Clinical and epidemiological aspects of a hepatitis E outbreak in Bangui, Central African Republic

Blood samples were collected from 411 patients aged 1-87 years, most of whom presented with jaundice, asthenia or signs of uncomplicated malaria, for a transversal study from June 2004 to September 2005. Patients were recruited at 11 health care centres, including two referral hospitals, after they had given informed consent. The diagnosis of HEV was made with a commercial ELISA test to detect IgM and/or IgG antibodies. HEV RNA was amplified by RT-PCR to confirm the presence of the viral genome.The most frequent clinical signs found were jaundice (93.4%), vomiting (50.7%), hepatalgia (47.4%), hepatomegaly (30.9%) and asthenia (26.8%), which are the general clinical signs of hepatic disease. Acute hepatitis E was found in 213 patients (51.8%) who were positive for HEV IgM antibodies. The IgG anti-HEV seroprevalence during this outbreak was high (79.5%). The age group 18-34 years was more frequently infected (91.2%) than those aged 1-17 (78.0%) or over 34 (64.9%) (p < 10-6). RT-PCR performed on 127 sera from the 213 IgM-HEV-positive patients was amplified, and the presence of the viral genome was found in 65 samples.Although no specific clinical signs exist for hepatitis E infection, people presenting with jaundice, vomiting, hepatalgia, asthenia, hepatomegaly or distended abdomen with no signs of uncomplicated malaria in tropical developing countries should be sent to a laboratory for testing for hepatitis E.Hepatitis E virus (HEV), a small, single-stranded, hepatotropic RNA virus, currently classified in the genus Hepevirus [1], is responsible for enteric non-A non-B hepatitis in humans. Infection with HEV, thought to spread via the faecal-oral route, causes outbreaks that have been linked to waterborne sources in developing countries; sporadic cases have also been seen [2]. Although the potential for zoonotic and cross-species transmission has been demonstrated [3,4], asymptomatic carriers of HEV have been reported, and such cases are potential human reservoirs of