An Outbreak of Hepatitis E Virus in Raipur, Chhattisgarh, India in 2014: A Conventional and Genetic Analysis

Study Background: An unprecedented outbreak of enterically transmitted acute hepatitis erupted in Raipur between April-June, 2014 claiming lives of 23 persons including 8 pregnant women. It was investigated by serological, biochemical and molecular methods to reveal its etiological agent, prevalence and genotype responsible for the outbreak. Methods: A total of one hundred six (106) blood samples from equal number of suspected cases of acute hepatitis cases presented in AIIMS Raipur for treatment were investigated for Anti-HEV IgM, Anti-HAV IgM, LFT, RT-PCR and sequencing. Results: Serological analysis incriminated HEV as the chief causative agent of this outbreak with attack rate of 68.8% followed by HAV (9.4%) while dual infection was noted in 2 cases (1.8%). Mortality rate of 2.87 per 10,000 population and incidence rate of 1.7% were recorded. In comparison to children and elderly cases, adults age group were more affected with men had higher attack rate than women and children (p<0.01). 98% cases had moderate to severely deranged LFT level. nRT-PCR and sequencing analysis confirmed the presence of HEV genotype 1a. Conclusion: Contamination of municipal water pipelines by sewage drain had triggered this outbreak caused predominantly by HEV genotype 1a with few HAV cases. This warranted the health and municipal authorities to change the defaulted water pipeline and segregate it from sewage drain resulting in progressive decline of this ill feted outbreak.