ABSTRACT
BACKGROUND: In March 2013, cases of acute hepatitis were reported from Lalkuan, Nainital district. We investigated the outbreak to identify the source of infection and to facilitate control measures. OBJECTIVES: To study the distribution of hepatitis cases, to find the source of infection, and to initiate the control measures in the affected area. MATERIALS AND METHODS: WE DEFINED A CASE OF ACUTE HEPATITIS AS THOSE CASES THAT HAD JAUNDICE WITH AT LEAST ONE OF THE FOLLOWING SYMPTOMS: Dark urine, fever, pain in abdomen, vomiting, and loss of appetite in the affected area between January and March 2013. Door-to-door survey was carried out. Thirteen blood samples were randomly collected from jaundice cases for immunoglobulin M (IgM) antibody for hepatitis A virus (HAV) and hepatitis E virus (HEV). Water samples were collected to test residual chlorine. RESULTS: Total 2,785 individuals were surveyed; of which 240 were suffering from acute viral hepatitis (attack rate (AR) = 8.61%). Out of 13 serum samples, 10 were found positive for HEV IgM antibodies and three cases had IgM antibodies for both HAV and HEV, which confirmed a hepatitis E outbreak. The difference in attack rate of hepatitis of both the sexes was statistically significant (P < 0.001). The attack rate was significantly higher in age groups >12 years of age (P < 0.001). Environmental investigation also confirmed the sewage contamination of drinking water in the distribution system. The attack rate was much higher (29.4%) among those who were exposed to the leaking pipeline than the nonexposed (χ(2) = 574.26, P < 0.01). CONCLUSION: HEV was confirmed as the major etiological agent in this outbreak that was transmitted by contaminated drinking water. The recognition of early warning signals, timely investigation, and application of specific control measures can contain the outbreak.
ABSTRACT
A cross-sectional study was conducted to assess the bacteriological quality of water in Haldwani block, Nainital District, India. Stratified random sampling was used to categorize water sources and consumer points. In total, 108 samples were collected: 15 from the Gola river, 51 from water taps, 24 from water treatment plants and 18 from tube wells. Samples were tested for coliforms by the most probable number technique. Identification of species was done by standard procedures. Of 108 water samples, 58.8% were found to be polluted. All samples of water (n = 15) from different sites of the Gola river were found to be highly contaminated. Out of 24 water treatment plant samples, four samples were found unsatisfactory, while more than half (51.6%) of its supplies to water taps were polluted. From tube wells and their water taps, 88.8 and 60% samples were found safe for drinking respectively. Bacterial contamination of water treatment plants and their supplies indicates significant disparities in the efficiency of water treatment processes. Contamination of water taps of tube wells suggests leakage of pipes. There is an urgent need to improve these services to ensure the supply of safe water for consumers.
