 and/or 2. We describe key outbreak epidemiological, prevention and response characteristics and major data gaps. RESULTS We identified 907 records from PubMed, 468 from Embase, and 247 from ProMED. We screened 1,362 potentially relevant records after deduplication. Seventy-one reports were synthesized, representing 44 HEV outbreaks in 19 countries. The populations at risk, case fatalities, and outbreak durations were not reported in 66% of outbreak reports. No reports described using HEV vaccines. Reported intervention efforts included improving sanitation and hygiene, contact tracing/case surveillance, chlorinating boreholes, and advising residents to boil water. Commonly missing data elements included specific case definitions used, testing strategy and methods, seroprevalence, impacts of interventions, and outbreak response costs. Approximately 20% of HEV outbreaks we found were not published in the peer-reviewed literature. CONCLUSION HEV represents a significant public health problem. Unfortunately, extensive data shortages and a lack of standardized reporting make it difficult to estimate the HEV disease burden accurately and to implement effective prevention and response activities. Our study has identified major gaps to guide future studies and outbreak reporting systems. Our results support the development of standardized reporting procedures/platforms for HEV outbreaks to ensure accurate and timely data distribution, including active and passive coordinated surveillance systems, particularly among high-risk populations.
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Affiliation(s)
- Fatima H Al-Shimari
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.
- Strategic Analysis, Research and Training (START) Center, Seattle, WA, USA.
| | - Camerin A Rencken
- Strategic Analysis, Research and Training (START) Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Carl D Kirkwood
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Ramya Kumar
- Strategic Analysis, Research and Training (START) Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Kirsten S Vannice
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Barclay T Stewart
- Strategic Analysis, Research and Training (START) Center, Seattle, WA, USA
- Department of Surgery, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
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Chaufan C, Dutescu IA, Fekre H, Marzabadi S, Noh KJ. The military as a neglected pathogen transmitter, from the nineteenth century to COVID-19: a systematic review. Glob Health Res Policy 2021; 6:48. [PMID: 34893071 PMCID: PMC8661370 DOI: 10.1186/s41256-021-00232-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background The risk of outbreaks escalating into pandemics has soared with globalization. Therefore, understanding transmission mechanisms of infectious diseases has become critical to formulating global public health policy. This systematic review assessed evidence in the medical and public health literature for the military as a disease vector. Methods We searched 3 electronic databases without temporal restrictions. Two researchers independently extracted study data using a standardized form. Through team discussions, studies were grouped according to their type of transmission mechanism and direct quotes were extracted to generate themes and sub-themes. A content analysis was later performed and frequency distributions for each theme were generated. Results Of 6477 studies, 210 met our inclusion criteria and provided evidence, spanning over two centuries (1810–2020), for the military as a pathogen transmitter, within itself or between it and civilians. Biological mechanisms driving transmission included person-to-person transmission, contaminated food and water, vector-borne, and airborne routes. Contaminated food and/or water were the most common biological transmission route. Social mechanisms facilitating transmission included crowded living spaces, unhygienic conditions, strenuous working, training conditions, absent or inadequate vaccination programs, pressure from military leadership, poor compliance with public health advice, contractor mismanagement, high-risk behaviours, and occupation-specific freedom of movement. Living conditions were the most common social transmission mechanism, with young, low ranking military personnel repeatedly reported as the most affected group. Selected social mechanisms, such as employment-related freedom of movement, were unique to the military as a social institution. While few studies explicitly studied civilian populations, considerably more contained information that implied that civilians were likely impacted by outbreaks described in the military. Conclusions This study identified features of the military that pose a significant threat to global health, especially to civilian health in countries with substantial military presence or underdeveloped health systems. While biological transmission mechanisms are shared by other social groups, selected social transmission mechanisms are unique to the military. As an increasingly interconnected world faces the challenges of COVID-19 and future infectious diseases, the identified features of the military may exacerbate current and similar challenges and impair attempts to implement successful and equitable global public health policies. Supplementary Information The online version contains supplementary material available at 10.1186/s41256-021-00232-0.
