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June 27, 1990, Vol 263, No. 24 >
ARTICLE | June 27, 1990

Epidemic Transmission of Enterically Transmitted Non-A, Non-B Hepatitis in Mexico, 1986-1987 FREE

Oscar Velazquez, MD; Harrison C. Stetler, MD; Carlos Avila, MD; Gloria Ornelas, MD; Carlos Alvarez, DDS; Stephen C. Hadler, MD; Daniel W. Bradley, PhD; Jaime Sepúlveda, MD
[+] Author Affiliations

Reprint requests to Dirección General de Epidemiología, Programa de Residencia en Epidemiología Aplicada, Aniceto Ortega No. 1321, 6° Piso, Colonia del Valle, 03100 México, DF Mexico (Dr Velázquez).


JAMA. 1990;263(24):3281-3285. doi:10.1001/jama.1990.03440240071018
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References

Outbreaks of acute hepatitis occurred in Huitzililla and Telixtac, two rural villages 70 miles south of Mexico City, Mexico, in late 1986. The first outbreak began in Huitzililla in June of that year, 1 month after the start of the rainy season. A census revealed 94 icteric case subjects, for an attack rate of 5%; two women died. Attack rates were higher for persons older than 15 years (10%) than for younger persons. A case-control study showed that illness was highly associated with water-related factors. The second outbreak began in August 1986 in Telixtac. There were 129 case subjects, for an attack rate of 6%; one woman died. Epidemiologic findings were similar to those in Huitzililla, except that most disease transmission was not linked to unsafe water sources. None of 62 case subjects in Huitzililla and only 2 of 53 case subjects in Telixtac tested had serological evidence for recent infection with hepatitis A or B. Two of eight stool samples from Huitzililla and one of eight stool samples from Telixtac were positive by immune electron microscopy for 32- to 34-nm viruslike particles similar to those seen in cases of enterically transmitted non-A, non-B hepatitis from Asia. To our knowledge, these investigations document for the first time the epidemic transmission of enterically transmitted non-A, non-B hepatitis virus in the Americas.

(JAMA. 1990;263:3281-3285)

REFERENCES

1 +
Fay O, Hadler S, Maynard J, Pinheiro F.  Hepatitis in the Americas . Epidemiol Bull Pan Am Health Organization. 1985;;6:1-7.
2 +
Hadler S, Fay O, Pinheiro F, Maynard J.  La hepatitis en las Americas: informe del grupo colaborador de la OPS . Bol Of Sanit Panam. 1987;;103:185-209.
3 +
Benenson AS.  Epidemic non-A, non-B hepatitis . In: Control of Communicable Diseases in Man . Washington, DC: The American Public Health Association; 1985;:179-182.
4 +
Tandon BN, Joshi YK, Jain SK, Gandhi BM, Mathiesen LR, Tandon HD. An epidemic of non-A, non-B hepatitis in north India. Indian J Med Res. 1982;;75:739-744.
5 +
Wong DC, Purcell RH, Sreenivasan MA, Prasad SR, Pavri KM. Epidemic and endemic hepatitis in India: evidence for a non-A, non-B hepatitis virus aetiology. Lancet. 1980;;2:876-879.
6 +
Khuroo MS. Study of an epidemic of non-A, non-B hepatitis: possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type. Am J Med. 1980;;68:818-824.
7 +
Kane MA, Bradley DW, Shrestha SM, et al. Epidemic non-B hepatitis in Nepal: recovery of a possible etiologic agent and transmission studies in marmosets. JAMA. 1984;;252:3140-3145.
8 +
Myint H, Soe MM, Khin T, Myint TM, Tin KM. A clinical and epidemiological study of an epidemic of non-A, non-B hepatitis in Rangoon. Am J Trop Med Hyg. 1985;;34:1183-1189.
9 +
De Cock KM, Bradley DW, Sandford NG, Govindarajan S, Maynard JE, Redeker AG. Epidemic non-A, non-B hepatitis in patients from Pakistan. Ann Intern Med. 1987;;106:227-230.
10 +
Balayan MS, Andjaparidze AG, Savinskaya SS, et al. Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route. Intervirology. 1983;;20:23-31.
11 +
Belabbes EH, Bourguermouh A, Benatallah A, Illoul G. Epidemic non-A, non-B viral hepatitis in Algeria: strong evidence for its spreading by water. J Med Virol. 1985;;16:257-263.
12 +
Centers for Disease Control. Enterically transmitted non-A, non-B hepatitis—East Africa. MMWR. 1987;;36:241-244.
13 +
Kumate J, Alvizouri AM, Isibasi A. Encuesta serológica de hepatitis A en niños de Mexico. Boll of Sanit Panam. 1982;;92:494-499.
14 +
Ruiz GJ, Bustamante CME. Hepatitis A antibodies: prevalence and persistence in a group of Mexican children. Am J Epidemiol. 1985;;121:116-119.
15 +
Landa L. Seroepidemiología de la hepatitis B. Gac Med Mex. 1976;;111:85-91.
16 +
Centers for Disease Control. Enterically transmitted non-A, non-B hepatitis—Mexico. MMWR. 1987;;36:597-602.
17 +
Bradley DW, Krawczynski K, Cook EH, et al. Enterically transmitted non-A, non-B hepatitis: serial passage of disease in cynomolgus macaques and tamarins and recovery of disease-associated 27- to 34-nm viruslike particles. Proc Natl Acad Sci U S A. 1987;;84:6277-6281.
18 +
Bradley D, Andjaparidze A, Cook EH, et al. Aetiological agent of enterically transmitted non-A, non-B hepatitis. J Gen Virol. 1988;;69:731-738.
19 +
Karmen A. A note on the spectrophotometric assay of glutamic-oxaloacetic transaminase activity in human blood serum. J Clin Invest. 1955;;34:126-133.
20 +
Wroblewski F, LaDue JS. Serum glutamic pyruvic transaminase in cardiac and hepatic disease. Proc Soc Exp Biol Med. 1956;;91:569.
21 +
Villarejos VM, Visoná KA, Eduarte CA, Provost PJ, Hilleman MR. Evidence for viral hepatitis other than type A or type B among persons in Costa Rica. N Engl J Med. 1975;;293:1350-1352.
22 +
Khuroo MS, Duermeyer W, Zargar SA, Ahanger MA, Shah MA. Acute sporadic non-A, non-B hepatitis in India. Am J Epidemiol. 1983;;118:360-364.
23 +
Khuroo MS. Chronic liver disease after non-A, non-B hepatitis. Lancet. 1980;;2:860-861.
24 +
Fortier D, Treadwell TL, Koff RS. Enterically transmitted non-A, non-B hepatitis: importation from Mexico to Massachusetts. N Engl J Med. 1989;;320:1281-1282.

