| Abstract
| - 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.
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