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Med Virol 1998 Mar;54(3):178-182
Association of Hepatitis E virus with an
outbreak of hepatitis at a military training camp in Nepal.
Clayson ET, Vaughn DW, Innis BL, Shrestha MP, Pandey R, Malla
DB
Department of Virology, Armed Forces Research Institute of
Medical Sciences, Bangkok, Thailand.
From 29 January 1995 to 15 March 1995, an outbreak of hepatitis
occurred among 692 soldiers at an isolated training camp 25
km east of Kathmandu. Thirty-two cases occurred approximately
8 weeks after arrival of soldiers at the camp. To determine
the etiology of the outbreak, patient sera were examined for
evidence of infection with Hepatitis A, B, C, and E viruses
using commercially available enzyme-linked immunosorbent assay
(ELISA) kits. The polymerase chain reaction (PCR) was used
to detect Hepatitis E virus (HEV) RNA. Evidence of recent
infection (IgM to HEV and/or HEV RNA) was found in all but
two patients, whereas none had evidence of recent infection
with Hepatitis A, B, or C viruses. Therefore, the outbreak
was attributed to HEV. Fecally contaminated drinking water
was suspected as the source of the outbreak. To determine
the extent of HEV infections among those without clinical
hepatitis, sera from the remaining soldiers were examined
for markers of HEV infection. Evidence of past infection (IgG
to HEV in the absence of IgM or HEV RNA) was found among 204
soldiers (prevalence = 30%), leaving 488 individuals susceptible
to infection at the onset of the outbreak. Evidence of recent
infection was found among another 83 individuals. We conclude
that most exposed, susceptible soldiers sustained HEV infection
without experiencing overt hepatitis. If the levels of virus
inoculum and prior immunity in this population were typical,
inapparent infection may be the usual adult response to virus
exposure in an endemic area.
PMID: 9515765, UI: 98175518
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