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Epidemic Non-A, Non-B Hepatitis in Nepal Recovery of a Possible Etiologic Agent and Transmission Studies in Marmosets

Mark A. Kane, MD; Daniel W. Bradley, PhD; Santosh M. Shrestha, MB, BS; James E. Maynard, MD, PhD; E. H. Cook, MS; Ram Prasad Mishra, ABMS; D. D. Joshi, MB, BS
JAMA. 1984;252(22):3140-3145. doi:10.1001/jama.1984.03350220046029.
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An epidemic of non-A, non-B hepatitis occurred in Kathmandu Valley, Nepal, during 1981-1982, with approximately 7.6% of households and 1.4% of individuals affected. Cases occurred preponderantly in the 15- to 34-year-old age group (70%), with most cases (75%) occurring in males. A high mortality rate (21%) occurred in pregnant women admitted to the hospital. No single water source was implicated, but epidemic peaks occurred during monsoon rains, and multiple opportunities for enteric transmission existed. One of eight patient stools examined by immune electron microscopy revealed aggregated, antibody-coated, 27-nm viruslike particles when convalescent serum samples were used as sources of antibody. Inoculation of two chimpanzees and four marmosets with a suspension of this stool resulted in elevated liver enzyme activity in three marmosets. Fecal excretion of 27-nm particles during the acute phase of disease (with temporally coincident antigen activity by radioimmunoassay) was observed in one marmoset, which also developed convalescent antibody against the particles in the original inoculum.

(JAMA 1984;252:3140-3145)


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