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Elmahdy EM, Shaheen MNF, Mahmoud LHI, Hammad IA, Soliman ERS. Detection of Norovirus and Hepatitis A Virus in Strawberry and Green Leafy Vegetables by Using RT-qPCR in Egypt. FOOD AND ENVIRONMENTAL VIROLOGY 2022; 14:178-189. [PMID: 35246828 DOI: 10.1007/s12560-022-09516-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
There is an upward trend of consumption of organic fresh vegetables due to consumer demand for healthy foods without chemical additives. On the other hand, the number of food borne outbreaks associated with contaminated fresh produce has raised, being human norovirus genogroup I (GI), GII and hepatitis A virus (HAV) the most commonly reported causative agents. This study aimed to detect the presence of these viruses in green leafy vegetables (watercress, leek, coriander, and parsley) and strawberry using quantitative reverse transcription polymerase chain reaction (RT-qPCR). Samples were collected from the Egyptian regions of Kalubia, Giza, and Mansoura. Overall HAV average occurrence in fresh strawberry was 48% with a mean concentration of 6.1 × 103 GC/g; Also NoV GI overall average occurrence was 25% with a mean concentration of 9.7 × 102 genome copies (GC)/g, while NoV GII was 40% with a mean concentration of 2.4 × 103 GC/g. For strawberry collected directly from Kalubia farms, neither HAV nor HNoV GI & GII were detected. In green leafy vegetable samples, the occurrence of HAV was 31.2% with a mean concentration of 9.2 × 104 GC/g, while occurrence of NoV GI and NoV GII were 20% and 30% with a mean concentrations of 1.1 × 104 and 2.03 × 103 GC/g, respectively. In conclusion, the importance of a virus surveillance program for soft fruits and fresh vegetables is highlighted by the outcomes of this study. Our findings should help with the management and control of microbial concerns in fresh foods, reducing the danger of consuming contaminated foods.
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Affiliation(s)
- Elmahdy M Elmahdy
- Environmental Virology Laboratory, Water Pollution Research Department, Environmental and Climate Change Research Institute, National Research Centre, Dokki, 12622, Giza, Egypt.
| | - Mohamed N F Shaheen
- Environmental Virology Laboratory, Water Pollution Research Department, Environmental and Climate Change Research Institute, National Research Centre, Dokki, 12622, Giza, Egypt
| | - Lamiaa H I Mahmoud
- Environmental Virology Laboratory, Water Pollution Research Department, Environmental and Climate Change Research Institute, National Research Centre, Dokki, 12622, Giza, Egypt
- Genetics and Molecular Biology Unit, Botany and Microbiology Department, Faculty of Science Helwan University, Helwan University, Helwan, Egypt
| | - Ibtisam A Hammad
- Genetics and Molecular Biology Unit, Botany and Microbiology Department, Faculty of Science Helwan University, Helwan University, Helwan, Egypt
| | - Elham R S Soliman
- Genetics and Molecular Biology Unit, Botany and Microbiology Department, Faculty of Science Helwan University, Helwan University, Helwan, Egypt
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Ruscher C, Faber M, Werber D, Stark K, Bitzegeio J, Michaelis K, Sagebiel D, Wenzel JJ, Enkelmann J. Resurgence of an international hepatitis A outbreak linked to imported frozen strawberries, Germany, 2018 to 2020. ACTA ACUST UNITED AC 2021; 25. [PMID: 32945256 PMCID: PMC7502883 DOI: 10.2807/1560-7917.es.2020.25.37.1900670] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Following outbreaks linked to frozen strawberries in Sweden and Austria in 2018, 65 cases linked to the same hepatitis A virus strain were detected in Germany between October 2018 and January 2020, presenting in two waves. Two case–control studies and a comparison of cases’ consumption frequencies with purchase data from a large consumer panel provided strong evidence for frozen strawberry cake as the main vehicle of transmission. Of 46 cases interviewed, 27 reported consuming frozen strawberry cake and 25 of these identified cake(s) from brand A spontaneously or in product picture-assisted recall. Trace back investigations revealed that the Polish producer involved in the previous outbreaks in Sweden and Austria had received frozen strawberries from Egypt via a wholesaler that also delivered frozen strawberries to manufacturer of brand A. Phylogenetic analyses linked the outbreak strain to similar strains formerly isolated from sewage, stool and strawberries in Egypt. Complete trace back and timely recall of products with strong evidence of contamination is important to control an outbreak and prevent later resurgence, particularly for food items with a long shelf life. Continued molecular surveillance of hepatitis A is needed to identify outbreaks and monitor the success of food safety interventions.
