Epidemic Investigation

Background: Diarrhoeal diseases affect millions of people around the world and have greatest impact on children, especially those in developing countries. Diarrhoeal disease outbreaks are cause of major public health emergencies in India. We investigated such an outbreak of acute gastroenteritis in Daslana Village of Ahmedabad district, Gujarat, to identify etiological agent, source of transmission and propose control measures.

Methodology: A cross sectional epidemiological study was carried out to find out the cases of acute gastroenteritis by house to house survey, and also inspected the sanitation and water supply.

Results: There were 38 cases of acute gastroenteritis among total 220 peoples who were residing near brick production sites, overall attack rate was 17.27%. Infants and children of 1 to 12 years of age were highly affected, (25%) and (20.56%) respectively.

Conclusion: The underlying cause for this outbreak of acute gastroenteritis was waterborne in nature and due to contamination of water with contributing factors of poor living condition.

This study explores geographic distribution, clinical profile of Hepatitis cases and confirms the strain serologically. The investigation was conducted by the rapid response team of the Smt. NHL Municipal Medical College in the Hirawadi area of North Zone of Ahmedabad following reporting increased numbers and clustering of jaundice cases during routine survey by the link and health workers of Ahmedabad Municipal Corporation. Re-survey of the affected area was carried out and occurrence of new cases in the areas was noted along with collection of blood samples. Assessment of water distribution system and correction of faults was carried out simultaneously by the engineering department of AMC. A total of 377 houses were surveyed and it had total population of 2039. Total jaundice cases reported were 94. Age profile was assessed among the population of 1245 and the age cut-off was taken as 12 years so as to make epidemiological distinction between two types of water borne Hepatitis based on the survey data before the reports of laboratory are available. Sex wise distribution of population and cases showed male preponderance. Overall ratio of jaundice cases among <12 years versus >12 years age category was 1:15.25. Households having turbid water supply had significantly a greater number of cases. Overall attack rate was 5.22% with significantly higher attack rate in population over 12 years. Total 44 blood samples were taken and 33 (75%) of samples were positive for Hepatitis E whereas 5 (11%) samples were positive for both hepatitis A and E. HEV was confirmed as the major etiological agent in this outbreak and contaminated drinking water was identified as the source of infection.

As outbreak of diphtheria reflects the impact of immunization outbreak investigation was carried out to assess the diphtheria outbreak pattern and case fatality rate in Dabela Village of Amirgagh Taluka and CHC, District, Banaskantha, Gujarat in 2007. Population stabilization, poverty alleviation, life-style modification, surveillance and control of communicable and non-communicable diseases constitute the major challenges demanding urgent attention in the future. Vaccine was efficacious among those who received >4 doses. The proportion of the population receiving boosters was low, especially among Muslims. We recommend increasing booster dose coverage. We investigated epidemic to 1) describe the epidemiology of diphtheria in terms of time, place, and person; 2) estimate vaccine coverage; and 3) to do SWOT analysis in Immunization services.4) To suggest  successful vaccination.

Background: Water, sanitation, and hygiene related infectious dis- eases are common in India. The Hepatitis E virus (HEV) virus is transmitted by the fecal-oral route. Transmission of HEV through contaminated water is the major concern for public health.

Materials and method: Present outbreak investigation was carried out by rapid response team of medical college Vadodara. Outbreak investigation was carried out to find out probable source of infec- tion, etiological agent, mode of transmission and to provide tech- nical support for prevention and control of epidemic. Consump- tion of contaminated water was suspected as primary source of in- fection for formation of hypothesis. Blood samples of clinically suspected cases and water samples from various sites were col- lected for laboratory confirmed diagnosis of disease under investi- gation.

Results: Total 42 jaundice cases were reported. Attack rate was higher in male (14.47 per 1000 population) compare to female (8.16 per 1000 population). Diagnosis of viral hepatitis E was confirmed by blood investigations

Conclusion: Mixing of contaminated water with piped water dis- tribution system was the primary source of infection and disease was spread through consumption of contaminated water  was  mode of transmission. Various measures for prevention and con- trol of hepatitis E Outbreak were suggested.

