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Foster MA, Hofmeister MG, Yin S, Montgomery MP, Weng MK, Eckert M, Nelson NP, Mermin J, Wester C, Teshale EH, Gupta N, Cooley LA. Widespread Hepatitis A Outbreaks Associated with Person-to-Person Transmission — United States, 2016–2020. MMWR Morb Mortal Wkly Rep 2022; 71:1229-1234. [PMID: 36173747 PMCID: PMC9533732 DOI: 10.15585/mmwr.mm7139a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mello VM, Bianchi LM, Sousa PSF, Tavares PS, Di Salvo DRG, Ginuino CF, Almeida NAA, Fernandes CAS, Mello FCA, Villar LM, Lewis-Ximenez LL, Lago BV. Increase in Hepatitis A Cases Linked to Imported Strains to Rio de Janeiro, Brazil: A Cross-Sectional Study. Viruses 2022; 14:v14020303. [PMID: 35215897 PMCID: PMC8874517 DOI: 10.3390/v14020303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to evaluate the epidemiological and molecular features associated with HAV transmission in adults in Rio de Janeiro during a period of increased registered cases of HAV (2017–2018). Socio-epidemiological data and serum samples from anti-HAV IgM+ individuals were obtained. HAV RNA was RT-PCR amplified and sequenced for further phylogenetic and phylogeographic analyses. From fifty-two HAV IgM+ individuals, most were men (78.85%; p = 0.024), aged 20–30 years old (84.61%; p < 0.001), resided in the Rio de Janeiro north zone (31/52; 59.62%; p = 0.001), and are men who have sex with men (MSM) (57.69%; p = 0.002). Sexual practices were more frequent (96%) than others risk factors (food-borne (44%), water-borne (42.31%), and parenteral (34.62%)). Individuals who traveled to endemic regions had a 7.19-fold (1.93–36.04; p < 0.01) increased risk of HAV. Phylogenetic analysis revealed four distinct clades of subgenotype IA, three of them comprised sequences from European/Asian MSM outbreaks and one from Brazilian endemic strains. Bayesian Inference showed that the imported strains were introduced to Brazil during large mass sportive events. Sexual orientation and sexual practices may play a role in acquiring HAV infection. Public policies targeting key populations must be implemented to prevent further dissemination of HAV and other STIs.
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Affiliation(s)
- Vinicius M. Mello
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Lucas M. Bianchi
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil;
| | - Paulo Sergio F. Sousa
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Pedro S. Tavares
- Research Group on Territory and Politics, Geosciences Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941-916, Brazil;
| | - Daniel R. G. Di Salvo
- Cartography Laboratory, Geosciences Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941-916, Brazil;
| | - Cleber F. Ginuino
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Nathalia A. A. Almeida
- Molecular Virology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil;
| | - Carlos A. S. Fernandes
- Hepatitis Division, Rio de Janeiro Health State Secretariat, Rio de Janeiro 20211-110, Brazil;
| | - Francisco C. A. Mello
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Livia M. Villar
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Lia L. Lewis-Ximenez
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
| | - Barbara V. Lago
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil; (V.M.M.); (P.S.F.S.); (C.F.G.); (F.C.A.M.); (L.M.V.); (L.L.L.-X.)
- Institute of Technology in Immunobiologics–Bio-Manguinhos, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, Brazil
- Correspondence: ; Tel.: +55-21-2562-1799
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Langan RC, Goodbred AJ. Hepatitis A. Am Fam Physician 2021; 104:368-374. [PMID: 34652109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hepatitis A is a common viral infection worldwide that is transmitted via the fecal-oral route. The incidence of infection in the United States decreased by more than 90% after an effective vaccine was introduced, but the number of cases has been increasing because of large community outbreaks in unimmunized individuals. Classic symptoms include fever, malaise, dark urine, and jaundice and are more common in older children and adults. People are most infectious 14 days before and seven days after the development of jaundice. Diagnosis of acute infection requires the use of serologic testing for immunoglobulin M anti-hepatitis A antibodies. The disease is usually self-limited, supportive care is often sufficient for treatment, and chronic infection or chronic liver disease does not occur. Routine hepatitis A immunization is recommended in children 12 to 23 months of age. Immunization is also recommended for individuals at high risk of contracting the infection, such as persons who use illegal drugs, those who travel to areas endemic for hepatitis A, incarcerated populations, and persons at high risk of complications from hepatitis A, such as those with chronic liver disease or HIV infection. The vaccine is usually recommended for pre- and postexposure prophylaxis, but immune globulin can be used in patients who are too young to be vaccinated or if the vaccine is contraindicated.
