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Aiemjoy K, Rumunu J, Hassen JJ, Wiens KE, Garrett D, Kamenskaya P, Harris JB, Azman AS, Teunis P, Seidman JC, Wamala JF, Andrews JR, Charles RC. Seroincidence of Enteric Fever, Juba, South Sudan. Emerg Infect Dis 2022; 28. [PMID: 36286224 PMCID: PMC9622235 DOI: 10.3201/eid2811.220239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We applied a new serosurveillance tool to estimate typhoidal Salmonella burden using samples collected during 2020 from a population in Juba, South Sudan. By using dried blood spot testing, we found an enteric fever seroincidence rate of 30/100 person-years and cumulative incidence of 74% over a 4-year period.
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Wamala JF, Loro F, Deng SJ, Berta KK, Guyo AG, Mpairwe A, Ndenzako F, Rumunu JP. Epidemiological characterization of COVID-19 in displaced populations of South Sudan. Pan Afr Med J 2022; 42:4. [PMID: 36158931 PMCID: PMC9474933 DOI: 10.11604/pamj.supp.2022.42.1.33767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction South Sudan is facing a protracted humanitarian crisis with increasing population vulnerability. The study aimed to describe the epidemiology of COVID-19 in displaced populations in South Sudan. Methods the study involved the internally displaced populations (IDP) in Bentiu IDP camp, South Sudan. This was a descriptive cross-sectional study involving individuals that met the COVID-19 probable and confirmed case definitions from May 2020 to November 2021. Case data were managed using Microsoft Excel databases. Results the initial COVID-19 case in Bentiu IDP camp was reported on 2 May 2020. The overall cumulative attack rate (cases per million) was 3,230 for Bentiu IDP and 1,038 at the national level. The COVID-19 Case Fatality Ratio (CFR) among the IDPs was 19.08% among confirmed and 1.06% at the national level. There was one wave of COVID-19 transmission in the IDPs that coincided with the second COVID-19 wave in South Sudan for the period May 2020 to November 2021. Adult males aged 20-49 years were the most affected and constituted 47.1% of COVID-19 cases. Most severe cases were reported among adults 60-69 years (53%) and ≥ 70 years (80%). The risk of COVID-19 death (deaths per 10,000) increased with age and was highest in patients aged ≥ 60 years at 64.1. The commonest underlying illnesses among COVID-19 deaths was HIV-related illness, heart disease, and tuberculosis. Conclusion COVID-19 constitutes a significant impact on internally displaced populations of South Sudan. The COVID-19 response in displaced populations and the high-risk groups therein should be optimized.
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Affiliation(s)
- Joseph Francis Wamala
- Emergency Preparedness and Response, World Health Organization Country Office, Juba, South Sudan,,Corresponding author Joseph Francis Wamala, Emergency Preparedness and Response, World Health Organization Country Office, Juba, South Sudan.
| | - Fredrick Loro
- Emergency Preparedness and Response, World Health Organization Country Office, Juba, South Sudan
| | - Simon John Deng
- Emergency Preparedness and Response, World Health Organization Country Office, Juba, South Sudan
| | - Kibebu Kinfu Berta
- Emergency Preparedness and Response, World Health Organization Country Office, Juba, South Sudan
| | - Argata Guracha Guyo
- Emergency Preparedness and Response, World Health Organization Country Office, Juba, South Sudan
| | - Allan Mpairwe
- World Health Organization Regional Office for Africa, Nairobi Hub, Kenya
| | - Fabian Ndenzako
- Emergency Preparedness and Response, World Health Organization Country Office, Juba, South Sudan
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Bwire G, Ario AR, Eyu P, Ocom F, Wamala JF, Kusi KA, Ndeketa L, Jambo KC, Wanyenze RK, Talisuna AO. The COVID-19 pandemic in the African continent. BMC Med 2022; 20:167. [PMID: 35501853 PMCID: PMC9059455 DOI: 10.1186/s12916-022-02367-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/13/2023] Open
Abstract
In December 2019, a new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and associated disease, coronavirus disease 2019 (COVID-19), was identified in China. This virus spread quickly and in March, 2020, it was declared a pandemic. Scientists predicted the worst scenario to occur in Africa since it was the least developed of the continents in terms of human development index, lagged behind others in achievement of the United Nations sustainable development goals (SDGs), has inadequate resources for provision of social services, and has many fragile states. In addition, there were relatively few research reporting findings on COVID-19 in Africa. On the contrary, the more developed countries reported higher disease incidences and mortality rates. However, for Africa, the earlier predictions and modelling into COVID-19 incidence and mortality did not fit into the reality. Therefore, the main objective of this forum is to bring together infectious diseases and public health experts to give an overview of COVID-19 in Africa and share their thoughts and opinions on why Africa behaved the way it did. Furthermore, the experts highlight what needs to be done to support Africa to consolidate the status quo and overcome the negative effects of COVID-19 so as to accelerate attainment of the SDGs.