Background: In March 2013, cases of acute hepatitis were reported from Lalkuan, Nainital district. We investigated the outbreak to identify the source of infection and to facilitate control measures. Objectives: To study the distribution of hepatitis cases,
to find the source of infection, and to initiate the control measures in the affected area. Materials and Methods: We defined a case of acute hepatitis as those cases that had jaundice with at least one of the following symptoms: Dark urine, fever, pain in
abdomen, vomiting, and loss of appetite in the affected area between January and March 2013. Door-to-door survey was carried out. Thirteen blood samples were randomly collected from jaundice cases for immunoglobulin M (IgM) antibody for hepatitis A virus (HAV) and hepatitis E virus (HEV). Water samples were collected to test residual chlorine. Results: Total 2,785 individuals were surveyed; of which 240 were suffering from acute viral hepatitis (attack rate (AR) = 8.61%). Out of 13 serum samples, 10 were found positive for HEV IgM antibodies and three cases had IgM antibodies for both HAV and HEV, which confirmed a hepatitis E outbreak. The difference in attack rate of hepatitis of both the sexes was statistically significant (P < 0.001). The attack rate was significantly higher in age groups >12 years of age (P < 0.001). Environmental investigation also confirmed the sewage contamination of drinking water in the distribution system. The attack rate was much higher (29.4%) among those who were exposed to the leaking pipeline than the nonexposed (c2 = 574.26, P < 0.01). Conclusion: HEV was confirmed as the major
etiological agent in this outbreak that was transmitted by contaminated drinking water.  The recognition of early warning signals, timely investigation, and application of specific control measures can contain the outbreak.

Background: Hepatitis-E Virus (HEV) infection is endemic in Punjab, India. On 4th April 2013, public officials of Labour Colony, Amritsar reported > 20 jaundice cases occurring within several days. Methods: We performed a case-control study to identify the cause and prevent additional cases of jaundice cases in Amritsar, Punjab, India in 2013. Results: A total of 159 cases (attack rate 3.6%) and 1 death were identified in Labour and 5 adjoining colonies from January 1 to June 5, 2013. Persons with jaundice were more likely to report foul-smelling piped water (adjusted odds ratio [AOR], 4.0, 95% confidence interval [CI], 2.2-7.2) and used piped water for drinking (AOR, 5.1; 95% CI, 2.2-11.4) than persons without jaundice. Among 14 cases tested, all had anti-hepatitis E virus IgM, and none had anti-hepatitis A virus IgM. Additionally, 21/23 tap water samples from affected households had detectable fecal coliforms. An environmental investigation found that water pipelines were damaged during sewer construction and likely led to contamination of drinking water with hepatitis E virus. Conclusions: Hepatitis E outbreaks are common in India, to curb future outbreaks of hepatitis E; measures to ensure safe drinking water are urgently needed.

This study explores geographic distribution, clinical profile of Hepatitis cases and confirms the strain serologically. The investigation was conducted by the rapid response team of the Smt. NHL Municipal Medical College in the Hirawadi area of North Zone of Ahmedabad following reporting increased numbers and clustering of jaundice cases during routine survey by the link and health workers of Ahmedabad Municipal Corporation. Re-survey of the affected area was carried out and occurrence of new cases in the areas was noted along with collection of blood samples. Assessment of water distribution system and correction of faults was carried out simultaneously by the engineering department of AMC. A total of 377 houses were surveyed and it had total population of 2039. Total jaundice cases reported were 94. Age profile was assessed among the population of 1245 and the age cutoff was taken as 12 years so as to make epidemiological distinction between two types of water borne Hepatitis based on the survey data before the reports of laboratory are available. Sex wise distribution of population and cases showed male preponderance. Overall ratio of jaundice cases among <12 years versus >12 years age category was 1:15.25. Households having turbid water supply had significantly more number of cases. Overall attack rate was 5.22% with significantly higher attack rate in population over 12 years. Total 44 blood samples were taken and 33 (75%) of samples were positive for Hepatitis E whereas 5 (11%) samples were positive for both hepatitis A and E. HEV was confirmed as the major etiological agent in this outbreak and contaminated drinking water was identified as the source of infection. Key words: Epidemic investigation, faeco-oral route, hepatitis E, serological examination, water borne transmission. INTRODUCTION Acute viral hepatitis is caused by six distinct types of viruses A,B,C,D,E and G. Hepatitis E, Hepatitis E virus, consists of small, 32-to 34-nm diameter, icosahedral, nonenveloped particles with a singlestranded, positive-sense, 7.5-kb RNA. Hepatitis E virus (HEV) is the agent largely responsible for epidemic as well as sporadic hepatitis in the developing countries. The virus is transmitted by the feco-oral route, often through contaminated water. Primarily a self-limiting disease, it produces chronic sequelae. The epidemic investigation was carried out to explore area wise distribution and epidemiological parameters of the affected persons and area; to serologically confirm the strain of the Hepatitis virus; and, to make hypothesis about the agent, probable source, route of transmission, susceptible hosts and suggest actions and preventive measures MATERIALS AND METHOD The city of Ahmedabad is divided into six zones by Ahmedabad Municipal Corporation (AMC) for the purpose of provision of heath and other services. The health department of AMC reported increase in number and clustering of cases of jaundice during their routine survey by the link and health workers in the Hirawadi area of North Zone. Rapid Response Team was formed from Smt. NHL Municipal Medical College for investigating the epidemic. The team comprised of the faculty and residents from the Department of Community

