Outbreak Investigation of acute viral hepatitis E – Landikotal, Pakistan 2017

  • Viral hepatitis and HIV
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On March 24, 2017, Landikotal Agency Hospital reported suspected cases of acute viral hepatitis. We conducted an outbreak investigation to assess the magnitude, evaluate risk factors, and recommend control measures.

Active case finding was done to identify the cases and a case control study was conducted. A case was defined as anorexia, nausea or vomiting, yellow discoloration of sclera and dark urine in a person residing in the camp colony, from February 10, 2017 to May 20, 2017. Age and gender matched controls were identified from the same area in a ratio of 1:2. Information regarding the source of drinking water was obtained. Frequencies were calculated, attack rates determined and odd ratios calculated at 95% CI and p-value <0.05. A total of 98 water samples including the four water sources were sent to a local lab for microbial analysis.

A total of 52 cases (males=67%) were found with an attack rate (AR) of 3.4% and case fatality rate=3.8%. The mean age was 28 years (range 17-54). Most affected age group was 15 to 29 years (AR=8.7%). Hospital admission was required for 29% cases. Of the 52 cases, 23 reported drinking water from the Masjid tank (OR 4.4, 95% CI 2.0-9.4) and 11 from Dance Party (DP) tank (OR 3.2 95% CI 1.2-8.6). Eight reported drinking boiled water (OR 0.37 95% CI 0.16-0.88). Of the four water samples sent, two (Masjid and DP Tank) were found to be heavily contaminated with coliforms following heavy rains in hills.

The most probable cause of the outbreak was drinking water from Masjid and DP tanks. Heavy rains in the hills contaminated the springs supplying these tanks. Awareness on consuming boiled water was imparted to the residents. On our recommendation, a sand filter was installed and chlorination of water reservoirs was done.

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