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Affiliation(s)
- Robert C Langan
- St. Luke's Family Medicine Residency Program, Sacred Heart Campus, Allentown, PA, USA
| | - Andrew J Goodbred
- St. Luke's Family Medicine Residency Program, Anderson Campus, Easton, PA, USA
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Hofmeister MG, Xing J, Foster MA, Augustine RJ, Burkholder C, Collins J, McBee S, Thomasson ED, Thoroughman D, Weng MK, Spradling PR. Factors Associated With Hepatitis A Mortality During Person-to-Person Outbreaks: A Matched Case-Control Study-United States, 2016-2019. Hepatology 2021; 74:28-40. [PMID: 33217769 PMCID: PMC11017379 DOI: 10.1002/hep.31645] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS During 2016-2020, the United States experienced person-to-person hepatitis A outbreaks that are unprecedented in the vaccine era, during which case-fatality ratios reported by some jurisdictions exceeded those historically associated with hepatitis A. APPROACH AND RESULTS To identify factors associated with hepatitis A-related mortality, we performed a matched case-control study (matched on age [±5 years] and county of residence in a 1:4 ratio) using data collected from health department and hospital medical records of outbreak-associated patients in Kentucky, Michigan, and West Virginia. Controls were hepatitis A outbreak-associated patients who did not die. There were 110 cases (mean age 53.6 years) and 414 matched controls (mean age 51.9 years); most cases (68.2%) and controls (63.8%) were male. Significantly (P < 0.05) higher odds of mortality were associated with preexisting nonviral liver disease (adjusted odds ratio [aOR], 5.2), history of hepatitis B (aOR, 2.4), diabetes (aOR, 2.2), and cardiovascular disease (aOR, 2.2), as well as initial Model for End-Stage Liver Disease (MELD) score ≥ 30 (aOR, 10.0), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio > 2 (aOR, 10.3), and platelet count < 150,000/μL (aOR, 3.7) among hepatitis A outbreak-associated patients in the independent multivariable conditional logistic regression analyses (each model adjusted for sex). CONCLUSIONS Preexisting liver disease, diabetes, cardiovascular disease, and initial MELD score ≥ 30, AST/ALT ratio ≥ 1, and platelet count < 150,000/μL among hepatitis A patients were independently associated with higher odds of mortality. Providers should be vigilant for such features and have a low threshold to escalate care and consider consultation for liver transplantation. Our findings support the recommendation of the Advisory Committee on Immunization Practices to vaccinate persons with chronic liver disease, though future recommendations to include adults with diabetes and cardiovascular disease should be considered.
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Affiliation(s)
- Megan G. Hofmeister
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jian Xing
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Monique A. Foster
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ryan J. Augustine
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cole Burkholder
- Division of Communicable Diseases, Michigan Department of Health and Human Services, Lansing, MI
| | - Jim Collins
- Division of Communicable Diseases, Michigan Department of Health and Human Services, Lansing, MI
| | - Shannon McBee
- Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV
| | - Erica D. Thomasson
- Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, GA
| | - Douglas Thoroughman
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, GA
- Kentucky Department for Public Health, Frankfort, KY
| | - Mark K. Weng
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Philip R. Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
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Hofmeister MG, Xing J, Foster MA, Augustine RJ, Burkholder C, Collins J, McBee S, Thomasson ED, Thoroughman D, Weng MK, Spradling PR. Hepatitis A Person-to-Person Outbreaks: Epidemiology, Morbidity Burden, and Factors Associated With Hospitalization-Multiple States, 2016-2019. J Infect Dis 2021; 223:426-434. [PMID: 33097935 PMCID: PMC10993993 DOI: 10.1093/infdis/jiaa636] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Since 2016, the United States has experienced person-to-person hepatitis A outbreaks unprecedented in the vaccine era. The proportion of cases hospitalized in these outbreaks exceeds historical national surveillance data. METHODS We described the epidemiology, characterized the reported increased morbidity, and identified factors associated with hospitalization during the outbreaks by reviewing a 10% random sample of outbreak-associated hepatitis A cases in Kentucky, Michigan, and West Virginia-3 heavily affected states. We calculated descriptive statistics and conducted age-adjusted log-binomial regression analyses to identify factors associated with hospitalization. RESULTS Participants in the random sample (n = 817) were primarily male (62.5%) with mean age of 39.0 years; 51.8% were hospitalized. Among those with available information, 73.2% reported drug use, 14.0% were experiencing homelessness, 29.7% were currently or recently incarcerated, and 61.6% were epidemiologically linked to a known outbreak-associated case. Residence in Michigan (adjusted risk ratio [aRR] = 1.8), being a man who has sex with men (aRR = 1.5), noninjection drug use (aRR = 1.3), and homelessness (aRR = 1.3) were significantly (P < .05) associated with hepatitis A-related hospitalization. CONCLUSIONS Our findings support current Advisory Committee on Immunization Practices recommendations to vaccinate all persons who use drugs, men who have sex with men, and persons experiencing homelessness against hepatitis A.
