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An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox’s Bazar, Bangladesh: Findings from enhanced epidemiological surveillance

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 ea...

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Autores principales: Mazhar, Md Khadimul Anam, Finger, Flavio, Evers, Egmond Samir, Kuehne, Anna, Ivey, Melissa, Yesurajan, Francis, Shirin, Tahmina, Ajim, Nurul, Kabir, Ahammadul, Musto, Jennie, White, Kate, Baidjoe, Amrish, le Polain de Waroux, Olivier
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084213/
https://www.ncbi.nlm.nih.gov/pubmed/33914782
http://dx.doi.org/10.1371/journal.pone.0250505
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author Mazhar, Md Khadimul Anam
Finger, Flavio
Evers, Egmond Samir
Kuehne, Anna
Ivey, Melissa
Yesurajan, Francis
Shirin, Tahmina
Ajim, Nurul
Kabir, Ahammadul
Musto, Jennie
White, Kate
Baidjoe, Amrish
le Polain de Waroux, Olivier
author_facet Mazhar, Md Khadimul Anam
Finger, Flavio
Evers, Egmond Samir
Kuehne, Anna
Ivey, Melissa
Yesurajan, Francis
Shirin, Tahmina
Ajim, Nurul
Kabir, Ahammadul
Musto, Jennie
White, Kate
Baidjoe, Amrish
le Polain de Waroux, Olivier
author_sort Mazhar, Md Khadimul Anam
collection PubMed
description 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.
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spelling pubmed-80842132021-05-06 An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox’s Bazar, Bangladesh: Findings from enhanced epidemiological surveillance Mazhar, Md Khadimul Anam Finger, Flavio Evers, Egmond Samir Kuehne, Anna Ivey, Melissa Yesurajan, Francis Shirin, Tahmina Ajim, Nurul Kabir, Ahammadul Musto, Jennie White, Kate Baidjoe, Amrish le Polain de Waroux, Olivier PLoS One Research Article 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. Public Library of Science 2021-04-29 /pmc/articles/PMC8084213/ /pubmed/33914782 http://dx.doi.org/10.1371/journal.pone.0250505 Text en © 2021 Mazhar et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Mazhar, Md Khadimul Anam
Finger, Flavio
Evers, Egmond Samir
Kuehne, Anna
Ivey, Melissa
Yesurajan, Francis
Shirin, Tahmina
Ajim, Nurul
Kabir, Ahammadul
Musto, Jennie
White, Kate
Baidjoe, Amrish
le Polain de Waroux, Olivier
An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox’s Bazar, Bangladesh: Findings from enhanced epidemiological surveillance
title An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox’s Bazar, Bangladesh: Findings from enhanced epidemiological surveillance
title_full An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox’s Bazar, Bangladesh: Findings from enhanced epidemiological surveillance
title_fullStr An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox’s Bazar, Bangladesh: Findings from enhanced epidemiological surveillance
title_full_unstemmed An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox’s Bazar, Bangladesh: Findings from enhanced epidemiological surveillance
title_short An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox’s Bazar, Bangladesh: Findings from enhanced epidemiological surveillance
title_sort outbreak of acute jaundice syndrome (ajs) among the rohingya refugees in cox’s bazar, bangladesh: findings from enhanced epidemiological surveillance
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084213/
https://www.ncbi.nlm.nih.gov/pubmed/33914782
http://dx.doi.org/10.1371/journal.pone.0250505
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