Two concurrent outbreaks of hepatitis A highlight the risk of infection for non-immune travellers to Morocco, January to June 2018

Martyna Gassowski; Kai Michaelis; Jürgen J Wenzel; Mirko Faber; Julie Figoni; Lina Mouna; Ingrid Hm Friesema; Harry Vennema; Ana Avellon; Carmen Varela; Lena Sundqvist; Josefine Lundberg Ederth; James Plunkett; Koye Balogun; Siew Lin Ngui; Sofie Elisabeth Midgley; Sofie Gillesberg Lassen; Luise Müller

doi:10.2807/1560-7917.ES.2018.23.27.1800329

Two concurrent outbreaks of hepatitis A highlight the risk of infection for non-immune travellers to Morocco, January to June 2018

Euro Surveill. 2018 Jul;23(27):1800329. doi: 10.2807/1560-7917.ES.2018.23.27.1800329.

Authors

Martyna Gassowski^{1

2

3

4}, Kai Michaelis^{1

5}, Jürgen J Wenzel^{1

6}, Mirko Faber⁵, Julie Figoni⁷, Lina Mouna⁸, Ingrid Hm Friesema⁹, Harry Vennema¹⁰, Ana Avellon¹¹, Carmen Varela¹², Lena Sundqvist¹³, Josefine Lundberg Ederth¹⁴, James Plunkett¹⁵, Koye Balogun¹⁵, Siew Lin Ngui¹⁵, Sofie Elisabeth Midgley¹⁶, Sofie Gillesberg Lassen¹⁷, Luise Müller¹⁷

Affiliations

¹ These authors contributed equally to this work.
² Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany.
³ Postgraduate Training for Applied Epidemiology (PAE, German Field Epidemiology Training Programme), Robert Koch Institute, Berlin, Germany.
⁴ European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
⁵ Department for Infectious Disease Epidemiology, Unit of Gastrointestinal Infections, Zoonoses, and Tropical Infections, Robert Koch Institute (RKI), Berlin, Germany.
⁶ National Consultant Laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Centre Regensburg, Regensburg, Germany.
⁷ Santé Publique France, French National Public Health Agency, Saint-Maurice, France.
⁸ AP-HP, National Reference Centre for Enterically Transmitted Hepatitis Viruses, Paul Brousse hospital, Villejuif, France.
⁹ Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
¹⁰ Centre for Infectious Diseases Research, Diagnostics and Screening, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
¹¹ Hepatitis Unit, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
¹² National Centre of Epidemiology, Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain.
¹³ Department of Communicable Disease Control and Health Protection, the Public Health Agency of Sweden, Stockholm, Sweden.
¹⁴ Department of Microbiology, the Public Health Agency of Sweden, Stockholm, Sweden.
¹⁵ National Infection Service, Public Health England, London, United Kingdom.
¹⁶ Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark.
¹⁷ Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.

PMID: 29991381
PMCID: PMC6152161
DOI: 10.2807/1560-7917.ES.2018.23.27.1800329

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.

Keywords: food-borne infections; hepatitis A; hepatitis A virus; imported viral diseases; outbreaks; travel.

MeSH terms

Adult
Disease Outbreaks*
Europe / epidemiology
Female
Hepatitis A / diagnosis*
Hepatitis A / epidemiology
Hepatitis A / virology
Hepatitis A virus / classification
Hepatitis A virus / genetics
Hepatitis A virus / isolation & purification*
Humans
Male
Morocco
Travel*
Vaccination