OUTBREAK OF HEPATITIS IN A RURAL COMMUNITY
SAMI ALI KACEM & WILL MLCUCH
Abstract
Lake County in northern Michigan in 1968 experienced an outbreak of
hepatitis A, resulting in this investigation. Risk factors and patterns of
transmission were the objectives of the study. After the unusual rise of
reported cases of total of 63 cases from April to May, the Investigation
started and consisted of interviews the victims and have been
questioned about date of illness, symptoms, and previous exposure. The
results have shown that the attack rate among young males from 10-19
years old (schoolchildren) is the highest comparing to the attack rate of
young and old females and old males.
Introduction
On May 17th ,1968 In Lake County Michigan there was a reported
break out of 32 hepatitis cases from April 30 to May 16, 1968. This
county is located on the northern part of Michigan with three bigger
cities and a mix of a rural population split by farms and forests. The
population of the county at the time was 9680 people according to a
1960 census, 2025 of them live in North trail where the investigation
was focused. We are trying to get an explanation on why and how there
was an outbreak of hepatitis in this small county in Michigan. Are
Hypothesis is the outbreak was due to students and people of the
community eating from the local bakery.
Methods
After the unusual rise of reported cases by May there were 39
reported cases and by the first of June total of 63 cases were
reported, the Investigation started and consisted of interviewing all
reported hepatitis victims which they were questioned about the
date of onset of illness, symptoms, previous exposure, history of
receiving injections of blood products also were asked about
specific sources of food, water, and milk. As the figure below used
to illustrate cases of infectious Hepatitis, also a table used to
measure the attack rates of the infections by age group and sex
during the period of April-May. To determine the sources of the
Epidemic the investigators gathered relevant information
concerning the school population as they had the highest infections
rates, table of exposure history also could help confirming the
information gathered.
Results
The characteristics of this outbreak are explained by common
exposure to a food item. The analytics conducted and the
observation that almost all of the Hepatitis A cases living in Lake
County had eaten baked goods from the North Trail Bakery, along
with the comparison of the number of cases and the percentage of
customers at the bakery, led us to conclude that the bakery was
responsible for the outbreak. One month after exposure to North
Trail Bakery, infectious hepatitis occurred. Many cases indicated
that infectious hepatitis could only result from exposure to baked
goods. Since they had no contact with the North Trail municipal
water supply, any of the local restaurants, or any other food-
handling establishment, infectious hepatitis can only be caused by
contact with baked goods. None of those cases had ever been
exposed to infectious hepatitis or jaundice. None had a history of
infections or administration of blood products within 6 months
prior to the onset of illness, and none had a history of recent
ingestion of shellfish.
Discussion
There were 63 total cases from April to June most of the
cases were children aged 10-19 years old. This study found
that the bakery in the town was the source of the hepatitis
breakout. The case history led right to the culprit, there was a
history of almost all the infected individuals having a prior
encounter with someone who ate the food from the bakery,
or they personally had something from the bakery. We can
also conclude that because the students at the local school
had access to this bakery it had a direct impact on who was
initially infected and where the outbreak occurred.
Conclusion
Through looking at the study we can concluded that main point of
this hepatitis break out was the local bakery in the town. Both the
data and the Case history support this claim. Cases 1-10 involved
people that lived outside the city, and they all had one thing in
common. They all ate something or came in contact with someone
who had eaten baked good from the bakery. With the outbreaks
being involved with the school and students having access to the
bakery as well as the goods such as icing being frozen for several
days at a time, we can conclude that the source of the outbreak can
be contributed to the bakeries baked goods. However, the bakery
was permitted to open again after the epidemic curve showed that
the outbreak was ending at this time (June 3rd).
References
Tong, J L., M., Cullingford, J.S.,
Shimp, D. T., & Love, C. E, (1962).
American Journal of Public Health,
52, 976.