Abstract
BackgroundHepatitis-E Virus (HEV) infection is endemic in Punjab, India. On 4th April 2013, public officials of Labour Colony, Amritsar reported > 20 jaundice cases occurring within several days.MethodsWe performed a case-control study to identify the cause and prevent additional cases of jaundice cases in Amritsar, Punjab, India in 2013.ResultsA total of 159 cases (attack rate 3.6%) and 1 death were identified in Labour and 5 adjoining colonies from January 1 to June 5, 2013. Persons with jaundice were more likely to report foul-smelling piped water (adjusted odds ratio [AOR], 4.0, 95% confidence interval [CI], 2.2–7.2) and used piped water for drinking (AOR, 5.1; 95% CI, 2.2–11.4) than persons without jaundice. Among 14 cases tested, all had anti-hepatitis E virus IgM, and none had anti-hepatitis A virus IgM. Additionally, 21/23 tap water samples from affected households had detectable fecal coliforms. An environmental investigation found that water pipelines were damaged during sewer construction and likely led to contamination of drinking water with hepatitis E virus.ConclusionsHepatitis E outbreaks are common in India, to curb future outbreaks of hepatitis E; measures to ensure safe drinking water are urgently needed.
Highlights
Article summary An investigation into a 2013 outbreak of jaundice in Amritsar, India found the likely cause was hepatitis E virus from a contaminated water pipeline broken during sewer construction, an accident residents were not alerted to
There are 20 million Hepatitis E virus (HEV) infections that result in 44,000 deaths annually as per World Health Organization (WHO) estimates [1, 2]
A jaundice case patient was defined as a person who resided in Labour Colony, Dhakka Colony, Baba Jeevan Singh Colony, Sat Kartar Nagar, Vikas Nagar or Shakti Nagar and reported jaundice with at least 1 of the following symptoms — anorexia, nausea, vomiting, abdominal pain, or fever between December 1, 2012 and July 15, 2013
Summary
There are 20 million Hepatitis E virus (HEV) infections that result in 44,000 deaths annually as per World Health Organization (WHO) estimates [1, 2]. More than 60% of recognized HEV infections and deaths occur in South Asia [3]. Amritsar is a large city in the state of Punjab in the northern part of India and situated next to the Pakistan border. Amritsar has a population of 2.5 million [5] and the city has grown quickly with insufficient infrastructure for water and sanitation. The area of the city reporting the outbreak has a large population of migrant settlers with poor infrastructure. Hepatitis-E Virus (HEV) infection is endemic in Punjab, India. On 4th April 2013, public officials of Labour Colony, Amritsar reported > 20 jaundice cases occurring within several days
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