title: The important role of early diagnosis and preventive management during a large-scale outbreak of hepatitis A in Thailand.
abstract: BACKGROUND
  Acute hepatitis A is a worldwide public health problem especially in developing countries. Recently, a large, community-wide outbreak of hepatitis A occurred in the northeast part of Thailand.
  
  
  METHODS
  Demographic and clinical data as well as blood samples were collected and analyzed from patients with acute hepatitis who attended the Buengkan Provincial Hospital from June to September 2012. About 1619 patients with clinical symptoms of hepatitis A visited the hospital during the outbreak which manifested in three waves. Blood samples were collected from 205 patients.
  
  
  RESULTS
  One hundred and seventy eight patients had hepatitis A confirmed by the presence of anti-hepatitis A virus (HAV) IgM and/or HAV-RNA. The sensitivities for anti-HAV IgM and HAV-RNA were 95·5% (170/178) and 61·8% (110/178), respectively. When HAV-RNA was combined with anti-HAV IgM test, this increased the diagnostic yield by 7·2% (8/111) in the early phase of the acute infection (less than 5 days). Investigation of the molecular structure of the detected viruses indicated that all of the infections were caused by HAV genotype IA. There were no fatalities from this outbreak. Rapid detection, health education, sanitation campaigns, and vaccination offered on a voluntary basis have steadily reduced the number of infected patients and stopped the outbreak.
  
  
  CONCLUSIONS
  Occasionally a large-scale outbreak of HAV genotype IA can occur. A combination of HAV-RNA and anti-HAV IgM tests can increase the diagnostic yield during the early phase of the acute infection. Early diagnosis and preventive management campaigns can slow down and stop the outbreak.
authors.forename: Kittiyod
authors.initials: K
authors.lastname: Poovorawan
authors.forename: Paiboon
authors.initials: P
authors.lastname: Chattakul
authors.forename: Sirirat
authors.initials: S
authors.lastname: Chattakul
authors.forename: Thanunrat
authors.initials: T
authors.lastname: Thongmee
authors.forename: Apiradee
authors.initials: A
authors.lastname: Theamboonlers
authors.forename: Piyawat
authors.initials: P
authors.lastname: Komolmit
authors.forename: Yong
authors.initials: Y
authors.lastname: Poovorawan
mesh_terms: D017677:Age Distribution; D004196:Disease Outbreaks / Q000517:prevention & control*; D042241:Early Diagnosis; D005260:Female; D005838:Genotype; D006506:Hepatitis A / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D035922:Hepatitis A Antibodies / Q000097:blood*; D030041:Hepatitis A virus / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D010802:Phylogeny; D011634:Public Health; D012367:RNA, Viral / Q000097:blood*; D013785:Thailand / Q000453:epidemiology; D014611:Vaccination
chemical_list: D035922:Hepatitis A Antibodies; D012367:RNA, Viral
keywords: Genotype IA,; HAV,; Hepatitis A,; Outbreaks; Thailand,