Main Article Content
Abstract
RÉSUMÉ
Introduction. En 2017, la région de Diffa a notifié une hausse des cas de syndrome ictérique à huit cas dont 6 (75%) décès. Suite à la confirmation, une équipe multidisciplinaire a investigué cette flambée épidémique. L’objectif était de caractériser la population à risque, d’identifier la source de l'infection et de mettre en place des mesures de contrôle et de prévention. Méthodes. Nous avons conduit une étude descriptive des cas d’HVE survenus dans la région de Diffa, du 23 avril au 4 juin 2017. Une recherche active des cas a été menée dans les villages et les camps des réfugiés et des déplacés internes. Nous avons effectué des entretiens avec les malades et une revue documentaire. Une liste linéaire a été établie. Des prélèvements ont été collectés. Epi Info 7.2 pour l’analyse. Résultats. 329 cas dont 26 (7,90%) décès ont été enregistrés. Le sexe féminin représentait 63,1%. L’âge médian était de 26 ans (2 à 75 ans). La tranche d’âge ≥15 ans représentait 85,41%. Les femmes enceintes ou allaitantes représentaient 38,16% de l’effectif. Les signes cliniques étaient une fièvre, des céphalées, ictère, d’asthénies, de myalgies, d'arthralgies. Les populations se ravitaillaient en eau de boisson au niveau des abreuvoirs destinés aux animaux. La défécation se faisait à l’air libre dans les camps de réfugiés et des déplacés. Conclusion. L’investigation de l’épidémie a permis de décrire les cas et mettre en place des mesures de contrôle et de prévention. Nous recommandons de sensibiliser les populations sur l’hygiène et assainissement.
ABSTRACT
Introduction. In 2017, the Diffa region reported an increase in cases of icteric syndrome, eight cases including six (75%) deaths. Following confirmation, a multidisciplinary team investigated this outbreak. Our objective was to characterize the population at risk, to identify the source of the infection and to implement control and prevention measures. Methods. We conducted a descriptive study of HVE cases in Diffa region, from 23 April to 4 June 2017. We conducted active case research in the villages and refugee camps. We conducted patient interviews and review. A linelist was established. Samples were collected. We used Epi Info 7.2 for analysis. Results. 329 cases including 26 (7.90%) deaths were recorded. Female patients represented 63.1% of the sample. The median age was 26 years (range: 2 to 75 years). The patients aged 15 years or more accounted for 85.41%. Pregnant or lactating women accounted for 38.16% of the sample. The main clinical signs were fever, headache, jaundice, asthenia, myalgia and arthralgia. The populations supplied themselves with drinking water at the drinking troughs for animals. Defecation was done in the open air in refugee camps. Conclusion. The investigation of the epidemic made possible to describe the cases and to implement control and prevention measures. We recommend raising awareness about hygiene and sanitation.
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References
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- OMS. Plan d’action régional contre l’hépatite virale dans le Pacifique occidental 2016-2020. Guam (Etats Unis d’Amérique): Bureau Régional du Pacifique Occidental; 2015. Report No.: WPR/RC66/4.
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- Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology. 2012;55:988‑97.
- Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet Lond Engl. 10 sept 2016;388(10049):1081‑8.
- Franco MR, Ilaria DB, Eleonora P, Giorgia A, Marcello T, Fabio O. Zoonotic transmission of hepatitis E virus in industrialized countries. 2013;36:331‑44.
- Shata MT, Daef EA, Zaki ME, Abdelwahab SF, Marzuuk NM, Sobhy M, et al. Protective role of humoral immune responses during an outbreak of hepatitis E in Egypt. Trans R Soc Trop Med Hyg. 1 oct 2012;106(10):613‑8.
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- Boccia D, Guthmann J-P, Klovstad H, Hamid N, Tatay M, Ciglenecki I, et al. High Mortality Associated with an Outbreak of Hepatitis E among Displaced Persons in Darfur, Sudan. Clin Infect Dis. 15 juin 2006;42(12):1679‑84.
- Bile K, Isse A, Mohamud O, et al. Contrasting roles of rivers and wells as sources of drinking water on attack and fatality rates in a hepatitis E epidemic in Somalia. Am J Trop Med Hyg. 1994;51:466‑74.
- Awsathi S, Rawat V, Rawat CMS, Semwal V, Bartwal SJ. Epidemiological Investigation of the Jaundice Outbreak in Lalkuan, Nainital District, Uttarakhand. Indian J Community Med Off Publ Indian Assoc Prev Soc Med. 2014;39(2):94‑7.
- K T, Luis Dvorzak J, J L. Investigation of hepatitis E outbreak among refugees, Upper Nile, South Sudan, 2012-2013. Morb Mortal Wkly Rep. 2013;62:581‑6.
