title: Contrasting roles of rivers and wells as sources of drinking water on attack and fatality rates in a hepatitis E epidemic in Somalia.
abstract: In early 1988, an increased incidence of acute hepatitis was observed in villages along the Shebeli River in the Lower Shebeli region of Somalia. This was followed by a large epidemic that lasted until late 1989. In a survey of 142 villages with a population of 245,312 individuals, 11,413 icteric cases were recorded, of which 346 died, corresponding to an attack rate and a case fatality rate of 4.6% and 3.0%, respectively. The etiologic role of hepatitis E virus (HEV) in this epidemic was proven by demonstrating anti-HEV in 128 of 145 sampled cases as a sign of recent infection with HEV. In three villages, where a special study protocol was implemented, the attack rate was found to increase significantly with age from 5% in the group 1-4 years of age to 13% in the group 5-15 years of age and to 20% for persons older than 15 years of age. Among cases 20-39 years of age, the female-to-male ratio was 1.5:1, which was a significant predominance of females. As in other hepatitis E outbreaks, there was a high fatality rate in pregnant females, estimated to be 13.8%. The epidemic peaked with the rise in the level of the river during rainfall, suggesting that the disease was waterborne. The attack rate was higher (6.0%) in villages supplied with river water, while fewer cases were recorded in those relying on wells or ponds for their water supply, 1.7% and 1.2%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine, Faculty of Medicine, Somali National University, Mogadishu.
authors.forename: K
authors.initials: K
authors.lastname: Bile
authors.forename: A
authors.initials: A
authors.lastname: Isse
authors.forename: O
authors.initials: O
authors.lastname: Mohamud
authors.forename: P
authors.initials: P
authors.lastname: Allebeck
authors.forename: L
authors.initials: L
authors.lastname: Nilsson
authors.forename: H
authors.initials: H
authors.lastname: Norder
authors.forename: I K
authors.initials: IK
authors.lastname: Mushahwar
authors.forename: L O
authors.initials: LO
authors.lastname: Magnius
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005618:Fresh Water; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000453:epidemiology* / Q000401:mortality; D016752:Hepatitis E virus / Q000276:immunology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000401:mortality; D011891:Rain; D012621:Seasons; D012737:Sex Factors; D012998:Somalia / Q000453:epidemiology; D014881:Water Supply
chemical_list: D006508:Hepatitis Antibodies