Journal Article

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

Jean-Paul Guthmann, Hilde Klovstad, Delia Boccia, Nuha Hamid, Loretxu Pinoges, Jacques-Yves Nizou, Mercedes Tatay, Francisco Diaz, Alain Moren, Rebecca Freeman Grais, Iza Ciglenecki, Elisabeth Nicand and Philippe Jean Guerin

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 42, issue 12, pages 1685-1691
Published in print June 2006 | ISSN: 1058-4838
Published online June 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/504321
A Large Outbreak of Hepatitis E among a Displaced Population in Darfur, Sudan, 2004: The Role of Water Treatment Methods

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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.

Journal Article.  4044 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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