title: Investigation of hepatitis A outbreak in district of Manjung, Perak, Malaysia, October 2012.
abstract: BACKGROUND
  In September 2012, 10 cases suspected to be hepatitis A were notified to the Manjung District Health Department. An investigation was conducted to identify the possible mode of transmission, source of the outbreak and to recommend prevention and control measures.
  
  
  METHODS
  A case was a person with acute illness with discrete onset of symptoms and jaundice or elevated serum aminotransferase levels in September 2012 in the Manjung District. We conducted a case-control study and environmental assessments of processing plants and food premises.
  
  
  RESULTS
  There were 78 confirmed cases of hepatitis A; an attack rate of 3.1 per 10,000 population. Multiple logistic regression showed that being male (odds ratio [OR]: 18.4 [5.13-65.9]; P < 0.001) and drinking toddy at processing place A (Adjusted OR: 2.70 [1.17-6.25]; P < 0.05) were associated with being a case. Environmental investigations of this and one other processing place found them to be unhygienic, and the pH of the toddy was at levels that encouraged growth of hepatitis A virus.
  
  
  CONCLUSIONS
  Toddy was possibly the primary source of this outbreak based on both epidemiological and environmental results. Both toddy preparation places and several food premises were closed as a result of this investigation.
authors: Unit of Epidemiology and Biostatistics, Medical Research Resource Centre, Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia .
authors: Faudzi Ahmad
authors: FA
authors: Yusoff
authors: Melaka State Health Department (Public Health), Hang Tuah Jaya, Melaka, Malaysia .
authors: Rusdi Abdul
authors: RA
authors: Rahman
authors: Manjung Health District Department, Perak Darul Ridzuan, Malaysia .
authors: Ling He
authors: LH
authors: May
authors: Manjung Health District Department, Perak Darul Ridzuan, Malaysia .
authors: Suzana Binti
authors: SB
authors: Budart
authors: Office of the Deputy Director General of Health (Public Health), Ministry of Health Malaysia, Putrajaya, Malaysia .
authors: Lokman Hakim
authors: LH
authors: Sulaiman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000434:Alcoholic Beverages; D016022:Case-Control Studies; D004196:Disease Outbreaks; D004784:Environmental Monitoring; D005260:Female; D006506:Hepatitis A / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006920:Hygiene / Q000592:standards; D015994:Incidence; D016015:Logistic Models; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012147:Restaurants / Q000592:standards; D055815:Young Adult