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Affiliation(s)
- Godfrey Bwire
- grid.415705.2Department of Integrated Epidemiology Surveillance and Public Health Emergencies, Ministry of Health, P.O Box 7272, Kampala, Uganda
- grid.11194.3c0000 0004 0620 0548School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | - Patricia Eyu
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Felix Ocom
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Kwadwo A. Kusi
- grid.8652.90000 0004 1937 1485Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Latif Ndeketa
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
| | - Kondwani C. Jambo
- grid.419393.50000 0004 8340 2442Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rhoda K. Wanyenze
- grid.11194.3c0000 0004 0620 0548School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ambrose O. Talisuna
- grid.463718.f0000 0004 0639 2906Epidemic Preparedness and Response Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo
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4
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El-Kafrawy SA, El-Daly MM. Hepatitis E virus in Saudi Arabia: more surveillance needed. Future Virol 2022. [DOI: 10.2217/fvl-2021-0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hepatitis E virus (HEV) is a small quasi-enveloped ssRNA causing acute hepatitis. HEV is the leading cause of intermittent acute hepatitis and fulminant hepatic failure. Risk factors include drinking contaminated water in developing countries and consumption of infected animal products in developed countries. Previous reports on HEV prevalence in Saudi Arabia had small sample sizes. Nationwide systematic seroprevalence studies are needed to investigate risk factors and annual incidence. Camels play a cultural and economic role in the life of Saudi citizens with frequent human contact and potential role in zoonotic transmission. Future research needs to include larger sample-sizes and nationwide studies. Future studies should also focus on raising awareness of HEV infection and the need for wider population testing and screening.
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Affiliation(s)
- Sherif Aly El-Kafrawy
- Special Infectious Agents Unit-BSL3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Mai Mohamed El-Daly
- Special Infectious Agents Unit-BSL3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
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Prevalence and Diversity of Hepatitis Virus Markers among Patients with Acute Febrile Jaundice in Chad. MICROBIOLOGY RESEARCH 2021. [DOI: 10.3390/microbiolres12040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Only a minority of the patients with acute febrile jaundice evaluated through the Yellow Fever surveillance program were found positive for antibodies against Yellow Fever Virus (YFV). In order to characterize patients with acute febrile jaundice negative for YFV, we collected 255 sera between January to December 2019. We screened for HBV antigens, and antibodies against HCV and HEV. The seroprevalences observed were 10.6% (27/255) for HBV, 2% (5/255) for HCV, 17.3% (44/255) for HEV IgG, 4.3% (11/255) for HEV IgM, and 12.5% (32/255) for both IgG and IgM HEV. Prevalence of HEV was significantly higher in females than males (p < 0.01). HEV IgG prevalence was highest in those 20–29 years old, but the highest incidence rate (IgM positive) was in children 0–9 years old. Exposure to HEV was higher in the Sahelian zone (55.8%, 95% CI: 40.97–70.66) than in the Sudanese zone (30.2%, 95% CI: 24.01–36.37, p = 0.003). The high prevalence rates and hepatitis virus diversity underline the challenge of routine clinical diagnosis in Chad’s Yellow Fever surveillance program.
