Clinical and epidemiological profile of a Hepatitis A outbreak among medical students at Shaheed Ziur Rahman Medical College hostel: A cross-sectional study

Abstract

Background: Hepatitis A virus (HAV) continues to be a significant public health concern, causing acute viral hepatitis outbreaks, particularly in South Asia's overcrowded settings characterized by suboptimal sanitation. In late 2023, a cluster of jaundice cases emerged among residents of the Shaheed Ziaur Rahman Medical College (SZMC) hostel in Bogura, prompting a detailed epidemiological investigation.

Objectives: To investigate the clinical and epidemiological features of the outbreak, identify the source and modes of transmission, assess existing preventive measures, and propose evidence-based strategies for future risk mitigation.

Methods: A descriptive cross-sectional study was conducted from January to June 2025 to investigate the outbreak that occurred in late 2023. Cases were defined as students residing in the hostel with clinical signs of acute hepatitis and laboratory-confirmed IgM anti-HAV positivity via ELISA (98.9% sensitivity, 99.4% specificity). A structured question- naire captured demographic, clinical symptom, water and food consumption habits, and personal hygiene data. An environmental survey of the hostel's water sources and sanitation infrastructure was conducted to identify potential contamination points.

Results: A total of 22 confirmed HAV cases were identified. The affected population comprised 62.1% male and 37.9% female students. The mean age of the confirmed students was 23.1 years (SD ±1.1). Common symptoms included jaundice (100%, n=22), fatigue (95.2%, n=21), anorexia (85.7%, n=19), and nausea/vomiting (81%, n=18). Epidemiolog- ical investigation revealed a strong association with specific risk factors: a majority of students (77%, n=17) reported consuming water from a tube well found to be adjacent to a cracked underground sewage pipe with evidence of leakage. Furthermore, the college canteen was identified as a highly probable common food source, with 72% (n=16) of affected students reporting consumption from it, and observations noted unhygienic conditions. Suboptimal hygiene practices, including inconsistent hand-washing (only 33.3%, n=7) of students reported consistent hand-washing before meals), were common, and none of the affected students had received HAV vaccination.

Conclusion: The outbreak was most likely a common-source event caused by fecal contamination of the hostel water supply, further amplified by unhygienic conditions in the college canteen and poor personal hygiene practices in commu- nal areas. Targeted interventions, including water source repair, hygiene promotion, and health education, are crucial for effective control. Regular monitoring of water systems, sustained public health awareness campaigns, and consideration of HAV vaccination in high-risk communal settings are strongly recommended for preventing future outbreaks.

CME J 2025; 4(2):37-48