Outbreak of Hepatitis E in Urban Bangladesh Resulting in Maternal and Perinatal Mortality

Abstract

A large outbreak of hepatitis E occurred in urban Bangladesh during 2008–2009, resulting in increased maternal and neonatal mortality in the affected community. Case-patients who took paracetamol during their illness were more likely to die than other case-patients.

Surveillance at Private Laboratories Identifies Small Outbreaks of Hepatitis E in Urban Bangladesh

“…27 In Bangladesh, patients typically seek care for acute jaundice from informal health-care providers who do not provide laboratory testing. 9,28 In our study, the majority of laboratory-confirmed hepatitis E cases reported monthly household expenditure above the average monthly household expenditure of Bangladeshi families. Among many acute jaundice cases within each cluster, only a few sought care from health-care facilities and paid for the cost of the test.…”

“…16 Residents living in close proximity are likely to share a municipally supplied water source, a wellknown source of exposure for hepatitis E infection. 9,17,18 Though deep tube well water in Dhaka meets WHO drinkingwater standards at extraction points, water supplied at the household level through pipelines does not. 19,20 Water may become contaminated between the extraction point and household taps in the community through leakage in a pipeline.…”

“…During 2008-2009 in Tongi, Bangladesh, 4,751 suspected hepatitis E cases were identified; 17 of these cases died. 9 Compared with large outbreaks, small clusters in endemic areas are less frequently reported to public health authorities and published in the literature. 10,11 The Institute of Epidemiology, Disease Control and Research (IEDCR) of the Government of Bangladesh conducts ongoing media screening to identify outbreaks throughout the country.…”

Evaluating the risks posed by hepatitis E virus to blood supply safety

“…The present study demonstrates that the majority of notified overseas-acquired HEV infections in Australia were in travellers returning from South Asia, namely India, Bangladesh and Nepal. These countries are endemic for HEV, where large water-borne outbreaks occur seasonally (13,148,243,290). Thus, there is a potential risk to blood safety in Australia from donors after their return from such countries.…”

“…However, the causative agent was not identified until 1983 (93). HEV outbreaks continue to occur in many developing countries including Bangladesh, Nepal and Sudan (202,243,244). HEV is considered endemic in many developing countries.…”