Abstract
From September to November 2008, 34 cases of hepatitis A imported from Egypt were reported to the German public health authorities. Investigations point to a continuing common source of infection, most likely linked to Nile river cruises. The patients affected had not been vaccinated, which emphasises the need for more effective travel advice before trips to hepatitis A endemic countries.
Highlights
Following the French notification in the Early Warning and Response System (EWRS) on 15 October 2008 about an increase of hepatitis A cases in travellers returning from Egypt and possibly related to cruises on the Nile, the Belgian health authorities were alerted in order to verify whether a similar increase had been observed in Belgium
A confirmed case was defined as a clinically compatible case with IgM hepatitis A serology, with disease onset between 1 September and 30 November 2008 and with a history of travel to Egypt between 2 to 6 weeks prior to symptom onset
A limited epidemiological investigation was performed in order to verify a possible link between the Belgian cases and the possible sources, mentioned by name in the French alert
Summary
Following the French notification in the Early Warning and Response System (EWRS) on 15 October 2008 about an increase of hepatitis A cases in travellers returning from Egypt and possibly related to cruises on the Nile, the Belgian health authorities were alerted in order to verify whether a similar increase had been observed in Belgium. A large outbreak of hepatitis A among travellers to Egypt in 2004 has been described to be associated with the consumption of orange juice [4]. Hepatitis A is endemic in Egypt and import of hepatitis A from endemic countries is common in Belgium, as it was the case in at least 14% of the hepatitis A notifications in Flanders in 2008. Over the last twenty years the prevalence of hepatitis A in Belgium shifted from intermediate to low, which makes the population more prone to clusters or outbreaks. International and Belgian travel medicine guidelines recommend hepatitis A vaccination of travellers to hepatitis A endemic countries [1]
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