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Koyuncu A, Mapemba D, Ciglenecki I, Gurley ES, Azman AS. Setting a Course for Preventing Hepatitis E in Low and Lower-Middle-Income Countries: A Systematic Review of Burden and Risk Factors. Open Forum Infect Dis 2021; 8:ofab178. [PMID: 34113684 PMCID: PMC8186248 DOI: 10.1093/ofid/ofab178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/09/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) is responsible for outbreaks of acute jaundice in Africa and Asia, many of which occur among displaced people or in crisis settings. Although an efficacious vaccine for HEV has been developed, we lack key epidemiologic data needed to understand how best to use the vaccine for hepatitis E control in endemic countries. METHODS We conducted a systematic review of articles published on hepatitis E in low-income and lower-middle-income countries in Africa and Asia. We searched PubMed, Scopus, and Embase databases to identify articles with data on anti-HEV immunoglobulin (Ig)G seroprevalence, outbreaks of HEV, or risk factors for HEV infection, disease, or death, and all relevant data were extracted. Using these data we describe the evidence around temporal and geographical distribution of HEV transmission and burden. We estimated pooled age-specific seroprevalence and assessed the consistency in risk factor estimates. RESULTS We extracted data from 148 studies. Studies assessing anti-HEV IgG antibodies used 18 different commercial assays. Most cases of hepatitis E during outbreaks were not confirmed. Risk factor data suggested an increased likelihood of current or recent HEV infection and disease associated with fecal-oral transmission of HEV, as well as exposures to blood and animals. CONCLUSIONS Heterogeneity in diagnostic assays used and exposure and outcome assessment methods hinder public health efforts to quantify burden of disease and evaluate interventions over time and space. Prevention tools such as vaccines are available, but they require a unified global strategy for hepatitis E control to justify widespread use.
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Affiliation(s)
| | - Daniel Mapemba
- South African Field Epidemiology Training Program, National Institute for Communicable Diseases, Division of National Health Laboratory Services, Johannesburg, South Africa
| | | | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew S Azman
- Médecins Sans Frontières, Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Alhatlani BY, Aljabr WA, Almarzouqi MS, Alhatlani SM, Alzunaydi RN, Alsaykhan AS, Almaiman SH, Aleid AA, Alsughayir AH, Bishawri YE, Almusallam AA. Seroprevalence of the hepatitis E virus antibodies among blood donors in the Qassim region, Saudi Arabia. Future Virol 2021. [DOI: 10.2217/fvl-2021-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aim: Hepatitis E virus (HEV) transmission through blood transfusion is a major public health issue worldwide. We aimed to determine the seroprevalence of HEV in blood donors in the Qassim region of Saudi Arabia. Materials & methods: Serum samples (n = 1078) were collected from volunteer blood donors and tested for the presence of anti-HEV IgG and IgM by indirect ELISA. Results: The seroprevalence of anti-HEV IgG among the blood donors was 5.7% overall. Anti-HEV IgG and IgM seropositivity were significantly higher in non-Saudi donors than in Saudi donors (22.1 vs 3 and 7.8 vs 0.2% for anti-HEV IgG and IgM, respectively). Conclusion: The seroprevalence of HEV among blood donors in the Qassim region was lower than previous estimates for other regions of the country and neighboring countries.
