Hepatitis Group, ICMR-National Institute of Virology, Pune, Maharashtra, India.
Department of Health, Yavatmal, Maharashtra, India.
J Med Virol. 2021 Jun;93(6):3761-3768. doi: 10.1002/jmv.26377. Epub 2020 Oct 25.
Hepatitis E, a public health concern in developing countries, frequently presents in epidemic, as well as in sporadic forms. This study investigated an outbreak of viral hepatitis at Yavatmal, Maharashtra, India in March 2019. Blood samples from 10 patients were received at Indian Council of Medical Research-National Institute of Virology, Pune to test for the presence of enterically transmitted hepatitis viruses. Subsequently, 49 suspected cases were screened for anti-hepatitis E virus (HEV)/hepatitis A virus (HAV) immunoglobulin M and immunoglobulin G (IgG) antibodies, alanine amino-transferase levels and HEV RNA. Water samples were screened for HEV and HAV RNA followed by phylogenetic analysis. Overall 32 of 49 (65.3%) suspected cases had recent acute HEV infection, while dual infection with HAV was noted in one case (2.04%). Forty-eight of 49 suspected cases were positive for anti-HAV IgG antibodies indicative of previously acquired immunity against HAV. Water samples had evidence of HEV contamination as detected by reverse transcription-polymerase chain reaction. Sequencing of HEV RNA from both patients (n = 2) and water samples (n = 5) indicated HEV genotype 1 to be the etiological agent of this outbreak. Serological and molecular evidence confirmed HEV as the etiology. Mixing of contaminated drain water with the domestic water supply may have triggered this outbreak. Subsequent changing of the defaulted water pipelines and its segregation from drain pipelines by the health authorities resulted in progressive decline of this outbreak. Despite the limitations, periodic surveillance of HEV exposure pattern and reporting of small outbreaks would supplement to the global disease burden data of hepatitis E.
戊型肝炎是发展中国家的公共卫生关注点，常以流行和散发形式出现。本研究调查了 2019 年 3 月印度马哈拉施特拉邦亚瓦特马尔的一起病毒性肝炎暴发。印度医学研究理事会-国家病毒学研究所收到了来自 10 名患者的血液样本，以检测肠传播型肝炎病毒的存在。随后，对 49 例疑似病例进行了抗戊型肝炎病毒（HEV）/甲型肝炎病毒（HAV）免疫球蛋白 M 和免疫球蛋白 G（IgG）抗体、丙氨酸氨基转移酶水平和 HEV RNA 的检测。对水样进行了 HEV 和 HAV RNA 的筛查，随后进行了系统进化分析。总体而言，49 例疑似病例中有 32 例（65.3%）最近发生了急性 HEV 感染，1 例（2.04%）为 HAV 双重感染。49 例疑似病例中有 48 例抗 HAV IgG 抗体阳性，表明之前对 HAV 有获得性免疫力。水样中存在 HEV 污染的证据，通过逆转录聚合酶链反应检测到。从 2 名患者（n=2）和 5 份水样（n=5）的 HEV RNA 测序结果表明，HEV 基因型 1 是此次暴发的病原体。血清学和分子证据证实 HEV 是病因。受污染的污水与家庭用水混合可能引发了此次暴发。随后，卫生当局更换了默认的供水管线，并将其与污水管线隔离，导致疫情逐渐减少。尽管存在局限性，但定期监测 HEV 暴露模式并报告小型暴发将补充全球戊型肝炎疾病负担数据。
