Water borne epidemic of gastroenteritis in Ghallour sub-centre of Jawalamukhi block, Kangra District, Himachal Pradesh, India

Background: On August 31, 2014, eighty cases of the gastroenteritis were reported in Ghallour sub-center area. We investigated the outbreak to identify the source, propose control, and preventive measures. Materials and Methods: We defined a case as occurrence of three or more watery stools with or without vomiting, w.e.f January 27, till February 2, 2014 in residents of Ghallour sub-center area of Jawalamukhi block. We hypothesized it as a water borne outbreak. We determined age and sex specific attack rate. We collected information about personal history on age, sex, residence, and date of onset of symptom from case patient and established line list. We collected nine stool samples/rectal swabs from the cases; three pre and four post chlorination water samples and sent them for microbiological testing. We mapped water supply pipelines of the area and reviewed the water chlorination record. Results: We identified 390 cases in 16 villages under the sub center. The overall attack rate was 8% with a range of 1.3% to 36%. The cases patients were reported from all age groups and both the genders with the youngest student; 1-year old to the oldest one as 88 years. Two-third of the cases reported vomiting with some complaining of pain abdomen. Villages like Jathman, Khattni, Rajol Patta, Kohara has 100% case patients of loose motions while villages like Dhroli, (100%), Sasan (63%) and Ghallour (50%), etc., have combined symptoms of loose motions and vomiting. No fatality was reported. Escherichia coli was detected in the samples from water samples. Records of chlorination were not properly maintained. Conclusion / Recommendation: The outbreak was associated due to contamination of water at the source in Jolly Khad. Regular treatment of the water needs to be done right at the source before being lifted