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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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Kareem N, Al-Salahat K, Bakri FG, Rayyan Y, Mahafzah A, Sallam M. Tracking the Epidemiologic Shifts in Hepatitis A Sero-Prevalence Using Age Stratification: A Cross-Sectional Study at Jordan University Hospital. Pathogens 2021; 10:pathogens10091081. [PMID: 34578114 PMCID: PMC8468970 DOI: 10.3390/pathogens10091081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
The study of hepatitis A virus (HAV) epidemiology and sero-prevalence has important public health implications. Changes in the epidemiology of hepatitis A can result in a larger pool of susceptible persons in countries with improved sanitation and hygienic conditions if vaccination is not provided. The aim of this study was to investigate the prevalence of HAV immunoglobulin G (IgG) in Jordan. In addition, we aimed to identify the potential differences in HAV sero-prevalence based on age, among other variables. We recruited the study participants at Jordan University Hospital in Amman, Jordan, during October 2020-June 2021. Assessment of participants' socio-demographic variables was done using a paper-based questionnaire. Testing for HAV IgG was based on a competitive enzyme linked immunosorbent assay (ELISA). The study population comprised 360 individuals with a median age of 18 years. The overall sero-prevalence of HAV in our study sample was 38.3%. Divided by age, the sero-prevalence of HAV was 8.2%, 12.3%, and 20.8% among individuals aged 10 years or less, 15 years or less, and 30 years or less, respectively. The estimated age at mid-population immunity was between 21 and 30 years. Besides age, individuals residing outside the Central region of Jordan had a significantly higher HAV sero-prevalence. Additionally, the use of filtered municipal water was associated with a lower sero-prevalence of HAV compared with the use of unfiltered municipal water among individuals aged 15 years or less. The results of this study suggest an intermediate to low endemicity of HAV in Jordan. An epidemiologic shift of HAV sero-prevalence with a declining rate of positivity for HAV IgG was noticed in this study. This highlights the importance of the recently introduced HAV vaccination in Jordan. Future research to evaluate the public health benefits of HAV vaccination in Jordan is recommended.
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Affiliation(s)
- Nariman Kareem
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
| | - Khaled Al-Salahat
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Faris G. Bakri
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (F.G.B.); (Y.R.)
- Infectious Diseases and Vaccine Center, The University of Jordan, Amman 11942, Jordan
| | - Yaser Rayyan
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (F.G.B.); (Y.R.)
- Gastroenterology and Liver Division, Department of Internal Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Azmi Mahafzah
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan; (N.K.); (K.A.-S.); (A.M.)
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
- Correspondence: ; Tel.: +962-79-184-5186
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Aboubakr H, Goyal S. Involvement of Egyptian Foods in Foodborne Viral Illnesses: The Burden on Public Health and Related Environmental Risk Factors: An Overview. FOOD AND ENVIRONMENTAL VIROLOGY 2019; 11:315-339. [PMID: 31560123 DOI: 10.1007/s12560-019-09406-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 09/18/2019] [Indexed: 05/18/2023]
Abstract
Foodborne viral diseases are a major public health threat and pose a huge burden on the economies of both developed and developing countries. Enteric viruses are the causative agents of most foodborne illnesses and outbreaks. Egypt is classified by WHO among the regions with intermediate to high endemicity for various enteric viruses. This is manifested by the high prevalence rates of different enteric virus infections among Egyptian population such as Hepatitis A and E viruses, human rotaviruses, human noroviruses, human astroviruses, and human adenovirus. Recently, a number of foodborne gastroenteritis and acute hepatitis outbreaks have occurred in the US, Canada, Australia, and the European Union countries. Some of these outbreaks were attributed to the consumption of minimally processed foods imported from Egypt indicating the possibility that Egyptian foods may also be partially responsible for high prevalence of enteric virus infections among Egyptian population. In the absence of official foodborne-pathogen surveillance systems, evaluating the virological safety of Egyptian foods is a difficult task. In this review, we aim to provide a preliminary evaluation of the virological safety of Egyptian foods. A comprehensive review of prevalence studies on enteric virus infections shows hyperendemicity of several enteric viruses in Egypt and provides strong evidence of implication of Egyptian foods in these infections. We also address possible environmental risk factors that may lead to the contamination of Egyptian foods with enteric viruses. In addition, we describe potential obstacles to any plan that might be considered for improving the virological safety of Egyptian foods.
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Affiliation(s)
- Hamada Aboubakr
- Department of Veterinary Population Medicine and Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Minnesota, 1333 Gortner Ave, St. Paul, MN, 55108, USA.