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Affiliation(s)
- Claudia Ruscher
- State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
| | - Mirko Faber
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - Dirk Werber
- State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
| | - Klaus Stark
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - Julia Bitzegeio
- State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
| | - Kai Michaelis
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - Daniel Sagebiel
- State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
| | - Jürgen J Wenzel
- National Consultant Laboratory for Hepatitis A Virus and Hepatitis E Virus, Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - Julia Enkelmann
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
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Mollers M, Boxman ILA, Vennema H, Slegers-Fitz-James IA, Brandwagt D, Friesema IH, Batstra JS, Te Wierik MJM. Successful Use of Advertisement Pictures to Assist Recall in a Food-Borne Hepatitis A Outbreak in The Netherlands, 2017. FOOD AND ENVIRONMENTAL VIROLOGY 2018; 10:272-277. [PMID: 29728977 PMCID: PMC6096949 DOI: 10.1007/s12560-018-9347-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/25/2018] [Indexed: 05/04/2023]
Abstract
This study describes an outbreak investigation of 14 hepatitis A cases in the Netherlands. The hepatitis A virus (HAV) genotype IB sequences in cases were highly similar (459/460 nt). The origin of strains could be narrowed to Bulgaria based on information from EPIS-FWD. As an association with consumption of soft fruit was suspected, a case-control study was initiated using a questionnaire and a list of pictures of soft fruit available at the supermarket chain involved. Twelve out of 13 cases consumed a specific frozen raspberry/blueberry product shown on the list (OR 46.0, 95% CI 5.0-27). In multivariable regression analysis this product was the only risk factor (aOR 26.6, 95% CI 2.0-263). Laboratory analyses could not demonstrate HAV-RNA in batches that had been on the market in the incubation period of patients. Trace back of frozen fruit showed that raspberries had been traded by a producer in Bulgaria. After withdrawal of the product from the supermarket no new cases were reported. Use of advertisement pictures of consumed food was helpful in this investigation. Suspicion of the source was strengthened by data from molecular typing and food trace back activities, underlining the importance of good (inter)national cooperation between public health and food safety organisations.
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Affiliation(s)
- Madelief Mollers
- National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands.
- European Programme for Intervention Epidemiology Training (EPIET), ECDC, Tomtebodavägen 11a, 171 65, Solna, Sweden.
| | - Ingeborg L A Boxman
- Laboratory for Feed and Food Safety, Netherlands Food and Consumer Product Safety Authority (NVWA), Catharijnesingel 59, 3511 GG, Utrecht, The Netherlands
| | - Harry Vennema
- Infectious Diseases, Research, Diagnostics and Screening, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands
| | - Ife A Slegers-Fitz-James
- Incidence and Crisis Centre, Netherlands Food and Consumer Product Safety Authority (NVWA), Catharijnesingel 59, 3511 GG, Utrecht, The Netherlands
| | - Diederik Brandwagt
- European Programme for Intervention Epidemiology Training (EPIET), ECDC, Tomtebodavägen 11a, 171 65, Solna, Sweden
- Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands
| | - Ingrid H Friesema
- Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands
| | - Jenny S Batstra
- Incidence and Crisis Centre, Netherlands Food and Consumer Product Safety Authority (NVWA), Catharijnesingel 59, 3511 GG, Utrecht, The Netherlands
| | - Margreet J M Te Wierik
- National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3720 BA, Bilthoven, The Netherlands
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Zhou Z, Zuber S, Cantergiani F, Butot S, Li D, Stroheker T, Devlieghere F, Lima A, Piantini U, Uyttendaele M. Inactivation of viruses and bacteria on strawberries using a levulinic acid plus sodium dodecyl sulfate based sanitizer, taking sensorial and chemical food safety aspects into account. Int J Food Microbiol 2017; 257:176-182. [PMID: 28668727 DOI: 10.1016/j.ijfoodmicro.2017.06.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/16/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
