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An outbreak of hepatitis A virus infection in a secondary school in England with no undetected asymptomatic transmission among students. Epidemiol Infect 2022; 151:e6. [PMID: 36502811 PMCID: PMC9990387 DOI: 10.1017/s095026882200190x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases of hepatitis A virus (HAV) infection in staff at a secondary school. Investigation revealed that an earlier case worked as a food handler in the school kitchen. Indirect transmission through food from the canteen was considered the most likely route of transmission. Cases were described according to setting of exposure. Oral fluid was obtained from students for serological testing. Environmental investigations were undertaken at settings where food handling was considered a potential transmission risk. Thirty-three confirmed cases were linked to the outbreak. All of those tested (n = 31) shared the same sequence with a HAV IB genotype. The first three cases were a household cluster and included the index case for the school. A further 19 cases (16 students, 3 staff) were associated with the school and consistent with indirect exposure to the food handler. One late onset case could not be ruled out as a secondary case within the school and resulted in vaccination of the school population. Five cases were linked to a bakery where a case from the initial household cluster worked as a food server. No concerns about hygiene standards were noted at either the school or the bakery. Oral fluid samples taken at the time of vaccination from asymptomatic students (n = 219, 11-16 years-old) showed no evidence of recent or current infection. This outbreak included household and foodborne transmission but limited (and possibly zero) person-to-person transmission among secondary school students. Where adequate hygiene exists, secondary transmission within older students may not occur.
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Garcia Vilaplana T, Leeman D, Balogun K, Ngui SL, Phipps E, Khan WM, Balasegaram S. Hepatitis A outbreak associated with consumption of dates, England and Wales, January 2021 to April 2021. Euro Surveill 2021; 26:2100432. [PMID: 34018484 PMCID: PMC8138963 DOI: 10.2807/1560-7917.es.2021.26.20.2100432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We report a national hepatitis A virus (HAV) outbreak linked to the consumption of Medjool dates. Twenty-nine cases of three genetically related sequences have been identified. Epidemiological investigations identified a suspected product (adjusted odds ratio: 47.36; 95% confidence interval: 1.79-1,256.07; p = 0.021). Microbiological testing has confirmed the presence of HAV on dates recovered from two cases and the product has been recalled. Date consumption is currently likely to be increased in connection with Ramadan, with potential ongoing contamination risk.
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Affiliation(s)
- Tatiana Garcia Vilaplana
- These authors contributed equally to this article and share first authorship,Immunisations and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - David Leeman
- These authors contributed equally to this article and share first authorship,Field Epidemiology Training Programme, National Infection Service, Public Health England, London, United Kingdom
| | - Koye Balogun
- Immunisations and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom,Blood Safety, Hepatitis, STI and HIV Department, National Infection Service, Public Health England, London, United Kingdom
| | - Siew Lin Ngui
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Emily Phipps
- Blood Safety, Hepatitis, STI and HIV Department, National Infection Service, Public Health England, London, United Kingdom
| | - Wazirzada M Khan
- South London Health Protection Team, Public Health England, London, United Kingdom
| | - Incident Team
- Public Health England and Food Standards Agency, London, United Kingdom
| | - Sooria Balasegaram
- South East and London Field Service, National Infection Service, Public Health England, London, United Kingdom
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