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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...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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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. |
format | Online Article Text |
id | pubmed-8084213 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
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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