Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Apr;39(2):94-7.
doi: 10.4103/0970-0218.132725.

Epidemiological investigation of the jaundice outbreak in lalkuan, nainital district, uttarakhand

Sadhana Awsathi  1 , Vinita Rawat  2 , Chandra Mohan Singh Rawat  1 , Vandana Semwal  1 , Sunil Janki Bartwal  1
Affiliations

Epidemiological investigation of the jaundice outbreak in lalkuan, nainital district, uttarakhand

Sadhana Awsathi et al. Indian J Community Med. 2014 Apr.

Abstract

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 (χ(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.

Keywords: Epidemiological investigation; environmental sanitation; feco-oral route; infective hepatitis E; serological examination.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Epidemic curve of acute hepatitis cases in Lalkuana, Nainital District, 2013
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Khuroo MS, Duermeyer W, Zarger SA, Ahanger MA, Shah MA. Acute sporadic non-A, non-B in India. Am J Epidemiol. 1983;118:360–4. - PubMed
    1. Sreenivasan MA, Banerjee K, Pandya PG, Kotak RR, Pandya PM, Desai NJ, et al. Epidemiological investigation of the outbreak of infectious hepatitis in Ahmedabad city during 1975- 1976. Indian J Med Res. 1978;67:197–206. - PubMed
    1. Singh S, Mohanty A, Joshi YK, Deka D, Mohanty S, Panda KS. Mother to child transmission of Hepatitis E virus. Indian J Pediatr. 2003;30:37–9. - PubMed
    1. Park K. 21th ed. Jabalpur: Bhanot Publisher; 2011. Park's text book of preventive and social medicine; p. 198.
    1. Tandon BN, Gandhi MB, Joshi YK, Irshad M, Gupta H. Hepatitis virus-non-A and non B-the cause of a major public Health problem in India. Bull WHO. 1985;63:931–4. - PMC - PubMed