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. 2016 Dec;144(16):3387-3399.
doi: 10.1017/S0950268816001898. Epub 2016 Aug 22.

Epidemiological investigation of a tap water-mediated hepatitis E virus genotype 4 outbreak in Zhejiang Province, China

Y J Chen  1 , N X Cao  2 , R H Xie  1 , C X Ding  2 , E F Chen  1 , H P Zhu  1 , J M Sun  1 , X P Shang  1 , X X Wang  1 , Z P Miao  1
Affiliations

Epidemiological investigation of a tap water-mediated hepatitis E virus genotype 4 outbreak in Zhejiang Province, China

Y J Chen et al. Epidemiol Infect. 2016 Dec.

Abstract

An outbreak of acute hepatitis recently occurred in a nursing home in Zhejiang Province, China. The objectives of this study were to confirm the outbreak and identify the aetiology, source and transmission patterns. All residents and staff in or near the nursing home during the period from 1 October 2014 to 21 May 2015 were investigated regarding hygiene and for epidemiological information including water and food (eating meat especially pork products). Serum and stool specimens were collected for detection of hepatitis E virus (HEV) antibodies using ELISA and RNA using RT-PCR. Samples that were RNA positive were genotyped. Of 185 senior residents and 24 staff in the nursing home, there were 37 laboratory-confirmed cases during the outbreak. Of these cases, 12 patients (three deaths) were symptomatic with jaundice, a common clinical symptom for hepatitis E infection. HEV strains were isolated from three cases and they formed a single cluster within genotype 4d. A case-control study was conducted to investigate potential risk factors for the outbreak and the results revealed that cases more often washed their dishes and rinsed their mouths using tap water than the controls (P < 0·05). Based on hygiene investigation and meteorological information, it is likely that HEV-infected sewage and faeces contaminated the water network on rainy days. Collectively, these results suggest that the outbreak of HEV genotype 4 infection was most likely caused by contaminated tap water rather than food.

Keywords: Case-control study; genotype 4d; hepatitis E outbreak; tap water pollution.

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Figures

Fig. 1.
Fig. 1.
Location of Ganyao town in Zhejiang Province.
Fig. 2.
Fig. 2.
Profiles of the subjects. * Others included administrative staff and security guards.
Fig. 3.
Fig. 3.
The epidemic curve and rainfall amount. The epidemic curve (blue areas) represents cases. The start date of the histogram is 13 January and the time interval differentiated from the graph's horizontal axis is 5 days.
Fig. 4.
Fig. 4.
Phylogenetic trees were constructed based on the partial HEV ORF2 genome sequences (400 bp) using MEGA 5·1. Three Jiaxing strains were isolated in this study [JX18 (Genbank accession no.: KT337475), JX23 (Genbank accession no.: KT337476), JX25 (Genbank accession no.: KT337477)].
Fig. 5.
Fig. 5.
A brief diagram of the water supply and sewage of the nursing home.
See this image and copyright information in PMC

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