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Affiliation(s)
- Megan G. Hofmeister
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jian Xing
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monique A. Foster
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ryan J. Augustine
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cole Burkholder
- Division of Communicable Diseases, Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Jim Collins
- Division of Communicable Diseases, Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Shannon McBee
- Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
| | - Erica D. Thomasson
- Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Douglas Thoroughman
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Kentucky Department for Public Health, Frankfort, Kentucky, USA
| | - Mark K. Weng
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Philip R. Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Di Cola G, Fantilli AC, Pisano MB, Ré VE. Foodborne transmission of hepatitis A and hepatitis E viruses: A literature review. Int J Food Microbiol 2021; 338:108986. [PMID: 33257099 DOI: 10.1016/j.ijfoodmicro.2020.108986] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/19/2022]
Abstract
Foodborne viruses have been recognized as a growing concern to the food industry and a serious public health problem. Hepatitis A virus (HAV) is responsible for the majority of viral outbreaks of food origin worldwide, while hepatitis E virus (HEV) has also been gaining prominence as a foodborne viral agent in the last years, due to its zoonotic transmission through the consumption of uncooked or undercooked infected meat or derivatives. However, there is a lack of scientific reports that gather all the updated information about HAV and HEV as foodborne viruses. A search of all scientific articles about HAV and HEV in food until March 2020 was carried out, using the keywords "HAV", "HEV", "foodborne", "outbreak" and "detection in food". Foodborne outbreaks due to HAV have been reported since 1956, mainly in the USA, and in Europe in recent years, where the number of outbreaks has been increasing throughout time, and nowadays it has become the continent with the highest foodborne HAV outbreak report. Investigation and detection of HAV in food is more recent, and the first detections were performed in the 1990s decade, most of them carried out on seafood, first, and frozen food, later. On the other hand, HEV has been mainly looked for and detected in food derived from reservoir animals, such as meat, sausages and pate of pigs and wild boars. For this virus, only isolated cases and small outbreaks of foodborne transmission have been recorded, most of them in industrialized countries, due to HEV genotype 3 or 4. Virus detection in food matrices requires special processing of the food matrix, followed by RNA detection by molecular techniques. For HAV, a real-time PCR has been agreed as the standard method for virus detection in food; in the case of HEV, a consensus assay for its detection in food has not been reached yet. Our investigation shows that there is still little data about HAV and HEV prevalence and frequency of contamination in food, prevalent viral strains, and sources of contamination, mainly in developing countries, where there is no research and legislation in this regard. Studies on these issues are needed to get a better understanding of foodborne viruses, their maintenance and their potential to cause diseases.
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Affiliation(s)
- Guadalupe Di Cola
- Instituto de Virología "Dr. J. M. Vanella", Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enfermera Gordillo Gomez s/n, CP: 5016 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
| | - Anabella C Fantilli
- Instituto de Virología "Dr. J. M. Vanella", Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enfermera Gordillo Gomez s/n, CP: 5016 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - María Belén Pisano
- Instituto de Virología "Dr. J. M. Vanella", Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enfermera Gordillo Gomez s/n, CP: 5016 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Viviana E Ré
- Instituto de Virología "Dr. J. M. Vanella", Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enfermera Gordillo Gomez s/n, CP: 5016 Córdoba, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
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Affiliation(s)
| | - Arthur Y Kim
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Deborah A Williamson
- From the Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, and the Department of Microbiology, Royal Melbourne Hospital (D.A.W.), and Melbourne Sexual Health Centre, Alfred Health, and Central Clinical School, Monash University (M.Y.C.) - all in Melbourne, VIC, Australia
| | - Marcus Y Chen
- From the Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, and the Department of Microbiology, Royal Melbourne Hospital (D.A.W.), and Melbourne Sexual Health Centre, Alfred Health, and Central Clinical School, Monash University (M.Y.C.) - all in Melbourne, VIC, Australia
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Abstract
We implemented subgenomic and whole-genome sequencing to support the investigation of a large hepatitis A virus outbreak among persons experiencing homelessness, users of illicit drugs, or both in California, USA, during 2017-2018. Genotyping data helped confirm case-patients, track chains of transmission, and monitor the effectiveness of public health control measures.
