Abstract
From January to June 2018, two ongoing hepatitis A outbreaks affected travellers returning from Morocco and cases in Europe without travel history, resulting in 163 patients in eight European countries. Most interviewed travel-related cases were unaware of the hepatitis A risk in Morocco. Molecular analysis revealed two distinct hepatitis A virus (HAV) strains (subgenotype IA DK2018_231; subgenotype IB V18–16428). Vaccination recommendations should be emphasised to increase awareness among non-immune travellers to Morocco and HAV-endemic countries.
Highlights
We report on two distinct hepatitis A virus strains that are causing cases in travellers returning from Morocco and autochthonous cases in several European countries between 1 January and 18 June 2018
The epidemiological link to Morocco is more apparent in cluster IB, where the majority of cases had confirmed travelling to Morocco and all interviewed autochthonous cases had reported consuming food items brought home from there
In order to better reach individuals travelling to endemic countries, we propose engaging travel companies and airlines to inform and remind travellers about vaccination recommendations, as has been suggested by others [16,18]
Summary
The occurrence of the two concurrent HAV clusters in the first 6 months of 2018 serve as a reminder of the risk of contracting hepatitis A in Morocco, a country with intermediate endemicity [4,5]. The large proportion of autochthonous cases and their spatial distribution in this cluster suggest that an imported food item may have served as the vehicle in this outbreak. All of the eight countries where cases occurred have explicit recommendations of hepatitis A vaccination for travel to endemic countries, in accordance with World Health Organization (WHO) recommendations [14,15]. It appears that it is not uncommon for people to travel unvaccinated to HAV-endemic countries. Interviews with the German cases have rendered similar results, suggesting that there may be an information gap regarding both the risk of hepatitis A and the availability of a safe and effective vaccine
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
