IJCM_300A: Clinical medicine and Public health: Is the dichotomy justified? Epidemiological investigation of a Hepatitis A case admitted at a tertiary care hospital

Abstract

Background: Outbreaks of Hepatitis A Virus (HAV) infection have been associated with poor sanitation, inadequate sewage disposal and contamination of food and water. Objective: To identify the epidemiological factors associated with a patient who presented with fever and vomiting and diagnosed with Hepatitis A. Methodology: 23-year-old, female patient was admitted in the general medicine department of a tertiary care hospital with complaints of fever and vomiting. IgM ELISA tests for Hepatitis A and Hepatitis E were positive. The patient’s mother had similar symptoms. Community Medicine department was informed about the patient. A team comprising of postgraduate students, MSW, ASHA worker and Anganwadi worker visited the patient’s house. Information including clinical history, source of drinking water, history of food and water intake from outside, sanitation and waste disposal methods of the house hold were collected. Stakeholders including the counsellor and members of the self-help group of the area were informed. House to house visit of all houses in 200 meters radius from patients’ house was done to look for more cases and to assess the environment sanitation. Results: The team identified that the source of drinking water of the patient’s family was a well which was not sanitary. A nearby house was identified with an open well with open sullage less than one meter away. Seven children of that household had fever and jaundice and were treated from a local hospital, one week prior. Stakeholders were also informed and both the wells were chlorinated and the families were educated about the importance of boiling water before consumption, proper disposal of sullage and waste disposal. Conclusion: Interdepartmental communication between clinical medicine and public health played an important role in identifying and eliminating the source of infection even when one patient was diagnosed and helped to prevent HAV outbreak.