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Smith CR, Kershaw T, Johnson K, Meghnath K. An outbreak of hepatitis A in Canada: The use of a control bank to conduct a case-control study. Epidemiol Infect 2019; 147:e300. [PMID: 31711553 PMCID: PMC6873153 DOI: 10.1017/s0950268819001870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/24/2019] [Accepted: 10/13/2019] [Indexed: 01/07/2023] Open
Abstract
An outbreak of 18 cases of hepatitis A virus infection across five Canadian provinces was investigated. Case onsets occurred between October 2017 and May 2018. A retrospective matched case-control study was conducted to identify the likely source of the outbreak. Three matched controls were recruited for each case using a previously established control bank, supplemented by landline and cell phone call lists. Univariate and multivariate matched analyses were conducted to identify a potential outbreak source. Seventy-two per cent of controls were recruited through the control bank, and required on average 25.5 calls per recruited control; 20% of controls were recruited through a landline sample and 8% of controls were recruited through a cell phone sample, requiring an average of 847.3 and 331.7 calls per recruited control, respectively. Results of the analysis pointed to shrimp/prawns (odds ratio (OR) 15.75, p = 0.01) and blackberries (OR 7.21, p = 0.02) as foods of interest, however, an outbreak source could not be confirmed. The control bank proved to be a more efficient method for control recruitment than random call lists. Expanding the control bank size and using alternative methods, such as online surveys, may prove beneficial for increasing the timeliness of a case-control study during an outbreak investigation.
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Affiliation(s)
- C. R. Smith
- Outbreak Management Division, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - T. Kershaw
- Outbreak Management Division, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - K. Johnson
- Enteric, Zoonotic and Vectorborne Disease Unit, Public Health Ontario, Toronto, Ontario, Canada
| | - K. Meghnath
- Enteric, Zoonotic, Vectorborne and Environmental Infections Program, BC Centre for Disease Control, Vancouver, British Columbia, Canada
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Wooten DA. Forgotten but Not Gone: Learning From the Hepatitis A Outbreak and Public Health Response in San Diego. Top Antivir Med 2019; 26:117-121. [PMID: 30641485 PMCID: PMC6372360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The recent hepatitis A virus (HAV) outbreak in San Diego was driven by homelessness, associated sanitation conditions, and illicit drug use. As with an outbreak in Michigan, fueled by similar factors, morbidity and mortality were higher than what has been observed with post-vaccine era foodborne HAV outbreaks. Control of the outbreak in San Diego was accomplished with vaccine, sanitation, and education initiatives that targeted those at highest risk. Mass vaccination events and mobile foot teams and vans brought education and vaccine to high-risk individuals in affected areas. The homelessness crisis in San Diego and in many locales throughout the United States poses risk of increasing numbers of outbreaks of HAV and other infectious illnesses. This article summarizes an IAS-USA continuing education webinar given by Darcy A. Wooten, MD, on July 19, 2018.
