Hepatitis A outbreak in Ba subdivision, Fiji, October–December 2013

Abstract

Objective: A cluster of suspected hepatitis A cases was notified to the Fiji Ministry of Health on 22 October 2013. An outbreak investigation team was mobilized to confirm the existence of an outbreak of hepatitis A and advise appropriate public health interventions. Methods:A case definition for the outbreak investigation was established, and standardized data collection tools were used to collect information on clinical presentation and risk factors. An environmental assessment was also conducted.Results: There were 160 clinical cases of hepatitis A of which 15 were laboratory-confirmed. The attack rate was 349 per 10 000 population in the Nukuloa nursing zone; there were no reported deaths. Residents of the Nukuloa settlement were 6.6 times more likely to present with symptomatic hepatitis A infection (95% confidence interval: 3.8-12.6) compared with residents of another village with a different water supply.Discussion: This is the first significant hepatitis A outbreak documented in Ba subdivision and possibly in Fiji. Enhanced surveillance of hepatitis A may reveal other clusters in the country. Improving the primary water source dramatically reduced the occurance of disease in the affected community and adjacent areas.Hepatitis A outbreak in Ba subdivision, Fiji,

Surveillance strategies for the detection of disease outbreaks in the Pacific islands: meta‐analysis of published literature, 2010–2019

“…There was seven reported outbreaks in PNG [8,13–18]; six in each of Solomon Islands, [19–25] French Polynesia, [25–30] and FSM [31–36]; three in each of American Samoa[37–39] and Marshall Island[40–42]; two from Fiji [43,44] and Guam [45,46] and one in each of Kiribati, [47] Tuvalu, [48] New Caledonia, [30] and Wallis and Futuna [30]. The aetiological agents responsible for the outbreaks were dengue virus ( n = 7), [25,19,23,26,34,39,41] influenza virus ( n = 5), [16,30,31] chikungunya virus ( n = 3), [17,28,29] Hepatitis A causing Hepatovirus ( n = 3), [35,44,40] Shigella spp . ( n = 3), [13,16,38] Vibrio cholerae ( n = 2), [18,15,14,46] mumps virus ( n = 2), [32,45] Rotavirus ( n = 2), [21,47] Zika virus ( n = 2), [27,37] measles Rubeola virus ( n = 1), [33] Mumps, circulating vaccine‐derived poliovirus type 1 ( n = 1), [8] and Rickettsia parasite causing scrub typhus ( n = 1) [20].…”

“…Of the 37 reviewed reports, 19 were published as research articles, 13 were field reports, and five were letters to the editor. For 15 reports, the first author was a staff member at a national institution including ministries of health, national laboratories and universities [8,13,17,18,25,22,26–29,35,34,42,44,47]. Of international first authors, nine were from the United States Centers for Disease Control and Prevention [33,32,39,37,38,40,41,46,45]; seven were staff of WHO or the Pacific Community (the two main technical agencies providing outbreak‐related support to PICTs) [15,16,14,24,23,31,36]; five were academics from non‐PICT countries [19,21,20,43,48]; and one was from the French Government, which has responsibility for French Pacific territories [30].…”

“…The method by which most published outbreaks came to the attention of the national public health authority was formal health worker notification ( n = 30; 77%). Of these, 22 reports were made by clinicians (doctors and nurses) who signalled an outbreak based on their clinical judgement or after noticing temporospatial clustering of cases, [30,33,46,45,38,23,16,31,36,20,44,25,22,17,13,34,35,42,43,28] and eight were detected by laboratories. [24,26,29,32,39,37,40,41].…”

“…Ten reports, all based on primary reporting from clinicians, provided enough information to calculate (or reliably estimate) the time from outbreak onset to detection. These included a dengue outbreak in French Polynesia in 2009 [26]; a mumps outbreak in Guam in 2009‐10 [45]; enteric disease outbreaks in the Marshall Islands in 2009 [42] and in the FSM in 2010 [36]; rotavirus outbreaks in Kiribati in 2013 [47] and Solomon Islands in 2014 [21]; hepatitis A outbreaks in Fiji in 2013 [44] and the Marshall Islands in 2016/17 [40]; and acute respiratory illness outbreaks in Fiji in 2006 [43] and FSM in 2014 [31]. Analysis of data extracted from these reports indicated that the median time from onset to detection was 17 days (range: <1 to 44 days).…”

“…The aetiological agent responsible for the outbreak was confirmed in 34 of the 39 outbreaks; 16 by domestic laboratory services alone, [13,17,21,25–30,33,35,40,44,45,48] eight via testing within the domestic setting (e.g. through use of rapid diagnostic test kits or preliminary laboratory analysis) with confirmation provided by an overseas laboratory at a later date, [19,23–25,30,34,39,41,46] and five through transport of specimens to an overseas laboratory for primary testing [20,31,37,38,47]; the location where testing was performed was not reported for five confirmed outbreaks.…”