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Affiliation(s)
| | | | - Hanah Fekre
- Faculty of Health, York University, Toronto, Canada.
| | | | - K J Noh
- Independent Scholar, Oakland, USA
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Batool F, Nawaz H, Majeed MI, Rashid N, Bashir S, Bano S, Tahir F, Haq AU, Saleem M, Nawaz MZ, Almas F, Amin I. Surface-enhanced Raman spectral analysis for comparison of PCR products of hepatitis B and hepatitis C. Photodiagnosis Photodyn Ther 2021; 35:102440. [PMID: 34280557 DOI: 10.1016/j.pdpdt.2021.102440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/15/2021] [Accepted: 07/12/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surface-enhanced Raman spectroscopy is a reliable tool for identification and differentiation of two diseases showing similar symptoms, hepatitis B (HBV) and hepatitis C (HCV). OBJECTIVES To develop a polymerase chain reaction technique (PCR) based SERS technique for differentiation of two human pathological conditions sharing the same symptoms using multivariate data analysis techniques e.g. principle component analysis (PCA) and partial least square discriminate analysis (PLS-DA). METHODS PCR products of HBV and HCV were differentiated by SERS using silver nanoparticles (AgNPs) as a SERS substrate. For this analysis, PCR products of both the diseases with predetermined viral loads were collected and analyzed under SERS instrument and unique SERS spectra of HBV and HCV was compared showing many differences at various points. Diseased classes of HBV and HCV and their negative control classes (viral load less than 1) were compared. PCR products of true healthy DNA and RNA were also compared, which were significantly separated. Moreover, SERS data was analyzed using multivariate data analysis techniques including principle component analysis (PCA) and partial least square discriminate analysis (PLS-DA) and differences were so prominent to observe. RESULTS SERS spectral data of HBV and HCV showed clear differences and were significantly separated using PCA. Negative control samples of both disorders and their true healthy samples of DNA and RNA were separated according to 1st principle component. By analyzing data using partial least square discriminate analysis, differentiation of two disease classes was considered more valid with sensitivity, specificity and accuracy value of 96%, 94% and 98% respectively. Value of area under curve (AUROC) was 0.7527. CONCLUSION SERS can be employed for identification and comparison of two human pathological conditions sharing the same symptomology.
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Affiliation(s)
- Fatima Batool
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan
| | - Haq Nawaz
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan
| | - Muhammad Irfan Majeed
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan.
| | - Nosheen Rashid
- Institute of Microbiology, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan
| | - Saba Bashir
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan
| | - Saira Bano
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan
| | - Fatima Tahir
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan
| | - Anwar Ul Haq
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan
| | - Mudassar Saleem
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan
| | - Muhammad Zaman Nawaz
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan
| | - Farakh Almas
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38040, Pakistan
| | - Imran Amin
- Department of Chemistry, University of Central Punjab, Faisalabad Campus, Faisalabad, Pakistan
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Malhotra B, Deba F, Sharma P, Trivedi K, Tiwari J, Chouhan A, Singh R, Meena D, Verma HN. Hepatitis E outbreak in Jaipur due to Genotype IA. Indian J Med Microbiol 2020; 38:46-51. [PMID: 32719208 DOI: 10.4103/ijmm.ijmm_19_433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose Suddenly, many cases of fever with jaundice were reported from Sodala area at Jaipur. This outbreak of acute hepatitis at Jaipur Rajasthan was investigated for aetiology and subsequent phylogenetic analysis. Methods Blood samples were collected from 106 symptomatic patients of acute hepatitis and 39 pregnant females (with or without symptoms of hepatitis) during an outbreak at Jaipur. The samples were tested for hepatitis A virus (HAV) and hepatitis E virus (HEV) by serological and molecular methods (polymerase chain reaction [PCR]). Sequencing of nested PCR product was done for phylogenetic analysis. Hepatitis B surface antigen (HBs antigen), anti-hepatitis C virus (HCV), anti-Leptospira and anti-scrub typhus IgM enzyme-linked immunosorbent assay (ELISA) was done for patients negative for HEV and HAV. Results Among 106 symptomatic patients, HEV IgM was positive in 84/106 (79.2%) patients and HEV RNA in 72/106 (67.9%) patients. Among pregnant women, 6/39 (15.4%) were HEV IgM positive and 5/39 (12.8%) for HEV RNA. One (2.5%) pregnant woman died due to hepatitis. All the isolates belonged to genotype 1A of HEV. All HAV, HEV-negative samples were negative for HBs antigen, HCV antibody, Leptospira and scrub typhus IgM ELISA. Conclusion The outbreak was due to HEV genotype 1A. The municipal water supply was contaminated and sanitary conditions and waste disposal were poor in the area. Boiling of drinking water, fixing the water supply pipes and frequent hand washing helped in controlling the outbreak.
