Owada Kei, Sarkar Joyantee, Rahman Md Kaisar, Khan Shahneaz Ali, Islam Ariful, Hassan Mohammad Mahmudul, Soares Magalhães Ricardo J
Queensland Alliance for One Health Sciences, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia.
One Health Institute, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh.
Trop Med Infect Dis. 2022 Aug 6;7(8):170. doi: 10.3390/tropicalmed7080170.
Hepatitis E virus (HEV) is a waterborne zoonotic disease that can result in a high fatality rate in pregnant women and infants. In 2018, a large HEV outbreak emerged in Chattogram, Bangladesh, resulting in 2800 cases and a significant public health response to mitigate the transmission. While the source of the outbreak remained poorly understood, authorities suggested that possible risk factors for HEV infection included contamination of water supply, exacerbated by concurrent severe flooding events in the community. A cross-sectional study was conducted to investigate the distribution and risk factors for HEV seroprevalence between January and December 2018 in the Chattogram city area. A total of 505 blood samples were collected from symptomatic patients of 10 hospitals who met the case definition for an HEV infection. Standard ELISA tests were performed in all patients to identify anti-HEV antibodies. The size and location of HEV seroprevalence clusters within Chattogram were investigated using SaTScan. We investigated the association between risk of HEV infection and individual and environmentally lagged risk factors using Bernoulli generalised linear regression models. Our results indicate an overall HEV seroprevalence of 35% with significant variation according to sex, source of drinking water, and boiling of drinking water. A positive cross-correlation was found between HEV exposure and precipitation, modified normalised difference water index (MNDWI), and normalised difference vegetation index (NDVI). Our model indicated that risk of infection was associated with sex, age, source of drinking water, boiling of water, increased precipitation, and increased MNDWI. The results from this study indicate that source and boiling of drinking water and increased precipitation were critical drivers of the 2018 HEV outbreak. The communities at highest risk identified in our analyses should be targeted for investments in safe water infrastructure to reduce the likelihood of future HEV outbreaks in Chattogram.
戊型肝炎病毒（HEV）是一种经水传播的人畜共患病，可导致孕妇和婴儿的高死亡率。2018年，孟加拉国吉大港出现了一次大规模戊型肝炎病毒疫情，导致2800例病例，并引发了重大的公共卫生应对措施以减轻传播。虽然疫情的源头仍知之甚少，但当局表示，戊型肝炎病毒感染的可能风险因素包括供水污染，而社区同时发生的严重洪水事件加剧了这种污染。2018年1月至12月，在吉大港市地区进行了一项横断面研究，以调查戊型肝炎病毒血清阳性率的分布和风险因素。从10家医院符合戊型肝炎病毒感染病例定义的有症状患者中总共采集了505份血样。对所有患者进行了标准酶联免疫吸附测定（ELISA）试验，以鉴定抗戊型肝炎病毒抗体。使用时空扫描统计（SaTScan）研究了吉大港市戊型肝炎病毒血清阳性率聚集区的大小和位置。我们使用伯努利广义线性回归模型研究了戊型肝炎病毒感染风险与个体及环境滞后风险因素之间的关联。我们的结果表明，戊型肝炎病毒总体血清阳性率为35%，根据性别、饮用水来源和饮用水煮沸情况存在显著差异。发现戊型肝炎病毒暴露与降水量、修正归一化差异水指数（MNDWI）和归一化差异植被指数（NDVI）之间存在正互相关。我们的模型表明，感染风险与性别、年龄、饮用水来源、水的煮沸情况、降水量增加和MNDWI增加有关。这项研究的结果表明，饮用水的来源和煮沸情况以及降水量增加是2018年戊型肝炎病毒疫情的关键驱动因素。我们分析中确定的风险最高的社区应成为安全水基础设施投资的目标，以降低未来吉大港戊型肝炎病毒疫情爆发的可能性。
