An outbreak of hepatitis B with high mortality in India: association with precore, basal core promoter mutants and improperly sterilized syringes

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2010.01391.x/abstract

An outbreak of hepatitis B with high mortality in India: association with

precore, basal core promoter mutants and improperly sterilized syringes

V. A. Arankalle1, S. Gandhi2, K. S. Lole1, M. S. Chadha1, G. M. Gupte1, M. U.

Lokhande1

Article first published online: 26 NOV 2010

DOI: 10.1111/j.1365-2893.2010.01391.x

© 2010 Blackwell Publishing Ltd

Issue

Journal of Viral Hepatitis

Volume 18, Issue 4, pages e20–e28, April 2011

Summary.  In 2009, an outbreak of hepatitis B with high mortality was observed

in Sabarkantha district, Gujarat state, India with 456 cases and 89 deaths.

Hospitalized patients with self-limiting disease (152, AVH)) and fulminant

hepatic failure (39, FHF including 27 fatal and 12 survivals) were investigated.

These were screened for diagnostic markers for hepatitis viruses, hepatitis B

virus (HBV) genotyping and mutant analysis. Complete HBV genomes from 22 FHF and

17 AVH cases were sequenced. Serosurveys were carried out in the most and least

affected blocks for the prevalence of HBV and identification of mutants. History

of injection from a physician was associated with FHF and AVH cases.

Co-infection with other hepatitis viruses or higher HBV DNA load was not

responsible for mortality. Four blocks contributed to 85.7% (391/456) of the

cases and 95.5% (85/89) mortality while two adjacent blocks had negligible

mortality. Sequence analysis showed the presence of pre-core and basal core

promoter mutants and 4 amino acid substitutions exclusively among FHF cases.

None of the self-limiting patients exhibited these dual mutations. Genotype D

was predominant, D1 being present in all FHF cases while D2 was most prevalent

in AVH cases. Probably due to violation of accepted infection control procedures

by the qualified medical practitioners, HBV prevalence was higher in the

affected blocks before the outbreak. Gross and continued use of HBV contaminated

(mutant and wild viruses) injection devices led to an explosive outbreak with

high mortality with a striking association with pre-C/BCP mutants and D1

genotype.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2010.01391.x/abstract

An outbreak of hepatitis B with high mortality in India: association with

precore, basal core promoter mutants and improperly sterilized syringes

V. A. Arankalle1, S. Gandhi2, K. S. Lole1, M. S. Chadha1, G. M. Gupte1, M. U.

Lokhande1

Article first published online: 26 NOV 2010

DOI: 10.1111/j.1365-2893.2010.01391.x

© 2010 Blackwell Publishing Ltd

Issue

Journal of Viral Hepatitis

Volume 18, Issue 4, pages e20–e28, April 2011

Summary.  In 2009, an outbreak of hepatitis B with high mortality was observed

in Sabarkantha district, Gujarat state, India with 456 cases and 89 deaths.

Hospitalized patients with self-limiting disease (152, AVH)) and fulminant

hepatic failure (39, FHF including 27 fatal and 12 survivals) were investigated.

These were screened for diagnostic markers for hepatitis viruses, hepatitis B

virus (HBV) genotyping and mutant analysis. Complete HBV genomes from 22 FHF and

17 AVH cases were sequenced. Serosurveys were carried out in the most and least

affected blocks for the prevalence of HBV and identification of mutants. History

of injection from a physician was associated with FHF and AVH cases.

Co-infection with other hepatitis viruses or higher HBV DNA load was not

responsible for mortality. Four blocks contributed to 85.7% (391/456) of the

cases and 95.5% (85/89) mortality while two adjacent blocks had negligible

mortality. Sequence analysis showed the presence of pre-core and basal core

promoter mutants and 4 amino acid substitutions exclusively among FHF cases.

None of the self-limiting patients exhibited these dual mutations. Genotype D

was predominant, D1 being present in all FHF cases while D2 was most prevalent

in AVH cases. Probably due to violation of accepted infection control procedures

by the qualified medical practitioners, HBV prevalence was higher in the

affected blocks before the outbreak. Gross and continued use of HBV contaminated

(mutant and wild viruses) injection devices led to an explosive outbreak with

high mortality with a striking association with pre-C/BCP mutants and D1

genotype.