An epidemic investigation of hepatitis E in Juna Sachivalay area of Gandhinagar city, Gujarat, India
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20163081Keywords:
Outbreak, Epidemic, Hepatitis E, Jaundice, Polluted waterAbstract
Background: Hepatitis E occurs around the world both as outbreaks and as sporadic cases. The objectives of the study were, to perform a detailed epidemiological investigation of an outbreak to determine the incidence of the disease, cause and source of the outbreak and to propose appropriate control and preventive measures.
Methods: An outbreak of jaundice had been reported from Juna Sachivalay area of Gandhinagar city to Gandhinagar Municipal Corporation during mid January 2016. Epidemic investigation was started by Rapid Response Team of GMERS Medical College, Gandhinagar in all blocks of Juna Sachivalay during 03/02/2016 to 03/03/2016. Total 4395 employees were surveyed and line listing of cases had been made. Water sample had been also collected from suspected 9 places to examine contamination and chlorination. Plasma samples from randomly selected 16 patients were screened for anti-HEV and HEA IgM antibodies using ELISA to confirm the diagnosis.
Results: Total 4395 employees were surveyed. Out of 4395 employees, 124 have a recent history of jaundice. Attack rate of Hepatitis E in our study was 2.82%. Out of these cases, 92 cases were contacted either by personal interview or telephonic interview. 16 patients were screened for anti-HEV and HEA IgM antibodies using ELISA to confirm the diagnosis and found positive for Hepatitis E. So, epidemic of Hepatitis E was confirmed. Age range of the patients was 20 years – 65 years. Out of 92 cases, majority (77, 83.7%) were male. Majority of the cases, (62 cases, 67.39%) were reported between 21-50 years age group. (Table 1) Water samples were collected from suspected 9 places to examine chlorination and contamination.
Conclusions: Water sources of 1st and 2nd floor Block-11, Block-12, 1st floor Block-1, in front Gujarat board office and Meenabazar, area nearby Sachivalay was found polluted and contaminated with fecal matter, human excreta or sewage was the reason of an epidemic of Hepatitis E.References
Labrique AB, Thomas DL, Stoszek SK, Nelson KE. Hepatitis E: an emerging infectious disease. Epidemiol Rev. 1999;21:162-79.
World Health Organization. Hepatitis E. Document WHO/CDSCSR/ EDC/2002.12 Geneva: World Health Organization, Department of Communicable Disease Surveillance and Response. 2001.
Aggarwal R. The global prevalence of hepatitis E virus infection and susceptibility: a systematic review. Geneva: World Health Organization. 2010. http://whqlibdoc.who.int/hq/2010/WHO_IVB_10.14_eng.pdf (accessed 01 May 2014).
Aggarwal R, Jameel S. Hepatitis E. Hepatology. 2011;54:2218-26.
Aggarwal R, Naik S. Epidemiology of hepatitis E: current status. J Gastroenterol Hepatol. 2009;24:1484-93.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-128.
Kane MA, Bradley DW, Shrestha SM. Epidemic non- A, non-B hepatitis in Nepal. Recovery of a possible etiologic agent and transmission studies in marmosets. Journal of the American Medical Association. 1984;252:3140-5.
Khuroo MS. Study of an epidemic of non-A, non-B hepatitis: possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B type. American Journal of Medicine. 1980;68:818-23.
Naik SR, Aggarwal R, Salunke PN, Mehrotra NN. A large waterborne viral hepatitis E epidemic in Kanpur, India. Bulletin of the World Health Organization. 1992;70:597-604.
Tsega E, Hansson BG, Krawczynski K, Nordenfelt E. Acute sporadic viral hepatitis in Ethiopia: causes, risk factors, and effects on pregnancy. Clinical Infectious Diseases. 1992;14:961-5.
Kumar A, Beniwal M, Kar P, Sharma JB, Murthy NS. Hepatitis E in pregnancy. International Journal of Gynaecology and Obstetrics. 2004;85:240-4.
Patra S, Kumar A, Trivedi SS, Puri M, Sarin SK. Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection. Annals of Internal Medicine. 2007;147:28-33.
Rasheeda CA, Navaneethan U, Jayanthi V. Liver disease in pregnancy and its influence on maternal and fetal mortality: a prospective study from Chennai, Southern India. European Journal of Gastroenterology and Hepatology. 2008;20:362-4.
Lopez P, Dizer JMH, Wolfgang D. Wastewater treatment and elimination of pathogens: new prospects for an old problem. Microbiology. 1996;12:525-36.
