 | |
| Date | early 2009 |
|---|---|
| Location | Modasa, Gujarat, India |
| Casualties | |
| 49 dead [1] | |
| 125+ infected [2] | |
The 2009 Gujarat hepatitis B outbreak was a cluster of hepatitis B cases that appeared in Modasa, northern Gujarat, India in 2009. Over 125 people were infected and up to 49 people died. [1] [2] Several doctors were investigated and arrested after the outbreaks.[ citation needed ]
The hepatitis B virus infects the liver and causes an inflammation called hepatitis. It is a DNA virus and one of many unrelated viruses that cause viral hepatitis. The disease, originally known as "serum hepatitis", [3] has caused epidemics in parts of Asia and Africa, and it is endemic in China. [4] About a third of the world's population, more than 2 billion people, have been infected with the hepatitis B virus. [5] This includes 350 million chronic carriers of the virus. [6] The acute illness causes liver inflammation, vomiting and jaundice. The infection is preventable by vaccination. [7]
Transmission of hepatitis B results from exposure to infectious blood or body fluids containing blood. Possible forms of transmission include (but are not limited to) unprotected sexual contact, blood transfusions, re-use of contaminated needles & syringes, and vertical transmission from mother to child during childbirth. HBV can be transmitted between family members within households, possibly by contact of nonintact skin or mucous membrane with secretions or saliva containing HBV. [8] [9] However, at least 30% of reported cases of hepatitis B among adults cannot be associated with an identifiable risk factor. [10]
The doctors were accused of re-using syringes, which had been contaminated with hepatitis B virus, to treat other patients. Eight medical practitioners, including doctors Govind and Chintal Patel, were arrested under the Indian Penal Code for culpable homicide not amounting to murder after allegedly re-using infected syringes. [11] One of them was also charged with attempted murder. [2] Most of the people affected had received medical treatment from Dr. Patel in the last six months. Medical officials conducted a raid on Patel's clinic and found several used syringes and other medical waste. [2] [12]
The Government of Gujarat started a mass immunization drive under strict medical supervision in Modasa, which set up 60 booths in Modasa and nearby cities. [13] 224 medical teams, including some from All Indian Institute of Medical Sciences and National Institute of Virology set up camps in Modasa and remained there for about a month. [1] [14] According to the officials 25,000 vaccines were sent to the most affected area and 600,000 more vaccines was arranged from Hyderabad. [15] In addition, the government distributed 30,000 pamphlets and mounted a campaign to inform residents about the disease. [14] The Health Department of the Gujarat government have sent 600,000 doses of vaccine to the area. [16]
Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), poor appetite, vomiting, tiredness, abdominal pain, and diarrhea. Hepatitis is acute if it resolves within six months, and chronic if it lasts longer than six months. Acute hepatitis can resolve on its own, progress to chronic hepatitis, or (rarely) result in acute liver failure. Chronic hepatitis may progress to scarring of the liver (cirrhosis), liver failure, and liver cancer.
Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection period, people often have mild or no symptoms. Early symptoms can include fever, dark urine, abdominal pain, and yellow tinged skin. The virus persists in the liver, becoming chronic, in about 70% of those initially infected. Early on, chronic infection typically has no symptoms. Over many years however, it often leads to liver disease and occasionally cirrhosis. In some cases, those with cirrhosis will develop serious complications such as liver failure, liver cancer, or dilated blood vessels in the esophagus and stomach.
Hepatitis D is a type of viral hepatitis caused by the hepatitis delta virus (HDV). HDV is one of five known hepatitis viruses: A, B, C, D, and E. HDV is considered to be a satellite because it can propagate only in the presence of the hepatitis B virus (HBV). Transmission of HDV can occur either via simultaneous infection with HBV (coinfection) or superimposed on chronic hepatitis B or hepatitis B carrier state (superinfection).
Hepatitis A is an infectious disease of the liver caused by Hepatovirus A (HAV); it is a type of viral hepatitis. Many cases have few or no symptoms, especially in the young. The time between infection and symptoms, in those who develop them, is 2–6 weeks. When symptoms occur, they typically last 8 weeks and may include nausea, vomiting, diarrhea, jaundice, fever, and abdominal pain. Around 10–15% of people experience a recurrence of symptoms during the 6 months after the initial infection. Acute liver failure may rarely occur, with this being more common in the elderly.
Hepatitis E is inflammation of the liver caused by infection with the hepatitis E virus (HEV); it is a type of viral hepatitis. Hepatitis E has mainly a fecal-oral transmission route that is similar to hepatitis A, although the viruses are unrelated. HEV is a positive-sense, single-stranded, nonenveloped, RNA icosahedral virus and one of five known human hepatitis viruses: A, B, C, D, and E.
Hepadnaviridae is a family of viruses. Humans, apes, and birds serve as natural hosts. There are currently 18 species in this family, divided among 5 genera. Its best-known member is hepatitis B virus. Diseases associated with this family include: liver infections, such as hepatitis, hepatocellular carcinomas, and cirrhosis. It is the sole accepted family in the order Blubervirales.
