Investigation of an Outbreak of Hepatitis A in a Coastal Area, Kerala, Southern India

Raveendran, Sandhya; Rakesh, P S; Dev, Soumya; Vijayakumar, N.; Prasannakumar, Prathibha

doi:10.1177/2150131916647007

Cited by 10 publications

(11 citation statements)

References 2 publications

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“…Several HAV outbreaks were reported across India between 2004 and 2017 [4, 31, 38–43] as well as one in Sri Lanka in 2009–2010 [33, 44] (Table S2). It was noted that men were more affected as were adolescents and young adults (16–30 years, 142 cases) [42, 43]. The highest attack rate was found among 15–24 year olds followed by 5–14 year olds [41].…”

Section: Resultsmentioning

confidence: 99%

Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent

et al. 2019

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Hepatitis A, an acute inflammatory liver disease caused by hepatitis A virus (HAV) infection from close contact with infected people, is highly endemic in the Indian subcontinent. Due to poor sanitary conditions, most of the population is exposed to the virus in childhood. At this age, the disease is asymptomatic and provides lifelong protection against the disease. Due to rapid socioeconomic development in some areas, however, pockets of the population are reaching adolescence/ adulthood without prior exposure to the virus and are thus susceptible to infection. At these ages, infection carries a higher risk of symptomatic disease and complications including mortality. This review of epidemiology and burden of disease studies in the Indian subcontinent, published since 2005, shows increasing evidence of a shift from high to intermediate endemicity in high-income-typically urban-populations. The prevalence of anti-HAV antibodies (previously reported at [ 90%) is lower now in adolescents and young adults (e.g., around 80% in Bangladesh and 55% in 5-15 years in India). As a result, HAV is responsible for more acute viral hepatitis predominantly in this age group (e.g., [ 15 years: 3.

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Section: Resultsmentioning

confidence: 99%

Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent

et al. 2019

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“…19,20 Based on the evidence, the most probable source of contamination of the food prepared at a hotel was through poor hand hygiene of the food handlers. 5,[15][16][17] Though the main risk factors for the disease transmission were lemon juice and water that were served at the restaurant, these routes of transmission existed due to a combination of factors such as overcrowding, drinking unprotected water and lack of personal hygiene among hotel food handlers and that of probable use of contaminated ice could have facilitated this transmission. Further evidence also suggests that little over 60% of the cases in the community could be explained by drinking lemon juice or the served water.…”

Section: Discussionmentioning

confidence: 99%

Infected food handlers led to an outbreak of hepatitis A in Ernakulam district, Kerala, Southern India, 2016

Kurup

Ponnaiah

Gurav

2020

Clinical Epidemiology and Global Health

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Integrated Disease Surveillance Programme (IDSP) of Ernakulam district of Kerala, India received reports of a cluster of acute jaundice on 26th November 2016 at Panchayath A. We investigated to identify the agent, source and propose recommendations. Method: We defined a probable case as acute onset of jaundice with or without malaise, anorexia, fever, dark urine among residents of Panchayath A, Ernakulam district, since 2nd week of November 2016. Result: A total of 385 cases (Attack rate: 8/1000) and 3 deaths (Case fatality ratio: 0.8%) were reported from 45th week of 2016 to 1st week of 2017. The attack rate was highest among men (83%) and those aged 16-30 years (61%). The cases were clustered in ward 3 of the Panchayath, where a hotel was situated. Most casepatients interviewed (84%) stated that they dined at that hotel. The index case was a construction worker who resided with hotel staff and subsequently reported illness. We confirmed HAV IgM in all specimens tested. HAV was associated with consumption of lemon juice [OR = 17.1; 95% CI: 3.8-76.7; PAF = 61%] and drinking water [OR: 15.3; 95% CI: 3.7-63.2; PAF = 66%] at the hotel. Conclusion: Consumption of lime juice prepared by infected food handlers led to outbreak of hepatitis A. We recommended safe food preparation, drinking boiled water and super-chlorination of wells.

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“…Although most of the large hepatitis outbreaks in India in the past were caused by HEV, and HAV outbreaks have been rare because of high population immunity, in recent years, HAV outbreaks have been reported from Kerala, Tamil Nadu, Himachal Pradesh, and Maharashtra, affecting children and adults. [12][13][14][15] The predominance of males among both HAV and HEV cases has been reported previously. 2,7 This might be related to a higher level of exposure of males to contaminated water or differences in the health-seeking behavior of males and females.…”

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confidence: 92%

Epidemiology of Hepatitis A and Hepatitis E Based on Laboratory Surveillance Data—India, 2014–2017

Murhekar

Ashok

Kanagasabai

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Hepatitis A and hepatitis E viruses (HAV and HEV) are the most common etiologies of viral hepatitis in India. To better understand the epidemiology of these infections, laboratory surveillance data generated during 2014-2017, by a network of 51 virology laboratories, were analyzed. Among 24,000 patients tested for both HAV and HEV, 3,017 (12.6%) tested positive for HAV, 3,865 (16.1%) for HEV, and 320 (1.3%) for both HAV and HEV. Most (74.6%) HAV patients were aged ≤ 19 years, whereas 76.9% of HEV patients were aged ≥ 20 years. These laboratories diagnosed 12 HAV and 31 HEV clusters, highlighting the need for provision of safe drinking water and improvements in sanitation. Further expansion of the laboratory network and continued surveillance will provide data necessary for informed decision-making regarding introduction of hepatitis-A vaccine into the immunization program.

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Investigation of an Outbreak of Hepatitis A in a Coastal Area, Kerala, Southern India

Cited by 10 publications

References 2 publications

Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent

Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent

Infected food handlers led to an outbreak of hepatitis A in Ernakulam district, Kerala, Southern India, 2016

Epidemiology of Hepatitis A and Hepatitis E Based on Laboratory Surveillance Data—India, 2014–2017

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