title: A hepatitis E outbreak caused by a temporary interruption in a municipal water treatment system, Baripada, Orissa, India, 2004.
abstract: In January 2004, we investigated a cluster of acute hepatitis in Baripada, Orissa, India. Between January and March 2004, 538 cases (definition: fever with loss of appetite and jaundice) were reported (attack rate: 263 per 100 000, 5 deaths, case fatality rate: 0.93%). Forty-seven of 48 sera were positive for IgM antibodies to hepatitis E virus. Cases peaked in February 2004 and decreased rapidly, suggesting a common source outbreak. Five neighbourhoods supplied by a common water supply were most affected. Ninety-one percent of the 538 cases and 30% of 538 unaffected controls reported drinking water from one source (odds ratio 31, 95% CI 27-48). The neighbourhood's water was pumped directly from a river and had not been treated during a 10-day period in early January (1 month before the peak of the outbreak) because of a strike at the treatment plant. This large hepatitis E outbreak was associated with drinking untreated raw river water. Measures must be in place to check the quality of municipal water and to ensure essential services in case of strikes.
authors.affiliation: Field Epidemiology Training Programme, Master of Applied Epidemiology, National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India.
authors.forename: Susanta K
authors.initials: SK
authors.lastname: Swain
authors.forename: Prameela
authors.initials: P
authors.lastname: Baral
authors.forename: Yvan J
authors.initials: YJ
authors.lastname: Hutin
authors.forename: T Venkat
authors.initials: TV
authors.lastname: Rao
authors.forename: Manoj
authors.initials: M
authors.lastname: Murhekar
authors.forename: Mohan D
authors.initials: MD
authors.lastname: Gupte
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D005260:Female; D016751:Hepatitis E / Q000453:epidemiology* / Q000276:immunology / Q000635:transmission; D016752:Hepatitis E virus / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007565:Jaundice / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012423:Rural Health / Q000592:standards; D014871:Water Microbiology / Q000592:standards*; D014881:Water Supply / Q000592:standards*; D055815:Young Adult