Background: In March 2013, cases of acute hepatitis were reported from Lalkuan, Nainital district. We investigated the outbreak to identify the source of infection and to facilitate control measures. Objectives: To study the distribution of hepatitis cases, to find the source of infection, and to initiate the control measures in the affected area. Materials and Methods: We defined a case of acute hepatitis as those cases that had jaundice with at least one of the following symptoms: Dark urine, fever, pain in abdomen, vomiting, and loss of appetite in the affected area between January and March 2013. Door-to-door survey was carried out. Thirteen blood samples were randomly collected from jaundice cases for immunoglobulin M (IgM) antibody for hepatitis A virus (HAV) and hepatitis E virus (HEV). Water samples were collected to test residual chlorine. Results: Total 2,785 individuals were surveyed; of which 240 were suffering from acute viral hepatitis (attack rate (AR) = 8.61%). Out of 13 serum samples, 10 were found positive for HEV IgM antibodies and three cases had IgM antibodies for both HAV and HEV, which confirmed a hepatitis E outbreak. The difference in attack rate of hepatitis of both the sexes was statistically significant (P < 0.001). The attack rate was significantly higher in age groups >12 years of age (P < 0.001). Environmental investigation also confirmed the sewage contamination of drinking water in the distribution system. The attack rate was much higher (29.4%) among those who were exposed to the leaking pipeline than the nonexposed (c 2 = 574.26, P < 0.01). Conclusion: HEV was confirmed as the major etiological agent in this outbreak that was transmitted by contaminated drinking water. The recognition of early warning signals, timely investigation, and application of specific control measures can contain the outbreak.

Hepatitis E is an enterically transmitted viral disease, highly prevalent in India and mainly presents as a sporadic disease. This study investigated an outbreak of viral hepatitis at Ahmednagar Maharashtra, India. There was a rise in the number of viral hepatitis cases in a regimental training centre, Ahmednagar in May-Jun 2006 and an outbreak of viral hepatitis was suspected. The clinical case sheets and preliminary investigations carried out in the local military hospital (MH) were reviewed. A cross sectional descriptive epidemiological study was undertaken with survey of the suspected sewage and water pipelines. A total of 49 cases occurred from 12 May 2006 to 26 Jul 2006. There was clustering in time and space suggesting common source epidemic. All the 49 serum samples tested for IgM anti HEV antibodies were positive. Exploration of the water pipelines revealed sewage contamination due to leakage in the water pipeline which was passing through the sewage line. This water pipeli...