The efficacy of levulinic acid (LVA) in combination with sodium dodecyl sulfate (SDS) in removal of foodborne viruses, enteric bacterial pathogens and their surrogates on fresh strawberries was investigated. Inoculated strawberries were treated with potable water, sodium hypochlorite solution (50ppm), 0.5% LVA plus 0.5% SDS solution, and 5% LVA plus 2% SDS solution respectively for 2min, followed by spray-rinsing with potable water. Water washing removed at least 1.0-log of the tested viral and bacterial strains from the strawberries' surfaces. The 50ppm chlorine wash induced 3.4, 1.5 and 2.1-log reductions for hepatitis A virus (HAV), murine norovirus-1 (MNV-1) and MS2 bacteriophage, respectively. In comparison, the tested bacterial strains showed uniform reductions around 1.6-log CFU/ml. The 0.5% LVA plus 0.5% SDS wash induced 2.7, 1.4 and 2.4-log reductions for HAV, MNV-1 and MS2, which were comparable with the reductions induced by chlorine (P>0.05). For bacteria, over 2.0-log reductions were obtained for Enterococcus faecium, Listeria monocytogenes and Salmonella, while Escherichia coli O157:H7 and Escherichia coli P1 showed reductions of 1.9 and 1.8-log CFU/ml. Higher concentration of LVA plus SDS showed no significantly higher reductions (P>0.05). Sensory tests of washed strawberries and chemical residue analysis of LVA on strawberries after washing were also performed. In conclusion, this study demonstrates good performance of 0.5% LVA plus 0.5% SDS to reduce the levels of enteric pathogens if present on strawberries without altering taste and introducing chemical safety issues.
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Affiliation(s)
- Zijin Zhou
- Laboratory of Food Microbiology and Food Preservation, Faculty of Bioscience Engineering, Ghent University, Coupure links 653, B-9000 Ghent, Belgium.
| | - Sophie Zuber
- Nestlé Research Centre, Food Safety & Quality Competence Pillar, 1000 Lausanne 26, Switzerland
| | - Frédérique Cantergiani
- Nestlé Research Centre, Food Safety & Quality Competence Pillar, 1000 Lausanne 26, Switzerland
| | - Sophie Butot
- Nestlé Research Centre, Food Safety & Quality Competence Pillar, 1000 Lausanne 26, Switzerland
| | - Dan Li
- Laboratory of Food Microbiology and Food Preservation, Faculty of Bioscience Engineering, Ghent University, Coupure links 653, B-9000 Ghent, Belgium
| | - Thomas Stroheker
- Nestlé Research Centre, Food Safety & Quality Competence Pillar, 1000 Lausanne 26, Switzerland
| | - Frank Devlieghere
- Laboratory of Food Microbiology and Food Preservation, Faculty of Bioscience Engineering, Ghent University, Coupure links 653, B-9000 Ghent, Belgium
| | - Anthony Lima
- Nestlé Research Centre, Food Safety & Quality Competence Pillar, 1000 Lausanne 26, Switzerland
| | - Umberto Piantini
- University of applied sciences western Switzerland, Institute of Life Technologies, Route du Rawyl 64, 1950 Sion, Switzerland
| | - Mieke Uyttendaele
- Laboratory of Food Microbiology and Food Preservation, Faculty of Bioscience Engineering, Ghent University, Coupure links 653, B-9000 Ghent, Belgium
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Thompson C, Dey A, Fearnley E, Polkinghorne B, Beard F. Impact of the national targeted Hepatitis A immunisation program in Australia: 2000-2014. Vaccine 2016; 35:170-176. [PMID: 27876203 DOI: 10.1016/j.vaccine.2016.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
In November 2005, hepatitis A vaccine was funded under the Australian National Immunisation Program for Aboriginal and Torres Strait Islander (Indigenous) children aged 12-24months in the targeted jurisdictions of Queensland, South Australia, Western Australia and the Northern Territory. We reviewed the epidemiology of hepatitis A from 2000 to 2014 using data from the Australian National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database, and Australian Bureau of Statistics causes-of-death data. The impact of the national hepatitis A immunisation program was assessed by comparison of pre-vaccine (2000-2005) and post-vaccine time periods (2006-2014), by age group, Indigenous status and jurisdiction using incidence rate ratios (IRR) per 100,000 population and 95% confidence intervals (CI). The national pre-vaccine notification rate in Indigenous people was four times higher than the non-Indigenous rate, and declined from 8.41 per 100,000 (95% CI 5.03-11.79) pre-vaccine to 0.85 per 100,000 (95% CI 0.00-1.99) post-vaccine, becoming similar to the non-Indigenous rate. Notification and hospitalisation rates in Indigenous children aged <5years from targeted jurisdictions declined in the post-vaccine period when compared to the pre-vaccine period (notifications: IRR=0.07; 95% CI 0.04-0.13; hospitalisations: IRR=0.04; 95% CI 0.01-0.16). As did notification rates in Indigenous people aged 5-19 (IRR=0.08; 95% CI 0.05-0.13) and 20-49years (IRR=0.06; 95% CI 0.02-0.15) in targeted jurisdictions. For non-Indigenous people from targeted jurisdictions, notification rates decreased significantly in children aged <5years (IRR 0.47; 95% CI 0.31-0.71), and significantly more overall (IRR=0.43; 95% CI 0.39-0.47) compared to non-Indigenous people from non-targeted jurisdictions (IRR=0.60; 95% CI 0.56-0.64). The national hepatitis A immunisation program has had a significant impact in the targeted population with relatively modest vaccine coverage, with evidence suggestive of substantial herd protection effects.
