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. 2019 Jan:147:e210.
doi: 10.1017/S0950268819000967.

Suspected spread of hepatitis A virus from a restaurant among adults in rural area of the Kerala state, India

Y K Gurav  1 , G Retheesh Babu  1 , K P Vinu  2 , K S Lole  1
Affiliations

Suspected spread of hepatitis A virus from a restaurant among adults in rural area of the Kerala state, India

Y K Gurav et al. Epidemiol Infect. 2019 Jan.

Abstract

India is experiencing a substantial decrease in early childhood exposure to hepatitis A virus (HAV). Kerala has experienced several hepatitis A outbreaks in young adults/adults in the recent past. The current hepatitis outbreak occurred in Nellikuzhi, Kerala state, India in December 2016. Investigation was carried by preparing a line list of suspected hepatitis cases. The blood and stool samples collected from patients were tested for anti-HAV/anti-Hepatitis E virus (HEV) immunoglobulin (IgM) antibodies and RNA respectively. A total of 562 suspected hepatitis cases were reported during the outbreak. Along with the first case (35 years, male), 86.1% (484/562) of the cases gave history of consuming food/water/cold drinks from one restaurant. Anti-HAV IgM positivity was 74.5% (73/98) in tested samples and amongst the positives, 81% were adults/young adults and adolescents. None of the samples tested positive for anti-HEV IgM. There were three HAV associated deaths without any co-morbidity. Sequence analysis of HAV RNA positive stool samples showed the presence of genotype IIIA HAV. The suspected source of the infection was a private well situated in the premise of a restaurant. Considering increasing HAV naive population in Kerala, there is a need to introduce hepatitis A vaccine in high-risk age groups.

Keywords: Hepatitis A.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Distribution of laboratory-confirmed hepatitis A cases (n = 60) in the study area during the investigation period from October 2016 to January 2017.
Fig. 2.
Fig. 2.
Weekly distribution of the suspected and laboratory-confirmed hepatitis A cases in the study area in Ernakulam district, Kerala, from October 2016 to January 2017.
Fig. 3.
Fig. 3.
Phylogenetic analyses based on 5′NCR (291 nt) sequences of HAV isolates: the Nellikuzhi sequences are labelled as NEL1, NEL2, NEL3 and NEL4. Per cent bootstrap support is indicated by the values at each node. Accession numbers and strains of the sequences used for the analysis were as follows: genotype IA: X75215 (GBM), AF485328 (LY6), genotype IB: M14707 (HM175), M20273 (MBB), genotype IIIA: AY644337 (isolate from Germany), M34084 (PA21), DQ004690 (isolate from Kottayam, Kerala, India), DQ172920 (isolate from Daund, Maharashtra, India), genotype V: D00924 (AGM27) and Genotype VII: AY032861 (SLF88).
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