Risk factors, person, place and time characteristics associated with Hepatitis E Virus outbreak in Napak District, Uganda
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
BMC infectious diseases
Abstract
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.
Methods: 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.
Results: 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).
Conclusion: 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.
Description
Keywords
Hepatitis E, Epidemic, Uganda
Citation
Amanya, G., Kizito, S., Nabukenya, I., Kalyango, J., Atuheire, C., Nansumba, H., ... & Karamagi, C. (2017). Risk factors, person, place and time characteristics associated with Hepatitis E Virus outbreak in Napak District, Uganda. BMC infectious diseases, 17(1), 1-8. DOI 10.1186/s12879-017-2542-2