BHUBANESWAR: Hepatitis E is fast emerging as a major public health problem in Odisha necessitating more epidemiological investigation and surveillance to map its burden and undertake effective control measures.
More than 278 cases of hepatitis E (HEV) were identified between 2012 and 2013 with the disease claiming two lives. There were around 12 outbreaks across eight districts during the two years, according to a study by the Regional Medical Research Centre (RMRC).
Hepatitis E is a viral infection affecting liver that occurs sporadically and in epidemic form. Like other viral hepatitis infections, it is transmitted through faecal-oral route, primarily consumption of contaminated water like sewage seeping into drinking water supply system, drinking from unclean sources and lack of adequate personal hygiene.
It accounts for majority of acute liver failures and also jaundice in pregnant women. The infection can be asymptomatic in many cases but its major manifestations are jaundice, upper abdominal pain, anorexia, nausea and vomiting. Fatality rate in symptomatic HEV is estimated to be around 0.5 per cent to four per cent but it is more serious in pregnant women. As high as 10 to 25 per cent pregnant women in third trimester are in danger of succumbing if they are infected with HEV.
Led by RMRC Director Dr SK Kar, the joint exercise with International Vaccine Institute, Seoul and the Integrated Disease Surveillance Project of Odisha Government, has screened jaundice outbreak in the State from 2012 to 2013. Around 12 districts reported 31 different jaundice outbreaks of which 12 were confirmed HEV. The HEV outbreaks were reported in eight districts concentrated in the east coastal region, Western Odisha and tribal pockets.
Bargarh district accounted for three outbreaks while Khurda and Jagatsinghpur reported two each. The rest Kalahandi, Balangir, Nayagarh, Cuttack and Kendrapara reported one outbreak each. As high as 34 per cent of HEV cases in women were in the 15-45 age group while 73 per cent of male HEV patients were below 45 years. The outbreaks showed two peaks, one from January to March and the second from August to October.
The data, however, are not representative of the State. Most outbreaks were reported from districts which had functional capacity to report, investigate and manage such situations.
“A systematic epidemiological investigation and prospective surveillance spanning different regions as well as detailed outbreak reporting and examination is required to establish the burden. Armed with definitive information along disease patterns and characteristics, appropriate control measures can be put in place,” Dr Kar said.