Flambée épidémique d'hépatite virale à forte létalité dans la région de Diffa (Niger) en 2017

Introduction. En 2017, la région de Diffa a notifié une hausse des cas de syndrome ictérique à huit cas dont 6 (75%) décès. Suite à la confirmation, une équipe multidisciplinaire a investigué cette flambée épidémique. L'objectif était de caractériser la population à risque, d'identifier la source de l'infection et de mettre en place des mesures de contrôle et de prévention. Méthodes. Nous avons conduit une étude descriptive des cas d'HVE survenus dans la région de Diffa, du 23 avril au 4 juin 2017. Une recherche active des cas a été menée dans les villages et les camps des réfugiés et des déplacés internes. Nous avons effectué des entretiens avec les malades et une revue documentaire. Une liste linéaire a été établie. Des prélèvements ont été collectés. Epi Info 7.2 pour l'analyse. Résultats. 329 cas dont 26 (7,90%) décès ont été enregistrés. Le sexe féminin représentait 63,1%. L'âge médian était de 26 ans (2 à 75 ans). La tranche d'âge ≥15 ans représentait 85,41%. Les femmes enceintes ou allaitantes représentaient 38,16% de l'effectif. Les signes cliniques étaient une fièvre, des céphalées, ictère, d'asthénies, de myalgies, d'arthralgies. Les populations se ravitaillaient en eau de boisson au niveau des abreuvoirs destinés aux animaux. La défécation se faisait à l'air libre dans les camps de réfugiés et des déplacés. Conclusion. L'investigation de l'épidémie a permis de décrire les cas et mettre en place des mesures de contrôle et de prévention. Nous recommandons de sensibiliser les populations sur l'hygiène et assainissement

Contribution of hepatitis E virus in acute sporadic hepatitis in north western India.

Background & objectives: Hepatitis E virus (HEV) causes acute viral hepatitis. Majority of the documented studies on hepatitis E have been focused on the incidence of this disease in northern and south central India. Limited data are available on HEV infection among acute sporadic hepatitis cases in north western India. The present study was undertaken to investigate the contribution of hepatitis E virus infection in sporadic hepatitis cases in Rajasthan and neighbouring States. Methods: Seven hundred and thirty six patients suspected to have viral hepatitis were screened for the hepatotropic viral markers, hepatitis A, B, C and E by using commercial enzyme immunoassay kits with a high sensitivity and specificity. The acute nature of HEV infection was also confirmed by the detection of HEV RNA by nested RT-PCR. Results: Hepatitis E was found to be the major cause of acute sporadic viral hepatitis (49.7%) in this region of India. Mixed infections of HEV-HAV (1.2%), HEV-HBV (6.1%), and HEV-HCV (1.7%) were also detected. No viral marker was detected in 32 per cent cases. Interpretation & conclusion: HEV was found as the major aetiological agent of acute sporadic viral hepatitis in Rajasthan (north western India). It is important to screen primarily for all the common enterically and parenterally transmitted hepatotropic viral markers in acute sporadic viral hepatitis. There is a need to do additional serological and molecular tests to identify the aetiological agent in the cases of acute hepatitis.

Seroepidemiology of hepatitis E virus infection in 2-25-year-olds in Sari district, Islamic Republic of Iran

The seroprevalence of hepatitis E virus infection [HEV] in children and young adults was determined in a community-based survey in an area of northern Islamic Republic of Iran. Serum samples were taken from 1080 randomly selected apparently healthy 2-25-year-olds from urban and rural regions of Sari district. Anti-HEV IgG antibodies were detected in 25 individuals [2.3%]. Seroprevalence increased significantly with age from 3/255 [1.2%] in children < 10 years to 8/110 [7.3%] in those aged 20-25 years. No differences in HEV status were noted between the sexes. Earlier age at exposure to infection and a higher infection rate were found in people residing in rural areas than in urban areas

[TT virus infection among Iranian blood donors: its prevalence and relationship to serum alanine aminotransferase [ALT] leve]

TT virus [TTV] is a DNA virus and is proposed as a potential cause of non-A to E hepatitis. We aimed to investigate, for the first time, the prevalence of TTV in Iranian healthy blood donors. Three hundred and twelve healthy Iranian blood donors were randomly selected and tested for TTV DNA by the seminested polymerase chain reaction method. Serum alanine aminotransferase [ALT] levels were determined in those infected and uninfected individuals that adequate serum were available. HBsAg or HCV antibody-positive subjects were excluded. Results: TT virus DNA was detected in 70 [22.4%] of the 312 subjects under study. ALT was elevated in 8 [18.2%] of the 44 TTV positive blood donors and in 8 [10.9%] of the 73 TTV negative blood donors. There was no significant difference between these two groups. TTV viremia is common among Iranian blood donors. Its prevalence in Iran is higher than US [1%] and most West-European countries and is comparable to China [28%] but lower than Thailand [37%] and Italy [42.4%]. Our data do not support the correlation between TTV viremia and elevated ALT level

Etiology of acute non-A, B, C hepatitis in Thai patients: preliminary study.

