An outbreak of hepatitis E tracked to a spring in the foothills of the Himalayas, India, 2005.
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Date
2009-05
Journal Title
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Abstract
In July 2005, cases of hepatitis were reported from three villages in Nainital district, Uttarakhand, India. We investigated this cluster to identify the source and propose recommendations.
A door-to-door search for cases of acute hepatitis was carried
out in the three villages. We described the outbreak by time,
place and person and conducted a cohort study to identify the
source of infection. In addition, sera from cases were tested.
We identified 205 cases among 1238 persons (attack rate:
16%, no deaths) between May and September 2005. Of the
23 sera tested, 21 were positive for IgM antibodies against
hepatitis E virus. The attack rate was highest among 15–44
years old (19%). Cases began on May 3, 2005, peaked in
July and decreased rapidly. The incidence was highest (23%)
in one of the villages predominantly using water from an
unprotected spring, which was distributed after stone bed
filtration alone. In this village, the attack rate increased from
9% among those not using the spring, to 13.8% among
those partly using it (RR [95% CI] 1.6 [0.8-3.4]), and to
29% among those exclusively using it (RR [95% CI] 3.4
[2.0-6.0]). Untreated drinking water from an unprotected
spring may have been the source of this outbreak in a rural
area. Sources of water supply must be protected and treated,
including with chlorination. Reporting and investigation of smaller outbreaks in rural areas should be improved.
Description
Keywords
Cohort study, Hepatitis E, Outbreak, Water safety, Water-borne diseases
Citation
Martolia Harish Chandra Singh, Hutin Yvan, Ramachandran Vidya, Manickam Ponniah, Murhekar Manoj, Gupte Mohan. An outbreak of hepatitis E tracked to a spring in the foothills of the Himalayas, India, 2005. Indian Journal of Gastroenterology. 2009 May-Jun; 28(3): 99-101.