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Affiliation(s)
- Bharti Malhotra
- Department of Microbiology and Immunology, SMS Medical College, Jaipur, Rajasthan, India
| | - Farah Deba
- Department of Microbiology and Immunology, SMS Medical College; Department of Microbiology, Jaipur National University, Jaipur, Rajasthan, India
| | - Pratibha Sharma
- Department of Microbiology and Immunology, SMS Medical College, Jaipur, Rajasthan, India
| | - Khushbu Trivedi
- Department of Microbiology and Immunology, SMS Medical College, Jaipur, Rajasthan, India
| | - Jitendra Tiwari
- Department of Microbiology and Immunology, SMS Medical College, Jaipur; Government Medical College, Bharatpur, Rajasthan, India
| | - Aradhana Chouhan
- Department of Microbiology and Immunology, SMS Medical College, Jaipur, Rajasthan, India
| | - Ruchi Singh
- State Microbiologist IDSP, Directorate of Medical and Health, Jaipur, Rajasthan, India
| | - Deepa Meena
- State Microbiologist IDSP, Directorate of Medical and Health, Jaipur, Rajasthan, India
| | - H N Verma
- Department of Microbiology, Jaipur National University, Jaipur, Rajasthan, India
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Hakim MS, Wang W, Bramer WM, Geng J, Huang F, de Man RA, Peppelenbosch MP, Pan Q. The global burden of hepatitis E outbreaks: a systematic review. Liver Int 2017; 37:19-31. [PMID: 27542764 DOI: 10.1111/liv.13237] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/15/2016] [Indexed: 12/12/2022]
Abstract
Hepatitis E virus (HEV) is responsible for repeated water-borne outbreaks since the past century, representing an emerging issue in public health. However, the global burden of HEV outbreak has not been comprehensively described. We performed a systematic review of confirmed HEV outbreaks based on published literatures. HEV outbreaks have mainly been reported from Asian and African countries, and only a few from European and American countries. India represents a country with the highest number of reported HEV outbreaks. HEV genotypes 1 and 2 were responsible for most of the large outbreaks in developing countries. During the outbreaks in developing countries, a significantly higher case fatality rate was observed in pregnant women. In fact, outbreaks have occurred both in open and closed populations. The control measures mainly depend upon improvement of sanitation and hygiene. This study highlights that HEV outbreak is not new, yet it is a continuous global health problem.
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Affiliation(s)
- Mohamad S Hakim
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Microbiology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Wenshi Wang
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jiawei Geng
- Department of Infectious Diseases, The First People's Hospital of Yunnan Province, Kunming, China
| | - Fen Huang
- Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maikel P Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
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Banerjee A. Comments on investigating a community wide outbreak of hepatitis a in India. J Glob Infect Dis 2015; 7:45-6. [PMID: 25722624 PMCID: PMC4338454 DOI: 10.4103/0974-777x.146379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amitav Banerjee
- Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
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Kotwal A, Singh H, Verma A, Gupta R, Jain S, Sinha S, Joshi R, Teli P, Khunga V, Bhatnagar A, Ranjan R. A study of Hepatitis A and E virus seropositivity profile amongst young healthy adults in India. Med J Armed Forces India 2014; 70:225-9. [PMID: 25378774 PMCID: PMC4213908 DOI: 10.1016/j.mjafi.2014.06.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 06/23/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Various Serosurveys and studies provide ample evidence of differing perspectives regarding epidemiology of HAV and HEV in India. This study was conducted to assess the seroprevalence of HAV and HEV and its associated factors with an aim to provide inputs to planners regarding requirement of HAV vaccine. METHODS A multi-centric cross sectional survey amongst 4175 healthy trainees (young adults) was carried out in training centres, selected by multistage random sampling, giving equal representation to all regions of India. Sample size was calculated by taking prevalence of HAV seropositivity amongst adults as 60% and alpha 0.05. RESULTS Seroprevalence for HAV and HEV was 92.68% (95% CI 91.82, 93.47) and 17.05% (15.90, 18.26), respectively. Logistic regression showed that hand washing without soap, regular close contact with domestic animals, consumption of unpasteurized milk and regular consumption of food outside home were risk factors for HAV (p < 0.05). For HEV, irregular hand washing, consumption of unpasteurized milk and irregular consumption of freshly prepared food were risk factors (p < 0.05). CONCLUSION High level of immunity against HAV among the healthy young adults clearly demonstrates that vaccination against HAV is not required at present in our country. The large proportion being susceptible to HEV points towards the requirement of preventive strategies in the form of safe drinking water supply, hygiene, sanitation, increasing awareness and behaviour change with respect to personal hygiene especially hand and food hygiene.