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Affiliation(s)
- Bader Y Alhatlani
- Department of Applied Medical Sciences, Unayzah Community College, Qassim University, Unayzah, Saudi Arabia
| | - Waleed A Aljabr
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed S Almarzouqi
- Department of Applied Medical Sciences, Unayzah Community College, Qassim University, Unayzah, Saudi Arabia
| | - Sami M Alhatlani
- Department of Medical Laboratory, Blood Donor Unit, King Saud Hospital, Unayzah, Saudi Arabia
| | - Rayan N Alzunaydi
- Department of Medical Laboratory, Blood Donor Unit, King Saud Hospital, Unayzah, Saudi Arabia
| | - Abeer S Alsaykhan
- Department of Medical Laboratory, Blood Donor Unit, King Saud Hospital, Unayzah, Saudi Arabia
| | - Sulaiman H Almaiman
- Department of Medical Laboratory, Blood Donor Unit, King Saud Hospital, Unayzah, Saudi Arabia
| | - Ahmed A Aleid
- Gastroenterology & Department of Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ammar H Alsughayir
- Transfusion Medicine & Department of Hematopathology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yara E Bishawri
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman A Almusallam
- Department of Applied Medical Sciences, Unayzah Community College, Qassim University, Unayzah, Saudi Arabia
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Cooper B, Behnke NL, Cronk R, Anthonj C, Shackelford BB, Tu R, Bartram J. Environmental health conditions in the transitional stage of forcible displacement: A systematic scoping review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 762:143136. [PMID: 33153751 DOI: 10.1016/j.scitotenv.2020.143136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
In 2019, 30,000 people were forced to leave their homes due to conflict, persecution, and natural disaster each day. Eighty-five percent of refugees live in developing countries, and they often face underfunded and inadequate environmental health services. Many displaced persons live in camps and other temporary settlements long after the displacement event occurs. However, there is little evidence on environmental health conditions in the transitional phase-defined by the United Nations High Commissioner for Refugees as six months to two years after displacement. To address this gap in research, we conducted a systematic scoping review of environmental health conditions, exposures, and outcomes in transitional displacement settings, as well as reported obstacles and recommendations for improvement. Eighty-eight publications met the inclusion criteria. Water supply was the most frequently discussed environmental health topic. Overcrowding was the most common risk factor reported, Vibrio cholerae was the most common pathogen reported, and diarrhea was the most commonly reported health outcome. Obstacles and recommendations were categorized as institutional, political or implementation-based. Identified knowledge gaps included minimal information on setting logistics and on topics such as menstrual hygiene, oral hygiene and fomite contamination. In order to improve environmental health conditions in transitional displacement settings, all levels of government and non-governmental organizations should increase collaboration to improve resource provision. This study is the first to report on environmental health conditions in this important time of transition between the emergency and protracted stages of displacement.
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Affiliation(s)
- Brittany Cooper
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Nikki L Behnke
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Ryan Cronk
- ICF, 2635 Meridian Pkwy Suite 200, Durham, NC 27713.
| | - Carmen Anthonj
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States; Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands
| | - Brandie Banner Shackelford
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Raymond Tu
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Jamie Bartram
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States; School of Civil Engineering, University of Leeds, Woodhouse Ln, Woodhouse, Leeds LS2 9DY, United Kingdom
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Pallerla SR, Harms D, Johne R, Todt D, Steinmann E, Schemmerer M, Wenzel JJ, Hofmann J, Shih JWK, Wedemeyer H, Bock CT, Velavan TP. Hepatitis E Virus Infection: Circulation, Molecular Epidemiology, and Impact on Global Health. Pathogens 2020; 9:E856. [PMID: 33092306 PMCID: PMC7589794 DOI: 10.3390/pathogens9100856] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022] Open
Abstract
Infection with hepatitis E virus (HEV) represents the most common source of viral hepatitis globally. Although infecting over 20 million people annually in endemic regions, with major outbreaks described since the 1950s, hepatitis E remains an underestimated disease. This review gives a current view of the global circulation and epidemiology of this emerging virus. The history of HEV, from the first reported enteric non-A non-B hepatitis outbreaks, to the discovery of the viral agent and the molecular characterization of the different human pathogenic genotypes, is discussed. Furthermore, the current state of research regarding the virology of HEV is critically assessed, and the challenges towards prevention and diagnosis, as well as clinical risks of the disease described. Together, these points aim to underline the significant impact of hepatitis E on global health and the need for further in-depth research to better understand the pathophysiology and its role in the complex disease manifestations of HEV infection.
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Affiliation(s)
- Srinivas Reddy Pallerla
- Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; (S.R.P.); (T.P.V.)
