A CLUSTER OF ACUTE HEPATITIS-E INFECTION IN UNITED-NATIONS BANGLADESHI PEACEKEEPERS IN HAITI

In the fall of 1995, within a month of deployment to Haiti for peaceke eping duty, four Bangladeshi soldiers developed acute icteric hepatiti s in rapid succession. Hepatitis E virus (HEV) was found to be the eti ology by demonstrating HEV genomic sequences in serum samples by the p olymerase chain reaction (PCR) and serologically by the detection of e levated IgM titers to HEV. No case had serologic evidence of acute hep atitis A or C infection. The soldiers had probably acquired their infe ction while living in a cantonment area outside Dhaka, Bangladesh for one month prior to deployment. Cloning and sequencing of amplified PCR products demonstrated a single strain suggestive of a common source o f infection. Furthermore, high genomic identity with Asian strains of HEV and dissimilarity with the Mexican strain was demonstrated, verify ing that the strain had indeed been imported. Human waste management f rom the Bangladesh camp in Haiti was strictly controlled and no second ary cases were observed. A convenience sample of 105 (12%) soldiers fr om the Bangladesh battalion (850 men) revealed anicteric or asymptomat ic HEV infection in seven (7%) of 105. This report contains the first demonstration of acute hepatitis E in natives of Bangladesh and demons trates the power of the PCR in the rapid diagnosis and epidemiologic a nalysis of HEV infection. More importantly, this cluster demonstrates the importation of an important infectious disease by multinational pe acekeepers to a potentially susceptible host country.