Finally, the correct cause of this outbreak was found and it was found to be the mixing of sewage water with the drinking water pipelines due to leakages in pipelines. Without giving any second thought on this serious issue, the administration has also declared that the present outbreak has been controlled. It is too early to comment about the control of the outbreak as it needs a professional, systematic and an expertise way of diagnosing and controlling the outbreak.

Real picture-  It is to be remembered that 5000 odd cases of Gastroenteritis cases which have been reported in initial few days of this outbreak is just the tip of iceberg and still many more would be reported in upcoming days with different disease profiles. Let’s try to understand this proposition from public health perspective. Firstly, with regard to cause of outbreak, it was amply clear right at the start that this outbreak was due to cross contamination of drinking water pipelines with those of sewage lines and it was just the matter of time to find out the exact location of leakages and its immediate repair. This action could have been completed within initial few hours to at the most few days of outbreak! Secondly, the mixing of sewage with drinking water means contamination of drinking water with various micro-organisms present in excreta (including protozoa, viruses, bacteria) responsible for causation of various diseases.

The first bout of cases of Gastroenteritis which have been reported to the hospitals were only the initial ones, which were caused due to viral and protozoal micro-organisms whose Incubation Period ( interval between entry of organism in body and appearance of first symptom) was between 12 to 72 hours. The decrease in number of Gastro-enteritis cases after few days was only because of this fact on Incubation period of microbes. It doesn’t mean that the flow of patients would stop completely after this. It is to be noted that there are many more organisms which have already entered into affected population via this contaminated water and these organisms are just waiting for their turn to produce the disease symptoms.

Their Incubation Period ranges from two to eight weeks. Few patients with symptoms of jaundice, dysentery will report within this time span of 15 days to 2 months duration post-outbreak reporting period. Hepatiis – A virus has got the Incubation Period of 2 to 4 weeks whereas that of Hepatitis- E virus is 3 to 8 weeks. One would not be surprised if there is increase in number of jaundice cases in upcoming two months from Aurangabad Cantonment Board area. So a casual remark about control of outbreak is factually and technically incorrect.

Futuristic perspective-     Outbreak management is an expert territory and just treatment of patients is not sufficient to control the same. The diagnosis and control of an epidemic is an art and science and is very well developed by the public health experts. Unfortunately, the public health experts or the principles of preventive medicine are only remembered after the outbreak occurs! The administrative authorities should have approached and taken help of public health experts from Army as well as Government Medical College and Hospital, Aurangabad.

The internationally acclaimed public health experts and epidemiologists are available in and around Aurangabad and their timely services could have averted and controlled the outbreak in initial few days only. A proper emphasis on periodical survey of pipelines, regular hygienic inspections of eating installations, surveillance mechanism and involvement of public health experts in health policy making and implementation would avert such kind of public health catastrophe in future. A timely action in true letter and spirit with focus on public health is the need of hour or otherwise it would be just the matter of time for another outbreak in some other area with some other cause…

(The author of this article is Lt Col (Dr) Satish Dhage is a public helath expert and an Ex Deputy Assistant Director Health in Army. He has been credited with control of number of epidemics in various states throughout India. He can be contacted at drsatishdhage@gmal.com)