Lok Sabha Question No. 4145 (UNSTARRED), answered on 2017-08-11
Subject: Jaundice Outbreak in Shimla
Ministry: HEALTH AND FAMILY WELFARE
Asked by: ANURAG SINGH THAKUR

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 4145 TO BE ANSWERED ON 11 TH AUGUST, 2017

## JAUNDICE OUTBREAK IN SHIMLA

## 4145. SHRI ANURAG SINGH THAKUR:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether Shimla faced acute jaundice outbreak in 2007 - 08, 201- 11, 2013 and in 2016;
- (b) the steps taken by the Government to ensure that the same is not repeated; and
- (c)  whether National  Institute  of  Virology,  Pune  collected  samples  and  highlighted  is relating to the untreated sewage water and the issues were also highlighted by the High and Centre for Science and Environment and if so, the details of the contents of th e report and recommendations which were adopted?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE ( SMT. ANUPRIYA PATEL )

- (a):     Yes, Shimla faced acute hepatitis outbreak in the years 2007, 2010, 2013 and in 2
- (b):     A Central team visited the affected areas under Shimla Municipal Corporation du period from 11 to 15 January, 2016 to investigate jaundice outbreak. The team observed that:
- A total of 564 jaundice cases were reported from 11th December 20 15 to 15th January 2016 in SMC wards. The overall attack rate was 90.7 per 10000 persons.
- Appropriate treatment process of the contaminated water was not followed in the Ashw Khudd treatment plant resulting in the supply of contaminated water to the reservoir and to the community settings.
- Out  of  53  serum  samples  collected  in  January  2016,  43  samples  were  positive  for  I antibody to HEV. None of the samples tested was found positive for IgM antibody to HAV.
- The State Director Health Services had also formed a committee to investigate, monitor and control the outbreak.

The following activities are undertaken to ensure that the disease is not repeated:

- i) House to house survey of jaundice cases.
2. ii) Use of boiled water for drinking and hand - hygiene practic e are emphasized.
3. iii) Community is sensitized to use water filter and not to defecate in the open.

Contd…….

- iv) State  Irrigation & Public Health Departments have been requested to ensure proper effective treatment of sewerage and also to treat the drinking water before supply.
- v) Other IEC activities are also being undertaken for prevention and control of jaundice

(c ): Yes. The National Institute of Virology (NIV) was involved in investigating the 2 and 2016 outbreaks.

(i ) 2007 Outbreak: The NIV team visited Shimla on 18.02.2007 and collected 89 patient's samples and 55 samples were tested positive for Hepatitis A virus (HAV) lgM antibodies 1  tested  positive  for  both  HAV  and  Hepatitis  E  virus  (HEV)  lgM.  The  etiology  o f  this outbreak  was  hepatitis  A  virus.  The  team  collected  water  samples  from  Malyana  sewa treatment plant (pre - treatment and post treatment), Ashwani Khudd water supply plant (pre -treatment  and  post  treatment)  and  kasumpti  water  tank.  Of  these,  Kasumpti water  was negative  for  HAV  RNA,  while  all  other  samples  were  positive  for  HAV  RNA  indicating contamination of water with HAV.

(ii)2016 Outbreak: The NIV team visited IGMC Hospital, DDU Hospital, Kamala Nehru Hospital, Malyana sewage treatment plant [STP] , Ashwini Khudd water pumping station, and Solan  district  hospital.  Of  the  57  patient's  samples,  46  were  found  to  be  anti - HEV  lgM antibody  positive  and  none  were  anti -HAV  lgM  positive  confirming  it  to  be  hepatitis  E outbreak.  Water  samples  from  the  STP,  wa ter  pumping  station,  affected  and  unaffected households in the area, and from Solan district were collected. All the water sample positive for both HEV and HAV RNA indicating contamination of the water.

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