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Hepatitis A outbreak 'caused by fecal matter in swimming pool'

Five people, including three children, fell ill with the disease last year.

File photo
File photo
Image: Shutterstock/UnderTheSea

MEDICS SUSPECT THAT a swimming pool in the HSE South area was the cause of an outbreak of Hepatitis A last year.

A new paper in the current edition of the Irish Medical Journal (IMJ) shows that last summer five people, including three children – two aged 10 – fell ill with the disease.

The disease is extremely rare here and there were only two other cases of the bug confirmed in the HSE South area in 2016, and both were people returning from travel overseas.

However, the medics at the Public Health Office HSE South state that the outbreak could have been contained and illnesses prevented if there had not been a 13-day delay in notifying it of the first case.

They stated that the case “illustrates the public health consequences of delayed notification”.

“Timely notification would have facilitated prompt contact vaccination and may have prevented illness in subsequent contacts. Improved communication with clinicians and laboratory staff should improve the speed of notification in the future,” they said.

The five Hepatitis A cases were notified over a four week-period between 9 August and 7 September last.

The public health office there detected a link between two of the victims attending a swimming pool which had sub-optimal chlorine levels. People can contract Hepatitis A by swallowing water with fecal content.

In very rare cases, it can result in death but, for the vast majority, the symptoms of fever, nausea, fatigue and jaundice usually last less than two months, although some people can be ill for as long as six months.

Swimming pool link

In the first case in the HSE South area, a 10-year-old child was hospitalised in July 2016 for investigation of jaundice, anorexia and vomiting and was diagnosed with Hepatitis A on 27 July. However, the public health office was not notified until 13 days later – on 9 August.

The onset of symptoms for another 10-year-old going to the same school commenced on 6 August and the child was diagnosed on 8 August. The public health office was notified of the Hepatitis A case on 12 August. Prompt notification would have prevented the parents of the first child contracting the disease.

The 38-year-old mother of the first child contracted the bug and was diagnosed on 22 August with the public health office notified the following day while the child’s 38-year-old father got the bug and was diagnosed on 29 August, with the public office notified the same day.

A fifth case was confirmed on 21 August of a 13-year-old girl but there was an 18-day delay in the public health office being notified. The girl went to a secondary school in a different geographical area.

However, the medics found a potential link between the first child to contract the bug and the 13-year-old girl “via a visit to a swimming pool with suboptimal chlorine levels”.

Investigation

In response to the suspected outbreak, the public health office launched a comprehensive investigation consisting of epidemiological, environmental and microbiological investigations.

The investigators found that swimming pool attendance in early July 2016 was the only ascertainable link between the first child and the 13-year-old girl.

To avoid contracting the bug, a vaccine must be administered within two weeks of exposure. However, the medics point out that the contacts of the first child’s case and the teenage girl’s “were outside the window of vaccination due to delayed notification”.

Dr Helena Ferris, Specialist Registrar in Public Health Medicine, said yesterday: “A swimming pool with suboptimal chlorination levels was identified as one possible source.”

She said the investigation by the outbreak control team included a site inspection and repeat water sampling at the pool.

“The findings were discussed with the management of the swimming pool and the outbreak control team was satisfied that the sub-chlorination had been addressed and a satisfactory management plan put in place by swimming pool management to prevent a recurrence.”

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Gordon Deegan

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