A team comprising of an Epidemiologist and a Microbiologist visited Mandi District (H.P.) to investigate the outbreak of jaundice during 19^th March to 2^nd April 2002.    

·         Analysis of records showed total No. of cases reported at various hospitals of Mandi Town from 01.02.2002 to 31.03.2002 to be 456.

·         A total population of 4575 was surveyed (at 9 different locations representing the whole Mandi town.), out of total town population of 35000.

·         Attack rate was 1.137 % amongst the surveyed population.

·         Over all relative risk of jaundice cases among the population who were consuming tap water supply was 2.8 as compared to those who were consuming water from other sources like Bauri, well etc.

·         Relative risk among   population living in the area with water supply from Motipur water treatment plant was infinitive as compared to those who were consuming water from other sources.

·         On checking residual chlorine levels running piped water it was found that, nil residual chlorine was detected in the two samples out of the total nine tested on 24.03.2002.

·         Team visited Motipur water treatment plant and found some of the deficiencies namely infrequent mixing of alum at rapid sand filtration unit, inadequate chlorination and use of defective chloroscopes.  The same was communicated to the concerned authorituies.

·         City waste disposal/ dumping site, was located at the riverbank, 3 Kilometres upstream to place from where Motipur water treatment plant draws water. Team observed presence of a stream passing through the dumping site and carrying the polluted water to the river Beas.

·         8 out of nine blood samples tested positive for IgM HEV antibody.

·         Clinical, epidemiological and laboratory findings indicate that current outbreak of jaundice was due to Hepatitis E virus infection.

·         Irrigation and Public Health department should ensure mixing of alum in pre-treatment tank in adequate quantity so as to coagulate and sediment all the dissolved organic material and microorganisms

·         IPH deptt. need to ensure the proper chlorination of the filtered water before supplying the same to the town in terms of quantity of chlorine added and time period for which chlorine has been applied to inactivate micro organism and its regular monitoring at source and consumer points.

·         There is a need to repair / replace leaking water pipes.

·         Periodic IEC- activities to be carried out to prevent water borne disease outbreaks.

·         There is an urgent need to improve disease - surveillance system in the district. As it is difficult to receive disease surveillance data from the various difficult/ distant areas of district, it is advisable to use modern means of communications for an effective surveillance.