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Surveillance program identifies hepatitis disease patterns in India
The first report from a national virus surveillance program in India demonstrated that from 2011 to 2013, the numbers of hepatitis A and E cases were high and outbreaks were common, caused by poor water quality and a lack of sanitation.
In addition, analysis revealed a seasonal pattern for hepatitis A outbreaks.
Although viral hepatitis is common in India, there has been a dearth of national surveillance data. To address this problem, the Integrated Disease Surveillance Programme (IDSP) began collecting data about epidemic-prone disease across India in 2009.
“Hepatitis surveillance data obtained through IDSP can be used to monitor disease trends, identify local hepatitis outbreaks and to evaluate the effectiveness of sanitation, safe water, immunization and other prevention and control measures,” Tripurari Kumar, MPH, and colleagues wrote.
Recent data — the first reported from the IDSP — indicated that from 2011 to 2013, there were 804,782 reported cases of hepatitis and 291 outbreaks. The etiology was undetermined in 92% of reported cases, the researchers wrote.
Etiology was known in 163 outbreaks: 47.9% were caused by hepatitis E, 33.1% by hepatitis A, 12% by both hepatitis A and E, and 7% by hepatitis B or hepatitis C, according to the researchers.
Although not currently performed by the IDSP, routine testing for hepatitis B and C may help identify the epidemiology of unknown cases, and will improve the understanding of disease burden in India, according to Kumar and colleagues.
There appeared to be seasonal patterns associated with hepatitis A, the researchers said. Reported cases surged each year from June through September, coinciding with monsoon season. Cases of laboratory-confirmed hepatitis A cases followed the same pattern.
Contaminated drinking water was considered the most likely culprit.
“Improvements in water quality and sanitation as well as inclusion of hepatitis A vaccine in childhood immunization programs should be considered to reduce the public health burden of hepatitis in India,” the researchers wrote. – by Colleen Owens
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