Outbreak of Hepatitis E in Urban Bangladesh Resulting in Maternal and Perinatal Mortality
Background. Hepatitis E virus (HEV) causes outbreaks of jaundice associated with maternal mortality. Four deaths among pregnant women with jaundice occurred in an urban community near Dhaka, Bangladesh, in late 2008 and were reported to authorities in January 2009. We investigated the etiology and r...
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| Veröffentlicht in: | Clinical infectious diseases 2014-09, Vol.59 (5), p.658-665 |
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| creator | Gurley, Emily S. Hossain, M. Jahangir Paul, Repon C. Sazzad, Hossain M. S. Islam, M. Saiful Parveen, Shahana Faruque, Labib I. Husain, Mushtuq Ara, Khorshed Jahan, Yasmin Rahman, Mahmudur Luby, Stephen P. |
| description | Background. Hepatitis E virus (HEV) causes outbreaks of jaundice associated with maternal mortality. Four deaths among pregnant women with jaundice occurred in an urban community near Dhaka, Bangladesh, in late 2008 and were reported to authorities in January 2009. We investigated the etiology and risk factors for jaundice and death. Methods. Field workers identified suspected cases, defined as acute onset of yellow eyes or skin, through house-to-house visits. A subset of persons with suspected HEV was tested for immunoglobulin M (IgM) antibodies to HEV to confirm infection. We used logistic regression analysis to identify risk factors for HEV disease and for death. We estimated the increased risk of perinatal mortality associated with jaundice during pregnancy. Results. We identified 4751 suspected HEV cases during August 2008–January 2009, including 17 deaths. IgM antibodies to HEV were identified in 56 of 73 (77%) case-patients tested who were neighbors of the case-patients who died. HEV disease was significantly associated with drinking municipally supplied water. Death among persons with HEV disease was significantly associated with being female and taking paracetamol (acetaminophen). Among women who were pregnant, miscarriage and perinatal mortality was 2.7 times higher (95% confidence interval, 1.2–6.1) in pregnancies complicated by jaundice. Conclusions. This outbreak of HEV was likely caused by sewage contamination of the municipal water system. Longer-term efforts to improve access to safe water and license HEV vaccines are needed. However, securing resources and support for intervention will rely on convincing data about the endemic burden of HEV disease, particularly its role in maternal and perinatal mortality. |
| doi_str_mv | 10.1093/cid/ciu383 |
| format | Article |
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Jahangir ; Paul, Repon C. ; Sazzad, Hossain M. S. ; Islam, M. Saiful ; Parveen, Shahana ; Faruque, Labib I. ; Husain, Mushtuq ; Ara, Khorshed ; Jahan, Yasmin ; Rahman, Mahmudur ; Luby, Stephen P.</creator><creatorcontrib>Gurley, Emily S. ; Hossain, M. Jahangir ; Paul, Repon C. ; Sazzad, Hossain M. S. ; Islam, M. Saiful ; Parveen, Shahana ; Faruque, Labib I. ; Husain, Mushtuq ; Ara, Khorshed ; Jahan, Yasmin ; Rahman, Mahmudur ; Luby, Stephen P.</creatorcontrib><description>Background. Hepatitis E virus (HEV) causes outbreaks of jaundice associated with maternal mortality. Four deaths among pregnant women with jaundice occurred in an urban community near Dhaka, Bangladesh, in late 2008 and were reported to authorities in January 2009. We investigated the etiology and risk factors for jaundice and death. Methods. Field workers identified suspected cases, defined as acute onset of yellow eyes or skin, through house-to-house visits. A subset of persons with suspected HEV was tested for immunoglobulin M (IgM) antibodies to HEV to confirm infection. We used logistic regression analysis to identify risk factors for HEV disease and for death. We estimated the increased risk of perinatal mortality associated with jaundice during pregnancy. Results. We identified 4751 suspected HEV cases during August 2008–January 2009, including 17 deaths. IgM antibodies to HEV were identified in 56 of 73 (77%) case-patients tested who were neighbors of the case-patients who died. HEV disease was significantly associated with drinking municipally supplied water. Death among persons with HEV disease was significantly associated with being female and taking paracetamol (acetaminophen). Among women who were pregnant, miscarriage and perinatal mortality was 2.7 times higher (95% confidence interval, 1.2–6.1) in pregnancies complicated by jaundice. Conclusions. This outbreak of HEV was likely caused by sewage contamination of the municipal water system. Longer-term efforts to improve access to safe water and license HEV vaccines are needed. However, securing resources and support for intervention will rely on convincing data about the endemic burden of HEV disease, particularly its role in maternal and perinatal mortality.