title: Epidemic of hepatitis E in a military unit in Abbotrabad, Pakistan.
abstract: An outbreak of hepatitis caused by hepatitis E virus (HEV) in Abbottabad, Pakistan was traced to fecal contamination of a water system. Of 109 men hospitalized with hepatitis, 104 (95%) had serologic evidence of acute hepatitis E (IgM antibody to HEV [anti-HEV]), three (3%) probably had acute hepatitis E (high titers of IgG anti-HEV without IgM), and two had acute hepatitis A. Among a subset of 44 men with acute hepatitis E from whom three serum specimens were obtained over a four-month period, the anti-HEV IgG geometric mean titers (GMTs) decreased from 1,519 during the outbreak to 657 at four months. The IgM anti-HEV was detected in 40 (91%) of 44 sera obtained at admission (GMT = 533 during acute disease), but in only six (14%) four months later. The prevalence of anti-HEV in this population before the outbreak was estimated to be 30%. The presence of IgG anti-HEV appeared to protect against clinical hepatitis or development of serologic evidence of new infection with HEV. This is the second major epidemic of hepatitis E in the Pakistani military confirmed by an anti-HEV enzyme-linked immunosorbent assay (ELISA). Evidence that pre-existing antibody as measured by this ELISA protects against disease is important for assessment of vaccine development.
authors.affiliation: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA. Bryanjp@state.gov
authors.forename: Joe P
authors.initials: JP
authors.lastname: Bryan
authors.forename: Mohammad
authors.initials: M
authors.lastname: Iqbal
authors.forename: Sergei
authors.initials: S
authors.lastname: Tsarev
authors.forename: Iftikhar A
authors.initials: IA
authors.lastname: Malik
authors.forename: J Fred
authors.initials: JF
authors.lastname: Duncan
authors.forename: Aftab
authors.initials: A
authors.lastname: Ahmed
authors.forename: Asad
authors.initials: A
authors.lastname: Khan
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khan
authors.forename: Abdul Rauf
authors.initials: AR
authors.lastname: Rafiqui
authors.forename: Robert H
authors.initials: RH
authors.lastname: Purcell
authors.forename: Llewellyn J
authors.initials: LJ
authors.lastname: Legters
mesh_terms: D000293:Adolescent; D000328:Adult; D004196:Disease Outbreaks; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D016752:Hepatitis E virus / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D010154:Pakistan / Q000453:epidemiology
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M