VIRAL HEPATITIS OUTBREAK IN A CANTONMENT AREA OF NORTHERN INDIA: FINDINGS FROM A FIELD INVESTIGATION
Main Article Content
Keywords
Cantonment, Environmental surveillance, Fecal-oral transmission, Outbreak, Public health response, Viral hepatitis
Abstract
Background: Viral hepatitis remains a significant public health concern, particularly in closed communities where shared amenities and communal living increase the possibility of outbreaks. A notable increase in viral hepatitis cases was reported in a cantonment in northern India, prompting an urgent epidemiological investigation to comprehend the cause, extent, mode, various contributing environmental and behavioral risk factors.
Methods: An ambispective descriptive epidemiological study was conducted using a line listing of reported hepatitis cases from January to July 2024. An environmental health assessment was carried out focussing on the water quality aspects, hygiene, sanitation and public health infrastructure. The structural integrity of the water and sewage pipelines was also inspected to identify any leakages.
Results: Over seven months, a total of 36 viral hepatitis cases were reported in the cantonment, primarily among individuals with a history of travel and those residing in blocks served by old, leaking water pipelines. Water testing showed high coliform counts, with 6-11 pipeline leaks and 1-5 sewage blockages reported monthly. Laboratory confirmation primarily pointed to hepatitis A virus (HAV) and hepatitis E virus (HEV).
Conclusions: The outbreak was attributed to contaminated drinking water, primarily due to water pipeline leakage and sewage intermixing. Recommendations include the urgent replacement of compromised pipelines, enforcement of regular water quality monitoring and public health education on hygiene practices. This investigation highlights the importance of robust environmental surveillance and rapid response mechanisms in high-density residential closed communities.
References
2. Kankaria A, Gupta M, Bashar MA, Aggarwal S, Murugan S, Bhag C, et al. Epidemiological investigation of an outbreak of acute viral hepatitis A and E in a semi-urban locality in Chandigarh, North Indian Union Territory, 2016-17. J Fam Med Prim Care. 2020;9(4):1856.
3. World Health Organization. Hepatitis E. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-E. Accessed on 05 June 2024.
4. Naik SR, Aggarwal R, Salunke PN, Mehrotra NN. A large waterborne viral hepatitis E epidemic in Kanpur, India. Bull World Health Organ. 1992;70(5):597.
5. Chauhan NT, Prajapati P, Trivedi AV, Bhagyalaxmi A. Epidemic investigation of the jaundice outbreak in Girdharnagar, Ahmedabad, Gujarat, India, 2008. Indian J Community Med. 2010;35(2):294-7.
6. Acharya SK. This is hepatitis: know it, confront it. Indian J Med Res. 2013;138(1):8-10.
7. Kaur M, Sidhu SK, Singh K, Devi P, Kaur M, Singh NJ. Hepatitis E virus: a leading cause of waterborne viral hepatitis in northwest districts of Punjab, India. J Lab Phys. 2017;9(02):121-4.
8. Chadha MS, Walimbe AM, Chobe LP, Arankalle VA. Comparison of etiology of sporadic acute and fulminant viral hepatitis in hospitalized patients in Pune, India during 1978-81 and 1994-97. Indian J Gastroenterol. 2003;22:11-5.
9. WHO. Global health sector strategy on viral hepatitis 2016-2021 towards ending viral hepatitis. Available from: https://iris.who.int/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf. Accessed on 05 June 2024.
10. Das P, Adhikary KK, Gupta PK. An outbreak investigation of viral hepatitis E in south Dumdum Municipality of Kolkata. Indian J Community Med. 2007;1.
11. Das K, Agarwal A, Andrew R, Frösner GG, Kar P. Role of hepatitis E and other hepatotropic virus in aetiology of sporadic acute viral hepatitis: a hospital based study from urban Delhi. Eur J Epidemiol. 2000;16(10):937-40.
12. Vivek R, Nihal L, Illiayaraja J, Reddy PK, Sarkar R, Eapen CE, et al. Investigation of an epidemic of Hepatitis E in Nellore in south India. Trop Med Int Health. 2010;15(11):1333-9.
13. Sailaja B, Murhekar MV, Hutin YJ, Kuruva S, Murthy SP, Reddy KSJ, et al. Outbreak of waterborne hepatitis E in Hyderabad, India, 2005. Epidemiol Infect. 2009;137(2):234-40.
14. Nandi B, Hadimani P, Arunachalam R, Ganjoo RK. Spectrum of acute viral hepatitis in southern India. Med J Armed Forces India. 2009;65(1):7-9.
15. Arora D, Jindal N, Shukla RK, Bansal R. Water borne hepatitis A and hepatitis E in Malwa Region of Punjab, India. J Clin Diagn Res. 2013;7(10):2163-6.
16. Viswanathan R. Infectious hepatitis in Delhi (1955-56): a critical study-epidemiology. 1957. Natl Med J India. 2013;26(6):362-77.
17. Principles and steps of an outbreak investigation Module 2.1. 2022. Available from: https://www.who.int/docs/librariesprovider2/default-document-library/module_2.1_outbreak-investigation_ds_220830.pdf. Accessed on 05 June 2024.
18. WHO. Technical considerations and case definitions to improve surveillance for viral hepatitis. Available from: https://iris.who.int/bitstream/handle/10665/204501/9789241549547_eng.pdf. Accessed on 05 June 2024.
19. WHO. Guidelines for drinking-water quality incorporating the 1st addendum. 4th ed. Geneva: WHO; 2017.
20. Ahmed S, Yadav AK, Singh S, Nimonkar RA, Pardal MPS, Sharma S, et al. Futile flow of ineffective chlorination: an outbreak investigation of acute gastroenteritis. J Marine Med Soc. 2024:10-4103.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr TK Rath
MD Base Hospital, Delhi Cantt [email protected]
Dr Prashant Pandit
MD, Military Hospital, Meerut [email protected]
Dr Saurabh Mahajan
MD, Station Health Organisation, Shakurbasti [email protected]
