Academic Journal
Environmental investigation of a hepatitis A outbreak associated with spring water consumption in an Anabaptist community: Kentucky, 2018-2019.
| Title: | Environmental investigation of a hepatitis A outbreak associated with spring water consumption in an Anabaptist community: Kentucky, 2018-2019. |
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| Authors: | Miko S; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA., Kahler A; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA., Roundtree A; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA., Benedict K; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA., Foster M; Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA., Thoroughman D; Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, GA, USA.; Kentucky Department for Public Health, Frankfort, KY, USA., Odegard A; Kentucky Department for Public Health, Frankfort, KY, USA., Khoury J; Kentucky Department for Public Health, Frankfort, KY, USA., Rush C; Kentucky Department for Public Health, Frankfort, KY, USA., Zafrullah M; Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA., Hayden T; Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA., Purdy M; Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA., Ganova-Raeva L; Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA., Williams D; Allen County Health Department, Scottsville, KY, USA., Mounsey L; Allen County Health Department, Scottsville, KY, USA., Massey A; Allen County Health Department, Scottsville, KY, USA., Mattioli M; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA E-mail: kuk9@cdc.gov. |
| Source: | Journal of water and health [J Water Health] 2026 Feb; Vol. 24 (2), pp. 264-277. Date of Electronic Publication: 2026 Jan 30. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: IWA Pub Country of Publication: England NLM ID: 101185420 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1477-8920 (Print) Linking ISSN: 14778920 NLM ISO Abbreviation: J Water Health Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London ; Avenel, NJ : IWA Pub., c2003- |
| MeSH Terms: | Hepatitis A*/epidemiology , Hepatitis A*/virology , Drinking Water*/virology , Hepatitis A virus*/isolation & purification , Natural Springs*/virology , Disease Outbreaks*, Kentucky/epidemiology ; Humans ; Water Microbiology ; Environmental Monitoring |
| Abstract: | In 2019, a hepatitis A outbreak in an Anabaptist community was reported to the Kentucky Department for Public Health. Epidemiological data suggested untreated spring water as a potential outbreak exposure. An environmental investigation was conducted to evaluate this less common hepatitis A virus (HAV) exposure source. We collected water samples from the main spring used for drinking and produce irrigation by the primary household where cases were identified, from springs feeding the main spring, and from the household's gray water discharge and human waste systems. Samples were tested for HAV, and viral and bacterial fecal indicators. HAV was detected in the main spring water and downstream of the household gray water discharge pipe. HAV was repeatedly detected in the follow-up samples from spring water and in wastewater from a new septic system. The environmental investigation confirmed HAV contamination of the household drinking water. Human-specific and general fecal indicators indicated a hydrological connection between the waste system and the drinking water source. Given that private springs are unregulated in the United States, spring water should be considered as a risk factor in HAV and other waterborne virus outbreaks within communities less likely to utilize water treatment systems. (© 2026 The Authors This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/).) |
| Competing Interests: | The authors declare there is no conflict. |
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| Grant Information: | CC999999 United States ImCDC Intramural CDC HHS |
| Contributed Indexing: | Keywords: coliphage; crAssphage; drinking water; groundwater; hepatitis A virus; septic system; spring water; wastewater |
| Substance Nomenclature: | 0 (Drinking Water) |
| Entry Date(s): | Date Created: 20260301 Date Completed: 20260710 Latest Revision: 20260813 |
| Update Code: | 20260813 |
| PubMed Central ID: | PMC13068161 |
| DOI: | 10.2166/wh.2026.248 |
| PMID: | 41764395 |
| Database: | MEDLINE |
| ISSN: | 1477-8920 |
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| DOI: | 10.2166/wh.2026.248 |