Hepatitis E, a major public health problem, continues to cause epidemics in different geographic areas in India and poses multi-sectoral challenges. The aim of the study was to determine the seroepidemiology of the hepatitis outbreak in the urban areas of district Shimla, Himachal Pradesh. Patients presenting with clinical features of acute viral hepatitis during and after the epidemic period were tested for seromarkers; IgM anti-HEV and IgM anti-HAV by enzyme linked immunosorbant assay. The weekly reporting under Integrated Disease and Surveillance Programme (IDSP) for cases of jaundice from Shimla from December 2015 to April 2016 was reviewed. The outbreak of hepatitis due to contamination of drinking water supply in urban Shimla beginning December 12, 2015 was confirmed by IDSP. A total of 425 serum samples (males: 292; females: 133) were tested for IgM anti-HAV and IgM anti-HEV by ELISA. Liver enzymes where deranged in all cases. Serological evidence of infection with HAV and/or HEV was seen in 64%. HEV infection alone was detected in 62.13%. All ages were affected, with one case of HEV infection below ten years. HEV infection alone was 5 times more common than HAV infection and co-infection was detected in 69 cases (m: 47; f:22). Six antenatal mothers were anti-HEV positive and the maternal mortality of 50% (n=3) due to fulminant hepatitis. Since HAV and HEV have a similar faecal-oral route of transmission, this study highlights periodic surveillance of HAV/HEV exposure pattern to improve levels of personal and food hygiene and inter-sectoral collaboration for provision of safe water supply and safe sewage disposal.

Hepatitis E, a major public health problem, continues to cause epidemics in different geographic areas in India and poses multi-sectoral challenges. The aim of the study was to determine the seroepidemiology of the hepatitis outbreak in the urban areas of district Shimla, Himachal Pradesh. Patients presenting with clinical features of acute viral hepatitis during and after the epidemic period were tested for seromarkers; IgM anti-HEV and IgM anti-HAV by enzyme linked immunosorbant assay. The weekly reporting under Integrated Disease and Surveillance Programme (IDSP) for cases of jaundice from Shimla from December 2015 to April 2016 was reviewed. The outbreak of hepatitis due to contamination of drinking water supply in urban Shimla beginning December 12, 2015 was confirmed by IDSP. A total of 425 serum samples (males: 292; females: 133) were tested for IgM anti-HAV and IgM anti-HEV by ELISA. Liver enzymes where deranged in all cases. Serological evidence of infection with HAV and/or HEV was seen in 64%. HEV infection alone was detected in 62.13%. All ages were affected, with one case of HEV infection below ten years. HEV infection alone was 5 times more common than HAV infection and co-infection was detected in 69 cases (m: 47; f:22). Six antenatal mothers were anti-HEV positive and the maternal mortality of 50% (n=3) due to fulminant hepatitis. Since HAV and HEV have a similar faecal-oral route of transmission, this study highlights periodic surveillance of HAV/HEV exposure pattern to improve levels of personal and food hygiene and inter-sectoral collaboration for provision of safe water supply and safe sewage disposal.

Hepatitis E, a major public health problem, continues to cause epidemics in different geographic areas in India and poses multi-sectoral challenges. The aim of the study was to determine the seroepidemiology of the hepatitis outbreak in the urban areas of district Shimla, Himachal Pradesh. Patients presenting with clinical features of acute viral hepatitis during and after the epidemic period were tested for seromarkers; IgM anti-HEV and IgM anti-HAV by enzyme linked immunosorbant assay. The weekly reporting under Integrated Disease and Surveillance Programme (IDSP) for cases of jaundice from Shimla from December 2015 to April 2016 was reviewed. The outbreak of hepatitis due to contamination of drinking water supply in urban Shimla beginning December 12, 2015 was confirmed by IDSP. A total of 425 serum samples (males: 292; females: 133) were tested for IgM anti-HAV and IgM anti-HEV by ELISA. Liver enzymes where deranged in all cases. Serological evidence of infection with HAV and/or HEV was seen in 64%. HEV infection alone was detected in 62.13%. All ages were affected, with one case of HEV infection below ten years. HEV infection alone was 5 times more common than HAV infection and co-infection was detected in 69 cases (m: 47; f:22). Six antenatal mothers were anti-HEV positive and the maternal mortality of 50% (n=3) due to fulminant hepatitis. Since HAV and HEV have a similar faecal-oral route of transmission, this study highlights periodic surveillance of HAV/HEV exposure pattern to improve levels of personal and food hygiene and inter-sectoral collaboration for provision of safe water supply and safe sewage disposal.

