Abstract
IntroductionUniversal vaccination of toddlers has led to very low hepatitis A (HAV) endemicity in Israel. However, sporadic outbreaks still occur, necessitating better surveillance.AimTo implement a comprehensive HAV surveillance programme.MethodsIn 2017 and 2018, sera from suspected HAV cases that tested positive for anti-HAV IgM antibodies were transferred to the Central Virology Laboratory (CVL) for molecular confirmation and genotyping. Sewage samples were collected in Israel and Palestine* and were molecularly analysed. All molecular (CVL), epidemiological (District Health Offices and Epidemiological Division) and clinical (treating physicians) data were combined and concordantly assessed.ResultsOverall, 146 cases (78 in 2017 and 68 in 2018, median age 34 years, 102 male) and 240 sewage samples were studied. Most cases (96%) were unvaccinated. In 2017, 89% of cases were male, 45% of whom were men who have sex with men (MSM). In 2018, 49% were male, but only 3% of them were MSM (p < 0.01). In 2017, 82% of cases and 63% of sewage samples were genotype 1A, phylogenetically associated with a global MSM-HAV outbreak. In 2018, 80% of cases and 71% of sewage samples were genotype 1B, related to the endemic strain previously identified in Israel and Palestine*. Environmental analysis revealed clustering of sewage and cases’ sequences, and country-wide circulation of HAV.ConclusionsMolecular confirmation of HAV infection in cases and analysis of environmental samples, combined with clinical and epidemiological investigation, may improve HAV surveillance. Sequence-based typing of both clinical and sewage-derived samples could assist in understanding viral circulation.
Highlights
Universal vaccination of toddlers has led to very low hepatitis A (HAV) endemicity in Israel.sporadic outbreaks still occur, necessitating better surveillance
Genotype 3A has been reported in India and the Central Asian Republics of the former Soviet Union [13], while specific strains of genotype 1A were recently linked to a global Hepatitis A virus (HAV) outbreak among men who have sex with men (MSM) [6,7,8,9]
Molecular analysis revealed that all grey zone samples (n = 41) were HAV RNA negative
Summary
Universal vaccination of toddlers has led to very low hepatitis A (HAV) endemicity in Israel.sporadic outbreaks still occur, necessitating better surveillance. As well as in the United States (US) and other countries with effective sanitation and hygiene practices, HAV endemicity is low and the antiHAV vaccine—which was, for example, approved by the US Food and Drug Administration in 1995 [2]—is most often recommended to individuals at increased risk of infection and to cases’ contacts [3]. In such countries, non-vaccinated adults remain susceptible to HAV and in recent years, outbreaks have become more frequent [4]
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