Threat of hepatitis E virus infection in Somalia during Operation Restore Hope

In support of Operation Restore Hope, the United States military established a diagnostic laboratory for infectious diseases, the Joint Forward Laboratory, in Mogadishu, Somalia. Because sporadic hepatitis due to unknown causes was a frequent problem, staff members of the Joint Forward Laboratory evaluated 31 Somalis, five displaced Ethiopians, and three Western relief workers who had acute clinical hepatitis. Patients lived in multiple locations in Somalia--Mogadishu, Baidoa, and Merca--and became ill between December 1992 and February 1993. IgM antibody to hepatitis A virus was found in one English relief worker, and IgM antibody to hepatitis E virus was found in 20 (65%) of 31 Somalis, two (40%) of five Ethiopians, and two (67%) of three Western relief workers. No patient had evidence of acute hepatitis B, malaria, yellow fever, or other arbovirus infections. These data indicate that hepatitis E virus--the major cause of enterically transmitted non-A, non-B hepatitis--was a common cause of acute sporadic hepatitis in Somalia during the initial stages of Operation Restore Hope.