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Affiliation(s)
- Craig Thompson
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospital Network, Westmead, NSW 2145, Australia; National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, ACT 2601, Australia.
| | - Aditi Dey
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospital Network, Westmead, NSW 2145, Australia; University of Sydney, NSW 2006, Australia
| | - Emily Fearnley
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, ACT 2601, Australia
| | | | - Frank Beard
- National Centre for Immunisation Research and Surveillance, Sydney Children's Hospital Network, Westmead, NSW 2145, Australia; University of Sydney, NSW 2006, Australia
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6
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Van Der Meeren O, Crasta P, de Ridder M. A retrospective pooled analysis assessing the effect of age on the immunogenicity of Havrix™ in healthy adults. Hum Vaccin Immunother 2016; 11:1729-34. [PMID: 26029816 PMCID: PMC4514304 DOI: 10.1080/21645515.2015.1045167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Over recent decades, the global incidence of hepatitis A virus infection has been reduced by improvements in sanitation infrastructure and through immunization programs. The immunogenicity and field efficacy of the inactivated hepatitis A vaccine (Havrix™, GSK, Belgium) has been demonstrated in clinical trials, population-impact studies as well as in several outbreak settings. However, immunological data in older populations are limited, with only few studies assessing the immune response of this vaccine in adults aged ≥40 years. This retrospective pooled analysis of 4 2-dose primary vaccination studies compared the immunogenicity and safety of the inactivated hepatitis A vaccine in adults aged ≥40 years with subjects aged 20–30 years (control group; N = 80 in each group). Fifteen days after the first vaccine dose, 79.7% (95% CI: 68.8–88.2) and 92.3% (95% CI: 84.0–97.1) of subjects were seropositive in the ≥40 years and control groups, respectively; 97.5% (95% CI: 91.2–99.7) and 97.4% (95% CI: 91.0–99.7), respectively, were seropositive one month after the first dose. All subjects in both groups (95% CIs: 95.4–100 and 95.3–100, respectively) were seropositive one month after the second dose. Safety profiles were similar in both groups. In conclusion, the inactivated hepatitis A vaccine induced similar immune responses in adults aged ≥40 and 20–30 years one month after the first and second dose whereas younger subjects may demonstrate a higher seroconversion rate 15 days after the first dose.
