title: Investigation of a hepatitis A outbreak in children in an urban slum in Vellore, Tamil Nadu, using geographic information systems.
abstract: OBJECTIVE
  An outbreak of symptomatic viral hepatitis in children less than 10 yr of age in Vellore, south India, was investigated and the disease pattern studied using serological and epidemiological methods, supplemented by geographic information systems (GIS) mapping.
  
  
  METHODS
  Three cases of hepatitis A were identified during routine surveillance in a birth cohort House-to-house visits were undertaken to identify other symptomatic cases and samples collected for anti- HAV IgM, ELISA testing. All cases and controls were mapped and geo-referenced using Arc View GIS 3.3. Spatial clustering was investigated using SaTScan 7.0.1 software. Drinking water sources were tested for coliform counts with the most probable number technique.
  
  
  RESULTS
  Of the 965 children surveyed, 26 (2.78%) had jaundice between February to July 2006. From the 26 patients, 11 (42.3%) blood samples were obtained and tested for anti-HAV IgM; 10 (90.9%) were found to be positive. Water analysis showed high coliform counts in all samples. No spatial clustering of cases could be detected.
  
  
  CONCLUSIONS
  The outbreak was identified because of the symptomatic presentation of the cases. Our study highlighted the increasing detection of symptomatic children with hepatitis A virus infection. Water sources in the area were contaminated and may have served as the source of infection. The lack of clustering in GIS analysis could be due to the common water source.
authors.affiliation: Departments of Gastrointestinal Sciences , Christian Medical College Vellore, Tamil Nadu, India.
authors.forename: Thuppal V
authors.initials: TV
authors.lastname: Sowmyanarayanan
authors.forename: Ashis
authors.initials: A
authors.lastname: Mukhopadhya
authors.forename: B P
authors.initials: BP
authors.lastname: Gladstone
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sarkar
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kang
mesh_terms: D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006506:Hepatitis A / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D011204:Poverty Areas; D014505:Urban Population / Q000706:statistics & numerical data*; D014881:Water Supply