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BMC Infect Dis. 2018 Jun 26;18(1):287. doi: 10.1186/s12879-018-3194-6.

Seroprevalence and risk factors of recent infection with hepatitis E virus during an acute outbreak in an urban setting in Chad, 2017.

Author information

1
Médecins sans Frontières, Operational Center Amsterdam (OCA), Quartier Aeroport, A1, Rue 1039, Porte 405, BP30, N'Djamena, Chad.
2
Médecins sans Frontières, Operational Center Amsterdam (OCA), Plantage Middenlaan 14, 1018DD, Amsterdam, the Netherlands.
3
Médecins sans Frontières, Operational Center Amsterdam (OCA), Plantage Middenlaan 14, 1018DD, Amsterdam, the Netherlands. annick.lenglet@amsterdam.msf.org.
4
Sanquin Diagnostic Services, Department of Virology, Plesmanlaan 125, 1066 CX, Amsterdam, The Netherlands.
5
Ministry of Health, BP440, N'Djamena, Chad.
6
Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E7HT, UK.

Abstract

BACKGROUND:

From September 2016-April 2017, Am Timan, Chad, experienced a large HEV outbreak in an urban setting with a limited impact in terms of morbidity and mortality. To better understand HEV epidemiology in this context, we estimated the seroprevalence of anti-HEV antibodies (IgM and IgG) and assessed the risk factors for recent HEV infections (positive anti-HEV IgM) during this outbreak.

METHODS:

A serological survey using simple random sampling was implemented in Am Timan at the tail-end of the outbreak (sample size aim = 384 household). Household members provided us with blood samples and household heads answered questions around water, sanitation and hygiene practices and animal ownership. Blood samples were tested for HEV IgG and IgM antibodies using Enzyme-Immune-Assay (EIA). We calculated weighted prevalence estimates and prevalence ratios (PRs) for possible risk factors for recent infection using multivariate Cox regression.

RESULTS:

We included 241 households (1529 participants). IgM prevalence decreased with age: 12.6% (< 5 years) to 4.3% (> 15 years). IgG prevalence increased with age: 23.5% (< 5 years) to 75.9% (> 15 years). Risk factors for recent HEV infections included: sharing the sanitation facility with other HHs (PR 1.72; 95%CI: 1.08-2.73), not systematically using soap for HW (PR 1.85; 95%CI: 1.30-2.63) and having animals sleeping inside the compound (PR 1.69; 95%CI: 1.15-2.50).

CONCLUSIONS:

Evidence suggests that Am Timan was already highly endemic for HEV before the outbreak, potentially explaining the limited extent of the outbreak. Recent infection with HEV was linked to household level exposures. Future HEV outbreak response must include ensuring access to safe water, and reducing household level transmission through active hygiene and sanitation promotion activities.

KEYWORDS:

Chad; Disease outbreaks; Hepatitis E virus; Risk factors; Seroepidemiologic studies

PMID:
29940939
PMCID:
PMC6020170
DOI:
10.1186/s12879-018-3194-6
[Indexed for MEDLINE]
Free PMC Article

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