Hepatitis outbreak caused by contaminated Tamarind water served in a mobile food kiosk in an affluent urban school of Mayurbhanj, Orissa, India, September 2010

Background: On 14th September, 2010 a private practitioner reported a cluster of school children studying in private English medium school suffering from hepatitis. We investigated the outbreak to plan containment measures. Method: We defined a case as fever, vomiting, yellow coloration of conjunctiva or colored urine since 20th July, 2010 among the school children. We collected information regarding age, sex, residence, date of onset of symptoms, travel history, supply of drinking water and inspected the food kiosk inside the school premises. We sent sera samples for laboratory confirmation of hepatitis. We conducted a case control study among school children and calculated odds ratio with 95% confidence interval and population attributable fraction. Results: We identified 119 cases of jaundice among 1320 children with overall attack rate of 9% (Males-11%, Females-7%). All case patients were school children aged less than 19 years. The index case occurred on 20th July, 2010 and most of the hepatitis case-patients were clustered in neighborhoods around the school. We recruited 119 controls among school children. Swallowing of tamarind water containing ‘gupchup’ served at the mobile food kiosk in the school is associated with hepatitis (OR: 8.6, 95% CI: 4.5 – 16, PAF – 96%).Of the seven sera samples three tested positive for IgM antibody for Hepatitis E and three for Hepatitis A. Conclusion: An outbreak of Hepatitis occurred among the children of affluent urban school due to swallowing of contaminated tamarind water in ‘gupchup’. We recommended to ban the vending of ‘gupchup’ in the food kiosk, disinfection of drinking water and educated the school children and food vendors to practice food and personal hygiene.

Author (s): 

Baral P1, Swain S2, Manickam P3, Murhekar M.3 1.MAE-FETP Trainee, National Institute of Epidemiology, Chennai, India 2.MAE-FETP Graduate, National Institute of Epidemiology, Chennai 3.National Institute of Epidemiology, Chennai

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