Martolia Harish Chandra Singh, Hutin Yvan, Ramachandran Vidya, Manickam Ponniah, Murhekar Manoj, Gupte Mohan
National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India.
Indian J Gastroenterol. 2009 May-Jun;28(3):99-101. doi: 10.1007/s12664-009-0036-x. Epub 2009 Nov 12.
In July 2005, cases of hepatitis were reported from three villages in Nainital district, Uttarakhand, India. We investigated this cluster to identify the source and propose recommendations. A door-to-door search for cases of acute hepatitis was carried out in the three villages. We described the outbreak by time, place and person and conducted a cohort study to identify the source of infection. In addition, sera from cases were tested. We identified 205 cases among 1238 persons (attack rate: 16%, no deaths) between May and September 2005. Of the 23 sera tested, 21 were positive for IgM antibodies against hepatitis E virus. The attack rate was highest among 15-44 years old (19%). Cases began on May 3, 2005, peaked in July and decreased rapidly. The incidence was highest (23%) in one of the villages predominantly using water from an unprotected spring, which was distributed after stone bed filtration alone. In this village, the attack rate increased from 9% among those not using the spring, to 13.8% among those partly using it (RR [95% CI] 1.6 [0.8-3.4]), and to 29% among those exclusively using it (RR [95% CI] 3.4 [2.0-6.0]). Untreated drinking water from an unprotected spring may have been the source of this outbreak in a rural area. Sources of water supply must be protected and treated, including with chlorination. Reporting and investigation of smaller outbreaks in rural areas should be improved.
2005年7月，印度北阿坎德邦奈尼塔尔县的三个村庄报告了肝炎病例。我们对这起聚集性病例进行了调查，以确定传染源并提出建议。在这三个村庄挨家挨户地搜索急性肝炎病例。我们按时间、地点和人群描述了此次疫情，并开展了一项队列研究以确定感染源。此外，还对病例的血清进行了检测。我们在2005年5月至9月期间，在1238人中发现了205例病例（发病率：16%，无死亡病例）。在检测的23份血清中，21份抗戊型肝炎病毒IgM抗体呈阳性。发病率在15 - 44岁人群中最高（19%）。病例于2005年5月3日开始出现，7月达到高峰，随后迅速下降。在主要使用未经保护的泉水且仅经过石床过滤后就进行分发的一个村庄中，发病率最高（23%）。在这个村庄，未使用泉水的人群发病率为9%，部分使用泉水的人群发病率升至13.8%（相对危险度[95%可信区间]1.6[0.8 - 3.4]），而完全使用泉水的人群发病率为29%（相对危险度[95%可信区间]3.4[2.0 - 6.0]）。未经保护的泉水中未经处理的饮用水可能是该农村地区此次疫情的传染源。必须对供水水源进行保护和处理，包括进行氯化消毒。应加强农村地区较小规模疫情的报告和调查。
