title: An outbreak of fulminant hepatitis delta in the Waorani, an indigenous people of the Amazon basin of Ecuador.
abstract: An outbreak of delta hepatitis occurred during 1998 among the Waorani of the Amazon basin of Ecuador. Among 58 people identified with jaundice, 79% lived in four of 22 Waorani communities. Serum hepatitis B surface antigen (HBsAg) was found in the sera of 54% of the jaundiced persons, and 14% of asymptomatic persons. Ninety-five percent of 105 asymptomatic Waorani had hepatitis B core (HBc) IgG antibody, versus 98% of 51 with jaundice. These data confirm that hepatitis B virus (HBV) infection is highly endemic among the Waorani. Sixteen of 23 (70%) HBsAg carriers identified at the onset of the epidemic had serologic markers for hepatitis D virus (HDV) infection. All 16 were jaundiced, where as only two of seven (29%) with negative HDV serology were jaundiced (P = .0006). The delta cases clustered in families, 69% were children and most involved superinfection of people chronically infected with HBV. The data suggest that HDV spread rapidly by a horizontal mode of transmission other than by the sexual route.
authors.affiliation: Hospital Vozandes del Oriente, Shell, Pastaza, Ecuador.
authors.forename: S R
authors.initials: SR
authors.lastname: Manock
authors.forename: P M
authors.initials: PM
authors.lastname: Kelley
authors.forename: K C
authors.initials: KC
authors.lastname: Hyams
authors.forename: R
authors.initials: R
authors.lastname: Douce
authors.forename: R D
authors.initials: RD
authors.lastname: Smalligan
authors.forename: D M
authors.initials: DM
authors.lastname: Watts
authors.forename: T W
authors.initials: TW
authors.lastname: Sharp
authors.forename: J L
authors.initials: JL
authors.lastname: Casey
authors.forename: J L
authors.initials: JL
authors.lastname: Gerin
authors.forename: R
authors.initials: R
authors.lastname: Engle
authors.forename: A
authors.initials: A
authors.lastname: Alava-Alprecht
authors.forename: C M
authors.initials: CM
authors.lastname: Martínez
authors.forename: N B
authors.initials: NB
authors.lastname: Bravo
authors.forename: A G
authors.initials: AG
authors.lastname: Guevara
authors.forename: K L
authors.initials: KL
authors.lastname: Russell
authors.forename: W
authors.initials: W
authors.lastname: Mendoza
authors.forename: C
authors.initials: C
authors.lastname: Vimos
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004484:Ecuador / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D003699:Hepatitis D / Q000150:complications / Q000453:epidemiology*; D003698:Hepatitis Delta Virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood
chemical_list: D006508:Hepatitis Antibodies; D006514:Hepatitis B Surface Antigens; D012367:RNA, Viral