- Mushahwar IK, Dawson GJ, Bile KM, Magnius LO. Serological studies of an enterically transmitted non-A, non-B hepatitis in Somalia. J Med Virol. 1993;218‑21.
- Teshale EH, Howard CM, Grytdal SP, et al. Hepatitis E epidemic, Uganda. Emerg Infect Dis. 2010;16:126‑9.
- Teshale EH, Grytdal SP, Howard C, et al. Evidence of person-to-person transmission of hepatitis E virus during a large outbreak in northern Uganda. Clin Infect Dis. 2010;50:1006‑10.
References
Hakim MS, Wang W, Bramer WM, Geng J, Huang F, de Man RA, et al. The global burden of hepatitis E outbreaks: a systematic review. Liver Int. 1 janv 2017;37(1):19‑31.
OMS. Plan d’action régional contre l’hépatite virale dans le Pacifique occidental 2016-2020. Guam (Etats Unis d’Amérique): Bureau Régional du Pacifique Occidental; 2015. Report No.: WPR/RC66/4.
Hoofnagle JH, Nelson KE, Purcell RH. Hepatitis E. N Engl J Med. 27 sept 2012;367(13):1237‑44.
Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology. 2012;55:988‑97.
Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet Lond Engl. 10 sept 2016;388(10049):1081‑8.
Franco MR, Ilaria DB, Eleonora P, Giorgia A, Marcello T, Fabio O. Zoonotic transmission of hepatitis E virus in industrialized countries. 2013;36:331‑44.
Shata MT, Daef EA, Zaki ME, Abdelwahab SF, Marzuuk NM, Sobhy M, et al. Protective role of humoral immune responses during an outbreak of hepatitis E in Egypt. Trans R Soc Trop Med Hyg. 1 oct 2012;106(10):613‑8.
Mast EE, Polish LB, Favorov MO, Khudyakova NS, Collins C, Tukei PM, et al. Hepatitis E Among Refugees in Kenya: Minimal Apparent Person-to-person Transmission, Evidence for Age-dependent Disease Expression, and New Serologic Assays. In: Viral Hepatitis and Liver Disease [Internet]. Springer, Tokyo; 1994 [cité 27 juill 2017]. p. 375‑8. Disponible sur: https://link.springer.com/chapter/10.1007/978-4-431-68255-4_94
Ahmed JA, Moturi E, Spiegel P, Schilperoord M, Burton W, Kassim NH, et al. Hepatitis E Outbreak, Dadaab Refugee Camp, Kenya, 2012. Emerg Infect Dis. juin 2013;19(6):1010‑1.
Goumba AI, Konamna X, Komas NP. Clinical and epidemiological aspects of a hepatitis E outbreak in Bangui, Central African Republic. BMC Infect Dis. 14 avr 2011;11:93.
Pérez-Gracia MT, Suay B, Mateos-Lindemann ML. Hepatitis E: an emerging disease. Infect Genet Evol J Mol Epidemiol Evol Genet Infect Dis. mars 2014;22:40‑59.
Kim J-H, Nelson KE, Panzner U, Kasture Y, Labrique AB, Wierzba TF. A systematic review of the epidemiology of hepatitis E virus in Africa. BMC Infect BioMed Cent Ltd. jui 2014;14(1).
Boccia D, Guthmann J-P, Klovstad H, Hamid N, Tatay M, Ciglenecki I, et al. High Mortality Associated with an Outbreak of Hepatitis E among Displaced Persons in Darfur, Sudan. Clin Infect Dis. 15 juin 2006;42(12):1679‑84.
Bile K, Isse A, Mohamud O, et al. Contrasting roles of rivers and wells as sources of drinking water on attack and fatality rates in a hepatitis E epidemic in Somalia. Am J Trop Med Hyg. 1994;51:466‑74.
Awsathi S, Rawat V, Rawat CMS, Semwal V, Bartwal SJ. Epidemiological Investigation of the Jaundice Outbreak in Lalkuan, Nainital District, Uttarakhand. Indian J Community Med Off Publ Indian Assoc Prev Soc Med. 2014;39(2):94‑7.
K T, Luis Dvorzak J, J L. Investigation of hepatitis E outbreak among refugees, Upper Nile, South Sudan, 2012-2013. Morb Mortal Wkly Rep. 2013;62:581‑6.
Mushahwar IK, Dawson GJ, Bile KM, Magnius LO. Serological studies of an enterically transmitted non-A, non-B hepatitis in Somalia. J Med Virol. 1993;218‑21.
Teshale EH, Howard CM, Grytdal SP, et al. Hepatitis E epidemic, Uganda. Emerg Infect Dis. 2010;16:126‑9.
Teshale EH, Grytdal SP, Howard C, et al. Evidence of person-to-person transmission of hepatitis E virus during a large outbreak in northern Uganda. Clin Infect Dis. 2010;50:1006‑10.