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Affiliation(s)
- Atul Kotwal
- Director, AFMS (Med Research), O/o DGAFMS, Ministry of Defence, New Delhi, India
- Professor and Head, Dept of Community Medicine, Army College of Medical Sciences, New Delhi 11001, India
| | | | - A.K. Verma
- Formerly, Professor & Head, Dept of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - R.M. Gupta
- Dy DGMS (IT), O/o DGMS (Army), L Block IHQ of MoD (A), New Delhi, India
| | | | - S. Sinha
- ADH, HQ 1 Corps, C/o 56 APO, India
| | - R.K. Joshi
- Classified Specialist (Community Medicine & Epidemiology), National Aids Research Institute, Pune, India
| | | | | | - Anuj Bhatnagar
- Assistant Professor, Dept of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - Richa Ranjan
- Classified Specialist (Pathology), Command Hospital (Central Command), Lucknow, India
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Awsathi S, Rawat V, Rawat CMS, Semwal V, Bartwal SJ. Epidemiological investigation of the jaundice outbreak in lalkuan, nainital district, uttarakhand. Indian J Community Med 2014; 39:94-7. [PMID: 24963225 PMCID: PMC4067936 DOI: 10.4103/0970-0218.132725] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 10/23/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In March 2013, cases of acute hepatitis were reported from Lalkuan, Nainital district. We investigated the outbreak to identify the source of infection and to facilitate control measures. OBJECTIVES To study the distribution of hepatitis cases, to find the source of infection, and to initiate the control measures in the affected area. MATERIALS AND METHODS WE DEFINED A CASE OF ACUTE HEPATITIS AS THOSE CASES THAT HAD JAUNDICE WITH AT LEAST ONE OF THE FOLLOWING SYMPTOMS: Dark urine, fever, pain in abdomen, vomiting, and loss of appetite in the affected area between January and March 2013. Door-to-door survey was carried out. Thirteen blood samples were randomly collected from jaundice cases for immunoglobulin M (IgM) antibody for hepatitis A virus (HAV) and hepatitis E virus (HEV). Water samples were collected to test residual chlorine. RESULTS Total 2,785 individuals were surveyed; of which 240 were suffering from acute viral hepatitis (attack rate (AR) = 8.61%). Out of 13 serum samples, 10 were found positive for HEV IgM antibodies and three cases had IgM antibodies for both HAV and HEV, which confirmed a hepatitis E outbreak. The difference in attack rate of hepatitis of both the sexes was statistically significant (P < 0.001). The attack rate was significantly higher in age groups >12 years of age (P < 0.001). Environmental investigation also confirmed the sewage contamination of drinking water in the distribution system. The attack rate was much higher (29.4%) among those who were exposed to the leaking pipeline than the nonexposed (χ(2) = 574.26, P < 0.01). CONCLUSION HEV was confirmed as the major etiological agent in this outbreak that was transmitted by contaminated drinking water. The recognition of early warning signals, timely investigation, and application of specific control measures can contain the outbreak.
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Affiliation(s)
- Sadhana Awsathi
- Department of Community Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Vinita Rawat
- Department of Microbiology, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Chandra Mohan Singh Rawat
- Department of Community Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Vandana Semwal
- Department of Community Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Sunil Janki Bartwal
- Department of Community Medicine, Government Medical College, Haldwani, Nainital, Uttarakhand, India
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