Epidemics of Non-A, Non-B Hepatitis in Pakistan

Ia, Malik; Ms, Qureshi; Luqman, Muhammad; Ma, Qamar; Ahmed, Aftab; Lj, Legters; Ahmad, Masood; Ma, Akhtar

doi:10.1177/004947558801800302

Cited by 12 publications

(8 citation statements)

References 10 publications

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“…Abbottabad is located in the foothills of the Himalayan Mountains 116 km northwest of Rawalpindi and Islamabad and 217 km northeast of Peshawar in the Northwest Frontier Province (Figure 1). An investigative team from the PULSE in Rawalpindi joined members from the hospital in Abbottabad during an initial investigation from August 22 to 24,1988. Through August 23, 68 persons were hospitalized with a diagnosis of hepatitis (Figure 2), as manifested by anorexia, nausea, occasional vomiting, malaise, dark urine, and icterus.…”

Section: Methodsmentioning

confidence: 99%

Epidemic of hepatitis E in a military unit in Abbotrabad, Pakistan.

Bryan¹,

Iqbal²,

Tsarev³

et al. 2002

The American Journal of Tropical Medicine and Hygiene

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Abstract. An outbreak of hepatitis caused by hepatitis E virus (HEV) in Abbottabad, Pakistan was traced to fecal contamination of a water system. Of 109 men hospitalized with hepatitis, 104 (95%) had serologic evidence of acute hepatitis E (IgM antibody to HEV [anti-HEV]), three (3%) probably had acute hepatitis E (high titers of IgG anti-HEV without IgM), and two had acute hepatitis A. Among a subset of 44 men with acute hepatitis E from whom three serum specimens were obtained over a four-month period, the anti-HEV IgG geometric mean titers (GMTs) decreased from 1,519 during the outbreak to 657 at four months. The IgM anti-HEV was detected in 40 (91%) of 44 sera obtained at admission (GMT ‫ס‬ 533 during acute disease), but in only six (14%) four months later. The prevalence of anti-HEV in this population before the outbreak was estimated to be 30%. The presence of IgG anti-HEV appeared to protect against clinical hepatitis or development of serologic evidence of new infection with HEV. This is the second major epidemic of hepatitis E in the Pakistani military confirmed by an anti-HEV enzyme-linked immunosorbent assay (ELISA). Evidence that pre-existing antibody as measured by this ELISA protects against disease is important for assessment of vaccine development.

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Section: Methodsmentioning

confidence: 99%

Epidemic of hepatitis E in a military unit in Abbotrabad, Pakistan.

Bryan¹,

Iqbal²,

Tsarev³

et al. 2002

The American Journal of Tropical Medicine and Hygiene

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“…Available data indicates that in Pakistan, Hepatitis E virus (HEV) remains highly endemic throughout the year, mainly affecting the adult population [10] [11] and sporadic cases of hepatitis E occurs frequently. A number of mini-epidemics have been reported in Pakistan and most of these have been due to fecal contamination of water supply, including those reported in Karachi in 1985 and 1986 [4] [5]. Other major reported outbreaks of HEV in Pakistan were 250 cases reported in an Army battalion in 1972 [12], 3827 cases from general population reported in Islamabad in the year 1993 [13].…”

Section: Introductionmentioning

confidence: 99%

Microbial Agents Responsible for Diarrheal Infections in Flood Victims: A Study from Karachi, Pakistan