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi 100000, Vietnam
| | - Dominik Harms
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany;
| | - Reimar Johne
- Unit Viruses in Food, Department Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany;
| | - Daniel Todt
- Department of Molecular and Medical Virology, Ruhr University Bochum, 44801 Bochum, Germany; (D.T.); (E.S.)
- European Virus Bioinformatics Center (EVBC), 07743 Jena, Germany
| | - Eike Steinmann
- Department of Molecular and Medical Virology, Ruhr University Bochum, 44801 Bochum, Germany; (D.T.); (E.S.)
| | - Mathias Schemmerer
- Institute of Clinical Microbiology and Hygiene, National Consultant Laboratory for HAV and HEV, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.S.); (J.J.W.)
| | - Jürgen J. Wenzel
- Institute of Clinical Microbiology and Hygiene, National Consultant Laboratory for HAV and HEV, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.S.); (J.J.W.)
| | - Jörg Hofmann
- Institute of Virology, Charité Universitätsmedizin Berlin, Labor Berlin-Charité-Vivantes GmbH, 13353 Berlin, Germany;
| | | | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30623 Hannover, Germany;
- German Center for Infection Research, Partner Hannover-Braunschweig, 38124 Braunschweig, Germany
| | - C.-Thomas Bock
- Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; (S.R.P.); (T.P.V.)
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany;
| | - Thirumalaisamy P. Velavan
- Institute of Tropical Medicine, University of Tübingen, 72074 Tübingen, Germany; (S.R.P.); (T.P.V.)
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi 100000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
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Lenglet A, Ehlkes L, Taylor D, Fesselet JF, Nassariman JN, Ahamat A, Chen A, Noh I, Moustapha A, Spina A. Does community-wide water chlorination reduce hepatitis E virus infections during an outbreak? A geospatial analysis of data from an outbreak in Am Timan, Chad (2016-2017). JOURNAL OF WATER AND HEALTH 2020; 18:556-565. [PMID: 32833681 DOI: 10.2166/wh.2020.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hepatitis E Virus (HEV) genotype 1 and 2 infect an estimated 20 million people each year, via the faecal-oral transmission route. An urban outbreak of HEV occurred in Am Timan, Chad, between September 2016 and April 2017. As part of the outbreak response, Médecins Sans Frontières and the Ministry of Health implemented water and hygiene interventions, including the chlorination of town water sources. We aimed to understand whether these water treatment activities had any impact on the number of HEV infections, using geospatial analysis of epidemiological and water treatment monitoring data. By conducting cluster analysis we investigated whether there were areas of particularly high and low infection risk during the outbreak and explored the reasons for this. We observed two high-risk spatial clusters of suspected cases and one high-risk cluster of confirmed cases. Our main finding was that confirmed HEV cases had a higher median number of days of exposure to unsafe water compared to suspected and non-confirmed cases (Kruskal-Wallis Chi Square: 15.5; p < 0.001). Our study confirms the mixed, but shifting, transmission routes during this outbreak. It also highlights the spatial and temporal analytical methods, which can be employed in future outbreaks to improve understanding of HEV transmission.
