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An outbreak investigation finds contaminated water as the main source of hepatitis A cases in an urban area, highlighting the need for better water management.
Summary In July 2023, we investigated a cluster of jaundice cases in Madurai district, Tamil Nadu, to identify outbreaks, etiology, and source and to propose control measures. A door-to-door survey identified 119 cases, with an attack rate of 8.3 per 1000. An environmental investigation and matched case–control study confirmed that the outbreak was linked to contaminated urban local body (ULB) water. Consuming ULB piped water caused 33% of cases (odds ratio [OR] 9.9, 95% confidence interval [CI]: 2.5–38.6), whereas drinking unboiled water caused 81% (OR 15.1, 95% CI: 5.4–42.3). The outbreak highlighted the need for improved water and sewage management in the district.
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Subramanian et al. (2026) studied this question.
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