In:
PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 4 ( 2021-4-29), p. e0250505-
Abstract:
In the summer of 2017, an estimated 745,000 Rohingya fled to Bangladesh in what has been described as one of the largest and fastest growing refugee crises in the world. Among numerous health concerns, an outbreak of acute jaundice syndrome (AJS) was detected by the disease surveillance system in early 2018 among the refugee population. This paper describes the investigation into the increase in AJS cases, the process and results of the investigation, which were strongly suggestive of a large outbreak due to hepatitis A virus (HAV). An enhanced serological investigation was conducted between 28 February to 26 March 2018 to determine the etiologies and risk factors associated with the outbreak. A total of 275 samples were collected from 18 health facilities reporting AJS cases. Blood samples were collected from all patients fulfilling the study specific case definition and inclusion criteria, and tested for antibody responses using enzyme-linked immunosorbent assay (ELISA). Out of the 275 samples, 206 were positive for one of the agents tested. The laboratory results confirmed multiple etiologies including 154 (56%) samples tested positive for hepatitis A, 1 (0.4%) positive for hepatitis E, 36 (13%) positive for hepatitis B, 25 (9%) positive for hepatitis C, and 14 (5%) positive for leptospirosis. Among all specimens tested 24 (9%) showed evidence of co-infections with multiple etiologies. Hepatitis A and E are commonly found in refugee camps and have similar clinical presentations. In the absence of robust testing capacity when the epidemic was identified through syndromic reporting, a particular concern was that of a hepatitis E outbreak, for which immunity tends to be limited, and which may be particularly severe among pregnant women. This report highlights the challenges of identifying causative agents in such settings and the resources required to do so. Results from the month-long enhanced investigation did not point out widespread hepatitis E virus (HEV) transmission, but instead strongly suggested a large-scale hepatitis A outbreak of milder consequences, and highlighted a number of other concomitant causes of AJS (acute hepatitis B, hepatitis C, Leptospirosis), albeit most likely at sporadic level. Results strengthen the need for further water and sanitation interventions and are a stark reminder of the risk of other epidemics transmitted through similar routes in such settings, particularly dysentery and cholera. It also highlights the need to ensure clinical management capacity for potentially chronic conditions in this vulnerable population.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0250505
DOI:
10.1371/journal.pone.0250505.g001
DOI:
10.1371/journal.pone.0250505.g002
DOI:
10.1371/journal.pone.0250505.g003
DOI:
10.1371/journal.pone.0250505.g004
DOI:
10.1371/journal.pone.0250505.g005
DOI:
10.1371/journal.pone.0250505.t001
DOI:
10.1371/journal.pone.0250505.t002
DOI:
10.1371/journal.pone.0250505.t003
DOI:
10.1371/journal.pone.0250505.t004
DOI:
10.1371/journal.pone.0250505.t005
DOI:
10.1371/journal.pone.0250505.s001
DOI:
10.1371/journal.pone.0250505.s002
DOI:
10.1371/journal.pone.0250505.s003
DOI:
10.1371/journal.pone.0250505.s004
DOI:
10.1371/journal.pone.0250505.s005
DOI:
10.1371/journal.pone.0250505.s006
DOI:
10.1371/journal.pone.0250505.s007
DOI:
10.1371/journal.pone.0250505.s008
DOI:
10.1371/journal.pone.0250505.s009
DOI:
10.1371/journal.pone.0250505.s010
DOI:
10.1371/journal.pone.0250505.r001
DOI:
10.1371/journal.pone.0250505.r002
DOI:
10.1371/journal.pone.0250505.r003
DOI:
10.1371/journal.pone.0250505.r004
DOI:
10.1371/journal.pone.0250505.r005
DOI:
10.1371/journal.pone.0250505.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2021
detail.hit.zdb_id:
2267670-3
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