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Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands E-mail: ; Department of Clinical Microbiology, Radboud UMC, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands; † These first authors contributed equally to the work
| | - Lutz Ehlkes
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands E-mail: ; Gesundheitsamt, Kölner Str. 180, Düsseldorf, Germany; † These first authors contributed equally to the work
| | - Dawn Taylor
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands E-mail:
| | - Jean-Francois Fesselet
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands E-mail:
| | | | - Abdelkhadir Ahamat
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad
| | - Alexandra Chen
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad
| | - Idriss Noh
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad
| | - Abakar Moustapha
- Médecins Sans Frontières, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad
| | - Alexander Spina
- College of Medicine and Health, St Luke's Campus, Exeter University, Heavitree Road, Exeter, United Kingdom
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11
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Choi Y, Zhang X, Skinner B. Analysis of IgG Anti-HEV Antibody Protective Levels During Hepatitis E Virus Reinfection in Experimentally Infected Rhesus Macaques. J Infect Dis 2020; 219:916-924. [PMID: 30325442 DOI: 10.1093/infdis/jiy603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/10/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Secondary spread of hepatitis E virus (HEV) infection occurs often in endemic settings in developing countries. The host immune signatures contributing to protection against subsequent HEV reinfection are unknown. METHODS Twelve seroconverted rhesus macaques were reinoculated with homologous HEV genotype 1 (gt1, Sar-55) and followed for 115 days. HEV RNA, HEV-specific T-cell responses, IgG anti-HEV antibody, and the IgG anti-HEV avidity index were tested. RESULTS Four animals with baseline IgG anti-HEV levels from 1.5 to 13.4 World Health Organization (WHO) U/mL evidenced reinfection as determined by HEV RNA in stool, and increase in IgG anti-HEV levels between 63- and 285-fold (P = .003). Eight animals with baseline IgG anti-HEV levels from 2.8 to 90.7 WHO U/mL did not develop infection or shed virus in feces, and IgG anti-HEV antibody levels were unchanged (P = .017). The 4 reinfected animals showed a lower HEV-IgG avidity index (average 35.5%) than the 8 protected animals (average 62.1%). HEV-specific interferon-gamma-producing T cells were 2-fold higher in reinfected animals (P = .018). CONCLUSIONS Preexisting antibody and high IgG avidity index (>50%) are important factors for protection against HEV reinfection. HEV-specific T-cell responses were elevated in reinfected animals after subsequent exposure to HEV.
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Affiliation(s)
- Youkyung Choi
- Laboratory Branch, Division of Viral Hepatitis, National Centers for HIV/AIDS, Viral Hepatitis, STD, and TB prevention
| | - Xiugen Zhang
- Laboratory Branch, Division of Viral Hepatitis, National Centers for HIV/AIDS, Viral Hepatitis, STD, and TB prevention
| | - Brianna Skinner
- Comparative Medicine Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Minkoff NZ, Buzzi K, Williamson AK, Hagmann SHF. Case Report: Acute Hepatitis E in a Pediatric Traveler Presenting with Features of Autoimmune Hepatitis: A Diagnostic and Therapeutic Challenge. Am J Trop Med Hyg 2019; 100:155-158. [PMID: 30350777 DOI: 10.4269/ajtmh.18-0640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hepatitis E virus (HEV) is globally the most common cause of acute viral hepatitis. In industrialized countries, HEV infection can be seen in travelers returning from hyperendemic countries or in individuals at risk for autochthonous infection due to zoonotic exposure. Hepatitis E virus infection is often unrecognized and at times misdiagnosed because of nonspecific findings that can overlap with other causes of hepatitis, including autoimmune hepatitis (AIH). Although most cases of acute HEV infection resolve spontaneously and do not require treatment, life-threatening acute liver failure may occur in some cases. We discuss the case of an 8-year-old boy returning from Bangladesh with progressive acute liver injury and a clinical profile suggestive of AIH, who showed a favorable response to corticosteroid treatment before the diagnosis of an acute HEV infection could be established.
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Affiliation(s)
- Nathan Z Minkoff
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York
| | - Kate Buzzi
- Division of Pediatric Gastroenterology, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York.,Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Alex K Williamson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.,Department of Pathology, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York
| | - Stefan H F Hagmann
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York.,Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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13
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Lagare A, Ibrahim A, Ousmane S, Issaka B, Zaneidou M, Kadadé G, Testa J. Outbreak of Hepatitis E Virus Infection in Displaced Persons Camps in Diffa Region, Niger, 2017. Am J Trop Med Hyg 2019; 99:1055-1057. [PMID: 30062983 DOI: 10.4269/ajtmh.17-0950] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Hepatitis E virus (HEV) infection in developing countries is associated with poor hygiene, lack of clean drinking water, and inadequate sanitation. In this study, we report the first case investigation and describe the present situation of HEV outbreak within displaced persons camps in the Diffa region, Republic of Niger. The investigation showed the outbreak to be closely linked to unclean water supply, low hygiene, and sanitation facility standards. Between January and September 2017, a total of 1,917 HEV suspect cases were recorded from which 736 (38.4%) have been confirmed positive for HEV by reverse transcription polymerase chain reaction and enzyme linked immunosorbent assay. Overall, 38 (1.9%) deaths were recorded, including 17 (44.7%) pregnant women. The ongoing outbreak highlights poor drinking water quality and sanitation conditions in displaced persons camps in the Diffa region. Disease containment and patient care activities, particularly for pregnant women, may have resulted in decreased transmission of infection and deaths.
