Hepatitis outbreak is traced to contaminated needles and barber shop razors, study shows

BMJ 2012; 345 doi: (Published 28 December 2012) Cite this as: BMJ 2012;345:e8700
  1. Meera Kay
  1. 1Bangalore

A village in the Ernakulam district in Kerala, India, has experienced a serious outbreak of hepatitis B virus, which has been traced to injections with contaminated needles and transmission in barber shops.

The origins of the outbreak were discovered after the local government commissioned a private firm, the Manipal Centre for Virus Research (MCVR), to carry out a disease mapping and risk factor study.

The centre’s head, G Arunkumar, said that the hepatitis B virus infection was possibly introduced into the population before 2011, and that it reached an outbreak threshold in late 2011 and early 2012.

The study found that of the 2017 people screened, 348 were infected (17%). Of these, 225 people are thought to have acquired the infection more than six to eight months earlier.

Nearly half of those infected were between 41 and 60 years of age. Although 19 children were infected with hepatitis B virus, none of their mothers were, ruling out the possibility of vertical transmission.

The study showed that nearly 43% of houses included in the study had at least one infected person, nearly 10% of houses contained more than one person infected with hepatitis B virus, and 2% of houses had more than two infected cases. The proportion of the Indian population that is infected with hepatitis B virus is between 2% and 7%.

Arunkumar said that the source of hepatitis B virus infection in this outbreak was unsafe injections. The study showed that injections received a year earlier, dental consultations and undergoing endoscopic examination were risk factors for acquiring the infection.

According to the study inadequate hygiene and infection control practices at barber shops was evident on inspection, and the samples from instruments and objects in barber shops showed presence of the virus. The study said that barber shops were substantially involved in the transmission of the virus.

Arunkumar said “This is the first such cohort established by conducting a detailed base line study and the follow-up of this cohort will immensely enrich our knowledge of hepatitis B virus and its clinical manifestations and will contribute to the nation’s public health preparedness.”

The study recommended that a three pronged strategy be followed for the prevention and control of outbreaks of hepatitis B virus. It consisted of increasing hepatitis B virus vaccination coverage, including 100% compliance with vaccination at birth; improving infection control practices at healthcare institutions, including implementation of safe injection practices and adequate sterilisation of endoscopes and catheters; and improved hand washing at all levels.


Cite this as: BMJ 2012;345:e8700