Viral hepatitis is liver inflammation due to a viral infection. It may present in acute form as a recent infection with relatively rapid onset, or in chronic form, typically progressing from a long-lasting asymptomatic condition up to a decompensated hepatic disease and hepatocellular carcinoma (HCC).
Lamivudine, commonly called 3TC, is an antiretroviral medication used to prevent and treat HIV/AIDS. It is also used to treat chronic hepatitis B when other options are not possible. It is effective against both HIV-1 and HIV-2. It is typically used in combination with other antiretrovirals such as zidovudine, dolutegravir, and abacavir. Lamivudine may be included as part of post-exposure prevention in those who have been potentially exposed to HIV. Lamivudine is taken by mouth as a liquid or tablet.
A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick injury are generally negligible, these injuries can lead to transmission of blood-borne diseases, placing those exposed at increased risk of infection from disease-causing pathogens, such as the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). In healthcare and laboratory settings globally, there are over 25 distinct types of blood-borne diseases that can potentially be transmitted through needlestick injuries to workers. In addition to needlestick injuries, transmission of these viruses can also occur as a result of contamination of the mucous membranes, such as those of the eyes, with blood or body fluids, but needlestick injuries make up more than 80% of all percutaneous exposure incidents in the United States. Various other occupations are also at increased risk of needlestick injury, including law enforcement, laborers, tattoo artists, food preparers, and agricultural workers.
The Jade Ribbon Campaign (JRC) also known as JoinJade, was launched by the Asian Liver Center (ALC) at Stanford University in May 2001 during Asian Pacific American Heritage Month to help spread awareness internationally about hepatitis B (HBV) and liver cancer in Asian and Pacific Islander (API) communities.
Hepatitis B is endemic in China. Of the 350 million individuals worldwide infected with the hepatitis B virus (HBV), one-third reside in China. As of 2006 China has immunized 11.1 million children in its poorest provinces as part of several programs initiated by the Chinese government and as part of the Global Alliance for Vaccines and Immunization (GAVI). However, the effects of these programs have yet to reach levels of immunization that would limit the spread of hepatitis B effectively.
HBsAg is the surface antigen of the hepatitis B virus (HBV). Its presence in blood indicates existing hepatitis B infection.
Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people, routine immunization results in more than 95% of people being protected.
Hepatitis B is an infectious disease caused by the Hepatitis B virus (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
Hepatitis B virus (HBV) is a partially double-stranded DNA virus, a species of the genus Orthohepadnavirus and a member of the Hepadnaviridae family of viruses. This virus causes the disease hepatitis B.
cccDNA is a special DNA structure that arises during the propagation of some viruses in the cell nucleus and may remain permanently there. It is a double-stranded DNA that originates in a linear form that is ligated by means of DNA ligase to a covalently closed ring. In most cases, transcription of viral DNA can occur from the circular form only. The cccDNA of viruses is also known as episomal DNA or occasionally as a minichromosome.
The transmission of hepadnaviruses between their natural hosts, humans, non-human primates, and birds, including intra-species host transmission and cross-species transmission, is a topic of study in virology.
Ground squirrel hepatitis virus, abbreviated GSHV, is a partially double-stranded DNA virus that is closely related to human Hepatitis B virus (HBV) and Woodchuck hepatitis virus (WHV). It is a member of the family of viruses Hepadnaviridae and the genus Orthohepadnavirus. Like the other members of its family, GSHV has high degree of species and tissue specificity. It was discovered in Beechey ground squirrels, Spermophilus beecheyi, but also infects Arctic ground squirrels, Spermophilus parryi. Commonalities between GSHV and HBV include morphology, DNA polymerase activity in genome repair, cross-reacting viral antigens, and the resulting persistent infection with viral antigen in the blood (antigenemia). As a result, GSHV is used as an experimental model for HBV.
The woolly monkey hepatitis B virus (WMHBV) is a viral species of the Orthohepadnavirus genus of the Hepadnaviridae family. Its natural host is the woolly monkey (Lagothrix), an inhabitant of South America categorized as a New World primate. WMHBV, like other hepatitis viruses, infects the hepatocytes, or liver cells, of its host organism. It can cause hepatitis, liver necrosis, cirrhosis, and hepatocellular carcinoma. Because nearly all species of Lagothrix are threatened or endangered, researching and developing a vaccine and/or treatment for WMHBV is important for the protection of the whole woolly monkey genus.
The epidemiology of hepatitis D occurs worldwide. Although the figures are disputed, a recent systematic review suggests that up to 60 million individuals could be infected. The major victims are the carriers of the hepatitis B surface antigen (HBsAg), who become superinfected by the HDV, and intravenous drug users who are the group at highest risk. The infection usually results in liver damage ; this is most often a chronic and severe hepatitis rapidly conducive to cirrhosis.