Abstract
In May 2013, Italy declared a national outbreak of hepatitis A, which also affected several foreign tourists who had recently visited the country. Molecular investigations identified some cases as infected with an identical strain of hepatitis A virus subgenotype IA. After additional European Union/European Economic Area (EU/EEA) countries reported locally acquired and travel-related cases associated with the same outbreak, an international outbreak investigation team was convened, a European outbreak case definition was issued and harmonisation of the national epidemiological and microbiological investigations was encouraged. From January 2013 to August 2014, 1,589 hepatitis A cases were reported associated with the multistate outbreak; 1,102 (70%) of the cases were hospitalised for a median time of six days; two related deaths were reported. Epidemiological and microbiological investigations implicated mixed frozen berries as the vehicle of infection of the outbreak. In order to control the spread of the outbreak, suspected or contaminated food batches were recalled, the public was recommended to heat-treat berries, and post-exposure prophylaxis of contacts was performed. The outbreak highlighted how large food-borne hepatitis A outbreaks may affect the increasingly susceptible EU/EEA general population and how, with the growing international food trade, frozen berries are a potential high-risk food.
Highlights
Hepatitis A virus (HAV) is a hepatovirus of the Picornaviridae family with a linear single-stranded genome of 7,500 nucleotides [1]
From 1 January 2013 to 31 August 2014, a total of 1,589 hepatitis A (HA) cases were reported as associated with this outbreak from 13 European Economic Area (EU/EEA) countries (Figure 1, Figure 2); most of the cases (n = 1,438; 90%) were reported in Italy
Ireland and Norway each reported around 30 cases and all other countries reported fewer cases, with Austria, Bulgaria and Denmark each reporting a single case associated with this outbreak
Summary
Hepatitis A virus (HAV) is a hepatovirus of the Picornaviridae family with a linear single-stranded genome of 7,500 nucleotides (nt) [1]. HAV mutation rate is low and its genome is relatively conserved over time [2]. Six HAV genotypes have been defined: genotypes I to III infect humans and are divided in subgenotypes A and B. Subgenotype IA is the predominant subgenotype circulating in Europe [1,3]. HAV is generally transmitted to humans through the faecal–oral route. The hepatitis A (HA) incubation period is approximately 28–30 days (range: 15–50). The disease, acute and generally self-limiting, affects the liver and is characterised by fever, diarrhoea and
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