The global epidemiology of Hepatitis A outbreaks 2016-2018 and the utility of EpiWATCH as a rapid epidemic intelligence service

Dyah Ayu Shinta Lesmanawati,Chandini Raina Macintyre,Mohana Priya Kunasekaran,Dillon C Adam,Aye Moa,Elmira Hooshmand

doi:10.31646/gbio.100

Abstract

Hepatitis A (Hep A) can cause sporadic or epidemic disease and has been frequently linked to contamination of the global food chain. Global surveillance data on Hep A are unavailable, and in some countries, reporting is incomplete or not timely, either because of lack of human resources or sensitivities around reporting. The use of vast open-source data such as news-feeds and social media however can overcome barriers to surveillance and provide timely data on global epidemics. In this study we use EpiWATCH, semi-automated outbreak scanning service to review the global epidemiology of Hep A reports from 2016-2018. We reviewed the EpiWATCH Outbreak Alerts database for reports on the Hep A dated between August 1, 2016, to April 31, 2018 which was the analysed by outbreak clusters, location, and time. Of 5098 total entries in the database a total of 169 non-duplicate Hep A outbreak reports were found and included for descriptive analysis. The majority of outbreak reports (68.6%%; N=116/169) originated from the United States of America (USA). The largest Hep A outbreaks were multi-country outbreaks in the European region, and multistate outbreaks in the USA and Australia. Homelessness (mainly in US outbreaks) was the predominant risk factor (40.2%), followed by foodborne outbreaks (26.6%) and outbreaks in men who have sex with men (6.5%). Using EpiWATCH we found that the emergence of outbreaks in homeless people has dominated the epidemiology of Hep A in the U.S and this appears a relatively new phenomenon. Epidemic intelligence systems such as EpiWATCH are a useful proxy for global surveillance of Hep A outbreaks and using open-source data can provide epidemic intelligence and outbreak alerts where global data is unavailable.

Highlights

Hepatitis A (Hep A) is a common cause of global foodborne outbreaks [1]
This study aimed to describe the epidemiology of global Hep A outbreaks between 20162018 using data from EpiWATCH
Surveillance data on reported Hep A outbreaks was obtained from EpiWATCH, an open source epidemic observatory established by the Australian National Health and Medical Research Council’s (NHMRC) Centre for Research Excellence’s (CRE) Integrated Systems for Epidemic Response (ISER) in 2016 [19]

Summary

Introduction

Hepatitis A (Hep A) is a common cause of global foodborne outbreaks [1]. Outbreaks of Hep A infection can be sporadic or epidemic in nature, sometimes with cyclic recurrences [5]. A safe and effective vaccine exists, which has impacted the global epidemiology of Hep A infections since 1991 [7], and universal childhood vaccination programs have reduced incidence rates significantly [8, 9]. In the United States of America (USA), Hep A infection has declined substantially since 1995 when the vaccination was first approved for individuals at risk, and recommendations later expanded to include universal childhood vaccination [8]

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