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Affiliation(s)
- Adamou Lagare
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
| | | | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
| | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
| | | | | | - Jean Testa
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
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14
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Azman AS, Ciglenecki I, Wamala JF, Lynch J, Aggarwal R, Rahman M, Wong S, Serafini M, Moussa AM, Dalton HR, Shrestha A, Pant R, Peck R, Gurley ES. Hepatitis E should be considered a neglected tropical disease. PLoS Negl Trop Dis 2019; 13:e0007453. [PMID: 31344038 PMCID: PMC6657817 DOI: 10.1371/journal.pntd.0007453] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Médecins Sans Frontières, Geneva, Switzerland
- * E-mail:
| | | | | | - Julia Lynch
- International Vaccine Institute, Seoul, South Korea
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Sid Wong
- Medical Department, Médecins Sans Frontières, Amsterdam, the Netherlands
| | | | - Ali M. Moussa
- Chad Ministry of Health, Department of Communicable Diseases, N’Djamena, Chad
| | | | | | | | - Raquel Peck
- World Hepatitis Alliance, London, United Kingdom
| | - Emily S. Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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15
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Dimeglio C, Kania D, Mantono JM, Kagoné T, Zida S, Tassembedo S, Dicko A, Tinto B, Yaro S, Hien H, Rouamba J, Bicaba B, Medah I, Meda N, Traoré O, Tuaillon E, Abravanel F, Izopet J. Hepatitis E Virus Infections among Patients with Acute Febrile Jaundice in Burkina Faso. Viruses 2019; 11:E554. [PMID: 31207982 PMCID: PMC6630816 DOI: 10.3390/v11060554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/06/2019] [Accepted: 06/12/2019] [Indexed: 12/24/2022] Open
Abstract
Hepatitis E virus infection is a significant public health problem in many parts of the world including Africa. We tested serum samples from 900 patients in Burkina Faso presenting with febrile icterus. They all tested negative for yellow fever, but those from 23/900 (2.6%) patients contained markers of acute HEV infection (anti-HEV IgM and HEV RNA positive). Genotyping indicated that 14 of the strains were HEV genotype 2b. There was an overall HEV IgG seroprevalence of 18.2% (164/900). In a bivariate analysis, the factors linked to HEV exposure were climate and patient age. Older patients and those living in arid regions were more likely to have HEV infection. HEV genotype 2b circulating only in humans can be involved in some acute febrile icterus cases in Burkina Faso. Better access to safe water, sanitation, and improved personal hygiene should improve control of HEV infection in this country.
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Affiliation(s)
- Chloé Dimeglio
- Laboratoire de virologie, Centre national de référence du virus de l'hépatite E, CHU Toulouse, Hôpital Purpan, 31300 Toulouse, France.
| | | | - Judith Mbombi Mantono
- Centre MURAZ, Bobo-Dioulasso, Burkina Faso.
- Université Catholique d'Afrique de l'Ouest, Bobo-Dioulasso, Burkina Faso.
| | | | - Sylvie Zida
- Centre MURAZ, Bobo-Dioulasso, Burkina Faso.
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso.
| | | | | | | | | | - Hervé Hien
- Centre MURAZ, Bobo-Dioulasso, Burkina Faso.
| | - Jérémi Rouamba
- Centre MURAZ, Bobo-Dioulasso, Burkina Faso.
- Université Ouaga I Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso.
| | - Brice Bicaba
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso.
| | - Isaïe Medah
- Ministère de la Santé, Ouagadougou, Burkina Faso.
| | - Nicolas Meda
- Ministère de la Santé, Ouagadougou, Burkina Faso.
| | - Oumar Traoré
- Agence nationale de biosécurité, Ouagadougou, Burkina Faso.