Background: Hepatitis-E Virus (HEV) infection is endemic in Punjab, India. On 4th April 2013, public officials of Labour Colony, Amritsar reported > 20 jaundice cases occurring within several days. Methods: We performed a case-control study to identify the cause and prevent additional cases of jaundice cases in Amritsar, Punjab, India in 2013. Results: A total of 159 cases (attack rate 3.6%) and 1 death were identified in Labour and 5 adjoining colonies from January 1 to June 5, 2013. Persons with jaundice were more likely to report foul-smelling piped water (adjusted odds ratio [AOR], 4.0, 95% confidence interval [CI], 2.2-7.2) and used piped water for drinking (AOR, 5.1; 95% CI, 2.2-11.4) than persons without jaundice. Among 14 cases tested, all had anti-hepatitis E virus IgM, and none had anti-hepatitis A virus IgM. Additionally, 21/23 tap water samples from affected households had detectable fecal coliforms. An environmental investigation found that water pipelines were damaged during sewer construction and likely led to contamination of drinking water with hepatitis E virus. Conclusions: Hepatitis E outbreaks are common in India, to curb future outbreaks of hepatitis E; measures to ensure safe drinking water are urgently needed.

Background: Hepatitis-E Virus (HEV) infection is endemic in Punjab, India. On 4th April 2013, public officials of Labour Colony, Amritsar reported > 20 jaundice cases occurring within several days. Methods: We performed a case-control study to identify the cause and prevent additional cases of jaundice cases in Amritsar, Punjab, India in 2013. Results: A total of 159 cases (attack rate 3.6%) and 1 death were identified in Labour and 5 adjoining colonies from January 1 to June 5, 2013. Persons with jaundice were more likely to report foul-smelling piped water (adjusted odds ratio [AOR], 4.0, 95% confidence interval [CI], 2.2-7.2) and used piped water for drinking (AOR, 5.1; 95% CI, 2.2-11.4) than persons without jaundice. Among 14 cases tested, all had anti-hepatitis E virus IgM, and none had anti-hepatitis A virus IgM. Additionally, 21/23 tap water samples from affected households had detectable fecal coliforms. An environmental investigation found that water pipelines were damaged during sewer construction and likely led to contamination of drinking water with hepatitis E virus. Conclusions: Hepatitis E outbreaks are common in India, to curb future outbreaks of hepatitis E; measures to ensure safe drinking water are urgently needed.

The burden of viral hepatitis in India is not well characterized. In 2009, the national Integrated Disease Surveillance Programme (IDSP) began conducting surveillance across all Indian states for epidemic-prone diseases, including foodborne and waterborne forms of viral hepatitis (e.g., hepatitis A and E). Information on outbreaks of all forms of viral hepatitis, including A, B, C, and E, also is collected. This report summarizes viral hepatitis surveillance and outbreak data reported to IDSP during 2011-2013. During this period, 804,782 hepatitis cases and 291 outbreaks were reported; the virus type was unspecified in 92% of cases. Among 599,605 cases tested for hepatitis A, 44,663 (7.4%) were positive, and among 187,040 tested for hepatitis E, 19,508 (10.4%) were positive. At least one hepatitis outbreak report was received from 23 (66%) of 35 Indian states. Two-thirds of outbreaks were reported from rural areas. Among 163 (56%) outbreaks with known etiology, 78 (48%) were caused ...

Background: Since 1976, seven outbreaks of hepatitis E occurred in Ahmedabad. Clusters of jaundice cases were reported on June 19, 2008, by a civic center, Girdharnagar ward, Ahmedabad. Objectives: The objectives were as follows: (1) to identify the etiological agent, source of outbreak, and mode of transmission; (2) to propose a control measure based on the outbreak investigation. Materials and Methods: We defined a case as an acute illness with (a) a discrete onset of symptoms and (b) jaundice or elevated serum aminotransferase levels, from March to September 2008 in the households of the Girdharnagar ward. We collected data through a door-to-door survey and hospital records. We described the outbreak in terms of time, place, and person. We collected laboratory investigation reports of case patients admitted to the civil hospital. To test our hypothesis we conducted a retrospective cohort study to find out the relative risk for hepatitis. We conducted environment investigation to find out the source of contamination of water supply. Results: A total 233 case patients of hepatitis were identified with the attack rate of 10.9/1000 population. Cases were reported in all the age groups with a higher attack rate in the age group of 20-29 years (18.5/1000). Out of 17 case patients, 16 were positive for the hepatitis E IgM antibody. The attack rate was two times more among those who were exposed to the leaking pipeline than the non-exposed (RR=2.3, 95% CI 1.76, 2.98). Environmental investigation also confirmed the sewage contamination of drinking water in the distribution system. Conclusion: The outbreak was due to hepatitis E virus. We recommended a temporary alternative water supply, repair of the leakages, and water quality surveillance.

