First documented outbreak of Hepatitis E in Northern Cameroon

Dear Sir,

The hepatitis E virus (HEV) is transmitted mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within 4-6 weeks. Occasionally, a fulminant form of hepatitis develops (acute liver failure), which can lead to death. It causes acute sporadic and epidemic viral hepatitis. Symptomatic infection (jaundice, fever, etc.) is most common in young adults aged 15-40 years. Although infection is frequent in children, the disease is mostly asymptomatic or causes a very mild illness without jaundice (anicteric) that could pass undiagnosed. ^[1]

An outbreak of illness associated with jaundice and fever occurred from September through October 2013 in Touboro Health District, Northern region of Cameroon [Figure 1]. All the cases were registered in two neighboring villages (Bogdibo and Golonbali) situated along the Cameroon-Chad border. Two deaths were recorded among whom one pregnant woman. The local health personnel suspected yellow fever virus infection and blood sample collected were sent to the National Reference Laboratory for yellow fever at Centre Pasteur of Cameroon (CPC) for confirmation. Laboratory evidence that the outbreak was neither yellow fever nor other arboviruses (dengue and West Nile) prompted a request for complementary analysis so as to determine the etiology for the outbreak.

A total of 37 serum samples received in CPC virology department were, therefore, tested for anti-HEV immunoglobulin G (IgG) and M (IgM) with enzyme-linked immunosorbent assay HEV IgG enzyme-linked immunosorbent assay (ELISA) and HEV IgM ELISA 3.0 kits, respectively (MP Biomedicals, Singapore) according to the manufacturer’s instructions. A total of 33 sera (89.2%) had elevated levels of HEV IgM consistent with recent infection, only one (2.7%) had elevated levels of HEV IgG without HEV IgM indicating a past infection, and three (8.1%) were negative for HEV antibodies. These results are consistent with data reported under outbreak conditions. ^[2],[3] Analysis of the confirm cases records showed that ages ranged from 7 to 50 years with only 21% (7/33) in the 0-14 years range [Table 1]. The great majority (75.7%) of these patients were males. This is to the best of our knowledge, the first ever documented outbreak of hepatitis E in Cameroon despite multiple outbreaks reported in the neighboring Chad during the last 2 decades. ^[4] Although it is important to use different biological tests (molecular and immunoenzymatic) for the HEV diagnosis, as none of the tests are sufficiently sensitive for use alone; ^[3] this first report of hepatitis E outbreak highlights the risk of infection and transmission in remote rural areas where hygiene conditions are poor and poverty is deepest. Consequently, pulling the communication cord is, therefore, needed for appropriate action to be taken by public authorities to maintain safe stools management and quality standards for public water supplies in these areas in order to reduce the risk of infection and transmission of waterborne diseases.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.140266

[Figure 1]

[Table 1]