Use of transmission network analysis as an epidemiological tool to support the investigation of a community hepatitis A outbreak, Lincolnshire, 2016
PHE ePoster Library. Giljohann C. Apr 10, 2019; 257462
Ms. Claudia Giljohann
Ms. Claudia Giljohann
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Abstract
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Abstract Background:
We utilised a transmission network analysis informed approach to support the investigation and control of a community hepatitis A outbreak in Lincolnshire during June 2016.
Methods:
Cases were defined living in the PE12 postcode area; with laboratory confirmed Hepatitis A and where available genotype IB. Risk factor data was collected via questionnaires and were also used for case finding. To elucidate networks of cases and their contacts as well as possible transmission routes of hepatitis A we used Microsoft Office Word to produce a network diagram to provide a visual representation of the cases and their contacts. Daily case and contact updates enabled timely updating of the diagram to demonstrate new links and guide the OCT investigations and implementation of control measures.
Results:
Nineteen cases of hepatitis A linked to the outbreak met the case definition(18 laboratory confirmed). Seven were asymptomatic. Cases comprised 6 adults and 13 children; 4 pre-school, 6 attending primary and 3 attending secondary schools. The network diagram provided a visual record of cases and demonstrated possible transmission pathways across 6 households, 2 schools, 1 playgroup and the community. Interventions to interrupt the transmission of infection included vaccination sessions in two primary schools (plus salivary swabbing at one); one playgroup vaccination session and GP vaccination mop-up vaccination programme. Conclusions The network diagram provided a simple overview of the cases and their contacts, facilitated tracking of the progression of the outbreak from the index, its investigation (including contact identification) and directed control measures. This streamlined the identification of epidemiological links and provided a central point of reference throughout the investigation.Further work using alternative network diagram software such as i2, R or similar is envisaged for future incidents to enable easy production and updating of network diagrams. Keywords:- Network diagram; Hepatitis A; Outbreak; i2, R
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