Abstract
Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16–25801 and RIVM-HAV16–090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16–090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour.
Highlights
Hepatitis A (HA) is an acute liver disease caused by the hepatitis A virus (HAV) [1]
European Centre for Disease Prevention and Control (ECDC) convened a multistate outbreak investigation team in December 2016. We report on this Europe-wide investigation of a multistrain HA outbreak to describe its extent and its characteristics within affected EU/EEA countries and to identify strain-specific risk factors associated with transmission
Characteristics and exposures of hepatitis A cases during the 8 weeks preceding symptoms onset in multi-strain outbreak affecting predominantly men who have sex with men (MSM), 1 June 2016–31 May 2017, participating European Union/European Economic Area countries (n = 308)
Summary
Hepatitis A (HA) is an acute liver disease caused by the hepatitis A virus (HAV) [1]. Transmission is faecaloral via consumption of contaminated food or water or through direct person-to-person contact, including sexual contact ( oro-anal, digito-anal and genito-oral sex). The mean incubation period is 28 days (range: 15–50). Laboratory diagnosis is based on the detection of serological (anti-HAV IgM) or molecular (HAV RNA) markers of acute HAV infection. Preschool children are usually asymptomatic; most adults experience symptoms such as fever, diarrhoea and acute jaundice [2]. Fulminant hepatic failure and death are rare (0.3% of clinical cases) [3]
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