An outbreak of hepatitis E in Yavatmal, India, 2019

• Published in: Journal of medical virology 2021-06, Vol.93 (6), p.3761-3768
• Main Authors: Tripathy, Anuradha S., Sharma, Meenal, Thorat, Neeta C., Jadhav, Santosh, Koshatwar, Kishor A.
• Format: Article
• Language: English
• Subjects: Alanine; Contamination; Developing countries; Disease transmission; Domestic water; drainage water; Epidemics; Etiology; Gene sequencing; Genotypes; Hepatitis; Hepatitis A; hepatitis E outbreak; IgG antibody; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; India; Infections; LDCs; Medical research; Outbreaks; Phylogeny; Pipelines; Polymerase chain reaction; Public health; Reverse transcription; Ribonucleic acid; RNA; Serology; Surveillance; Virology; Viruses; Water analysis; Water pipelines; Water pollution; Water sampling; Water shortages; Water supply; Yavatmal
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.26377

Hepatitis E, a public health concern in developing countries, frequently presents in epidemic, as well as in sporadic forms. This study investigated an outbreak of viral hepatitis at Yavatmal, Maharashtra, India in March 2019. Blood samples from 10 patients were received at Indian Council of Medical Research‐National Institute of Virology, Pune to test for the presence of enterically transmitted hepatitis viruses. Subsequently, 49 suspected cases were screened for anti‐hepatitis E virus (HEV)/hepatitis A virus (HAV) immunoglobulin M and immunoglobulin G (IgG) antibodies, alanine amino‐transferase levels and HEV RNA. Water samples were screened for HEV and HAV RNA followed by phylogenetic analysis. Overall 32 of 49 (65.3%) suspected cases had recent acute HEV infection, while dual infection with HAV was noted in one case (2.04%). Forty‐eight of 49 suspected cases were positive for anti‐HAV IgG antibodies indicative of previously acquired immunity against HAV. Water samples had evidence of HEV contamination as detected by reverse transcription‐polymerase chain reaction. Sequencing of HEV RNA from both patients (n = 2) and water samples (n = 5) indicated HEV genotype 1 to be the etiological agent of this outbreak. Serological and molecular evidence confirmed HEV as the etiology. Mixing of contaminated drain water with the domestic water supply may have triggered this outbreak. Subsequent changing of the defaulted water pipelines and its segregation from drain pipelines by the health authorities resulted in progressive decline of this outbreak. Despite the limitations, periodic surveillance of HEV exposure pattern and reporting of small outbreaks would supplement to the global disease burden data of hepatitis E. Highlights ‐ Hepatitis E outbreak at Yavatmal, Maharashtra, India in March 2019. ‐ Major cause of the outbreak was mixing of contaminated drain water with domestic water supply. ‐ Serological and molecular evidences confirmed HEV genotype 1 as the etiological agent. ‐ Data suggest a need to consider outbreak investigation along with periodic surveillance to avoid future outbreaks.