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciu383</identifier><identifier>PMID: 24855146</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Oxford: OXFORD UNIVERSITY PRESS</publisher><subject>Adolescent ; Adult ; Aged ; and Commentaries ; Antibodies, Viral - blood ; ARTICLES AND COMMENTARIES ; Bangladesh - epidemiology ; Biological and medical sciences ; Case-Control Studies ; Child ; Child, Preschool ; Disease Outbreaks ; Drinking water ; Epidemics ; Epidemiology ; Female ; Hepatitis ; Hepatitis E ; Hepatitis E - epidemiology ; Hepatitis E - mortality ; Hepatitis E virus ; Hepatitis E virus - immunology ; Homes ; Human viral diseases ; Humans ; Immunoglobulin M - blood ; Infant ; Infant, Newborn ; Infectious diseases ; Jaundice ; Jaundice - etiology ; Male ; Maternal & child health ; Maternal Death ; Medical sciences ; Middle Aged ; Perinatal Death ; Predisposing factors ; Pregnancy ; Pregnancy Complications, Infectious - epidemiology ; Pregnancy Complications, Infectious - mortality ; Pregnancy Outcome ; Regression analysis ; Risk Factors ; Sewage - virology ; Urban areas ; Viral diseases ; Viral hepatitis ; Water Supply ; Women ; Young Adult</subject><ispartof>Clinical infectious diseases, 2014-09, Vol.59 (5), p.658-665</ispartof><rights>Copyright © 2014 Oxford University Press on behalf of the Infectious Diseases Society of America</rights><rights>2015 INIST-CNRS</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.</rights><rights>Copyright Oxford University Press, UK Sep 1, 2014</rights><rights>The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c458t-6d1aaa2f15912d9a608e056d0c639a38eaab40fbc291636a78d099fd878fa4603</citedby><cites>FETCH-LOGICAL-c458t-6d1aaa2f15912d9a608e056d0c639a38eaab40fbc291636a78d099fd878fa4603</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/24032036$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/24032036$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,776,780,799,881,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28750460$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24855146$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gurley, Emily S.</creatorcontrib><creatorcontrib>Hossain, M. Jahangir</creatorcontrib><creatorcontrib>Paul, Repon C.</creatorcontrib><creatorcontrib>Sazzad, Hossain M. S.</creatorcontrib><creatorcontrib>Islam, M. Saiful</creatorcontrib><creatorcontrib>Parveen, Shahana</creatorcontrib><creatorcontrib>Faruque, Labib I.</creatorcontrib><creatorcontrib>Husain, Mushtuq</creatorcontrib><creatorcontrib>Ara, Khorshed</creatorcontrib><creatorcontrib>Jahan, Yasmin</creatorcontrib><creatorcontrib>Rahman, Mahmudur</creatorcontrib><creatorcontrib>Luby, Stephen P.</creatorcontrib><title>Outbreak of Hepatitis E in Urban Bangladesh Resulting in Maternal and Perinatal Mortality</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Background. Hepatitis E virus (HEV) causes outbreaks of jaundice associated with maternal mortality. Four deaths among pregnant women with jaundice occurred in an urban community near Dhaka, Bangladesh, in late 2008 and were reported to authorities in January 2009. We investigated the etiology and risk factors for jaundice and death. Methods. Field workers identified suspected cases, defined as acute onset of yellow eyes or skin, through house-to-house visits. A subset of persons with suspected HEV was tested for immunoglobulin M (IgM) antibodies to HEV to confirm infection. We used logistic regression analysis to identify risk factors for HEV disease and for death. We estimated the increased risk of perinatal mortality associated with jaundice during pregnancy. Results. We identified 4751 suspected HEV cases during August 2008–January 2009, including 17 deaths. IgM antibodies to HEV were identified in 56 of 73 (77%) case-patients tested who were neighbors of the case-patients who died. HEV disease was significantly associated with drinking municipally supplied water. Death among persons with HEV disease was significantly associated with being female and taking paracetamol (acetaminophen). Among women who were pregnant, miscarriage and perinatal mortality was 2.7 times higher (95% confidence interval, 1.2–6.1) in pregnancies complicated by jaundice. Conclusions. This outbreak of HEV was likely caused by sewage contamination of the municipal water system. Longer-term efforts to improve access to safe water and license HEV vaccines are needed. However, securing resources and support for intervention will rely on convincing data about the endemic burden of HEV disease, particularly its role in maternal and perinatal mortality.