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1 +
Fay O, Hadler S, Maynard J, Pinheiro F.  Hepatitis in the Americas . Epidemiol Bull Pan Am Health Organization. 1985;;6:1-7.
2 +
Hadler S, Fay O, Pinheiro F, Maynard J.  La hepatitis en las Americas: informe del grupo colaborador de la OPS . Bol Of Sanit Panam. 1987;;103:185-209.
3 +
Benenson AS.  Epidemic non-A, non-B hepatitis . In: Control of Communicable Diseases in Man . Washington, DC: The American Public Health Association; 1985;:179-182.
4 +
Tandon BN, Joshi YK, Jain SK, Gandhi BM, Mathiesen LR, Tandon HD. An epidemic of non-A, non-B hepatitis in north India. Indian J Med Res. 1982;;75:739-744.
5 +
Wong DC, Purcell RH, Sreenivasan MA, Prasad SR, Pavri KM. Epidemic and endemic hepatitis in India: evidence for a non-A, non-B hepatitis virus aetiology. Lancet. 1980;;2:876-879.
6 +
Khuroo MS. Study of an epidemic of non-A, non-B hepatitis: possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type. Am J Med. 1980;;68:818-824.
7 +
Kane MA, Bradley DW, Shrestha SM, et al. Epidemic non-B hepatitis in Nepal: recovery of a possible etiologic agent and transmission studies in marmosets. JAMA. 1984;;252:3140-3145.
8 +
Myint H, Soe MM, Khin T, Myint TM, Tin KM. A clinical and epidemiological study of an epidemic of non-A, non-B hepatitis in Rangoon. Am J Trop Med Hyg. 1985;;34:1183-1189.
9 +
De Cock KM, Bradley DW, Sandford NG, Govindarajan S, Maynard JE, Redeker AG. Epidemic non-A, non-B hepatitis in patients from Pakistan. Ann Intern Med. 1987;;106:227-230.
10 +
Balayan MS, Andjaparidze AG, Savinskaya SS, et al. Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route. Intervirology. 1983;;20:23-31.
11 +
Belabbes EH, Bourguermouh A, Benatallah A, Illoul G. Epidemic non-A, non-B viral hepatitis in Algeria: strong evidence for its spreading by water. J Med Virol. 1985;;16:257-263.
12 +
Centers for Disease Control. Enterically transmitted non-A, non-B hepatitis—East Africa. MMWR. 1987;;36:241-244.
13 +
Kumate J, Alvizouri AM, Isibasi A. Encuesta serológica de hepatitis A en niños de Mexico. Boll of Sanit Panam. 1982;;92:494-499.
14 +
Ruiz GJ, Bustamante CME. Hepatitis A antibodies: prevalence and persistence in a group of Mexican children. Am J Epidemiol. 1985;;121:116-119.
15 +
Landa L. Seroepidemiología de la hepatitis B. Gac Med Mex. 1976;;111:85-91.
16 +
Centers for Disease Control. Enterically transmitted non-A, non-B hepatitis—Mexico. MMWR. 1987;;36:597-602.
17 +
Bradley DW, Krawczynski K, Cook EH, et al. Enterically transmitted non-A, non-B hepatitis: serial passage of disease in cynomolgus macaques and tamarins and recovery of disease-associated 27- to 34-nm viruslike particles. Proc Natl Acad Sci U S A. 1987;;84:6277-6281.
18 +
Bradley D, Andjaparidze A, Cook EH, et al. Aetiological agent of enterically transmitted non-A, non-B hepatitis. J Gen Virol. 1988;;69:731-738.
19 +
Karmen A. A note on the spectrophotometric assay of glutamic-oxaloacetic transaminase activity in human blood serum. J Clin Invest. 1955;;34:126-133.
20 +
Wroblewski F, LaDue JS. Serum glutamic pyruvic transaminase in cardiac and hepatic disease. Proc Soc Exp Biol Med. 1956;;91:569.
21 +
Villarejos VM, Visoná KA, Eduarte CA, Provost PJ, Hilleman MR. Evidence for viral hepatitis other than type A or type B among persons in Costa Rica. N Engl J Med. 1975;;293:1350-1352.
22 +
Khuroo MS, Duermeyer W, Zargar SA, Ahanger MA, Shah MA. Acute sporadic non-A, non-B hepatitis in India. Am J Epidemiol. 1983;;118:360-364.
23 +
Khuroo MS. Chronic liver disease after non-A, non-B hepatitis. Lancet. 1980;;2:860-861.
24 +
Fortier D, Treadwell TL, Koff RS. Enterically transmitted non-A, non-B hepatitis: importation from Mexico to Massachusetts. N Engl J Med. 1989;;320:1281-1282.

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