An investigation of an outbreak of viral hepatitis B in Modasa town, Gujarat, India

Patel, Disha; Gupta, Praveg A.; Kinariwala, Deepa; Shah, Hetal; Trivedi, Grishma; Vegad, Mahendra

doi:10.4103/0974-777x.93762

Cited by 28 publications

(33 citation statements)

References 14 publications

(14 reference statements)

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“…This correlates well with the observations of other researchers who investigated blood-borne viral hepatitis outbreaks (Patel et al, 2012;Verma et al, 2014). From this, we conclude that this age group, being the most productive, seeks injections more often than others for any illness, based on the belief that injections are a more effective treatment than oral medications and will achieve a faster cure and hence decrease morbidity and disability days.…”

Section: Discussionsupporting

confidence: 90%

Molecular epidemiological analysis of three hepatitis C virus outbreaks in Jammu and Kashmir State, India

Chadha

Sharma

Chaudhary

et al. 2016

Journal of Medical Microbiology

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Outbreaks of hepatitis C virus (HCV) infection are associated with unsafe injection practices, intravenous drug abuse and other exposure to blood and body fluids. We report here three outbreaks of HCV infection from Jammu and Kashmir (J&K) State, India, which occurred over a period of 3 years and in which molecular epidemiological investigations identified a presumptive common source of infection, most likely a single healthcare venue. Representative blood samples collected from cases of hepatitis C were sent to the National Centre for Disease Control (NCDC) for molecular characterization. These samples were positive by HCV ELISA. Subsequently, specimens were also tested for the presence of HCV RNA by RT-PCR. Sequencing was carried out for all positive samples. A total of 812 cases were laboratory confirmed by HCV ELISA; a total of 115 samples were sent to the NCDC for RT-PCR, and 77 were positive. Subtype 3a of HCV was found in all samples from Anantnag (February 2013); and for subtype 3b, in all samples from Srinagar (May 2015). Subtypes 3a and 3g were identified from two samples from the Kulgam outbreak (July 2014). A detailed epidemiological investigation should be conducted whenever a cluster of HCV cases is revealed, as this potentially allows for the identification of larger outbreaks. Epidemiological investigations of outbreaks should be further supported by inclusion of molecular tests. Efforts to limit therapeutic injections to only those cases having strong medical/surgical indications and to restrict the use of non-sterile needles are essential to prevent transmission of HCV.

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Section: Discussionsupporting

confidence: 90%

Molecular epidemiological analysis of three hepatitis C virus outbreaks in Jammu and Kashmir State, India

Chadha

Sharma

Chaudhary

et al. 2016

Journal of Medical Microbiology

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“…There was an unusually high mortality in the present outbreak. [9] Initially, co-infection with other hepatotropic viruses was considered, but, as seen in our study, co-infection with other viruses was not found to be a co-factor. Four patients with co-infection with HAV and HEV seen in our study did not show any clinical severity of the disease.…”

Section: Discussionmentioning

confidence: 68%

“…Government authorities confirmed that the mode of transmission was from continuous use of contaminated needles and syringes as well as multiple use of single-use needle and syringes by private doctors in the Modasa town and adjoining areas by interviewing the patients, their family members and their doctors. [9] Unsafe injection practices are rampant, and investigations into this outbreak may be just an indicator of a major catastrophe waiting to occur. Reuse of single-use syringes and needles by the medical practioner also brought to light an illegal network for recycling medical waste existing in the region.…”

Section: Discussionmentioning

confidence: 99%

Unsafe injection practices: A potential weapon for the outbreak of blood borne viruses in the community

Gupta¹,

Bajpai²,

Sharma³

et al. 2013

Ann Med Health Sci Res

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Background:Unsafe injection practices are common in developing nations. Such practices, through contaminated needles and syringes, place injection recipient, healthcare workers and the community at large at risk of infection with blood borne viruses.Aim:An attempt was made to briefly describe an acute hepatitis outbreak that occurred in Gujarat, India, due to unsafe injection practices with a brief review of the literature.Subjects and Methods:An outbreak of acute hepatitis occurred in February-March 2009 in the Sabarkantha district of Gujarat in India. Blood samples were collected randomly from 25 cases, admitted in the local hospital during the ongoing outbreak. Screening was done using an immunoassay analyzer (Cobas e411; Roche Diagnostics, Indianapolis, IN, USA) for hepatitis B surface antigen (HBsAg), IgM and total antibodies to hepatitis B core antigen (HBc), hepatitis B e antigen (HBeAg) and antibody to HBe, antibodies to HCV, HIV and IgM antibodies to hepatitis A virus (HAV), as per the manufacturer's protocol.Results:Gross and continuous use of contaminated needle and syringes were responsible for this outbreak as all the patients gave history of receiving injections about 2-3 months prior to the development of clinical signs and symptoms, from one particular doctor. Mean age of the patients was 33.4 years (SD 12.9 years). Seventeen of these patients were males and eight were females. All patients were hepatitis B surface antigen positive, with median levels as 35,450 IU/mL (IQR 450-2,49,750 IU/mL). IgM HBc was positive in 22/25 (88%). HBe Ag was positive in 11 patients (44%). The median HBV DNA level was 2.6 × 104 IU/mL (IQR 1.18 × 102 to 6.7 × 106 IU/mL). No significant co-infection with other hepatitis viruses existed. All isolates were genotype D.Conclusions:The findings emphasize the role of unsafe injection practices in the community outbreak of hepatitis B infection, need to start routine surveillance system and increase awareness in health care workers regarding safe injection practices.

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“…397 Inadequately sterilised needles and syringes are an important cause of transmission of blood-borne hepatitis in India. 398 A large proportion of health-care workers in India are unvaccinated, many are unaware of their vaccination status, and are thus vulnerable to bloodborne infections. 399 The implementation of safe injection practices in the Indian health-care system is urgently needed.…”

Section: The Lancet Gastroenterology and Hepatology Commissionmentioning

confidence: 99%

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Sarin

Kumar

Eslam

et al. 2020

The Lancet Gastroenterology & Hepatology

389

303

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The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birthdose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region. 168 www.thelancet.com/gastrohep Vol 5 February 2020The Lancet Gastroenterology & Hepatology Commission accounted for 108 276 (8·2%) of the total liver-related deaths in the region in 2015, compared with 929 (1·2%) of 72 437 in the USA and 4032 (0·3%) of 197 179 in Europe. Deaths in the Asia-Pacific region represented three-quarters of the global total number of deaths due to acute viral hepatitis. In 2015, the region accounted for three-quarters of the global total number of deaths related to acute HBV, almost two-thirds of those due to acute hepatitis A infection, and almost 80% of those due to acute hepatitis E infection. Of all deaths du...

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An investigation of an outbreak of viral hepatitis B in Modasa town, Gujarat, India

Cited by 28 publications

References 14 publications

Molecular epidemiological analysis of three hepatitis C virus outbreaks in Jammu and Kashmir State, India

Molecular epidemiological analysis of three hepatitis C virus outbreaks in Jammu and Kashmir State, India

Unsafe injection practices: A potential weapon for the outbreak of blood borne viruses in the community

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

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