EPIDEMIOLOGY OF ENDEMIC VIRAL-HEPATITIS IN AN URBAN AREA OF INDIA - ARETROSPECTIVE COMMUNITY STUDY IN ALWAR

In a community study during a reference period of 1 year, 192 cases of jaundice were detected in an urban population of 69440 in Alwar, Raja sthan. Detected by paramedics and confirmed by physicians, these cases gave an annual incidence of 2.76 (95% CI: 2.37-3.15) per 1000 populat ion. At least one of these patients died, giving a case fatality ratio of 0.6%. The jaundice cases occurred in all areas investigated, and a ffected all socioeconomic strata. About 94% of the affected families h ad only single cases. Although cases occurred throughout the year, mor e than 59% occurred during June-September, which are the summer and mo nsoon months. The incidence was highest (5.23 per 1000) among under-5- year-olds and declined progressively and significantly thereafter Male s had a higher incidence than females at all ages; the differences wer e not significant. Blood samples from 56 cases who had jaundice in the last 3 months of the reference period were tested for markers of vira l hepatitis. Of these, 18 (32.1%), 1 (1.8%), 0, 2 (3.6%), and 4 (7.1%) were found to have hepatitis A, B, C, D and E, respectively. The etio logy of the remaining 31 cases (55%) could not be established; previou sly, they would have been included in the NANB (non-A, non-B) category , inflating its proportion. Hepatitis A (HA) was the predominant type: being comparatively mild, it is perhaps underrepresented in hospital- based data. Many HA cases were in adults, which may be the beginning o f an age shift of HA to the right owing to improvements in living stan dards of the study population. Five cases were carriers of hepatitis B virus (HBV), indicating the importance of HBV infection in India as w ell. Finally, the study found the annual incidence of laboratory-suppo rted cases of viral hepatitis to be 1.24 (95% CI: 0.98-1.5) per 1000 p opulation, which suggests that it is a major public health problem in India.