title: Surveillance at Private Laboratories Identifies Small Outbreaks of Hepatitis E in Urban Bangladesh.
abstract: Although large outbreaks of hepatitis E are regularly identified in south Asia, the majority of south Asian countries lack surveillance systems for this disease, which has hindered burden of disease estimates and prioritization of resources for prevention. Our study aimed to identify small hepatitis E outbreaks through a sentinel private laboratory in Dhaka, Bangladesh. We identified patients with detectable IgM antibody against hepatitis E virus. We defined a small outbreak as at least two laboratory-confirmed cases or ≥ 2 acute jaundice cases from the sentinel cases' family, neighborhood, or workplace. From November 2008 to November 2009, we identified 29 small outbreaks of hepatitis E from one private laboratory. The median number of cases in each outbreak was three. Cases were identified every month. Eighteen outbreaks occurred among families or neighbors, and 11 in the workplace. Among 103 cases identified as part of outbreaks, 31 (30%) sought care for diagnosis. In Bangladesh, collaboration between government public health surveillance and private laboratories can strengthen capacity for outbreak detection and improve estimates of disease burden.
authors.affiliation: International Center for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh. sazzad@icddrb.org.
authors.forename: Hossain M S
authors.initials: HM
authors.lastname: Sazzad
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Alain B
authors.initials: AB
authors.lastname: Labrique
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Chong-Gee
authors.initials: CG
authors.lastname: Teo
authors.affiliation: Stanford University, Stanford, California.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.affiliation: International Center for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Gurley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood*; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D016751:Hepatitis E / Q000453:epidemiology*; D016752:Hepatitis E virus / Q000302:isolation & purification*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M