Outbreak of Hepatitis A caused by Groundwater Contamination in a Long-term Psychiatric Hospital in Korea
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목적: 2017년 지하수를 식수로 사용하고 있는 한 장기요양 정신병원(H병원)에서 A형간염 환자가집단 발병하여 이에 대한 역학조사를 실시하고 조치 결과를 기술하고자 하였다. 방법: 노출기간 동안 H병원의 근로자 및 재원 환자 234명을 대상으로 사례군 조사 디자인으로역학조사를 실시하였고, IgM, IgG 혈청검사 및 A형간염 바이러스(HAV)에 대한 PCR검사를 시행하였다. 또한 오염원으로 의심되는 지하수, 병원에서 제공되는 식품 및 인근 저수지의 물에서HAV 검사를 실시하였고, 검출된 HAV는 유전형 검사를 진행하였다. 결과: H병원 환자 및 직원 234명 중 IgG 양성인 168명을 제외한 66명 중 19명이 최종적으로HAV 감염자로 확인되어 감수성자 중 발병률은 28.8%로 나타났다. 환자, 지하수, 식품(석박지) 및저수지에서 동일 유전형의 HAV가 검출되어 지하수 오염에 의한 집단발병으로 결론 내렸으나, 최초 오염원은 확인하지 못하였다. 유행 종결 선언 이후 지하수에 대한 관리로 염소소독과 UV 조사를 하였음에도 불구하고 6개월 동안 지속적으로 HAV가 검출되어 새로운 관정을 개발하여상황을 종결하였다. 결론: 본 연구에서 지하수를 식수로 사용하는 장기요양 정신병원에서 지하수 오염에 의한 19명의HAV 집단발병을 조사하였다. HAV 항체가 없는 대상자 중에서 HAV의 높은 발병률을 확인하였다. 지하수 수질검사에서 바이러스 검사는 포함되어 있지 않기 때문에 지하수가 HAV에 오염시 HAV 집단발병 가능성이 높고 상당기간 지속적으로 검출되기 때문에 지하수에 대한 관리지침에 바이러스 검출을 위한 방안을 추가하고 관련 법을 정비할 필요가 있다.
Abstract
.Abstract Background: The incidence of acute hepatitis A virus infection was rapidly increased, so it has been changed to legal infectious disease since 2010 in Korea. In this study, the outcome of an epidemiologic investigation regarding an outbreak of hepatitis A in a psychiatric hospital in Jeollabuk-do and the management for this outbreak were described. Method: This case series study was conducted on 234 patients or employees of the hospital who stayed during December 2017 to March 2018. The case definition of this outbreak was who has positive anti-HAV IgM result in serum from November 6, 2017 to March 12, 2018. Personal and environmental factors associated with this outbreak were also evaluated. Result: Total 19 cases were confirmed as HAV and the attack rate among the susceptible person was 28.8% (19/66). Overall attack rate includes non-susceptible was higher in the age group between 20 to 39 years compared with other age groups (25.0%). HAV was also detected in restored foods, groundwater, septic tank effluent, and nearby reservoir with HAV strains from collected samples showing 100% homology. A groundwater well and damaged waste pipe were within close proximity of one another. The damaged pipe was replaced, and a newly drilled groundwater well is now used as the water supply after verifying absence of HAV after 6 months of outbreak. Conclusion: We assumed that the cause of this outbreak was groundwater contamination due to sewer pipe damage. The outbreak continued to 23 days and the groundwater contamination lasted for 6 months. Since groundwater quality test does not include for viruses, there is a possibility of HAV outbreaks when groundwater is contaminated with HAV. Therefore it is necessary to add the items for virus in groundwater management guidelines and to overhaul related laws.
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