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Biological Health Hazard – Fatal Hepatitis Outbreak: India


Published Date: 2016-05-17 12:43:36
Subject: PRO/EDR> Hepatitis – India (04): waterborne
Archive Number: 20160517.4226799

Date: Wednesday 11 May 2016
Source: Daily Mail India [edited]

Waterborne viral hepatitis is afflicting hundreds of thousands of Indians every year in a country that experts say has the highest number of people in the world without access to safe water. Hepatitis viruses A and E, which damage the liver, can be transmitted through contaminated water or food and are rampant in developing countries. These acute forms of the disease are largely self-limiting and do not become chronic for healthy adults, but can be dangerous or even fatal for pregnant women.

According to Central Bureau of Health Intelligence (CBHI) data, a total of 133 625 cases and 397 deaths were recorded due to hepatitis A and E infections in 2015. Bihar led with 25 808 cases followed by Madhya Pradesh at 12 938, and Uttar Pradesh at 11 088. West Bengal reported 3865 cases with the highest number of deaths — 81– followed by Delhi at 76 and UP at 62. The national capital recorded a total of 8 362 such hepatitis cases in 2015.

“The main cause of hepatitis A and E is consumption of contaminated water and provision of safe drinking water is the main strategy to control diseases caused by drinking of contaminated water,” minister of state for health Shripad Yesso Naik told the Rajya Sabha this week.

The international charity Water Aid said this year that 75.8 million Indians — or nearly 5 percent of the population — are forced to either buy water at high rates or use supplies that are tainted with sewage or chemicals.

The United Nations says access to safe drinking water and adequate sanitation services is vital to human health.

The number of cases of viral hepatitis in India has been high in recent years, with health ministry data showing 94 402 cases in 2011, 118 880 in 2012, and 104 145 cases in 2013.

[Byline: Neetu Chandra Sharma]

Communicated by:
ProMED-mail from HealthMap Alerts

[Although this report clumps hepatitis A and hepatitis E together as a cause of maternal mortality, the risk of maternal deaths from hepatitis is primarily related to hepatitis E, particularly genotype 1, which predominates in the greater Ganges floodplains of Asia. Indeed, Labrique and colleagues (ref. 1) felt that almost 10 percent of pregnancy-related mortality in Asia could be caused by hepatitis E and as many as 10 500 maternal deaths could be occurring in the area each year. In this regard, prototypic vaccines are being studied and assessed from efficacy and safety in pregnancy (ref. 2).

Regarding acute hepatitis A infection in pregnancy, Elinav et al (3) reported on 13 cases of 2nd or 3rd trimester HAV infection. No maternal mortality was appreciated but 9 of the 13 developed gestational complications including premature contractions, premature rupture of membranes and vaginal bleeding which led to premature deliveries in 8 of the 9. Child outcome was favorable in all cases.

1. Labrique AB, Sikder SS, Krain LJ, et al: Hepatitis E, a vaccine-preventable cause of maternal deaths. Emerg Infect Dis 2012; 18:1401-4, available at
2. Zhao Y, Zhang X, Zhu F, et al: A preliminary cost-effectiveness analysis of hepatitis E vaccination among pregnant women in endemic regions. Hum Vaccin Immunother 2016: ahead of print, abstract available at
3. Elinav E, Ben-Dov IZ, Shapira Y, et al: Acute hepatitis A infection in pregnancy is associated with high rates of gestational complications and preterm labor. Gastroenterology 2006; 130:1129-34, available at – Mod.LL

A HealthMap/ProMED-mail map can be accessed at:]

See Also

Hepatitis – India (03): (MH) maternal deaths 20160505.4203697
Hepatitis – India (02): (OR) waterborne 20160409.4148944
Hepatitis – India: (OR) waterborne 20160329.4125901
Hepatitis E – India (08): (MH) hospital employees 20160306.4072026
Hepatitis E – India (07): (JK) 20160304.4067694
Hepatitis E – India (06): (JK) 20160301.4060023
Hepatitis E – India (05): (HP) 20160229.4057669
Hepatitis E – India (04): (HP) fatal 20160224.4041873
Hepatitis E – India (03): (HP) fatal 20160221.4039250
Hepatitis E – India (02): (HP) fatalities 20160212.4016257
Hepatitis E – Bangladesh: pregnancy, increased mortality, risk factors 20160115.3938772
Hepatitis E – India: (HP) waterborne, susp 20160108.3921128

Hepatitis B – India (03): (JK) 20151205.3842794
Hepatitis B – India (02): (JK) 20151117.3796278
Hepatitis B – India: (UT) 20150904.3624850
Hepatitis E – Nepal (02): ex India, commentary 20150412.3292842
Hepatitis E – Nepal: ex India 20150409.3287964

A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases

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