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Clin Infect Dis. 2010 Apr 1;50(7):1006-10. doi: 10.1086/651077.

Evidence of person-to-person transmission of hepatitis E virus during a large outbreak in Northern Uganda.

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  • 1Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Atlanta, Georgia 301333, USA.



Outbreaks of infection with hepatitis E virus (HEV) are frequently attributed to contaminated drinking water, even if direct evidence for this is lacking.


We conducted several epidemiologic investigations during a large HEV infection outbreak in Uganda.


Of 10,535 residents, 3218 had HEV infection; of these, 2531 lived in households with >1 case. HEV was not detected in drinking water or zoonotic sources. Twenty-five percent of cases occurred > or = 8 weeks after onset of hepatitis in an index case in the household. Households with > or = 2 cases were more likely to have a member(s) who attended a funeral, had close contact with a jaundiced person, or washed hands in a common basin with others (P < .05 for all).


A high attack rate in households, lack of a common source of infection, and poor hygienic practices in households with > or = 2 cases suggest person-to-person transmission of HEV during this outbreak.

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