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Andani A, Bunge E, Kassianos G, Eeuwijk J, Mellou K, Van Damme P, Mukherjee P, Steffen R. Hepatitis A occurrence and outbreaks in Europe over the past two decades: A systematic review. J Viral Hepat 2023; 30:497-511. [PMID: 36825922 DOI: 10.1111/jvh.13821] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
Hepatitis A (HA) is a vaccine-preventable liver disease with >170 million new cases occurring yearly. In recent outbreaks in the USA, hospitalization and case-fatality ratios were >60% and ~1%, respectively. In Europe, endemicity persists and outbreaks continue to occur. We performed a systematic literature review to understand the changes in HA occurrence in Europe over the past two decades. PubMed and Embase were systematically searched for peer-reviewed articles published between 1 January 2001 and 14 April 2021 using terms covering HA, 11 selected European countries, outbreaks, outcomes and HA virus circulation. Here, we focus on HA occurrence and outbreaks in the five countries with the largest population and the most comprehensive vaccination recommendations: France, Germany, Italy, Spain and the UK; 118 reports included data for these five European countries. Notification rates (≤9.7/100,000 population) and percentages of men among cases (≤83.0%) peaked in 2017. The number of person-to-person-transmitted cases and outbreaks decreased in children but increased in other risk groups, such as men who have sex with men (MSM). Sexually transmitted outbreaks in MSM clustered around 2017. Travel-related outbreaks were few; the proportion of travel-related cases decreased during the past two decades, while the number of domestic cases increased. Despite the existing risk-based vaccination recommendations, HA transmission shifted in proportions from travelers and children to other risk groups, such as MSM and older age groups. Because a substantial proportion of the European population is susceptible to HA, adherence to existing recommendations should be monitored more closely, and enhanced vaccination strategies should be considered.
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Affiliation(s)
| | - Eveline Bunge
- Pallas Health Research and Consultancy, Rotterdam, the Netherlands
| | | | - Jennifer Eeuwijk
- Pallas Health Research and Consultancy, Rotterdam, the Netherlands
| | | | | | | | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, University of Zurich, Zurich, Switzerland.,Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas, Houston, Texas, USA
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Michaelis K, Poethko-Müller C, Kuhnert R, Stark K, Faber M. Hepatitis A virus infections, immunisations and demographic determinants in children and adolescents, Germany. Sci Rep 2018; 8:16696. [PMID: 30420608 PMCID: PMC6232152 DOI: 10.1038/s41598-018-34927-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/28/2018] [Indexed: 12/17/2022] Open
Abstract
Hepatitis A is a vaccine-preventable disease with a global distribution. It predominantly occurs in regions with inadequate living conditions, but also affects populations in industrialised countries. Children are frequently involved in the transmission of hepatitis A virus (HAV) and thus play a central role in the epidemiology of hepatitis A. Here, we investigated HAV infections, immunisations, and associated demographic determinants in a nationwide, population-based, cross-sectional survey conducted in Germany from 2003-2006. Out of 17,640 children and adolescents, complete data sets (HAV serology, demographic information and vaccination card) were available for 12,249 (69%), all aged 3-17 years. We found protective antibody levels (>=20 IU/L) in 1,755 (14%) individuals, 1,395 (11%) were vaccinated against hepatitis A, 360 (3%) individuals were HAV seropositive without prior hepatitis A vaccination, thus indicating a previous HAV infection. Antibody prevalence (attributable to vaccination or infection) increased significantly with age. Multivariate logistic regression revealed that predominantly children and adolescents with migration background-even if they were born in Germany-are affected by HAV infections. Our results provide a rationale to emphasise existing vaccination recommendations and, moreover, to consider additional groups with a higher risk of infection for targeted vaccination, especially children with a migration background.
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Affiliation(s)
- Kai Michaelis
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), D-13353, Berlin, Germany.