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7
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Li D, De Keuckelaere A, Uyttendaele M. Fate of Foodborne Viruses in the "Farm to Fork" Chain of Fresh Produce. Compr Rev Food Sci Food Saf 2015; 14:755-770. [PMID: 32313514 PMCID: PMC7162173 DOI: 10.1111/1541-4337.12163] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/06/2015] [Indexed: 12/12/2022]
Abstract
Norovirus (NoV) and hepatitis A virus (HAV) are the most important foodborne viruses. Fresh produce has been identified as an important vehicle for their transmission. In order to supply a basis to identify possible prevention and control strategies, this review intends to demonstrate the fate of foodborne viruses in the farm to fork chain of fresh produce, which include the introduction routes (contamination sources), the viral survival abilities at different stages, and the reactions of foodborne viruses towards the treatments used in food processing of fresh produce. In general, the preharvest contamination comes mainly from soli fertilizer or irrigation water, while the harvest and postharvest contaminations come mainly from food handlers, which can be both symptomatic and asymptomatic. Foodborne viruses show high stabilities in all the stages of fresh produce production and processing. Low-temperature storage and other currently used preservation techniques, as well as washing by water have shown limited added value for reducing the virus load on fresh produce. Chemical sanitizers, although with limitations, are strongly recommended to be applied in the wash water in order to minimize cross-contamination. Alternatively, radiation strategies have shown promising inactivating effects on foodborne viruses. For high-pressure processing and thermal treatment, efforts have to be made on setting up treatment parameters to induce sufficient viral inactivation within a food matrix and to protect the sensory and nutritional qualities of fresh produce to the largest extent.
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Affiliation(s)
- Dan Li
- Laboratory of Food Microbiology and Food Preservation, Faculty of Bioscience Engineering Ghent Univ Coupure Links 653 B-9000 Ghent Belgium
| | - Ann De Keuckelaere
- Laboratory of Food Microbiology and Food Preservation, Faculty of Bioscience Engineering Ghent Univ Coupure Links 653 B-9000 Ghent Belgium
| | - Mieke Uyttendaele
- Laboratory of Food Microbiology and Food Preservation, Faculty of Bioscience Engineering Ghent Univ Coupure Links 653 B-9000 Ghent Belgium
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Importance of molecular typing in confirmation of the source of a national hepatitis A virus outbreak in Norway and the detection of a related cluster in Germany. Arch Virol 2015; 160:2823-6. [PMID: 26249822 DOI: 10.1007/s00705-015-2531-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/11/2015] [Indexed: 10/23/2022]
Abstract
In March 2014, after an increase of notifications of domestically acquired hepatitis A virus infections, an outbreak investigation was launched in Norway. Sequenced-based typing results showed that these cases were associated with a strain that was identical to one causing an ongoing multinational outbreak in Europe linked to frozen mixed berries. Thirty-three confirmed cases with the outbreak strain were notified in Norway from November 2013 to June 2014. Epidemiological evidence and trace-back investigations linked the outbreak to the consumption of a berry mix cake. Identification of the hepatitis A virus outbreak strain in berries from one of the implicated cakes confirmed the cake to be the source. Subsequently, a cluster in Germany linked to the cake was also identified.
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9
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Sánchez G. Processing Strategies to Inactivate Hepatitis A Virus in Food Products: A Critical Review. Compr Rev Food Sci Food Saf 2015. [DOI: 10.1111/1541-4337.12154] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Gloria Sánchez
- Dept. of Microbiology and Ecology; Univ. of Valencia, Dr. Moliner; 50. Burjassot Valencia Spain
- Inst. of Agrochemistry and Food Technology (IATA); Spanish Council for Scientific Research (CSIC); Agustín Escardino, 7. Paterna Valencia Spain
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10
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Severi E, Verhoef L, Thornton L, Guzman-Herrador BR, Faber M, Sundqvist L, Rimhanen-Finne R, Roque-Afonso AM, Ngui SL, Allerberger F, Baumann-Popczyk A, Muller L, Parmakova K, Alfonsi V, Tavoschi L, Vennema H, Fitzgerald M, Myrmel M, Gertler M, Ederth J, Kontio M, Vanbockstael C, Mandal S, Sadkowska-Todys M, Tosti ME, Schimmer B, O Gorman J, Stene-Johansen K, Wenzel JJ, Jones G, Balogun K, Ciccaglione AR, O' Connor L, Vold L, Takkinen J, Rizzo C. Large and prolonged food-borne multistate hepatitis A outbreak in Europe associated with consumption of frozen berries, 2013 to 2014. ACTA ACUST UNITED AC 2015; 20:21192. [PMID: 26227370 DOI: 10.2807/1560-7917.es2015.20.29.21192] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In May 2013, Italy declared a national outbreak of hepatitis A, which also affected several foreign tourists who had recently visited the country. Molecular investigations identified some cases as infected with an identical strain of hepatitis A virus subgenotype IA. After additional European Union/European Economic Area (EU/EEA) countries reported locally acquired and travel-related cases associated with the same outbreak, an international outbreak investigation team was convened, a European outbreak case definition was issued and harmonisation of the national epidemiological and microbiological investigations was encouraged. From January 2013 to August 2014, 1,589 hepatitis A cases were reported associated with the multistate outbreak; 1,102 (70%) of the cases were hospitalised for a median time of six days; two related deaths were reported. Epidemiological and microbiological investigations implicated mixed frozen berries as the vehicle of infection of the outbreak. In order to control the spread of the outbreak, suspected or contaminated food batches were recalled, the public was recommended to heat-treat berries, and post-exposure prophylaxis of contacts was performed. The outbreak highlighted how large food-borne hepatitis A outbreaks may affect the increasingly susceptible EU/EEA general population and how, with the growing international food trade, frozen berries are a potential high-risk food.
