Field investigation of viral hepatitis outbreak in a cantonment in northern India: an epidemiological perspective

Background: Viral hepatitis remains a significant public health concern, particularly in closed communities where shared amenities and communal living increase the possibility of outbreaks. A notable increase in viral hepatitis cases was reported in a cantonment in northern India, prompting an urgent epidemiological investigation to comprehend the cause, extent, mode, various contributing environmental and behavioral risk factors. Methods: An ambispective descriptive epidemiological study was conducted using a line listing of reported hepatitis cases from January to July 2025. An environmental health assessment was carried focussing on the water quality aspects, hygiene, sanitation and public health infrastructure. The structural integrity of the water and sewage pipelines was also inspected to identify any leakages. Results: Over seven months, a total of 36 viral hepatitis cases were reported in the cantonment, primarily among individuals with a history of travel and those residing in blocks served by old, leaking water pipelines. Water testing showed high coliform counts, with 6-11 pipeline leaks and 1-5 sewage blockages reported monthly. Laboratory confirmation primarily pointed to hepatitis A virus (HAV) and hepatitis E virus (HEV). Conclusions: The outbreak was attributed to contaminated drinking water, primarily due to water pipeline leakage and sewage intermixing. Recommendations include the urgent replacement of compromised pipelines, enforcement of regular water quality monitoring and public health education on hygiene practices. This investigation highlights the importance of robust environmental surveillance and rapid response mechanisms in high-density residential closed communities.