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We investigated an outbreak of HEV infection that occurred in September 2018 in the health district (HD) of Bocaranga-Koui, located in the northwestern part of Central African Republic (CAR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Blood samples were collected from 352 patients aged 0\u201385\u00a0years suspected to be infected with yellow fever (YF), according to the World Health Organization YF case definition. The notification forms from recorded cases were used. Water consumed in the HD were also collected. Human samples found negative for anti-YF IgM were then tested by ELISA for anti-HEV IgM and IgG antibodies. Positive anti-HEV (IgM and\/or IgG) samples and collected water were then subjected to molecular biology tests using a real time RT-PCR assay, followed by a nested RT-PCR assay for sequencing and phylogenetic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 352 icterus patients included, anti-HEV IgM was found in 142 people (40.3%) and anti-HEV IgG in 175 (49.7%). Although HEV infection was detected in all age groups, there was a significant difference between the 0\u201310 age groups and others age groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001). Elevated levels of serum aminotransferase were observed in anti-HEV IgM-positive subjects. Phylogenetic analysis showed HEV genotype 1e in infected patients as well as in the contaminated water.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This epidemic showed that CAR remains an HEV-endemic area. The genotype 1e strain was responsible for the HEV outbreak in Bocaranga-Koui HD. It is necessary to implement basic conditions of hygiene and sanitation to prevent further outbreaks of a HEV epidemics, to facilitate access to clean drinking water for the population, to launch intensive health education for basic hygiene measures, to sett up targeted hygiene promotion activities and, finally, to ensure that formal health care is available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-024-09116-3","type":"journal-article","created":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T04:03:14Z","timestamp":1708315394000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Hepatitis E outbreak in the health district of Bocaranga-Koui, Central African Republic, 2018\u20132019"],"prefix":"10.1186","volume":"24","author":[{"given":"Marina Prisca","family":"de Marguerite Nombot-Yazenguet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00ebl Wilfried","family":"Dot\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giscard Wilfried","family":"Koyaweda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe Armand","family":"Zemingui-Bembete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Selekon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Vickos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Manirakiza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Nakoune","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ionela","family":"Gouandjika-Vasilache","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narcisse Patrice Joseph","family":"Komas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,19]]},"reference":[{"issue":"6","key":"9116_CR1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2147\/HMER.S63417","volume":"3","author":"S Mirazo","year":"2014","unstructured":"Mirazo S, Ramos N, Mainardi V, Gerona S, Arbiza J. 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Because samples were taken as part of the national surveillance of yellow fever, and that the differential diagnosis of yellow fever is hepatitis E virus infection, the informed consent of the participants was not required.Written informed consent was waived by the \u00ab\u00a0Comit\u00e9 \u00c9thique et Scientifique\/Facult\u00e9 des Sciences, Universit\u00e9 de Bangui\/Institut Pasteur de Bangui (CES). Hence the CES gave authorization to publish the results from yellow fever national surveillance data used in the differential diagnosis of HEV infection without requiring informed consent. As the state of hepatitis E outbreak had been declared by the Ministry of Health and Population of the Central African Republic in this health district during this time, any person presenting conjunctival jaundice accompanied by a fever had to be systematically sampled for a HEV serological test, and symptomatic treatment was initiated if the serology (anti-HEV-IgM antibodies) of the HEV infection was positive.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"215"}}