Investigation of Hepatitis A outbreak in Palakkad district

Shilu M. Zachariah, Sreedevi C., Aswathy S., Prathyusha Kokkayil, Anila A. Mathews


Background: A study was carried out to investigate an outbreak of viral hepatitis reported by district health authorities from a self-administrative unit, Koppam of Palakkad district in Kerala in the month of November 2016.

Methods: An epidemiological investigation was carried out to investigate the outbreak, describe epidemiological features and recommend measures for control. An epidemiological case sheet was prepared, case definition formulated and blood samples were collected to confirm the diagnosis of hepatitis. Environmental samples were collected from wells, soil and tested for hepatitis A virus.

Results: 15 blood samples taken from cases of jaundice tested positive for hepatitis A, IgM antibody by ELISA test. More than three fourths 39 (79.6%) of the cases gave a history of having attended the same wedding function prior to the occurrence of symptoms. Attack rate (6.14%) was highest among 15-25 year age group. The water analysis from 3 of the wells in the area showed presence of coliform bacteria. Hepatitis A virus IIIA genotype was isolated from the soil sample of the house of the index case. Consumption of welcome drink was found to be associated significantly with cases than controls (OR 2.77; 95% CI: 1.02-7.52, p<0.05).

Conclusions: The hepatitis A (type IIIA) outbreak in Koppam was associated with poor sanitation practices among the people. During a socio-cultural-demographic event like marriage this led to an explosive outbreak. Involving community organizations to generate awareness regarding food sanitation, supported by a system of registration of such events, certification of food handlers can help to prevent future outbreaks. 


Outbreak, Hepatitis A, Sanitation

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