An outbreak of fulminant hepatitis delta in the Waorani, an indigenous people of the Amazon basin of Ecuador

Academic Article


  • An outbreak of delta hepatitis occurred during 1998 among the Waorani of the Amazon basin of Ecuador. Among 58 people identified with jaundice, 79% lived in four of 22 Waorani communities. Serum hepatitis B surface antigen (HBsAg) was found in the sera of 54% of the jaundiced persons, and 14% of asymptomatic persons. Ninety-five percent of 105 asymptomatic Waorani had hepatitis B core (HBc) IgG antibody, versus 98% of 51 with jaundice. These data confirm that hepatitis B virus (HBV) infection is highly endemic among the Waorani. Sixteen of 23 (70%) HBsAg carriers identified at the onset of the epidemic had serologic markers for hepatitis D virus (HDV) infection. All 16 were jaundiced, where as only two of seven (29%) with negative HDV serology were jaundiced (P = .0006). The delta cases clustered in families, 69% were children and most involved superinfection of people chronically infected with HBV. The data suggest that HDV spread rapidly by a horizontal mode of transmission other than by the sexual route.
  • Authors

    Digital Object Identifier (doi)

    Author List

  • Manock SR; Kelley PM; Hyams KC; Douce R; Smalligan RD; Watts DM; Sharp TW; Casey JL; Gerin JL; Engle R
  • Start Page

  • 209
  • End Page

  • 213
  • Volume

  • 63
  • Issue

  • 3-4