Evidence of person-to-person transmission of hepatitis E virus during a large outbreak in Northern Uganda.
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.
Teshale
Eyasu H
EH
Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Atlanta, Georgia 301333, USA. eht4@cdc.gov
Grytdal
Scott P
SP
Howard
Christopher
C
Barry
Vaughn
V
Kamili
Saleem
S
Drobeniuc
Jan
J
Hill
Vincent R
VR
Okware
Samuel
S
Hu
Dale J
DJ
Holmberg
Scott D
SD
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