Background: An outbreak of jaundice was reported from a girl’s hostel (Old Girl’s Hostel; OGH) of Maulana Azad Medical College (MAMC), Delhi in January-2014. We conducted an investigation to identify the etiological agent, source of infection, potential risk factors and to recommend control measures.
Methods: We conducted a retrospective cohort study of all OGH residents. We defined a case as illness in any person residing in OGH, who reported jaundice with ≥1 of the following symptoms: nausea, vomiting, diarrhea, fever, anorexia, or abdominal pain between 15th-August-2013 to 21st-February-2014. Data on potential exposures was collected using a pretested structured questionnaire and relative risks were calculated. Laboratory confirmation for acute viral hepatitis-A (IgM) and hepatitis-E (IgM) was conducted on case-patients using ELISA. Water specimens from end-points of water supply-lines were tested for fecal-coliforms using most probable number (MPN) method.
Results: All 226 residents of OGH were female students, median age 20 years (range=17-22); 28(12.2%) met the case definition. Students who came from urban were more affected compared to semi-urban & rural area (71.8% Vs 16.9%; χ2-109.4, p < .001). Clustering of cases was observed who drank water from kitchen water cooler. Those who drank from water coolers of the hostel kitchen were more likely to be cases than those who did not (96% vs 29%; Relative Risk-3.3, 95% Confidence Interval: 2.5-4.4). Of 11 specimens laboratory tested, 7 confirmed positive for Hepatitis-A. Onsite inspections revealed that the water-pipeline supplying the mess cooler was damaged. Among 41 water specimens from taps supplied by this pipeline, 17 demonstrated fecal-coliforms (median-17/100ml).
Conclusion: Improved hygiene, sanitation and living standard in urban area may be potential explanation of late exposure to HAV. Damaged water supply pipeline may have contaminated drinking water and resulted in this HAV outbreak. The water-pipeline was replaced leading to cessation of the outbreak.
Key words: Hepatitis-A, Viral hepatitis, Water-borne outbreak, Urban