An Epidemic of Infectious Hepatitis in a Rural Village Attributable to Widespread Contamination of Wells1

Infectious Hepatitis Outbreak Associated with Cafe Water

“…Reports of epidemic waterborne hepatitis date back as far as 1895, when 34 cases of jaundice in King's Lynn, England, over an 8-month period were attributed to waterborne infection (8) (2,7,10,20,21), three concluded that wells were infected by surface contamination (22)(23)(24), one cited a defective drain (17), and three did not identify the origin of contamination (13,25,26).…”

Impact of Technological Developments on Infectious Disease Epidemiology: Lessons From the First 100 Years of the American Journal of Epidemiology

“…Articles identified the typical symptoms and clinical course and suggested that the most likely route of transmission was fecal-oral (then called intestinal-oral) because most outbreaks pointed to polluted water supplies, large numbers of flies carrying human excrement, and poor environmental sanitation. Additional investigations identified common-source outbreaks with contaminated water supplies ( 41 ) and transmission chains likely taking place in schools and homes ( 39 ). What is most striking about these early reports is the amount of detail that is provided on the cases and the approach (analogous to a laboratory notebook), the in-depth discussion of biases in the data, and the use of methodology that is still being employed today (e.g., calculation of epidemic curves and age- and time-specific attack rates).…”

Epidemiologic Aspects of Viral Agents in Relation to Waterborne Diseases

“…With personto-person transmission the highest rate is usually among school children (1, 8). A predominance of cases in school children, however, does not exclude waterborne transmission (10).…”

“…By that time the human volunteer studies of World War II had shown the viral nature of the etiological agent, and the fecal-oral route of infection was experimentally established. Since 1945, there have been pub¬ lished reports of 31 epidemics, each involving from 6 to 29,000 persons, attributed to water (1,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) . While all the reports are not neces¬ sarily well substantiated, there is no question that waterborne transmission does occur.…”