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Persichilli JM. New Jersey Healthcare Providers Can Help Address Hepatitis A Outbreak. MD Advis 2019; 12:25-26. [PMID: 32501660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Zhang XS, Iacono GL. Estimating human-to-human transmissibility of hepatitis A virus in an outbreak at an elementary school in China, 2011. PLoS One 2018; 13:e0204201. [PMID: 30248120 PMCID: PMC6152969 DOI: 10.1371/journal.pone.0204201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/05/2018] [Indexed: 11/24/2022] Open
Abstract
Hepatitis A is caused by hepatitis A virus and occurs worldwide. Estimating the transmissibility, which is usually characterized by the basic reproductive number R0, the mean number of secondary infectious cases generated by a single primary infectious case introduced into a totally susceptible population, provides crucial information for the effort required to stop infection spreading. Hepatitis A virus is usually transmitted indirectly through contaminated food and environment. An outbreak from March to June 2011 was reported to have occurred at an elementary school of 698 pupils in China and it was found that the outbreak was due to direct transmission between school children. Based on the symptom onset date and the social contact network of the children, in this study we estimate the serial interval (i.e. the gap in symptom onset between an infectee and its infector) and use different statistical methods to estimate R0. Combining with the positivity of IgG antibodies tests, we develop a compartmental transmission dynamics model which includes both asymptomatic and symptomatic infections to estimate the overall R0. Our analysis suggests a serial interval of mean = 23.9 days and standard deviation = 20.9 days. The different statistical methods suggest estimates for R0 in the outbreak varying from 2.1 to 2.8, and the estimates from the transmission dynamics model are consistent with this range. Our estimates are in agreement with that from one study in England but are higher than that from one study in the United States. Our transmission dynamics model suggests that the proportion of symptomatic infections is about 9%, implying that there were about 344 asymptomatic infections along with the 32 observed symptomatic cases. Furthermore, it is shown that the inclusion of asymptomatic infection in the epidemic process increases the estimate of R0 but does not do so greatly provided that the proportion of symptomatic infections is constant over the outbreak and there is no difference in transmissibility between symptomatic and asymptomatic infections.
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Affiliation(s)
- Xu-Sheng Zhang
- National Infection Service, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, Norfolk Place, London, United Kingdom
- * E-mail:
| | - Giovanni Lo Iacono
- Chemical and Environmental Effects Centre for Radiation, Chemical and Environmental Hazards, Public Health England, London, United Kingdom
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
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Mook P, Gardiner D, Kanagarajah S, Kerac M, Hughes G, Field N, McCarthy N, Rawlings C, Simms I, Lane C, Crook PD. Use of gender distribution in routine surveillance data to detect potential transmission of gastrointestinal infections among men who have sex with men in England. Epidemiol Infect 2018; 146:1468-1477. [PMID: 29923475 PMCID: PMC9133680 DOI: 10.1017/s0950268818001681] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/20/2018] [Accepted: 05/23/2018] [Indexed: 11/06/2022] Open
Abstract
Detecting gastrointestinal (GI) infection transmission among men who have sex with men (MSM) in England is complicated by a lack of routine sexual behavioural data. We investigated whether gender distributions might generate signals for increased transmission of GI pathogens among MSM. We examined the percentage male of laboratory-confirmed patient-episodes for patients with no known travel history for 10 GI infections of public health interest in England between 2003 and 2013, stratified by age and region. An adult male excess was observed for Shigella spp. (annual maximum 71% male); most pronounced for those aged 25-49 years and living in London, Brighton and Manchester. An adult male excess was observed every year for Entamoeba histolytica (range 59.8-76.1% male), Giardia (53.1-57.6%) and Campylobacter (52.1-53.5%) and for a minority of years for hepatitis A (max. 69.8%) and typhoidal salmonella (max. 65.7%). This approach generated a signal for excess male episodes for six GI pathogens, including a characterised outbreak of Shigella among MSM. Stratified analyses by geography and age group were consistent with MSM transmission for Shigella. Optimisation and routine application of this technique by public health authorities elsewhere might help identify potential GI infection outbreaks due to sexual transmission among MSM, for further investigation.