Context: Rise in the number of jaundice cases were reported on 24 th of June 2010, in Dhola village, India. We investigated the outbreak to identify the source of infection and to facilitate control measures. Materials and Methods: We confirmed the outbreak by reviewing the rate of acute viral hepatitis in the year 2009-10. We defined a case of acute hepatitis as an acute illness with (a) discrete onset of symptoms and (b) jaundice or elevated serum aminotransferase levels, since March 2010 in Dhola village. We described the outbreak in terms of time, place, and person. We tested 20 blood samples of the case patient for hepatitis B surface antigen (HBs Ag), and immunoglobulin M (IgM) antibody for hepatitis A and E. We collected water samples for the bacteriological examination, and to test free chlorine in the water. Results: A total of 137 cases (attack rate 27.2/1000) were reported in this outbreak from March to August 2010. The attack rate was highest among the age group of 20-29 years. The attack rate was significantly higher in male (35/1000) than in female (18/1000). Out of 20 case-patients, 19 were found positive for hepatitis E virus (HEV) IgM antibodies. The water samples taken from households contained more than 10 coliforms in 100 ml sample. The relative risk of developing hepatitis E among people using pipeline water against those using ground water was 3.23 (95% CI of RR 1.59, 6.57). Conclusion: Outbreak that affected Dhola village was due to hepatitis E virus. Fecal contamination of water was the most likely source of this bimodal outbreak of hepatitis E.

Background: Since 1976, seven outbreaks of hepatitis E occurred in Ahmedabad. Clusters of jaundice cases were reported on June 19, 2008, by a civic center, Girdharnagar ward, Ahmedabad. Objectives: The objectives were as follows: (1) to identify the etiological agent, source of outbreak, and mode of transmission; (2) to propose a control measure based on the outbreak investigation. Materials and Methods: We defined a case as an acute illness with (a) a discrete onset of symptoms and (b) jaundice or elevated serum aminotransferase levels, from March to September 2008 in the households of the Girdharnagar ward. We collected data through a door-to-door survey and hospital records. We described the outbreak in terms of time, place, and person. We collected laboratory investigation reports of case patients admitted to the civil hospital. To test our hypothesis we conducted a retrospective cohort study to find out the relative risk for hepatitis. We conducted environment investigation to ...

Hepatitis E is an enterically transmitted viral disease, highly prevalent in India and mainly presents as a sporadic disease. This study investigated an outbreak of viral hepatitis at Ahmednagar Maharashtra, India. There was a rise in the number of viral hepatitis cases in a regimental training centre, Ahmednagar in May-Jun 2006 and an outbreak of viral hepatitis was suspected. The clinical case sheets and preliminary investigations carried out in the local military hospital (MH) were reviewed. A cross sectional descriptive epidemiological study was undertaken with survey of the suspected sewage and water pipelines. A total of 49 cases occurred from 12 May 2006 to 26 Jul 2006. There was clustering in time and space suggesting common source epidemic. All the 49 serum samples tested for IgM anti HEV antibodies were positive. Exploration of the water pipelines revealed sewage contamination due to leakage in the water pipeline which was passing through the sewage line. This water pipeline was laid illegally by the greedy canteen vendor to supplement water supply to his shop. The overall attack rate was 1.00%.The outbreak of viral hepatitis in the regimental training centre occurred due to sewage contamination of drinking water pipeline.

The burden of viral hepatitis in India is not well characterized. In 2009, the national Integrated Disease Surveillance Programme (IDSP) began conducting surveillance across all Indian states for epidemic-prone diseases, including foodborne and waterborne forms of viral hepatitis (e.g., hepatitis A and E). Information on outbreaks of all forms of viral hepatitis, including A, B, C, and E, also is collected. This report summarizes viral hepatitis surveillance and outbreak data reported to IDSP during 2011-2013. During this period, 804,782 hepatitis cases and 291 outbreaks were reported; the virus type was unspecified in 92% of cases. Among 599,605 cases tested for hepatitis A, 44,663 (7.4%) were positive, and among 187,040 tested for hepatitis E, 19,508 (10.4%) were positive. At least one hepatitis outbreak report was received from 23 (66%) of 35 Indian states. Two-thirds of outbreaks were reported from rural areas. Among 163 (56%) outbreaks with known etiology, 78 (48%) were caused ...

