Abstract

Between March and May 2013, three multi-country outbreaks of hepatitis A virus (HAV) infection were reported through the Epidemic Intelligence Information System for Food- and Water-borne diseases (EPIS-FWD) of the European Centre for Disease Prevention and Control (ECDC). The aim of this work is to put these outbreaks into a European Union (EU) and European Economic Area (EEA) perspective and highlight opportunities for improving detection and investigation of such outbreaks. Although HAV outbreaks are not unusual in the EU/EEA, having three large food-borne multi-country outbreaks declared within three months is an unexpected event, particularly when at least two of these outbreaks are associated with frozen berries. Factors influencing the occurrence of these events include the increased number of susceptible Europeans, the limited coverage of HAV vaccination, the global trade of potentially contaminated products introduced in the EU/EEA, and the 'awareness chain effect' leading to a wave of notifications. Further studies should be conducted to understand the risk posed by frozen berries. Laboratory capacity and surveillance of viral infections in the EU/EEA, as well as HAV vaccination recommendations to travellers to endemic countries should be strengthened. Finally, timely reporting food-borne events through EPIS-FWD, to ensure timely response.

Highlights

  • Between March and May 2013, three multi-country outbreaks of hepatitis A virus (HAV) infection were reported through the Epidemic Intelligence Information System for Food- and Water-borne diseases (EPIS-FWD) of the European Centre for Disease Prevention and Control (ECDC)

  • HAV outbreaks are not unusual in the European Union (EU)/Economic Area (EEA), having three large food-borne multi-country outbreaks declared within three months is an unexpected event, when at least two of these outbreaks are associated with frozen berries

  • Factors influencing the occurrence of these events include the increased number of susceptible Europeans, the limited coverage of HAV vaccination, the global trade of potentially contaminated products introduced in the EU/EEA, and the ‘awareness chain effect’ leading to a wave of notifications

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Summary

Food investigations

17 April 2013 Norway reports an outbreak in travellers returning from Egypt in EPIS-FWD. Estonia, Finland, France, Germany, Ireland, Latvia, Lithuania, Norway, Slovakia, Sweden, Switzerland, the Netherlands and the United Kingdom. As of 27 July, there were more than cases reported since 1 October 2012. 50% female, median age 36 years old. 61% female, median age 23 years old. 50% female, median age 36 years old. majority in Italy

Trawling questionnaire and case
Is there a link between these outbreaks?
Is this situation unusual or unexpected?
Findings
Avenues to prevent recurrence of similar HAV outbreaks

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