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Affiliation(s)
- P. Mook
- Field Epidemiology Service, Public Health England, London, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - D. Gardiner
- Field Epidemiology Service, Public Health England, London, UK
| | - S. Kanagarajah
- Field Epidemiology Service, Public Health England, London, UK
| | - M. Kerac
- Field Epidemiology Service, Public Health England, London, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Epidemiology & Public Health, Leonard Cheshire Disability & Inclusive Development Centre, University College London, London, UK
| | - G. Hughes
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - N. Field
- HIV and STI Department, National Infection Service, Public Health England, London, UK
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, London, UK
| | - N. McCarthy
- Field Epidemiology Service, Public Health England, London, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- National Institute Health Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, London, UK
| | - C. Rawlings
- Field Epidemiology Service, Public Health England, London, UK
| | - I. Simms
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - C. Lane
- Gastrointestinal, Emerging and Zoonotic Infections Department, Public Health England, London, UK
| | - P. D. Crook
- Field Epidemiology Service, Public Health England, London, UK
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16
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Lorenzo Ortega R, O Donnell Cortés B, Ortiz González Serna R, Gallardo García V, López Hernández B. [Changes in Hepatitis A epidemiological pattern in Andalucía: 2007-2017]. Rev Esp Salud Publica 2018; 92:e201805016. [PMID: 29745372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/18/2017] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Sexual transmission of hepatitis A (HAV) is documented, mainly by risk behaviors in men who have sex with men (MSM). There have been HAV outbreaks in MSM in countries of the European Union in the last years. The aim of this work was to study HAV epidemiology in Andalusia in the last 10 years (2007-2017) and the outbreaks among MSM in this period. METHODS Retrospective descriptive study of HAV cases reported in the Andalusia Epidemiological Surveillance System between January 2007 and May 2017. We calculated the annual incidence rate per 100000 habitants. We studied case distribution for gender and age. We used the male-female ratio as an indirect marker for MSM. RESULTS The mean annual incidence rate in the study period was 4.09 cases per 100000 habitants, with a difference by sex: 4.7 per 100000 men and 2.53 per 100000 women. Two large outbreaks were detected in this period: one in 2008-2009 and another in 2016-2017. The epidemiological characteristics of these outbreaks differ from the classical pattern of the disease, affecting young MSM with associated sexual risk behaviors. CONCLUSIONS MSM play a fundamental role in recent outbreaks of HAV. For disease control we must carry out a different strategy, assessing the introduction of systematic vaccination.
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Affiliation(s)
- Rocío Lorenzo Ortega
- Servicio de Medicina Preventiva. Hospital Virgen de la Victoria. Málaga. España
- Servicio de Vigilancia y Salud Laboral. Secretaría General de Salud Pública y Consumo. Consejería de Salud. Junta de Andalucía. Sevilla. España
- Departamento de Medicina Preventiva. Facultad de Medicina. Universidad de Málaga. Málaga. España. (4)
| | - Blanca O Donnell Cortés
- Servicio de Medicina Preventiva. Hospital Virgen de la Victoria. Málaga. España
- Departamento de Medicina Preventiva. Facultad de Medicina. Universidad de Málaga. Málaga. España
| | - Rocío Ortiz González Serna
- Servicio de Vigilancia y Salud Laboral. Secretaría General de Salud Pública y Consumo. Consejería de Salud. Junta de Andalucía. Sevilla. España
- TServicio de Medicina Preventiva. Hospital Reina Sofía. Córdoba. España
| | - Virtudes Gallardo García
- Servicio de Vigilancia y Salud Laboral. Secretaría General de Salud Pública y Consumo. Consejería de Salud. Junta de Andalucía. Sevilla. España
| | - Begoña López Hernández
- Servicio de Vigilancia y Salud Laboral. Secretaría General de Salud Pública y Consumo. Consejería de Salud. Junta de Andalucía. Sevilla. España
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Foster MA, Weil LM, Jin S, Johnson T, Hayden-Mixson TR, Khudyakov Y, Annambhotla PD, Basavaraju SV, Kamili S, Ritter JM, Nelson N, Mazariegos G, Green M, Himes RW, Kuhar DT, Kuehnert MJ, Miller JA, Wiseman R, Moorman AC. Transmission of Hepatitis A Virus through Combined Liver-Small Intestine-Pancreas Transplantation. Emerg Infect Dis 2018; 23:590-596. [PMID: 28322704 PMCID: PMC5367420 DOI: 10.3201/eid2304.161532] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Vaccination of the donor might have prevented infection in the recipient and subsequent transmission to healthcare workers. Although transmission of hepatitis A virus (HAV) through blood transfusion has been documented, transmission through organ transplantation has not been reported. In August 2015, state health officials in Texas, USA, were notified of 2 home health nurses with HAV infection whose only common exposure was a child who had undergone multi–visceral organ transplantation 9 months earlier. Specimens from the nurses, organ donor, and all organ recipients were tested and medical records reviewed to determine a possible infection source. Identical HAV RNA sequences were detected from the serum of both nurses and the organ donor, as well as from the multi–visceral organ recipient’s serum and feces; this recipient’s posttransplant liver and intestine biopsy specimens also had detectable virus. The other organ recipients tested negative for HAV RNA. Vaccination of the donor might have prevented infection in the recipient and subsequent transmission to the healthcare workers.
