Determinants of hepatitis A infection among students: A case study of an outbreak in Jember, Indonesia

Santi Martini
Division of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.

Firman Suryadi Rahman
Doctoral Program of Public Health, Faculty of Public Health Universitas Airlangga, Surabaya, Indonesia.


Background: Hepatitis A often occurs in school among students in the form of an outbreakThe transmission was through fecal-oral (Common Source) provided that the epidemic curve is close to propagated. The aim of the current study was to analyze the determinants of Hepatitis A Infection among students.

Design and methods: This study was a case-control study which was conducted at SMAN Plus with a sample size of 80 students chosen by using simple random sampling. The data obtained were then analyzed using logistic regression with 95% confidence level (α = 0.05), while the strength of the relationship between variables was identified using Odds Ratio (OR).

Results: Most of the students were at the age of 17 to 19 years old (65%) and male (57.5%). The average age in the case group was 17.1 years old, while in the control group was 16.75 years old. The habit of consuming raw foods (p = 0.001) as well as eating and drink at the same time during an activity (p = 0.000) had a significant influence on the outbreak of Hepatitis A in the curve epidemic of common source.

Conclusions: The outbreak is confirmed as a transmission occurs through fecal-oral which the common source epidemic curve. Risk factors that have been proven to be related to Hepatitis A include consuming raw food, eating shared meals during an activity, and drinking with shared drinking utensils.


Linder KA, Malani PN. Hepatitis a. JAMA 2017;318:2393. DOI:

Vaughan G, Rossi LM, Forbi JC, et al. Hepatitis A virus: host interactions, molecular epidemiology and evolution. Infect Genet Evol 2014;21:227-43. DOI:

Aggarwal R, Goel A. Hepatitis A: epidemiology in resource-poor countries. Curr Opin Infect Dis 2015;28:488-96. DOI:

East Java Health Office. Hepatitis A Report. 2015.

Jember Health Office. Hepatitis A Report. 2015.

Ministry of Health of the Republic of Indonesia. Hepatitis Virus. 2014.

Hikmah F, Nuraini N, Sari EP. Mapping and analysis of hepatitis A disease distribution based on risk factors in Bondowoso district. KEMAS: Jurnal Kesehatan Masyarakat 2019;14:303-10. DOI:

Franco E, Meleleo C, Serino L, et al. Hepatitis A: Epidemiology and prevention in developing countries. World J Hepatol 2012;4:68. DOI:

Raveendran S, Rakesh PS, Dev S, et al. Investigation of an outbreak of hepatitis a in a coastal area, Kerala, southern India. J Prim Care Community Health 2016;7:288-90. DOI:

Arora D, Jindal N, Shukla RK, Bansal R. Water borne hepatitis a and hepatitis e in malwa region of punjab, India. J Clin Diagn Res 2013;7:2163-6. DOI:

Mulyanto. Viral hepatitis in Indonesia: Past, present, and future. Euroasian J Hepatogastroenterol 2016;6:65-9. DOI:

Seo JY, Choi BY, Ki M, et al. Risk factors for acute hepatitis A infection in Korea in 2007 and 2009: a case-control study. J Korean Med Sci 2013;28:908-14. DOI:

Verhoef L, Boot HJ, Koopmans M, et al. Changing risk profile of hepatitis A in The Netherlands: a comparison of seroprevalence in 1995–1996 and 2006–2007. Epidemiol Infect 2011;139:1172-80. DOI:

Randazzo W, Sánchez G. Hepatitis A infections from food. J Appl Microbiol 2020;129:1120-32. DOI:

Viray MA, Hofmeister MG, Johnston DI, et al. Public health investigation and response to a hepatitis A outbreak from imported scallops consumed raw – Hawaii, 2016. Epidemiol Infect 2018;147:e28. DOI:

Food and Drug Administration. Hepatitis A virus. 2020. Available from:

Ministry of Health of the Republic of Indonesia. Guidelines for outbreak investigation. 2017.

Centers for Disease Control and Prevention [Internet]. Surveillance for Viral Hepatitis – United States, 2017 Available from:

Adelodun B, Ajibade FO, Ighalo JO, et al. Assessment of socioeconomic inequality based on virus-contaminated water usage in developing countries: a review. Environ Res 2021;192:110309. DOI:

Pérez-Sautu U, Costafreda MI, Lite J, et al. Molecular epidemiology of hepatitis A virus infections in Catalonia, Spain, 2005–2009: circulation of newly emerging strains. J Clin Virol 2011;52:98-102. DOI:

Pintó RM, Bosch A. Immunization recommendations against hepatitis A in Spain: Effectiveness of immunization in MSM and selection of antigenic variants – Authors' Reply. EbioMedicine 2019;45:21. DOI:

Furlow B. Widespread hepatitis A outbreaks in the USA strain public health agencies. Lancet Gastroenterol Hepatol 2019;4:755-6. DOI:

Zhou YH. Maternal immunisation and neonatal infection of hepatitis A or B virus. Lancet Infect Dis 2019;19:238. DOI:

Zhang XS, Iacono GL. Estimating human-to-human transmissibility of hepatitis A virus in an outbreak at an elementary school in China, 2011. PloS One 2018;13:e0204201. DOI:

Wu JB, Li XL, Zhang J, et al. Source identification through social networks in an epidemiological investigation of a hepatitis A outbreak at an elementary school in Anhui province, China. Epidemiol Infect 2014;142:1450-8. DOI:

Xu YG, Cui FG, Zhuo JT, et al. An outbreak of hepatitis A associated with a contaminated well in a middle school, Guangxi, China. Western Pac Surveill Response J 2012;3:44–7. DOI:

Andriati R, Indah FP, Pratiwi RD, et al. Determinant factors related to hepatitis A incidence outbreaks in Depok City, Indonesia. Malays J Med Health Sci 2020;16:84-7.

Retyono S, Rahardjo SS, Murti B. Multilevel analysis: Village does not have contextual effect on hepatitis A outbreak in Pacitan, East Java, Indonesia. J Epidemiol Public Health 2020;5:195-206. DOI:

Harisma FB, Syahrul F, Mubawadi T, Mirasa YA. Analysis of hepatitis A outbreak in high school X Lamongan district 2018. Jurnal Berkala Epidemiologi 2018;6:112-21. DOI:

Rahman FS. Hepatitis A outbreak in Jember Senior High School. Master Thesis, 2016.