Epidemiology and Infection

Original Papers

Hepatitis

Source identification through social networks in an epidemiological investigation of a hepatitis A outbreak at an elementary school in Anhui province, China

J. B. WUa1 , X. L. LIa2 , J. ZHANGa1, D. XUa1, J. J. ZHUa3 and B. S. ZHOUa2 c1

a1 Center for Disease Control and Prevention of Anhui Province, Hefei, China

a2 Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China

a3 Center for Disease Control and Prevention of MengCheng County, Anhui Province, Bozhou, China

SUMMARY

In May 2011, the Center for Disease Control and Prevention of a Chinese county found a rapid increase in the number of hepatitis A case notification; these were traced to an outbreak in an elementary school. Twenty-eight cases aged between 7 and 13 years with onset between 7 May and 8 June were serologically confirmed. Network method was conducted to reconstruct an outbreak network and to quantify the relative importance of those involved in the outbreak. A case-control study was used to study the association between the outbreak and putative risk factors. The network analysis suggested this was a disseminated outbreak originating from a 4-year-old boy with propagated spread. Evidence from the case-control study supported consumption of well water as a potential risk factor; however, this was unable to be established through field investigation. Outbreak networks can be used to identify the possible source of infectious disease outbreak, especially when the environmental investigation information is negative or not available.

(Received June 05 2013)

(Revised August 06 2013)

(Accepted August 28 2013)

(Online publication September 19 2013)

Key words

  • Hepatitis A;
  • outbreaks;
  • personal hygiene

Correspondence

c1 Author for correspondence: Dr B. S. Zhou, Department of Epidemiology, School of Public Health, China Medical University, No.92 Beier Road, Heping District, Shenyang, Liaoning province, PR China, 110001. (Email: bszhou@mail.cmu.edu.cn)

Footnotes

  These authors contributed equally to this work.

Metrics