Hakim¹,

Afaque²,

Javed³

et al. 2014

OJMM

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The present study was aimed to determine the frequency of water borne diarrheal infections and gastroenteritis in two of the flood affected camps of Karachi and nearby areas. Each year approximately, 579,732 people are adversely affected by this phenomenon, putting Pakistan 9th in terms of flood-affected countries worldwide. Patients and Methods: All patients suffering from diarrhea (more than 3 stools per day for the last 2 days), abdominal pain, vomiting or fever who were residing in the camps were included in the study. After taking consent, a fresh stool sample for D/R and C/S, and 5 ml of venous blood sample for CP and ALT and other viral markers were collected from each patient suffering from any of the symptoms like jaundice, diarrhea, vomiting, fever and abdominal pain during past 2 -3 days. Direct microscopy of the stools was done to see any protozoal or bacterial infection. Culture of stool was also set up simultaneously. Hemoglobin % age was noted for each patient. Serology of Hepatitis E and A virus using ELISA (Anti HEV-IgM, and anti HAV IgM) was done in those with more than 2 times raised ALT level. Results: A total of 500 samples collected from refugee camps of flood affected areas near Karachi were included in this study. All patients were mal nourished, having below normal Hb% ages, and were suspected cases or patients of diarrhea with elevated ALT (Alanine Transaminase) values. Occult blood was found positive in 40% (200) specimens; protozoa were also seen i.e., trophozoit stage of Giardia lamblia in 45% (225) of specimens; Entamoeba coli in 95% (475) and Balantidium coli in 20% (100) of stool specimens, while cyst forms of Entamoeba histolytica were present in 35% (175) specimens. Bacteriological analysis showed high bacterial prevalence of E. coli with 63% (315), followed by Enterobacter specie with 55% (275), then 20% (100) and 12% (60) of Klebseilla oxytoca and Klebseilla S. T. Hakim et al. 107pneumoniae respectively. Proteus vulgaris and Citrobacter freundii found in the same ratio of 8% (40, 39) with 2% (10) specimens of no microbial growth. Overall <0.05 P value and 95% of confidence interval level was observed. Further serological evidences for water associated viral hepatitis revealed 4% (20) positive specimens for anti-HEV IgM antibodies, and 2.6% (13) positive specimens of anti-HAV IgM antibodies. Conclusion: The present study reveals the presence of HEV and HAV associated viral diarrhea along with the presence of protozoal and bacterial infections in the flood relief camps. It is suggested that there is a strong need of natural disaster associated awareness program for general population in order to minimize the mortality and morbidity ratio associated with diseases, which can be easily controlled by managing proper sanitary conditions and supply of safe and clear water.

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“…[31] HEV though less stable than HAV, can withstand high temperatures and can remain viable for years. [32] HEV infection in South Asian countries exhibited distinct seasonal pattern with rainy season exhibiting the highest number of cases. However a bimodal pattern of incidence of the disease had been observed in the present study with the highest rate of positivity of HAV infection was observed in the months July followed by March.…”

Section: Discussionmentioning

confidence: 98%

Prevalence of Hepatitis a and Hepatitis E in West Bengal India- A Tertiary Care Hospital Based Study

Chatterjee¹,

Haldar²,

Dutta³

et al. 2019

jemds

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BACKGROUND Hepatitis A and E viruses are the most common causes of acute viral hepatitis and account for 10% deaths due to viral hepatitis globally. These viruses are endemic in India, and causes both epidemic and sporadic infections. Though there are several outbreak reports available, data on sporadic infections caused by these two viruses are very few. METHODSHistory of patients were recorded and blood samples collected to investigate possible hepatitis A and E infection. Laboratory assessments for detection of anti-HAV IgG and anti-HEV IgG antibodies was performed using enzyme linked immune-sorbent assay kits. RESULTSTotal 494 patients were investigated including 159 female and 335 male. Seroprevalence of HAV was found to be 11.2% and that of HEV was 20.05%. Both the infections demonstrated preponderance of male over female. Highest frequencies of HAV were found in age group of 11-20 and that of HEV were in age group 21-30. Seasonal distribution of both HAV and HEV infections followed a bimodal peak pattern with peaks reported in spring and rainy season. CONCLUSIONSMain modes of transmission of both the viruses are through feco-oral route. So by improving community hygiene and administering vaccination (For Hepatitis A) the number of positive cases can be reduced. A community program like "Swatchh Bharat Abhiyan" and a surveillance program by hospitals with multipronged approach of screening, treatment and immunization (against HAV) are expected to reduce incidences of infective viral hepatitis.

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Epidemics of Non-A, Non-B Hepatitis in Pakistan

Cited by 12 publications

References 10 publications

Epidemic of hepatitis E in a military unit in Abbotrabad, Pakistan.

Epidemic of hepatitis E in a military unit in Abbotrabad, Pakistan.

Microbial Agents Responsible for Diarrheal Infections in Flood Victims: A Study from Karachi, Pakistan

Prevalence of Hepatitis a and Hepatitis E in West Bengal India- A Tertiary Care Hospital Based Study

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