Background: There were many cases with symptoms,
suggestive of hepatitis in Ner village of Dhule district
during 2012. Aims: To investigate and control the
outbreak of hepatitis in a village community. Material
and Methods: The cases were identified by a survey in
the community. The suspected cases were interviewed
by a pre-defined & structured schedule. Those
identified cases were clinically examined and
confirmed by serological & biochemical laboratory
tests. An environmental study of the drinking water
supply system including testing of water samples from
different points in the distribution system was also
conducted in the area. The outbreak control measures
such as IEC drive, chlorination of drinking water and
repair of the water supply lines were initiated. Results:
The outbreak gave rise to a total of 180 cases in the
community. Predominantly adolescents & young
adults were affected with almost equal proportions in
males & females. No mortality was observed. The
outbreak was due to contamination of drinking water
pipeline with faecal matter. Conclusion: A large
outbreak of Hepatitis E involving 180 cases occurred
in a rural community which subsided after initiating
the control measures.

Context: Rise in the number of jaundice cases were reported on 24th of June 2010, in Dhola village, India.
We investigated the outbreak to identify the source of infection and to facilitate control measures. Materials
and Methods: We confirmed the outbreak by reviewing the rate of acute viral hepatitis in the year 2009-10.
We defined a case of acute hepatitis as an acute illness with (a) discrete onset of symptoms and (b) jaundice
or elevated serum aminotransferase levels, since March 2010 in Dhola village. We described the outbreak in
terms of time, place, and person. We tested 20 blood samples of the case patient for hepatitis B surface antigen
(HBs Ag), and immunoglobulin M (IgM) antibody for hepatitis A and E. We collected water samples for the
bacteriological examination, and to test free chlorine in the water. Results: A total of 137 cases (attack rate
27.2/1000) were reported in this outbreak from March to August 2010. The attack rate was highest among the
age group of 20–29 years. The attack rate was significantly higher in male (35/1000) than in female (18/1000).
Out of 20 case-patients, 19 were found positive for hepatitis E virus (HEV) IgM antibodies. The water samples
taken from households contained more than 10 coliforms in 100 ml sample. The relative risk of developing
hepatitis E among people using pipeline water against those using ground water was 3.23 (95% CI of RR 1.59,
6.57). Conclusion: Outbreak that affected Dhola village was due to hepatitis E virus. Fecal contamination of
water was the most likely source of this bimodal outbreak of hepatitis E.

Background: Since 1976, seven outbreaks of hepatitis E occurred in Ahmedabad. Clusters of jaundice cases were reported on June 19, 2008, by a civic center, Girdharnagar ward, Ahmedabad. Objectives: The objectives were as follows: (1) to identify the etiological agent, source of outbreak, and mode of transmission; (2) to propose a control measure based on the outbreak investigation. Materials and Methods: We defined a case as an acute illness with (a) a discrete onset of symptoms and (b) jaundice or elevated serum aminotransferase levels, from March to September 2008 in the households of the Girdharnagar ward. We collected data through a door-to-door survey and hospital records. We described the outbreak in terms of time, place, and person. We collected laboratory investigation reports of case patients admitted to the civil hospital. To test our hypothesis we conducted a retrospective cohort study to find out the relative risk for hepatitis. We conducted environment investigation to find out the source of contamination of water supply. Results: A total 233 case patients of hepatitis were identified with the attack rate of 10.9/1000 population. Cases were reported in all the age groups with a higher attack rate in the age group of 20-29 years (18.5/1000). Out of 17 case patients, 16 were positive for the hepatitis E IgM antibody. The attack rate was two times more among those who were exposed to the leaking pipeline than the non-exposed (RR=2.3, 95% CI 1.76, 2.98). Environmental investigation also confirmed the sewage contamination of drinking water in the distribution system. Conclusion: The outbreak was due to hepatitis E virus. We recommended a temporary alternative water supply, repair of the leakages, and water quality surveillance.