{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:54:28Z","timestamp":1761897268620},"reference-count":18,"publisher":"IWA Publishing","issue":"4","license":[{"start":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T00:00:00Z","timestamp":1591142400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"M\u00e9decins Sans Fronti\u00e8res","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["iwaponline.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Hepatitis E Virus (HEV) genotype 1 and 2 infect an estimated 20 million people each year, via the faecal-oral transmission route. An urban outbreak of HEV occurred in Am Timan, Chad, between September 2016 and April 2017. As part of the outbreak response, M\u00e9decins Sans Fronti\u00e8res and the Ministry of Health implemented water and hygiene interventions, including the chlorination of town water sources. We aimed to understand whether these water treatment activities had any impact on the number of HEV infections, using geospatial analysis of epidemiological and water treatment monitoring data. By conducting cluster analysis we investigated whether there were areas of particularly high and low infection risk during the outbreak and explored the reasons for this. We observed two high-risk spatial clusters of suspected cases and one high-risk cluster of confirmed cases. Our main finding was that confirmed HEV cases had a higher median number of days of exposure to unsafe water compared to suspected and non-confirmed cases (Kruskal-Wallis Chi Square: 15.5; p &amp;lt; 0.001). Our study confirms the mixed, but shifting, transmission routes during this outbreak. It also highlights the spatial and temporal analytical methods, which can be employed in future outbreaks to improve understanding of HEV transmission.<\/jats:p>","DOI":"10.2166\/wh.2020.032","type":"journal-article","created":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T06:11:11Z","timestamp":1591164671000},"page":"556-565","update-policy":"http:\/\/dx.doi.org\/10.2166\/iwapcrossmarkpolicypage","source":"Crossref","is-referenced-by-count":5,"title":["Does community-wide water chlorination reduce hepatitis E virus infections during an outbreak? A geospatial analysis of data from an outbreak in Am Timan, Chad (2016\u20132017)"],"prefix":"10.2166","volume":"18","author":[{"given":"Annick","family":"Lenglet","sequence":"first","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands"},{"name":"Department of Clinical Microbiology, Radboud UMC, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lutz","family":"Ehlkes","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands"},{"name":"Gesundheitsamt, K\u00f6lner Str. 180, D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn","family":"Taylor","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Francois","family":"Fesselet","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Plantage Middenlaan 14, 1018 DD, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Noel","family":"Nassariman","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelkhadir","family":"Ahamat","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Chen","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Idriss","family":"Noh","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abakar","family":"Moustapha","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Quartier Klemat, Rue 3211, Porte 429, N'Djamena, Chad"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Spina","sequence":"additional","affiliation":[{"name":"College of Medicine and Health, St Luke's Campus, Exeter University, Heavitree Road, Exeter, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"945","published-online":{"date-parts":[[2020,6,2]]},"reference":[{"key":"key-10.2166\/wh.2020.032-1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0007453"},{"key":"key-10.2166\/wh.2020.032-2","doi-asserted-by":"publisher","DOI":"10.3390\/v8100273"},{"key":"key-10.2166\/wh.2020.032-3","doi-asserted-by":"publisher","DOI":"10.2166\/wh.2014.027"},{"key":"key-10.2166\/wh.2020.032-4","doi-asserted-by":"publisher","DOI":"10.1080\/17474124.2016.1185365"},{"key":"key-10.2166\/wh.2020.032-5","doi-asserted-by":"publisher","DOI":"10.2166\/wh.2011.126"},{"key":"key-10.2166\/wh.2020.032-6","doi-asserted-by":"publisher","DOI":"10.1086\/504321"},{"key":"key-10.2166\/wh.2020.032-7","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.16-0620"},{"key":"key-10.2166\/wh.2020.032-8","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/978-4-431-68255-4_94","article-title":"Hepatitis E among refugees in Kenya: minimal apparent person-to-person transmission, evidence for age-dependent disease expression, and new serologic assays","volume-title":"Viral Hepatitis and Liver Disease","author":"Mast","year":"1994"},{"key":"key-10.2166\/wh.2020.032-9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0124688"},{"key":"key-10.2166\/wh.2020.032-10","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25505"},{"key":"key-10.2166\/wh.2020.032-11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0188240"},{"key":"key-10.2166\/wh.2020.032-12","doi-asserted-by":"crossref","unstructured":"Spina A., Beversluis D., Irwin A., Chen A., Nassariman J. N., Ahamat A., Noh I., Oosterloo J., Alfani P., Sang S., Lenglet A., Taylor D. L. 2018 Learning From Water Treatment and Hygiene Interventions in Response to A Hepatitis E Outbreak in an Open Setting in Chad.","DOI":"10.2166\/wh.2018.258"},{"key":"key-10.2166\/wh.2020.032-13","doi-asserted-by":"publisher","DOI":"10.1086\/651077"},{"key":"key-10.2166\/wh.2020.032-14","doi-asserted-by":"publisher","DOI":"10.3201\/eid1601.090764"},{"key":"key-10.2166\/wh.2020.032-15","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3194-6"},{"key":"key-10.2166\/wh.2020.032-16","unstructured":"World Health Organization 2014 Waterborne Outbreaks of Hepatitis E: Recognition, Investigation and Control. World Health Organization."},{"key":"key-10.2166\/wh.2020.032-17","unstructured":"World Health Organization 2015 Hepatitis E Vaccine: WHO Position Paper, May 2015. Weekly epidemiological record, No. 18 (May), pp. 185\u2013200."},{"key":"key-10.2166\/wh.2020.032-18","doi-asserted-by":"publisher","DOI":"10.3362\/1756-3488.17-00015"}],"container-title":["Journal of Water and Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/iwaponline.com\/jwh\/article-pdf\/18\/4\/556\/731087\/jwh0180556.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/iwaponline.com\/jwh\/article-pdf\/18\/4\/556\/731087\/jwh0180556.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T17:53:45Z","timestamp":1598291625000},"score":1,"resource":{"primary":{"URL":"https:\/\/iwaponline.com\/jwh\/article\/18\/4\/556\/74542\/Does-communitywide-water-chlorination-reduce"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,2]]},"references-count":18,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,6,2]]},"published-print":{"date-parts":[[2020,8,1]]}},"URL":"https:\/\/doi.org\/10.2166\/wh.2020.032","relation":{},"ISSN":["1477-8920","1996-7829"],"issn-type":[{"value":"1477-8920","type":"print"},{"value":"1996-7829","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,2]]}}}