Hepatitis A outbreak in Italy, 2013: a matched case–control study

Montaño-Remacha, Carmen; Ricotta, Lara; Alfonsi, Valeria; Bella, Antonino; Tosti, Maria Elena; Ciccaglione, Anna Rita; Bruni, Roberto; Taffon, Stefania; Equestre, Michele; Losio, Marina Nadia; Carraro, Valter; Franchini, S; Natter, B; Augschiller, M; Foppa, Adelheid; Gualanduzzi, C; Massimiliani, Erika; Finarelli, A C; Borrini, Bianca Maria; Gallo, Tolinda; Cozza, Vanessa; Chironna, Maria; Prato, Rosa; Rizzo, Caterina

doi:10.2807/1560-7917.es2014.19.37.20906

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…The shift in the mean age in which 50% of the population possessed anti-HAV IgG was associated with several indicators, including higher socio-economic status as measured by the declining infant mortality rate, improved sanitation facilities and hygiene practices, and increased GDP per capita to support better living standards. It is envisioned that future seroprevalence will continue to decline due to lower HAV endemicity, although this will render the population susceptible to occasional outbreaks as seen in very low endemic and developed countries [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Declining Trend of Hepatitis A Seroepidemiology in Association with Improved Public Health and Economic Status of Thailand

et al. 2016

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Hepatitis A virus (HAV) is transmitted via the fecal-oral route from contaminated food or water. As part of the most recent survey of viral hepatitis burden in Thailand, we analyzed the current seroprevalence of HAV in the country and compared with data dating back to 1971. From March to October, 2014, a total of 4,260 individuals between one month and 71 years of age from different geographical regions (North = 961; Central = 1,125; Northeast = 1,109; South = 1,065) were screened for anti-HAV IgG antibody using an automated chemiluminescent microparticle immunoassay. Overall, 34.53% (1,471/4,260) possessed anti-HAV IgG antibody, and the age-standardized seroprevalence was 48.6%. Seroprevalence rates were 27.3% (North), 30.8% (Central), 33.8% (Northeast) and 45.8% (South) and were markedly lower than in the past studies especially among younger age groups. The overall trend showed an increase in the age by which 50% of the population were anti-HAV IgG antibody: 4.48 years (1971–1972), 6 (1976), 12.49 (1990), 36.02 (2004) and 42.03 (2014).This suggests that Thailand is transitioning from low to very low HAV endemicity. Lower prevalence of HAV correlated with improved healthcare system as measured by decreased infant mortality rate and improved national economy based on increased GDP per capita. The aging HAV immuno-naïve population may be rendered susceptible to potential HAV outbreaks similar to those in industrialized countries and may benefit from targeted vaccination of high-risk groups.

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Section: Discussionmentioning

confidence: 99%

Declining Trend of Hepatitis A Seroepidemiology in Association with Improved Public Health and Economic Status of Thailand

et al. 2016

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“…Local Health Services (LHS) were promptly alerted by the Ministry of Health, that established an enhanced surveillance including virus genotyping. Early epidemiological and laboratory investigations linked the outbreak to mixed frozen berries [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Key Role of Sequencing to Trace Hepatitis A Viruses Circulating in Italy During a Large Multi-Country European Foodborne Outbreak in 2013

et al. 2016

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BackgroundFoodborne Hepatitis A Virus (HAV) outbreaks are being recognized as an emerging public health problem in industrialized countries. In 2013 three foodborne HAV outbreaks occurred in Europe and one in USA. During the largest of the three European outbreaks, most cases occurred in Italy (>1,200 cases as of March 31, 2014). A national Task Force was established at the beginning of the outbreak by the Ministry of Health. Mixed frozen berries were early demonstrated to be the source of infection by the identity of viral sequences in patients and in food. In the present study the molecular characterization of HAV isolates from 355 Italian cases is reported.MethodsMolecular characterization was carried out by PCR/sequencing (VP1/2A region), comparison with reference strains and phylogenetic analysis.ResultsA unique strain was responsible for most characterized cases (235/355, 66.1%). Molecular data had a key role in tracing this outbreak, allowing 110 out of the 235 outbreak cases (46.8%) to be recognized in absence of any other link. The data also showed background circulation of further unrelated strains, both autochthonous and travel related, whose sequence comparison highlighted minor outbreaks and small clusters, most of them unrecognized on the basis of epidemiological data. Phylogenetic analysis showed most isolates from travel related cases clustering with reference strains originating from the same geographical area of travel.ConclusionsIn conclusion, the study documents, in a real outbreak context, the crucial role of molecular analysis in investigating an old but re-emerging pathogen. Improving the molecular knowledge of HAV strains, both autochthonous and circulating in countries from which potentially contaminated foods are imported, will become increasingly important to control outbreaks by supporting trace back activities, aiming to identify the geographical source(s) of contaminated food, as well as public health interventions.

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“…The multinational hepatitis A outbreaks occurring in Europe in 2013 and 2014 with over 1400 cases linked to fresh and frozen strawberries and berry mix evidenced the usefulness of virus sequencing to link sporadic cases reported in different EU/EEA countries in outbreaks [66,67]. However, due to different sequencing practices and protocols in EU/EEA countries, the interpretation of the sequencing results was often challenging and untimely.…”

Section: Discussionmentioning

confidence: 99%

Foodborne viruses

Bosch

Pintó

Guix

2016

Current Opinion in Food Science

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Among the wide variety of viral agents liable to be found as food contaminants, noroviruses and hepatitis A virus are responsible for most well characterized foodborne virus outbreaks. Additionally, hepatitis E virus has emerged as a potential zoonotic threat.Molecular methods, including an ISO standard, are available for norovirus and hepatitis A virus detection in foodstuffs, although the significance of genome copy detection with regard to the associated health risk is yet to be determined through viability assays.More precise and rapid methods for early foodborne outbreak investigation are being developed and they will need to be validated versus the ISO standard. In addition, protocols for next-generation sequencing characterization of outbreak-related samples must be developed, harmonized and validated as well.

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Hepatitis A outbreak in Italy, 2013: a matched case–control study

Abstract: Binary file ES_Abstracts_Final_ECDC.txt matches

Cited by 11 publications

References 18 publications

Declining Trend of Hepatitis A Seroepidemiology in Association with Improved Public Health and Economic Status of Thailand

Declining Trend of Hepatitis A Seroepidemiology in Association with Improved Public Health and Economic Status of Thailand

Key Role of Sequencing to Trace Hepatitis A Viruses Circulating in Italy During a Large Multi-Country European Foodborne Outbreak in 2013

Foodborne viruses

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