Risk factors, person, place and time characteristics associated with Hepatitis E Virus outbreak in Napak District, Uganda.
Risk factors, person, place and time characteristics associated with Hepatitis E Virus outbreak in Napak District, Uganda.
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DOI：
10.1186/s12879-017-2542-2
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发表时间：
2017-06-26
影响因子：
3.7
通讯作者：
Karamagi C
中科院分区：
文献类型：
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作者：
Amanya G;Kizito S;Nabukenya I;Kalyango J;Atuheire C;Nansumba H;Abwoye SA;Opio DN;Kibuuka E;Karamagi C
戊型肝炎是自限性的，但可导致大多数高危人群死亡，如孕妇和先前存在急性肝病的人。在发展中国家，它作为流行病出现，2014年在乌干达Napak地区报告了戊型肝炎病毒（HEV）爆发。在这种情况下，可能传播这种HEV流行的因素，包括宿主、病原体和环境特征的作用仍然不清楚。因此，本研究进行调查的危险因素，人，地点和时间的特点，与戊型肝炎病毒（HEV）流行在Napak区。采用流行病学描述的线表资料和1：2比例的邻里和年龄配对病例对照研究，对纳巴克市戊型肝炎暴发的危险因素进行了评估。采用整群随机抽样方法，共获得样本332例（病例组111例，对照组221例）。使用条件logistic回归评估可能的相互作用和混杂因素。在2013/2014年HEV爆发期间报告了超过1359例病例和30例死亡。患者的平均年龄为29 ±岁，57.9%的病例为女性。总病死率在一般人群中为2.2%，但在孕妇中为65.2%。超过94%的病例报告在纳帕克县，5.7%的病例报告在邻近地区以外。疫情于2014年1月达到高峰，到2014年12月逐渐消退。发现与HEV相关的风险因素包括饮用未经处理的水（OR 6.69，95% CI 3.15-14.16），吃路边食品（OR 6.11，95% CI 2.85-13.09），报告不清洁餐具（OR 3.24，95% CI 1.55-1.76），是猎人（OR 1.14，95% CI 1.03-12.66）。这项研究的结果表明，该病毒是通过粪口途径通过污染的水传播。他们还建议，针对社区和日常个人卫生行动的积极监测和适当措施对于预防传播和减少死亡非常重要。
Hepatitis E is self-limiting, but can cause death in most at risk groups like pregnant women and those with preexisting acute liver disease. In developing countries it presents as epidemic, in 2014 Hepatitis E Virus (HEV) outbreak was reported in Napak district Uganda. The role of factors in this setting that might have propagated this HEV epidemic, including host, agent, and environmental characteristics, were still not clear. This study was therefore conducted to investigate the risk factors, person, place and time characteristics, associated with the hepatitis E virus (HEV) epidemic in Napak district. Review of line lists data for epidemiological description and matched case control study on neighborhood and age in the ratio of 1:2 were used to assess risk factors for HEV outbreak in Napak. Cluster and random sampling were used to obtain a sample size of 332, (111 cases, 221 controls). Possible interaction and confounding was assessed using conditional logistic regression. Over 1359 cases and 30 deaths were reported during 2013/2014 HEV outbreak. The mean age of patients was 29 ± years, 57.9% of cases were females. Overall case Fatality Ratio was 2.2% in general population but 65.2% in pregnant women. More than 94% of the cases were reported in the sub counties of Napak, 5.7% of cases were reported in the outside neighboring districts. The epidemic peaked in January 2014 and gradually subsided by December 2014. Risk factors found to be associated with HEV included drinking untreated water (OR 6.69, 95% CI 3.15–14.16), eating roadside food (OR 6.11, 95% CI 2.85–13.09), reported not cleaning utensils (OR 3.24, 95% CI 1.55–1.76), and being a hunter (OR 1.14, 95% CI 1.03–12.66). The results of this study suggest that the virus is transmitted by the feco-oral route through contaminated water. They also suggest that active surveillance and appropriate measures targeting community and routine individual health actions are important to prevent transmission and decrease the deaths.