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>and Commentaries</subject><subject>Antibodies, Viral - blood</subject><subject>ARTICLES AND COMMENTARIES</subject><subject>Bangladesh - epidemiology</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Disease Outbreaks</subject><subject>Drinking water</subject><subject>Epidemics</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Hepatitis</subject><subject>Hepatitis E</subject><subject>Hepatitis E - epidemiology</subject><subject>Hepatitis E - mortality</subject><subject>Hepatitis E virus</subject><subject>Hepatitis E virus - immunology</subject><subject>Homes</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunoglobulin M - blood</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infectious diseases</subject><subject>Jaundice</subject><subject>Jaundice - etiology</subject><subject>Male</subject><subject>Maternal & child health</subject><subject>Maternal Death</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Perinatal Death</subject><subject>Predisposing factors</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Infectious - epidemiology</subject><subject>Pregnancy Complications, Infectious - mortality</subject><subject>Pregnancy Outcome</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Sewage - virology</subject><subject>Urban areas</subject><subject>Viral diseases</subject><subject>Viral hepatitis</subject><subject>Water Supply</subject><subject>Women</subject><subject>Young Adult</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkdFLHDEQxoO0VKt96XtLQApFWJtsNrnsi9CKVUGxiD74FGaT7JnrXnIm2YL_fXPdq9o-DDNhfnz5mA-h95QcUtKyL9qZUiOTbAvtUM5mleAtfVVmwmXVSCa30duUFoRQKgl_g7brRnJOG7GD7q7G3EULP3Ho8ZldQXbZJXyCnce3sQOPv4GfD2BsusfXNo1Ddn6-3l5CttHDgMEb_MNG5yGX12WIpbn8uIde9zAk-27Td9Ht95Ob47Pq4ur0_PjrRaUbLnMlDAWAuqfFcm1aEERawoUhWrAWmLQAXUP6TtctFUzATBrStr2RM9lDIwjbRUeT7mrsltZo63OEQa2iW0J8VAGc-nfj3b2ah1-qoYwwuhb4vBGI4WG0KaulS9oOA3gbxqQo54yVvykt6P5_6CKM6yP8oRrOOBeyUAcTpWNIKdr-yQwlap2YKompKbECf3xp_wn9G1EBPm0ASBqGPoLXLj1zcsbJdIcPE7dIOcQXOoTVhAn2G6i3qOQ</recordid><startdate>20140901</startdate><enddate>20140901</enddate><creator>Gurley, Emily S.</creator><creator>Hossain, M. Jahangir</creator><creator>Paul, Repon C.</creator><creator>Sazzad, Hossain M. S.</creator><creator>Islam, M. Saiful</creator><creator>Parveen, Shahana</creator><creator>Faruque, Labib I.</creator><creator>Husain, Mushtuq</creator><creator>Ara, Khorshed</creator><creator>Jahan, Yasmin</creator><creator>Rahman, Mahmudur</creator><creator>Luby, Stephen P.</creator><general>OXFORD UNIVERSITY PRESS</general><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140901</creationdate><title>Outbreak of Hepatitis E in Urban Bangladesh Resulting in Maternal and Perinatal Mortality</title><author>Gurley, Emily S. ; Hossain, M. Jahangir ; Paul, Repon C. ; Sazzad, Hossain M. S. ; Islam, M. Saiful ; Parveen, Shahana ; Faruque, Labib I. ; Husain, Mushtuq ; Ara, Khorshed ; Jahan, Yasmin ; Rahman, Mahmudur ; Luby, Stephen P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c458t-6d1aaa2f15912d9a608e056d0c639a38eaab40fbc291636a78d099fd878fa4603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>and Commentaries</topic><topic>Antibodies, Viral - blood</topic><topic>ARTICLES AND COMMENTARIES</topic><topic>Bangladesh - epidemiology</topic><topic>Biological and medical sciences</topic><topic>Case-Control Studies</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Disease Outbreaks</topic><topic>Drinking water</topic><topic>Epidemics</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Hepatitis</topic><topic>Hepatitis E</topic><topic>Hepatitis E - epidemiology</topic><topic>Hepatitis E - mortality</topic><topic>Hepatitis E virus</topic><topic>Hepatitis E virus - immunology</topic><topic>Homes</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Immunoglobulin M - blood</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infectious diseases</topic><topic>Jaundice</topic><topic>Jaundice - etiology</topic><topic>Male</topic><topic>Maternal & child health</topic><topic>Maternal Death</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Perinatal Death</topic><topic>Predisposing factors</topic><topic>Pregnancy</topic><topic>Pregnancy Complications, Infectious - epidemiology</topic><topic>Pregnancy Complications, Infectious - mortality</topic><topic>Pregnancy Outcome</topic><topic>Regression analysis</topic><topic>Risk Factors</topic><topic>Sewage - virology</topic><topic>Urban areas</topic><topic>Viral diseases</topic><topic>Viral hepatitis</topic><topic>Water Supply</topic><topic>Women</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gurley, Emily S.