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. 2017 Nov 27;12(11):e0188240.
doi: 10.1371/journal.pone.0188240. eCollection 2017.

A large outbreak of Hepatitis E virus genotype 1 infection in an urban setting in Chad likely linked to household level transmission factors, 2016-2017

Alexander Spina  1   2   3 , Annick Lenglet  4 , David Beversluis  1 , Marja de Jong  1 , Larissa Vernier  1 , Craig Spencer  1 , Fred Andayi  1 , Charity Kamau  4 , Simone Vollmer  1 , Boris Hogema  5 , Andrea Irwin  1 , Roger Ngueremi Yary  1 , Açyl Mahamat Ali  6 , Ali Moussa  6 , Prince Alfani  1 , Sibylle Sang  4
Affiliations

A large outbreak of Hepatitis E virus genotype 1 infection in an urban setting in Chad likely linked to household level transmission factors, 2016-2017

Alexander Spina et al. PLoS One. .

Abstract

Background: In September 2016, three acutely jaundiced (AJS) pregnant women were admitted to Am Timan Hospital, eastern Chad. We described the outbreak and conducted a case test-negative study to identify risk factors for this genotype of HEV in an acute outbreak setting.

Methods: Active case finding using a community based surveillance network identified suspected AJS cases. Pregnant or visibly ill AJS cases presenting at hospital were tested with Assure® IgM HEV rapid diagnostic tests (RDTs) and some with Polymerase Chain Reaction (PCR) in Amsterdam; confirmed cases were RDT-positive and controls were RDT-negative. All answered questions around: demographics, household makeup, area of residence, handwashing practices, water collection behaviour and clinical presentation. We calculated unadjusted odds ratios (ORs) and 95% confidence intervals (95% CI).

Results: Between September and April 2017, 1443 AJS cases (1293 confirmed) were detected in the town(attack rate: 2%; estimated 65,000 population). PCR testing confirmed HEV genotype 1e. HEV RDTs were used for 250 AJS cases; 100 (40%) were confirmed. Risk factors for HEV infection, included: having at least two children under the age of 5 years (OR 2.1, 95%CI 1.1-4.3), having another household member with jaundice (OR 2.4, 95%CI 0.90-6.3) and, with borderline significance, living in the neighbourhoods of Riad (OR 3.8, 95%CI 1.0-1.8) or Ridina (OR 3.3, 95%CI 1.0-12.6). Cases were more likely to present with vomiting (OR 3.2, 9%CI 1.4-7.9) than controls; possibly due to selection bias. Cases were non-significantly less likely to report always washing hands before meals compared with controls (OR 0.33, 95%CI 0.1-1.1).

Discussion: Our study suggests household factors and area of residence (possibly linked to access to water and sanitation) play a role in HEV transmission; which could inform future outbreak responses. Ongoing sero-prevalence studies will elucidate more aspects of transmission dynamics of this virus with genotype 1e.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Epidemic curve of suspected cases, confirmed HEV cases and discarded cases on bi-weekly epidemiological week periods.
Am Timan, Chad, 2016–2017 (suspected cases = 1193; discarded cases = 150, confirmed cases = 100).
Fig 2
Fig 2. Geospatial distribution of suspected cases, confirmed HEV cases and discarded cases during an outbreak in Am Timan, Chad, 2016–2017 (suspected cases = 1193; discarded cases = 150, confirmed cases = 100).
See this image and copyright information in PMC

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