Abstract

Introduction There were limited data on outbreaks of hepatitis in rural settings in India. We describe an outbreak of Hepatitis B virus infection to confirm the existence of an outbreak of Hepatitis B in a rural area of West Bengal, India and to determine risk factors for the outbreak and recommend preventive measures. Methods We surveyed the entire village retrospectively followed by a cross sectional case control study. We selected Hepatitis B surface Antigen (HBsAg) positive patients as cases and recruited neighbours as controls with a ratio of 1:2. The study was undertaken between November 2013 and June 2014. We collected blood samples which were sent to the laboratory for virological examination. Data were analyzed with Epi-info and Excel software. Results We surveyed 2170 residents. Of the 1085 residents in the risk population, 54 were tested for hepatitis B and13 identified as hepatitis B positive. Among them 77% (10) were men. Overall attack rate was 0.59% (13/1085). One patient died (Case Fatality Ratio= 7.7%). Of the tested population, 53% (7) were illiterate and 39% (5) were migrant labour by occupation. Compared with controls, significantly higher number of cases were given injection by local medical practitioners (LMP) (OR 7.50 95% CI 1.19-78.93) and had unsafe sex with sex workers (OR 15.63, 95% CI 1.34-767.41). Conclusion Injections given by LMPs and unsafe sex with sex workers were risk factors for the outbreak. Awareness programmes were carried out for LMPs on safe injection practice and villagers on safe sex and blood borne diseases. Hepatitis B vaccination was recommended for infants and adults.

Highlights

  • There were limited data on outbreaks of hepatitis in rural settings in India

  • Significantly higher number of cases were given injection by local medical practitioners (LMP) and had unsafe sex with sex workers

  • Injections given by LMPs and unsafe sex with sex workers were risk factors for the outbreak

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Summary

Introduction

There were limited data on outbreaks of hepatitis in rural settings in India. We describe an outbreak of Hepatitis B virus infection to confirm the existence of an outbreak of Hepatitis B in a rural area of West Bengal, India and to determine risk factors for the outbreak and recommend preventive measures. Hepatitis B infection, formerly known as “Serum Hepatitis” affects the liver and produces acute and chronic liver diseases.[1] Globally, in 2012, it was estimated that 240 million people were chronically infected with Hepatitis B virus (HBV).[2] More than 780,000 people die each year due to consequences of Hepatitis B diseases.[3] High concentration of HBV is present in blood, serum and serum exudates and moderate concentration of HBV is present in saliva, vaginal fluid and seminal fluid. Risk of development of chronic liver disease depends on the age of acquiring

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