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic Infections., Etablissement Français du Sang, CHU Montpellier, INSERM, University of Montpellier, 34090 Montpellier, France.
| | - Florence Abravanel
- Laboratoire de virologie, Centre national de référence du virus de l'hépatite E, CHU Toulouse, Hôpital Purpan, 31300 Toulouse, France.
- Centre de Physiopathologie de Toulouse Purpan (CPTP), UMR Inserm, U1043, UMR CNRS, U5282, 31300 Toulouse, France.
| | - Jacques Izopet
- Laboratoire de virologie, Centre national de référence du virus de l'hépatite E, CHU Toulouse, Hôpital Purpan, 31300 Toulouse, France.
- Centre de Physiopathologie de Toulouse Purpan (CPTP), UMR Inserm, U1043, UMR CNRS, U5282, 31300 Toulouse, France.
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16
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Wang W, Wang Y, Qu C, Wang S, Zhou J, Cao W, Xu L, Ma B, Hakim MS, Yin Y, Li T, Peppelenbosch MP, Zhao J, Pan Q. The RNA genome of hepatitis E virus robustly triggers an antiviral interferon response. Hepatology 2018; 67:2096-2112. [PMID: 29194722 DOI: 10.1002/hep.29702] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED The outcomes of hepatitis E virus (HEV) infection are diverse, ranging from asymptomatic carrier, self-limiting acute infection, and fulminant hepatitis to persistent infection. This is closely associated with the immunological status of the host. This study aimed to understand the innate cellular immunity as the first-line defense mechanism in response to HEV infection. Phosphorylation of signal transducer and activator of transcription 1, a hallmark of the activation of antiviral interferon (IFN) response, was observed in the liver tissues of the majority of HEV-infected patients but not in the liver of uninfected individuals. In cultured cell lines and primary liver organoids, we found that HEV RNA genome potently induced IFN production and antiviral response. This mechanism is conserved among different HEV strains, including genotypes 1, 3, and 7 as tested. Interestingly, single-stranded HEV RNA is sufficient to trigger the antiviral response, without the requirement of viral RNA synthesis and the generation of an RNA replicative form or replicative intermediate. Surprisingly, the m7 G cap and poly A tail are not required, although both are key features of the HEV genome. Mechanistically, this antiviral response occurs in a retinoic acid-inducible gene-I-independent, melanoma differentiation-associated protein 5-independent, mitochondrial antiviral signaling protein-independent, and β-catenin-independent but IRF3-dependent and IRF7-dependent manner. Furthermore, the integrity of the Janus kinase-signal transducer and activator of transcription pathway is essentially required. CONCLUSION HEV infection elicits an active IFN-related antiviral response in vitro and in patients, triggered by the viral RNA and mediated by IFN regulatory factors 3 and 7 and the Janus kinase-signal transducer and activator of transcription cascade; these findings have revealed new insights into HEV-host interactions and provided the basis for understanding the pathogenesis and outcome of HEV infection. (Hepatology 2018;67:2096-2112).
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Affiliation(s)
- Wenshi Wang
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Yijin Wang
- Department of Pathology and Hepatology, Beijing 302 Hospital, Beijing, People's Republic of China
| | - Changbo Qu
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Shan Wang
- Department of Pathology and Hepatology, Beijing 302 Hospital, Beijing, People's Republic of China
| | - Jianhua Zhou
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu, People's Republic of China
| | - Wanlu Cao
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Lei Xu
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Buyun Ma
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Mohamad S Hakim
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Department of Microbiology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yuebang Yin
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Tiancheng Li
- Department of Virology II, National Institute of Infectious Diseases, Gakuen 4-7-1 Musashi-murayama, Tokyo, Japan
| | - Maikel P Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Jingmin Zhao
- Department of Pathology and Hepatology, Beijing 302 Hospital, Beijing, People's Republic of China
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
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