High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan
High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan
复制标题
DOI：
10.1086/504322
复制
发表时间：
2006-06-15
影响因子：
11.8
通讯作者：
Guerin, Philippe Jean
中科院分区：
文献类型：
--
作者：
Boccia, Delia;Guthmann, Jean-Paul;Guerin, Philippe Jean
背景资料。戊型肝炎病毒(HEV)在孕妇中引起急性黄疸和高病死率。我们提供了住院病例的临床描述，并评估了在苏丹达尔富尔西部Mornay难民营(78,800居民)的流离失所人口中，HEV感染大规模流行期间对孕妇的具体影响。我们查阅了医院记录。对20例临床病例进行了实验室确认。对这些患者进行了HEV(血清)免疫球蛋白G(IgG)和免疫球蛋白M(IgM)抗体检测以及HEV基因组(血清和粪便)扩增。我们在社区进行了横断面调查，以确定孕妇的发病率和病死率。6个月来，该院共记录HEV病例253例，其中孕妇61例(24.1%)。共有72例(占有临床记录者的39.1%)被诊断为肝性脑病。在45名死亡患者中(病死率为17.8%)，19名孕妇(特定病死率为31.1%)。急性戊型肝炎的阳性率为95%(19/20)，18例患者血清免疫球蛋白抗体阳性(光密度比=3)、免疫球蛋白M阳性(光密度比12)或两者同时阳性，1例血清免疫球蛋白和免疫球蛋白阴性，而HEV-RNA阳性。调查发现，在1,133名怀孕超过3个月的孕妇中，有220名患有黄斑症(发病率为19.4%)。在这些有黄褐症的孕妇中，共记录了18例死亡(特定病例-死亡率比，8.2%)。这次HEV感染的大规模流行说明了这种疾病对孕妇的巨大影响。迫切需要及时的干预措施和疫苗，以防止这一特殊群体的死亡。
Background. Hepatitis E virus (HEV) causes acute onset of jaundice and a high case-fatality ratio in pregnant women. We provide a clinical description of hospitalized case patients and assess the specific impact on pregnant women during a large epidemic of HEV infection in a displaced population in Mornay camp (78,800 inhabitants), western Darfur, Sudan.Methods. We reviewed hospital records. A sample of 20 clinical cases underwent laboratory confirmation. These patients were tested for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody to HEV (serum) and for amplification of the HEV genome (serum and stool). We performed a cross-sectional survey in the community to determine the attack rate and case-fatality ratio in pregnant women.Results. Over 6 months, 253 HEV cases were recorded at the hospital, of which 61 (24.1%) were in pregnant women. A total of 72 cases (39.1% of those for whom clinical records were available) had a diagnosis of hepatic encephalopathy. Of the 45 who died (case-fatality ratio, 17.8%), 19 were pregnant women (specific case-fatality ratio, 31.1%). Acute hepatitis E was confirmed in 95% (19/20) of cases sampled; 18 case-patients were positive for IgG (optical density ratio >= 3), for IgM (optical density ratio 12), or for both, whereas 1 was negative for IgG and IgM but positive for HEV RNA in serum. The survey identified 220 jaundiced women among the 1133 pregnant women recorded over 3 months (attack rate, 19.4%). A total of 18 deaths were recorded among these jaundiced pregnant women (specific case-fatality ratio, 8.2%).Conclusions. This large epidemic of HEV infection illustrates the dramatic impact of this disease on pregnant women. Timely interventions and a vaccine are urgently needed to prevent mortality in this special group.