Mumtaz A Khan, Muazam A R, Ansari JA, Tayyab R Rathore, Amir M Baig, Shehla Muzafar, Rana M Safdar, Jawad A Rana.
Clinical and Epidemiological Findings of Hepatitis-A Outbreak In Dhoke Kanety, Islambad.
Pak J Public Health Jan ;6(4):21-5.

Background: Hepatitis-A has an estimated global disease burden of 1.4 million/ year. Poor sanitation leads to children getting infected before the age of 10. A cluster of 10 Hepatitis-A patients was reported from Dhok-Kanety, Islamabad (approx. population 225) and an outbreak investigation was conducted from February 09 â??15, 2014. Methods: A case control study was conducted during 9-10 February 2014 in Dhoke Kanety, District Islamabad, Pakistan. A total of 24 cases and 72 Age and gender matched controls were selected from the study area. A case definition for Hepatitis A developed by World Health Organization was used to identify the suspected and confirmed cases. The cases and controls were interviewed and information was collected using a questionnaire including basic epidemiologic information, symptoms, time of onset, medical care, previous history of Jaundice, drinking water sources, consumption of raw vegetables and salad, and sanitation facilities. Samples of blood and water collected for laboratory analysis. Blood samples were tested through 3rd generation ELISA technique and water samples were analyzed through Physiochemical and Microbiological techniques at National Institute of Health Islamabad. Descriptive and inferential methods were used including person chi square test of independence and odd ratios for association. Data was analyzed through Epi-info soft ware and SPSS. Results: The average age of the respondents remained 8 years (range of 3-13 years). Half of the respondents were female. Overall attack rate was 27%. Among cases, 19 consumed well water (OR 14.4; 95% CI 7.5-18.7; p <0.05); 17 had open-drain toilets (OR 4.5.; 95% CI 2.2-6.2; p <0.05) and 17 had a contact with a case (OR 19; 95% CI 7-27; p <0.05). Moreover, boiling water (6/24; OR 0.1; 95% CI 0.04-0.3; p <0.05) and chlorination (5/24; OR 0.14; 95% CI 0.04-0.4; p <0.05) showed a protective effect. Results from water samples showed presence of fecal coliforms. Municipal water supply was disrupted due to civil works and a well was used as the source of water. Conclusion: Contaminated well water was identified as the source of infection. Health education was imparted on hygiene/sanitation.

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