Content area
Full Text
J. Singh,1 R. Bhatia,2 J.C. Gandhi,3 A.P. Kaswekar,4 S. Khare,5 S.B. Patel,6 V.B. Oza,7 D.C. Jain,8 & J. Sokhey9
In India, virtually all outbreaks of viral hepatitis are considered to be due to faeco-orally transmitted hepatitis E virus. Recently, a cluster of 15 cases of viral hepatitis B was found in three villages in Gujarat State. The cases were epidemiologically linked to the use of inadequately sterilized needles and syringes by a local unqualified medical practitioner.
The outbreak evolved slowly over a period of 3 months and was marked by a high case fatality rate (46.7%), probably because of concurrent infection with hepatitis D virus (HDV) or sexually transmitted infections. But for the many fatalities within 2-3 weeks of the onset of illness, the outbreak would have gone unnoticed.
The findings emphasize the importance of inadequately sterilized needles and syringes in the transmission of viral hepatitis B in India, the need to strengthen the routine surveillance system, and to organize an education campaign targeting all health care workers including private practitioners, especially those working in rural areas, as well as the public at large, to take all possible measures to prevent this often fatal infection.
Introduction
In India, virtually all outbreaks of viral hepatitis are considered to be due to faeco-orally transmitted hepatitis non-A, non-B virus (HEV) (1-3). Outbreaks of viral hepatitis A have also been reported occasionally (1 ). In contrast, although there has been a sudden increase in cases of viral hepatitis B admitted to hospitals (4, 5), no outbreaks have been reported in the community setting in India. However, an unusual clustering of cases of viral hepatitis B was recently observed in rural areas of Mehasana district, Gujarat State, India. In this article, we describe the epidemiological importance of this outbreak.
The outbreak was centred in three villages (Khata-Amba, Parsa, and Charadu), especially in Khata-Amba. Most of the population in the affected villages is engaged in occupations related to agriculture. Many people from Khata-Amba, including some of the patients, worked in nearby towns such as Surat and Ahmedabad, but came to the village every year around the time of Diwali (which in 1996 was on 10 November) to celebrate this festival.
The district health authorities learned on 13 January 1997...