Hepatitis E outbreak in Jaipur due to Genotype IA

Area of Science:

• Epidemiology
• Virology
• Public Health

Background:

• An unusual increase in jaundice and fever cases was observed in the Sodala area of Jaipur, Rajasthan.
• This prompted an investigation into the acute hepatitis outbreak to determine its cause and genetic characteristics.

Purpose of the Study:

• To investigate the aetiology of an acute hepatitis outbreak in Jaipur, Rajasthan.
• To perform phylogenetic analysis of the causative agent.
• To identify the source of infection and contributing factors.

Main Methods:

• Serological and molecular methods, including polymerase chain reaction (PCR), were used to test blood samples from 106 symptomatic patients and 39 pregnant women for hepatitis A virus (HAV) and hepatitis E virus (HEV).
• Sequencing of PCR products was performed for phylogenetic analysis.
• Additional tests for Hepatitis B surface antigen, anti-HCV, anti-Leptospira, and anti-scrub typhus IgM were conducted on samples negative for HAV and HEV.

Main Results:

• Hepatitis E virus (HEV) was identified as the primary cause, with 79.2% of symptomatic patients testing positive for HEV IgM and 67.9% for HEV RNA.
• HEV RNA was detected in 12.8% of pregnant women, and one pregnant woman died due to hepatitis.
• Phylogenetic analysis confirmed all HEV isolates belonged to genotype 1A.

Conclusions:

• The hepatitis outbreak was definitively linked to HEV genotype 1A, originating from contaminated municipal water supply.
• Poor sanitary conditions and inadequate waste disposal were identified as contributing factors.
• Implementing measures such as boiling drinking water, repairing water supply lines, and promoting hand hygiene were crucial in controlling the outbreak.