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Outbreak of hepatitis A in an orphanage in Pune city, India

Yogesh Gurav, Supriya Hundekar, Kavita Lole, Avinash Deoshatwar.

Aims: An outbreak of hepatitis was reported in an orphanage, located in the Pune city, India. Investigations were carried out to identify the etiological agent, source of infection and subclinical infections
Study design: Descriptive study.
Place and Duration of Study: An orphanage, located in the Pune city, India. Study was carried out in August - September 2014.
Methodology: The children in the orphanage were investigated for hepatitis. Clinical, epidemiological findings were recorded and sanitary survey was done. Sera collected from children were tested for anti HAV IgM antibodies, anti HEV IgM antibodies, HBsAg, and serum alanine amino transferase levels. Stools were processed for HAV RNA detection, sequencing and phylogenetic analysis.
Results: Fourteen suspected jaundice cases were line listed (boys:7, girls:7). Overall clinical attack rate was 15.1% (14/93). Among all 93 resident children, blood samples 83.9% (78/93) and stool samples 67.7% (78/93) could be investigated. Presence of anti HAV IgM antibodies were detected in 20 children (14 symptomatic and 6 asymptomatic). Presence of HAV RNA detected in 16 stool samples and all HAV RNA sequences clustered with genotype IIIA. Potential source of the infection was probably food served to children.
Conclusion: An outbreak of HAV in children was confirmed by serology and virus detection by PCR in stool samples. It would be advisable to vaccinate all children above one year of age in an orphanage set ups.

Key words: {Hepatitis A, Jaundice, Outbreak, Orphanage, Children }

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