Volume : VIII, Issue : II, February - 2018

Early detection of Hepatitis- E/A outbreak in Shimla based on routine IDSP surveillance system with key epidemiological parameters Environmental factors aggravate situation to make this outbreak fatal

Dr. Omesh Kumar Bharti, Dr. Rakesh Roshan Bhardwaj, Prof Dr. Rita Mittal, Dr. Hiten Banyal

Abstract :

 Background: Hepatitis E virus (HEV) infection is a foremost  reason  of waterborne outeaks . HEV is transmitted via fecal–oral route through a contaminated water source. Contaminated water caused a massive Hepatitis A outeak in Shimla town in 2007. Since then sporadic cases continued to be reported due to contamination of drinking water source upstream by the discharge from ill maintained sewerage treatment plant. Though cases were being reported since 2007 but no serious illness/deaths were reported till present outeak that claimed 33 lives and thousands were taken ill.

Methods & Materials: Integrated Disease Surveillance Project (IDSP) data entry operators informed the Shimla District Surveillance Officer that some cases of jaundice are coming daily. We supervised the trends and found that some clustering (Two or more cases) of cases is happening in Vikasnagar locality where the municipal water tank supplies drinking water lifted from Ashwani River/Khud. Clustering of cases started happening in Vikasnagar and nearby localities rapidly.  The DDU hospital doctors were orally alerted for a possible outeak situation. Some of the patients were referred by the doctors to a private lab for getting their serology for Hepatitis E/A. We tracked the patients and found majority of them suffering from Hepatitis E. As soon as first patient of Hepatitis E was reported by lab and more than five adjoining clusters of cases appeared, we sent a letter to Municipal Corporation and District Administration that there is possibility of Hepatitis outeak in Shimla Municipality and we need to immediately hyper chlorinate water and check drinking water sources.

Results: The late response of the municipality resulted in 33deaths and more than 6000 people suffering from jaundice and other associated symptoms. Most of the deaths were due to predisposition to alcoholism, pregnancy and medically compromised position that aggravated the illness. Virology for water samples was found to be positive for Hepatitis E/A as the sewerage treated water, upstream, contaminated the drinking water source below that was being routinely chlorinated and the contamination could not be detected due to non availability of virology lab in the municipality. Conclusion: Early application of epidemiological tools informally helped predict fatal Hepatitis Outeak in Shimla and these epidemiological tools can be applied in similar situations to avoid such catastrophes in other settings. More waterborne outeaks are predicted in near future due to climatic disturbances i.e. global rise in temperature and decline in snowfall/ rainfall.

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Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

Dr. Omesh Kumar Bharti, Dr. Rakesh Roshan Bhardwaj, Prof (Dr.) Rita Mittal, Dr. Hiten Banyal, Early detection of Hepatitis- E/A outbreak in Shimla based on routine IDSP surveillance system with key epidemiological parameters Environmental factors aggravate situation to make this outbreak fatal, INDIAN JOURNAL OF APPLIED RESEARCH : Volume-8 | Issue-2 | February-2018

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