Abstract
Hepatitis A is a mandatory notifiable disease in Greece. Here, we present the epidemiological data for 2009-2018 and the results of outbreak investigations performed, and discuss future public health priorities.Overall, 1193 cases were reported; 320 migrants/refugees, 240 Roma, 112 travellers and 521 from the general population. The median age of the affected general population (37 years) had an increasing trend (from 30.8 years in 2009 to 40.5 in 2018, P < 0.001) and was significantly higher than that among Roma and migrants (7 and 8 years, respectively, P < 0.001). Twenty-two cases (2.2%) were unvaccinated patients with a chronic liver disease. Fifty clusters with 2-12 cases each were recorded; 44 were attributed to person-to-person transmission and six to food consumption. Three outbreaks accounting for 32.3% of the total number of recorded cases were identified; in 2013 among Roma (112 cases), in 2016 among refugees (188 cases) and in 2017 among men having sex with men (96 cases; 33 of them (34.4%) HIV-positive). The epidemiological data depict that improving living conditions and vaccination coverage of deprived populations, and informing adults on the disease focusing at faecal-oral transmission during sexual intercourse and travel should be the future public health priorities.
Highlights
Hepatitis A is an acute liver disease caused by the hepatitis A virus (HAV)
According to the latest reported data of the European Centre for Disease Prevention and Control, the mean notification rate reported by the European Union and European Economic Area (EU/EEA) countries was 3.03 cases per 100 000 population for the year 2018 [2]
The aim of this article is to summarise the available epidemiological data of HAV disease in the country over the period 2009– 2018, discuss the factors that led to the occurrence of outbreaks at specific groups of the population, and define priorities for future public health action
Summary
Hepatitis A is an acute liver disease caused by the hepatitis A virus (HAV). According to the latest reported data of the European Centre for Disease Prevention and Control, the mean notification rate reported by the European Union and European Economic Area (EU/EEA) countries was 3.03 cases per 100 000 population for the year 2018 [2]. Data indicate that even though the notification rate in Europe is low, the disease occurs at higher ages compared to the past, increasing the chance for potentially large outbreaks in older non-immunised individuals [3]. In 2017, notification rate was doubled compared to 2016 mainly due to the occurrence of a large European HAV outbreak disproportionately affecting men who have sex with men (MSM) [4]
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