| | - Christina Poethko-Müller
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), D-12101, Berlin, Germany
| | - Ronny Kuhnert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), D-12101, Berlin, Germany
| | - Klaus Stark
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), D-13353, Berlin, Germany
| | - Mirko Faber
- Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), D-13353, Berlin, Germany
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Brook G, Bhagani S, Kulasegaram R, Torkington A, Mutimer D, Hodges E, Hesketh L, Farnworth S, Sullivan V, Gore C, Devitt E, Sullivan AK. United Kingdom National Guideline on the Management of the viral hepatitides A, B and C 2015. Int J STD AIDS 2016; 27:501-25. [PMID: 26745988 DOI: 10.1177/0956462415624250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/01/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Gary Brook
- London North West Healthcare NHS Trust, London, UK
| | | | | | | | - David Mutimer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Louise Hesketh
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Simon Farnworth
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | - Emma Devitt
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ann K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Seo JY, Choi BY, Ki M, Jang HL, Park HS, Son HJ, Bae SH, Kang JH, Jun DW, Lee JW, Hong YJ, Kim YS, Kim CH, Chang UI, Kim JH, Yang HW, Kim HS, Park KB, Hwang JS, Heo J, Kim IH, Kim JS, Cheon GJ. Risk factors for acute hepatitis A infection in Korea in 2007 and 2009: a case-control study. J Korean Med Sci 2013; 28:908-14. [PMID: 23772157 PMCID: PMC3678009 DOI: 10.3346/jkms.2013.28.6.908] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/09/2013] [Indexed: 11/29/2022] Open
Abstract
This study aimed to identify the risk factors associated with acute hepatitis A virus (HAV) infection in the Korean population. Participants were recruited from five referral hospitals across the country in 2007 and from 11 hospitals in 2009. Patients with positive anti-HAV IgM antibody tests became the case group, while patients treated for non-contagious diseases at the same hospitals were recruited as controls. A total of 222 and 548 case-control pairs were studied in the 2007 and 2009 surveys, respectively. Data from the surveys were analyzed jointly. In a multivariate analysis, sharing the household with HAV-infected family members (OR, 6.32; 95% CI, 1.4-29.6), contact with other HAV-infected individuals (OR, 4.73; 95% CI, 2.4-9.4), overseas travel in 2007 (OR, 19.93; 95% CI, 2.3-174.4), consumption of raw shellfish (OR, 2.51; 95% CI, 1.8-3.5), drinking bottled water (OR, 1.64; 95% CI, 1.3-8.4), and occupation that involve handling food (OR, 3.30; 95% CI, 1.3-8.4) increased the risk of HAV infection. Avoiding contact with HAV-infected individuals and avoiding raw foods eating could help minimize the risk of hepatitis A infection. Immunization must be beneficial to individuals who handle food ingredients occupationally or travel overseas to HAV-endemic areas.
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Affiliation(s)
- Joo Youn Seo
- Department of Preventive Medicine/Institute of Community Health, Hanyang University, College of Medicine, Seoul, Korea
| | - Bo Youl Choi
- Department of Preventive Medicine/Institute of Community Health, Hanyang University, College of Medicine, Seoul, Korea
| | - Moran Ki
- Department of Preventive Medicine, Eulji University, School of Medicine, Daejeon, Korea
| | - Hye Lim Jang
- Department of Preventive Medicine/Institute of Community Health, Hanyang University, College of Medicine, Seoul, Korea
| | - Hee Suk Park
- Department of Preventive Medicine/Institute of Community Health, Hanyang University, College of Medicine, Seoul, Korea
| | - Hyun Jin Son
- Division of Public Health Crisis Response, Korea Centers for Disease Control and Prevention, Cheongwon, Korea
| | - Si Hyun Bae
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Han Kang
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Young Jin Hong
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chang-Hwi Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - U Im Chang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | | | - Hong Soo Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Kyeong Bae Park
- Department of Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jae Seok Hwang
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong Heo
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - In Hee Kim
- Department of Internal Medicine, Chonbuk National Unversity Medical School and Hospital, Jeonju, Korea
| | - Jung Soo Kim
- Department of Pediatrics, Chonbuk National Unversity Medical School and Hospital, Jeonju, Korea
| | - Gab Jin Cheon
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Use of PCR for detection of faecal HAV as a screening tool in an outbreak of hepatitis A in daycare centres. Epidemiol Infect 2012; 141:549-55. [PMID: 22584109 DOI: 10.1017/s0950268812000854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Using polymerase chain reaction (PCR) to detect faecal hepatitis A virus (HAV) can be a useful tool for investigating HAV outbreaks, especially in low-endemic countries. We describe the use of faecal HAV PCR as a non-invasive tool for screening. Two Dutch children visiting different daycare centres were diagnosed with hepatitis A in 2011. A systematic contact investigation was started in the daycare centres and relevant contacts were screened. The faecal HAV PCR test was used to screen the children. The employees were screened with a serum IgM. The faecal HAV PCR test proved to be an appropriate tool for screening. The screening of a total of 135 children and employees in the daycare centres resulted in evidence of eight asymptomatic infections and transmission to three related daycare centres. Control measures were taken including immunization. Compared to an epidemiological investigation without screening, 144 extra contacts were vaccinated based on the screening results. This most likely led to improved prevention of expansion of the outbreak.
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Abstract
SUMMARYBetween March and June 2008, 12 cases of hepatitis A were notified in Winchester. Cases were from a primary school and a nursery school with no direct linkage. Hepatitis A virus (HAV) RNA sequenced from nine cases confirmed the strain in both schools to be identical. The outbreak could have affected three other schools and a maternity unit and was controlled by immunization and screening of neonates in the maternity unit by dried blood spots. No neonates were infected and no further cases were reported until 5 months later when the index case's mother became infected with same strain of virus associated with the outbreak despite vaccination. Neither the source of the outbreak or the subsequent infection of the index case's mother was identified; however, with the timing of the cases continued transmission in the community by children with asymptomatic infection or a recurrent source cannot be ruled out.
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Epidemiological and genetic analysis of a sustained community-wide outbreak of hepatitis A in the Republic of Korea, 2008: A hospital-based case–control study. J Clin Virol 2009; 46:184-8. [DOI: 10.1016/j.jcv.2009.07.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 07/01/2009] [Accepted: 07/15/2009] [Indexed: 11/15/2022]
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