title: Evidence of person-to-person transmission of hepatitis E virus during a large outbreak in Northern Uganda.
abstract: BACKGROUND
  Outbreaks of infection with hepatitis E virus (HEV) are frequently attributed to contaminated drinking water, even if direct evidence for this is lacking.
  
  
  METHODS
  We conducted several epidemiologic investigations during a large HEV infection outbreak in Uganda.
  
  
  RESULTS
  Of 10,535 residents, 3218 had HEV infection; of these, 2531 lived in households with >1 case. HEV was not detected in drinking water or zoonotic sources. Twenty-five percent of cases occurred > or = 8 weeks after onset of hepatitis in an index case in the household. Households with > or = 2 cases were more likely to have a member(s) who attended a funeral, had close contact with a jaundiced person, or washed hands in a common basin with others (P < .05 for all).
  
  
  CONCLUSIONS
  A high attack rate in households, lack of a common source of infection, and poor hygienic practices in households with > or = 2 cases suggest person-to-person transmission of HEV during this outbreak.
authors.affiliation: Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Atlanta, Georgia 301333, USA. eht4@cdc.gov
authors.forename: Eyasu H
authors.initials: EH
authors.lastname: Teshale
authors.forename: Scott P
authors.initials: SP
authors.lastname: Grytdal
authors.forename: Christopher
authors.initials: C
authors.lastname: Howard
authors.forename: Vaughn
authors.initials: V
authors.lastname: Barry
authors.forename: Saleem
authors.initials: S
authors.lastname: Kamili
authors.forename: Jan
authors.initials: J
authors.lastname: Drobeniuc
authors.forename: Vincent R
authors.initials: VR
authors.lastname: Hill
authors.forename: Samuel
authors.initials: S
authors.lastname: Okware
authors.forename: Dale J
authors.initials: DJ
authors.lastname: Hu
authors.forename: Scott D
authors.initials: SD
authors.lastname: Holmberg
mesh_terms: D000293:Adolescent; D004196:Disease Outbreaks; D005260:Female; D016751:Hepatitis E / Q000453:epidemiology* / Q000635:transmission*; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D007565:Jaundice / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D013997:Time Factors; D014454:Uganda / Q000453:epidemiology; D014871:Water Microbiology; D014881:Water Supply; D055815:Young Adult