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Affiliation(s)
- E Severi
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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11
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Wenzel JJ, Schemmerer M, Oberkofler H, Kerschner H, Sinha P, Koidl C, Allerberger F. Hepatitis A Outbreak in Europe: Imported Frozen Berry Mix Suspected to be the Source of At least One Infection in Austria in 2013. FOOD AND ENVIRONMENTAL VIROLOGY 2014; 6:297-300. [PMID: 25183415 PMCID: PMC4228166 DOI: 10.1007/s12560-014-9165-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/23/2014] [Indexed: 06/03/2023]
Abstract
We tested 19 sera from Austrian patients with acute hepatitis A. A serum from a 48-year-old female patient yielded HAV-nucleic acid that showed 99.7% homology to the HAV-sequence obtained from samples taken during the current outbreak in several European countries, which is associated with consumption of frozen berries. So far, Austria was considered not to be affected by this hepatitis A outbreak.
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Affiliation(s)
- J J Wenzel
- Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - M Schemmerer
- Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - H Oberkofler
- Institut für Medizinisch-Chemische Labordiagnostik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Austria
| | - H Kerschner
- Analyse BioLab, Elisabethinen Hospital Linz, Linz, Austria
| | - P Sinha
- Institut für Labordiagnostik und Mikrobiologie, Klinikum Klagenfurt, Klagenfurt, Austria
| | - C Koidl
- Institut für Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universität Graz, Graz, Austria
| | - F Allerberger
- Österreichische Agentur für Gesundheit und Ernährungssicherheit (AGES), Spargelfeldstraße 191 A-1220, Vienna, Austria.
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12
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Fitzgerald M, Thornton L, O'Gorman J, O'Connor L, Garvey P, Boland M, Part AM, Rogalska J, Coughlan H, MacDiarmada J, Heslin J, Canny M, Finnegan P, Moran J, O'Flanagan D. Outbreak of hepatitis A infection associated with the consumption of frozen berries, Ireland, 2013--linked to an international outbreak. ACTA ACUST UNITED AC 2014; 19. [PMID: 25375902 DOI: 10.2807/1560-7917.es2014.19.43.20942] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In May 2013, a European alert was issued regarding a hepatitis A virus (HAV) outbreak in Italy. In June 2013, HAV subgenotype IA with an identical sequence was identified in Ireland in three cases who had not travelled to Italy. The investigation consisted of descriptive epidemiology, a case-control study, microbiological testing of human and food specimens, molecular typing of positive specimens and food traceback. We identified 21 outbreak cases (14 confirmed primary cases) with symptom onset between 31 January and 11 October 2013. For the case-control study, we recruited 11 confirmed primary cases and 42 matched controls. Cases were more likely than controls to have eaten berry cheesecake (matched odds ratio (mOR): 12; 95% confidence interval (CI): 1.3-114), whole frozen berries (mOR: 9.5; 95% CI: 1.0-89), yoghurt containing frozen berries (mOR: 6.6, 95% CI: 1.2-37) or raw celery (mOR: 4; 95% CI: 1.2-16). Among cases, 91% had consumed at least one of four products containing frozen berries (mOR: 12; 95% CI: 1.5-94). Sixteen food samples tested were all negative for HAV. As products containing frozen berries were implicated in the outbreak, the public were advised to heat-treat frozen berries before consumption.
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Affiliation(s)
- M Fitzgerald
- Health Service Executive (HSE) - Health Protection Surveillance Centre (HPSC), Dublin, Ireland
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