Published: 2020-03-26

Clinical and epidemiological aspects of an outbreak of viral hepatitis E in a training centre

Maninder Pal Singh Pardal, Rajiva ., T. K. Rath, M. S. Mustafa


Background: HEV infection is responsible for half of all outbreaks of acute liver disease in endemic areas. The  present  study  deals  with  eighty eight cases of  faeces  orally  transmitted  Hepatitis E virus (HEV)  in  a  regimental  training  center  in  South India in October 2016 to November 2016.

Methods: Methodology and case definitions which were used for confirmed case and presumptive case of viral hepatitis were same as those which were used by Singh et al in their study.  Surveillance data for all the cases was reviewed. The outbreak was described in terms of person, place and time. A sanitary survey carried out to detect the likely sources of contamination of water and to study the methods of sewage disposal with regards to septic tanks/soak pits.

Results: Out of eighty-eight cases, two persons were HBsAg +ve, five were positive for both Hepatitis A and E, sixty-eight were positive for hepatitis E, five were positive for Hepatitis A, 8 persons were found negative for all the above hepatitis viruses. Overflow of sewage with foul smell and leaking water pipeline in 2 places were observed in the unit area. The overall attack rate was 27.69%.

Conclusions: The present outbreak was due to faecal contamination of drinking water supplied to the regimental centre, which occurred due to old and corroded leaking pipelines in close proximity to old sewage lines having leakage through their walls. Medical authorities should maintain surveillance for all water and food borne diseases.


Outbreak, Viral hepatitis, Sewage contamination, Epidemiological investigation

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Banerjee A, Sahni AK, Rajiva, Nagendra A, Saiprasad GS. Outbreak of viral hepatitis E in a regimental training centre. Med J Armed Forces India. 2005;61(4):326-9.

Scotto G, Bulla F, Campanale F, Tartaglia A, Fazio V. Hepatitis E. Infez Med. 2013;21(3):175-88.

Zhao Y, Zhang X, Zhu F, Jin H, Wang B. A preliminary cost-effectiveness analysis of hepatitis E vaccination among pregnant women in epidemic regions. Hum Vaccin Immunother. 2016;12(8):2003-9.

Prasad GS, Prasad S, Bhupali A, Patil AN, Parashar K. A study of hepatitis E in pregnancy: maternal and fetal outcome. J Obstet Gynaecol India. 2016;66(Suppl 1):18-23.

Goel A, Aggarwal R. Advances in hepatitis E- II: Epidemiology, clinical manifestations, treatment and prevention. Expert Rev Gastroenterol Hepatol. 2016;10(9):1065-74.

Pérez-Gracia MT, García M, Suay B, Mateos-Lindemann ML. Current Knowledge on Hepatitis E. J Clin Transl Hepatol. 2015;3(2):117-26.

Majumdar M, Singh MP, Goyal K, Chawla Y, Ratho RK. Detailed investigation of ongoing subclinical hepatitis E virus infections; occurring in outbreak settings of North India. Liver Int. 2015;35(3):826-33.

Lara J, Purdy MA, Khudyakov YE. Genetic host specificity of hepatitis E virus. Infect Genet Evol. 2014;24:127-39.

De Schryver A, De Schrijver K, François G, Hambach R, van Sprundel M, Tabibi R, et al. Hepatitis E virus infection: an emerging occupational risk? Occup Med (Lond). 2015;65(8):667-72.

Shrestha AC, Flower RL, Seed CR, Rajkarnikar M, Shrestha SK, Thapa U, et al. Hepatitis E virus seroepidemiology: a post-earthquake study among blood donors in Nepal. BMC Infect Dis. 2016;16(1):707.

Fierro NA, Realpe M, Meraz-Medina T, Roman S, Panduro A. Hepatitis E virus: An ancient hidden enemy in Latin America. World J Gastroenterol. 2016;22(7):2271-83.

Yugo DM, Meng XJ. Hepatitis E Virus: Foodborne, Waterborne and Zoonotic Transmission. Int J Environ Res Public Health. 2013;10(10):4507-33.

Jacobs C, Chiluba C, Phiri C, Lisulo MM, Chomba M, Hill PC, et al. Seroepidemiology of hepatitis E virus infection in an urban population in Zambia: strong association with HIV and environmental enteropathy. J Infect Dis. 2014;209(5):652-7.

Hakim MS, Wang W, Bramer WM, Geng J, Huang F, de Man RA, et al. The global burden of hepatitis E outbreaks: a systematic review. Liver Int. 2017;37(1):19-31.

Pérez-Gracia MT, Suay B, Mateos-Lindemann ML. Hepatitis E: an emerging disease. Infect Genet Evol. 2014;22:40-59.

Khuroo MS, Khuroo MS. Hepatitis E: an emerging global disease. From discovery towards control and cure. J Viral Hepat. 2016;23(2):68-79.

Singh PMP, Handa SK, Banerjee A. Epidemiological investigation of an outbreak of viral hepatitis. Med J Armed Forces India. 2006;62(4):332-4.

NICD. Investigation and control of outbreaks. Viral hepatitis. National Institute of Communicable Diseases. 22 Sham Nath Marg, Delhi-110054. 2001: 1-20.

Clemente-Casares P, Pina S, Buti M, Jardi R, Martín M, Bofill-Mas S, et al . Hepatitis E virus epidemiology in industrialized countries. Emerg Infect Dis. 2003;9(4):449.

Vogin GD. Hepatitis E Linked to 3 Deaths. Medscape Medical News; 2002. Available from: Accessed on 29 June 2004.