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Background: Hepatitis E virus (HEV) is the leading cause of acute viral hepatitis with over 2 billion cases per year. In India, HEV accounts for 60% of acute viral hepatitis cases. On 10 July 2015, Mandya district in Karnataka, India reported 50 cases of jaundice from factory A. We investigated to describe the outbreak, identify risk factors and propose recommendations. Methods & Materials: We defined a case as acute onset of jaundice (yellow discoloration of eyes/dark coloured urine) in factory A worker between April and July 2015. We did a retrospective cohort study between 15th and 30th July. We interviewed workers about socio-demographic characteristics, food exposures and water sources. We calculated relative risk (RR) and 95% confidence interval (CI). We collected 19 serum samples for IgM testing by ELISA for Hepatitis A, Hepatitis E and Leptospirosis. We assessed water sources and collected water samples from canteen, overhead tank and river for testing faecal coliforms. Results: We identified 132 cases between 25 May and 28 July 2015. There werenodeaths, but most (73%) cases were hospitalised. Attack rate was 14% (132/950) and almost equal between genders (females 14% [114/812] and males (13% [18/138]). Median age was 29 years. Drinking water from factory tap (RR=1.7, 95% CI=1.2-2.5), eating lunch daily from factory canteen (RR= 2.1, 95% CI=1.4-3.1), or eating at least once from factory canteen in past three months (RR=2.4, 95%CI=1.7-3.3) were associated with illness. Using public water for drinking or cooking at home (RR=1.1, 95% CI=0.8-1.4) was not significant. Washing hands with soap after defecation was protective (RR=0.6, 95%CI: 0.4-0.9). Eighteen serum were positive for HEV. River water was filtered in sand filter and stored in overhead tank, but was never chlorinated. Factory tap water was used for cooking in canteen. Water samples from all three sites were positive for faecal coliforms. Conclusion: This HEV outbreak in factory A in Mandya district was probably due to drinking water from factory and eating from factory canteen. We recommend providing safe water for drinking and cooking by changing sand in filters, chlorination and periodic testing of water. We recommend promoting hand washing practices. [ABSTRACT FROM AUTHOR]