To better characterize the etiology of acute non-A, B, C hepatitis, 24 sera from 50 acute hepatitis without acute markers for hepatitis A, B, and C were examined for acute markers for the hepatitis E virus (HEV), cytomegalovirus (CMV), herpes simplex virus type 2 (HSV-2), and Epstein-Barr virus. Immunoglobulin M (IgM) specific for HEV, HSV-2, and CMV was detected using ELISA and total Ig specific to EBV was determined by standard indirect immunofluorescence. IgM to CMV was not observed in sera from any of the patients; whereas, IgM to HEV was detected in sera from 2 patients and IgM to HSV-2 was detected in 5 of 24 acute hepatitis patients. In addition, high titer of antibody was found in 2 of the patients. This results indicate that HSV-2 and HEV circulate in Thailand and are responsible for a small proportion of non-A, B, C hepatitis in Thailand.

etiology of community-acquired viral hepatitis in Cairo Egypt: diagnosis of HEV infections

From May 1993 to June 1994, 219 adults [ages 18-60 years] with acute jaundice were admitted to the, Abbassia Fever Hospital in Cairo, Egypt. Included for analysis of acute viral hepatitis were 143 [65%] with ALT and/or AST 5X normal and total bilirubin 2.3 mg/dl. Of the 143, 1.4% had acute hepatitis [A], 36.3% hepatitis [B], 8.4% hepatitis [C], 21.7% hepatitis E and 5.6% HDV coinfection with HBV. Four patients [2.8%] had an acute hepatitis superimposed on chronic hepatitis [B], and an additional 11 [7.7%] had acute hepatitis caused by more than one virus. Seventeen patients [11.9%] had no Ig[M] antibodies against known hepatitis viruses. HEV is a leading cause of acute sporadic hepatitis in Egyptian adults who are generally younger than other patients with acute hepatitis. No known risk factors were identified for HEV infection. Anti-HEV Ig[G] antibodies persisted in all patients with acute HEV hepatitis

Hepatite pelo virus E / E virus hepatitis

Os autores revisam os diversos aspectos concernentes a hepatite pelo virus E. Consideram que a mesma e uma forma frequente em paises em desenvolvimento, transmitindo-se principalmento pela via fecal-oral. E causada por um virus RNA poliadenilado de cadeia simples e sentido positivo, o virus da hepatite E. Clinicamente manifesta-se de forma semelhante a uma doenca aguda icterica autolimitada, emprestando, no entanto, um mau prognostico quando acomete gestantes. Seu diagnostico e sorologico atraves da deteccao de anticorpos das classes IgG e IgM por tecnicas de enzimoimunoensaios e de Western blot. Nao ha tratamento especifico e a prevencao fundamenta-se no saneamento basico

Hepatitis E virus infection in pregnant rhesus monkeys.

Ten non-pregnant female monkeys and four pregnant monkeys (all Macaca mulatta) in the last third of their gestation period were infected intravenously with the stool sample of a patient with hepatitis E virus infection (immuno-electronmicroscopy positive for hepatitis E virus). Four more non-pregnant monkeys were inoculated with a lower dose (less number of virus particles by IEM) of a stool sample collected on a different day from the same patient. The average incubation period as evidenced by the rise of serum alanine transferase in the non-pregnant monkeys, was 36.4 +/- 4.9 days. The dose of the virus did not affect the incubation period. Two of the pregnant monkeys had incubation periods of 9 and 13 days respectively. They delivered healthy babies on 40th and 53rd day respectively after inoculation. At the age of 11 months, both babies were negative for anti-HEV antibodies. One monkey which delivered a healthy baby on the 2nd day after inoculation had incubation period of 36 days. The baby of this monkey was anti-HEV positive at the age of 11 months. The incubation period was 41 days in the fourth monkey which delivered a macerated foetus on the 36th day after infection. No fatality was recorded in the infected monkeys. Bile samples collected from all monkeys showed strong signals in nested polymerase chain reaction (PCR). It seems that the incubation period in pregnant monkeys was determined by the state of pregnancy.