- Department of Food Science and Technology, Faculty of Agriculture, Alexandria University, El-Shatby, 21545, Alexandria, Egypt.
| | - Sagar Goyal
- Department of Food Science and Technology, Faculty of Agriculture, Alexandria University, El-Shatby, 21545, Alexandria, Egypt
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Gossner CM, Severi E, Danielsson N, Hutin Y, Coulombier D. Changing hepatitis A epidemiology in the European Union: new challenges and opportunities. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.16.21101] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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Affiliation(s)
- C M Gossner
- European Centre for Disease Prevention and Control (ECDC), Surveillance and Response Support Unit, Stockholm, Sweden
- These authors contributed equally to the paper
- School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - E Severi
- These authors contributed equally to the paper
- European Centre for Disease Prevention and Control (ECDC), Surveillance and Response Support Unit, Stockholm, Sweden
| | - N Danielsson
- European Centre for Disease Prevention and Control (ECDC), Surveillance and Response Support Unit, Stockholm, Sweden
| | - Y Hutin
- European Centre for Disease Prevention and Control (ECDC), Public Health Capacity and Communication, Stockholm, Sweden
| | - D Coulombier
- European Centre for Disease Prevention and Control (ECDC), Surveillance and Response Support Unit, Stockholm, Sweden
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Gossner CM, Severi E. Three simultaneous, food-borne, multi-country outbreaks of hepatitis A virus infection reported in EPIS-FWD in 2013: what does it mean for the European Union? Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.43.20941] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- C M Gossner
- European Centre for Disease Prevention and Control, Stockholm, Sweden
- School of Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Severi
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Wu D, Guo CY. Epidemiology and prevention of hepatitis A in travelers. J Travel Med 2013; 20:394-9. [PMID: 24165384 DOI: 10.1111/jtm.12058] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/11/2013] [Accepted: 06/14/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Hepatitis A is the second most common vaccine-preventable travel-associated infectious disease and hepatitis A virus (HAV) is the most common cause of viral hepatitis. The incidence of infection is closely related to sanitary conditions and the level of economic development. METHODS We evaluated HAV incidence, infection-related risk factors, and HAV vaccination rates in international travelers through retrospective analyses using major databases, such as CENTRAL, MEDLINE, EMBASE, and the current literature describing epidemiological data for HAV infection in recent years. RESULTS AND CONCLUSIONS We found that the incidence of HAV infection in developed countries is very low. As international travel increases, the incidence of hepatitis A among travelers remains high and likely leads to regional outbreaks. Travelers should visit the Centers for Disease Control and Prevention website or Infectious Disease Prevention Center of their countries to learn about the incidence of infectious diseases associated with their destination before going abroad to determine if they should be vaccinated.
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Affiliation(s)
- Dong Wu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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What causes hepatitis A in travellers to endemic countries? Travel is necessary but not sufficient--a risk factor, not a cause. Epidemiol Infect 2012; 140:1821-2. [PMID: 22300866 DOI: 10.1017/s0950268812000064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Outbreak of hepatitis A in an extended family after importation by non-immune travellers. Epidemiol Infect 2011; 140:1813-20. [PMID: 22142642 DOI: 10.1017/s0950268811002561] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The incidence of hepatitis A in England has declined in recent years, but travel-related cases and imported infections remain a challenge. We report an outbreak of hepatitis A in an extended family where two primary cases were infected while in Pakistan and two secondary cases were infected in England. All four were infected by the same genotype IIIA virus. Testing of the children in the extended family by dried blood spots (DBS) determined that three had evidence of recent past infections (anti-HAV IgM positive), one had a current asymptomatic infection (anti-HAV IgM and HAV RNA positive) and one was incubating the virus (anti-HAV IgM negative, HAV RNA positive). HAV RNA from the DBS was identical to the adult cases. This outbreak demonstrates secondary spread of hepatitis A by asymptomatic children after importation from abroad and highlights the importance of preventing travel-associated hepatitis A infection.
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Roque-Afonso AM, Desbois D, Dussaix E. Hepatitis A virus: serology and molecular diagnostics. Future Virol 2010. [DOI: 10.2217/fvl.10.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The diagnosis of hepatitis A virus (HAV) infection is based on the detection of anti-HAV IgM. Shortcomings of this serological approach include the persistence of IgM after normalization of liver enzymes or its detection during polyclonal activation of the immune system due to unrelated viral infection or autoimmune diseases. Molecular diagnosis of HAV along with anti-HAV IgG avidity measurement are helpful in case of positive IgM where laboratory evidence of acute hepatitis is absent and there is no epidemiologic link to other cases. Molecular epidemiology allows us to determine whether viruses from different locations are related to each other and provides further understanding of viral epidemiology by identifying sources and transmission modes. It has been demonstrated that the rapid turnover of HAV strains in low-endemicity countries is caused by their introduction by travelers. Growing sequence databases allow for the identification of geographic origin of viral strains. Collaboration between surveillance laboratories, including database sharing, should be promoted for deeper investigation of outbreaks and improved prevention approaches.
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Affiliation(s)
- Anne Marie Roque-Afonso
- Centre National de Référence pour les Virus à Transmission Entérique, AP-HP, Hôpital Paul Brousse, Laboratoire de Virologie, Villejuif, 94804, France
| | - Delphine Desbois
- Centre National de Référence pour les Virus à Transmission Entérique, AP-HP, Hôpital Paul Brousse, Laboratoire de Virologie, Villejuif, 94804, France
| | - Elisabeth Dussaix
- Centre National de Référence pour les Virus à Transmission Entérique, AP-HP, Hôpital Paul Brousse, Laboratoire de Virologie, Villejuif, 94804, France
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Mahboobi N, Safari S, Alavian SM. Hepatitis A virus in Middle East countries: More evidence needed. Arab J Gastroenterol 2010. [DOI: 10.1016/j.ajg.2010.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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