Evidence of Person-to-Person Transmission of Hepatitis E Virus during a Large Outbreak in Northern Uganda

Background. Outbreaks of infection with hepatitis E virus (HEV) are frequently attributed to contaminated drinking water, even if direct evidence for this is lacking. Methods. We conducted several epidemiologic investigations during a large HEV infection outbreak in Uganda. Results. Of 10,535 residents, 3218 had HEV infection; of these, 2531 lived in households with >1 case. HEV was not detected in drinking water or zoonotic sources. Twenty-five percent of cases occurred ≥8 weeks after onset of hepatitis in an index case in the household. Households with ≥2 cases were more likely to have a member(s) who attended a funeral, had close contact with a jaundiced person, or washed hands in a common basin with others (P < .05 for all). Conclusions. A high attack rate in households, lack of a common source of infection, and poor hygienic practices in households with ≥2 cases suggest person-to-person transmission of HEV during this outbreak.