</creatorcontrib><creatorcontrib>Hossain, M. 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Saiful</creatorcontrib><creatorcontrib>Parveen, Shahana</creatorcontrib><creatorcontrib>Faruque, Labib I.</creatorcontrib><creatorcontrib>Husain, Mushtuq</creatorcontrib><creatorcontrib>Ara, Khorshed</creatorcontrib><creatorcontrib>Jahan, Yasmin</creatorcontrib><creatorcontrib>Rahman, Mahmudur</creatorcontrib><creatorcontrib>Luby, Stephen P.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gurley, Emily S.</au><au>Hossain, M. Jahangir</au><au>Paul, Repon C.</au><au>Sazzad, Hossain M. S.</au><au>Islam, M. Saiful</au><au>Parveen, Shahana</au><au>Faruque, Labib I.</au><au>Husain, Mushtuq</au><au>Ara, Khorshed</au><au>Jahan, Yasmin</au><au>Rahman, Mahmudur</au><au>Luby, Stephen P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outbreak of Hepatitis E in Urban Bangladesh Resulting in Maternal and Perinatal Mortality</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2014-09-01</date><risdate>2014</risdate><volume>59</volume><issue>5</issue><spage>658</spage><epage>665</epage><pages>658-665</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Background. Hepatitis E virus (HEV) causes outbreaks of jaundice associated with maternal mortality. Four deaths among pregnant women with jaundice occurred in an urban community near Dhaka, Bangladesh, in late 2008 and were reported to authorities in January 2009. We investigated the etiology and risk factors for jaundice and death. Methods. Field workers identified suspected cases, defined as acute onset of yellow eyes or skin, through house-to-house visits. A subset of persons with suspected HEV was tested for immunoglobulin M (IgM) antibodies to HEV to confirm infection. We used logistic regression analysis to identify risk factors for HEV disease and for death. We estimated the increased risk of perinatal mortality associated with jaundice during pregnancy. Results. We identified 4751 suspected HEV cases during August 2008–January 2009, including 17 deaths. IgM antibodies to HEV were identified in 56 of 73 (77%) case-patients tested who were neighbors of the case-patients who died. HEV disease was significantly associated with drinking municipally supplied water. Death among persons with HEV disease was significantly associated with being female and taking paracetamol (acetaminophen). Among women who were pregnant, miscarriage and perinatal mortality was 2.7 times higher (95% confidence interval, 1.2–6.1) in pregnancies complicated by jaundice. Conclusions. This outbreak of HEV was likely caused by sewage contamination of the municipal water system. Longer-term efforts to improve access to safe water and license HEV vaccines are needed. However, securing resources and support for intervention will rely on convincing data about the endemic burden of HEV disease, particularly its role in maternal and perinatal mortality.</abstract><cop>Oxford</cop><pub>OXFORD UNIVERSITY PRESS</pub><pmid>24855146</pmid><doi>10.1093/cid/ciu383</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical infectious diseases, 2014-09, Vol.59 (5), p.658-665 |
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| source | Jstor Complete Legacy; Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged and Commentaries Antibodies, Viral - blood ARTICLES AND COMMENTARIES Bangladesh - epidemiology Biological and medical sciences Case-Control Studies Child Child, Preschool Disease Outbreaks Drinking water Epidemics Epidemiology Female Hepatitis Hepatitis E Hepatitis E - epidemiology Hepatitis E - mortality Hepatitis E virus Hepatitis E virus - immunology Homes Human viral diseases Humans Immunoglobulin M - blood Infant Infant, Newborn Infectious diseases Jaundice Jaundice - etiology Male Maternal & child health Maternal Death Medical sciences Middle Aged Perinatal Death Predisposing factors Pregnancy Pregnancy Complications, Infectious - epidemiology Pregnancy Complications, Infectious - mortality Pregnancy Outcome Regression analysis Risk Factors Sewage - virology Urban areas Viral diseases Viral hepatitis Water Supply Women Young Adult |
| title | Outbreak of Hepatitis E in Urban Bangladesh Resulting in Maternal and Perinatal Mortality |
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