Epidemic non-A, non-B hepatitis in Nepal. Recovery of a possible etiologic agent and transmission studies in marmosets

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Abstract
An epidemic of non-A, non-B hepatitis occurred in Kathmandu Valley, Nepal, during 1981-1982, with .apprx. 7.6% of households and 1.4% of individuals affected. Cases occurred preponderantly in the 15-34-yr-old age group (70%), with most cases (75%) occurring in males. A high mortality rate (21%) occurred in pregnant women admitted to the hospital. No single water source was implicated, but epidemic peaks occurred during monsoon rains and multiple opportunities for enteric transmission existed. One of 8 patient stools examined by immune EM revealed aggregated, antibody-coated, 27-nm virus-like particles with convalescent serum samples were used as sources of antibody. Inoculation of 2 chimpanzees and 4 marmosets with a suspension of this stool resulted in elevated liver enzyme activity in 3 marmosets. Fecal excretion of 27-nm particles during the acute phase of disease (with temporally coincident antigen activity by radioimmunoassay) was observed in 1 marmoset, which also developed convalescent antibody against the particles in the original inoculum.