Abstract
Following the notification of nine hepatitis A cases clustered in the Cotes d Armor district in northwestern France, epidemiological, environmental and microbiological investigations were set up in order to identify the source and vehicle of contamination and implement control measures. In total, 111 cases were identified in the outbreak, all of whom lived or had stayed as tourists in the Cotes d Armor district. Of the cases, 87% had eaten raw shellfish, and 81% specifically oysters. Traceback investigations carried out on raw shellfish consumed by the cases showed that the raw shellfish originated from a single shellfish farm. The shellfish were probably contaminated either in the submersible tanks or in a depuration land-based tank where they were stored. The source of contamination was not identified but shellfish could have been tainted by sewage overflows or by wastewater releases from a polluted storm sewer close to the shellfish farm or from on-site sanitation facilities. To prevent future hepatitis A outbreaks due to shellfish consumption from this area, hazards specific to each farm should be analysed. Timely information on sewage overflows should also be part of communities efforts regarding sewage collection and treatment.
Highlights
Hepatitis A virus (HAV) is transmitted via the faecal-oral route by either person-to-person contact or consumption of contaminated food or water
The cases were identified through mandatory notification
We described a large hepatitis A outbreak which was the largest reported since the beginning of the mandatory notification in November 2005
Summary
Hepatitis A virus (HAV) is transmitted via the faecal-oral route by either person-to-person contact or consumption of contaminated food or water. The incubation period ranges from 15 to 50 days with a mean of 30 days. The disease is usually diagnosed by detection of immunoglobulin M antibodies to hepatitis A (IgM anti-HAV) in the serum. In France, surveillance of acute hepatitis A has been based on mandatory notification since November 2005. The notification form collects information on socio-demographic, clinical, biological characteristics and main at risk exposures to HAV infection. The incidence of reported cases of hepatitis A (notification rate) was 2.2/100,000 in 2006 and 1.6/100,000 in 2007 [1]
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