Authors:

Abstract

Introduction
There were limited data on outbreaks of hepatitis in rural settings in India. We describe an outbreak of Hepatitis B virus infection to confirm the existence of an outbreak of Hepatitis B in a rural area of West Bengal, India and to determine risk factors for the outbreak and recommend preventive measures.

Methods
We surveyed the entire village retrospectively followed by a cross sectional case control study. We selected Hepatitis B surface Antigen (HBsAg) positive patients as cases and recruited neighbours as controls with a ratio of 1:2.  The study was undertaken between November 2013 and June 2014. We collected blood samples which were sent to the laboratory for virological examination. Data were analyzed with Epi-info and Excel software.

Results
We surveyed 2170 residents.  Of the 1085 residents in the risk population, 54 were tested for hepatitis B and13 identified as hepatitis B positive. Among them 77% (10) were men. Overall attack rate was 0.59% (13/1085). One patient died (Case Fatality Ratio= 7.7%).  Of the tested population, 53% (7) were illiterate and 39% (5) were migrant labour by occupation. Compared with controls, significantly higher number of cases were given injection by local medical practitioners (LMP) (OR 7.50 95% CI 1.19-78.93) and had unsafe sex with sex workers (OR 15.63, 95% CI 1.34-767.41).

Conclusion
Injections given by LMPs and unsafe sex with sex workers were risk factors for the outbreak. Awareness programmes were carried out for LMPs on safe injection practice and villagers on safe sex and blood borne diseases. Hepatitis B vaccination was recommended for infants and adults. 

Keywords: Hepatitis B, Unsafe injection, Rural, India