Outbreak of viral hepatitis B in a rural community in India linked to inadequately sterilized needles and syringes

Abstract

In India, virtually all outbreaks of viral hepatitis are considered to be due to faeco-orally transmitted hepatitis E virus. Recently, a cluster of 15 cases of viral hepatitis B was found in three villages in Gujarat State. The cases were epidemiologically linked to the use of inadequately sterilized needles and syringes by a local unqualified medical practitioner. The outbreak evolved slowly over a period of 3 months and was marked by a high case fatality rate (46.7%), probably because of concurrent infection with hepatitis D virus (HDV) or sexually transmitted infections. But for the many fatalities within 2-3 weeks of the onset of illness, the outbreak would have gone unnoticed. The findings emphasize the importance of inadequately sterilized needles and syringes in the transmission of viral hepatitis B in India, the need to strengthen the routine surveillance system, and to organize an education campaign targeting all health care workers including private practitioners, especially those working in rural areas, as well as the public at large, to take all possible measures to prevent this often fatal infection.

PIP: Viral hepatitis outbreaks in India are generally due to feco-orally transmitted hepatitis E virus. Described in this paper is a cluster of 15 cases of viral hepatitis B found in three villages in Gujarat State's Mehasana District linked to the use of inadequately sterilized needles and syringes by an unqualified medical practitioner. Patients were identified by house-to-house surveys and blood tests. The outbreak, which evolved slowly over a 3-month period, had a 46.7% case fatality rate because of concurrent infection with hepatitis D infection and sexually transmitted diseases. Without fatalities, this outbreak would not have been noticed. This event indicates a need to strengthen the routine hepatitis B surveillance system in India as well as to target health care workers in rural areas for an educational campaign about the importance of sterile equipment.