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18
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Campos-Outcalt D. CDC provides advice on recent hepatitis A outbreaks. J Fam Pract 2018; 67:30-32. [PMID: 29309473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The epidemiology of hepatitis A virus disease has changed. Since July 2016, there have been 5 large outbreaks of infection involving more than 1600 cases, with affected states requiring assistance from the Centers for Disease Control and Prevention. Two of these outbreaks were foodborne, and 3 involved person-to-person transmission. This article reviews the extent of the outbreaks, what's behind the outbreaks, and outbreak-specific vaccine recommendations.
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Rossati A, Bargiacchi O, Kroumova V, Nebbiolo C, Tacca MG, Pratillo S, Garavelli PL. Outbreak of severe Hepatitis A in Eastern Piedmont, Italy. Infez Med 2017; 25:344-346. [PMID: 29286013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hepatitis A (HA) is caused by a hepatovirus from the family Picornaviridae (Hepatitis A Virus, HAV). Transmission occurs mainly by the orofaecal route through food or water contaminated by faeces. Sexual transmission has also been reported among men who have sex with men (MSM). From February to May 2017, 14 patients with HA were hospitalized at the University Hospital "Maggiore della Carità", Novara (Eastern Piedmont), Italy. One patient was two years old and was therefore admitted to the Paediatric Unit, the remaining 13 to the Infectious Disease Unit. Two of the adults were female and the rest (11) were male. The male patients were MSM, and contracted the infection sexually; three of them were known to be HIV positive, while two had a new diagnosis of syphilis infection. Women contracted the infection from contaminated food.
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Affiliation(s)
- Antonella Rossati
- Infectious Diseases Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Olivia Bargiacchi
- Infectious Diseases Department, University Hospital "Maggiore della Carità", Novara, Italy
| | - Vesselina Kroumova
- Infection Control Unit, University Hospital "Maggiore della Carità", Novara, Italy
| | - Claudio Nebbiolo
- Infectious Diseases Department, University Hospital "Maggiore della Carità", Novara, Italy
| | | | | | - Pietro Luigi Garavelli
- Infectious Diseases Department, University Hospital "Maggiore della Carità", Novara, Italy
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Koenig KL, Shastry S, Burns MJ. Hepatitis A Virus: Essential Knowledge and a Novel Identify-Isolate-Inform Tool for Frontline Healthcare Providers. West J Emerg Med 2017; 18:1000-1007. [PMID: 29085529 PMCID: PMC5654866 DOI: 10.5811/westjem.2017.10.35983] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/25/2017] [Accepted: 10/02/2017] [Indexed: 01/14/2023] Open
Abstract
Infection with hepatitis A virus (HAV) causes a highly contagious illness that can lead to serious morbidity and occasional mortality. Although the overall incidence of HAV has been declining since the introduction of the HAV vaccine, there have been an increasing number of outbreaks within the United States and elsewhere between 2016 and 2017. These outbreaks have had far-reaching consequences, with a large number of patients requiring hospitalization and several deaths. Accordingly, HAV is proving to present a renewed public health challenge. Through use of the "Identify-Isolate-Inform" tool as adapted for HAV, emergency physicians can become more familiar with the identification and management of patients presenting to the emergency department (ED) with exposure, infection, or risk of contracting disease. While it can be asymptomatic, HAV typically presents with a prodrome of fever, nausea/vomiting, and abdominal pain followed by jaundice. Healthcare providers should maintain strict standard precautions for all patients suspected of having HAV infection as well as contact precautions in special cases. Hand hygiene with soap and warm water should be emphasized, and affected patients should be counseled to avoid food preparation and close contact with vulnerable populations. Additionally, ED providers should offer post-exposure prophylaxis to exposed contacts and encourage vaccination as well as other preventive measures for at-risk individuals. ED personnel should inform local public health departments of any suspected case.
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Affiliation(s)
- Kristi L. Koenig
- Medical Director, EMS, County of San Diego, Health & Human Services Agency
- University of California Irvine, Department of Emergency Medicine, Orange, California
| | - Siri Shastry
- University of California Irvine, Department of Emergency Medicine, Orange, California
| | - Michael J. Burns
- University of California Irvine School of Medicine, Department of Emergency Medicine, and Department of Medicine, Division of Infectious Diseases, Orange, California
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22
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Ferris HA, Dillon A, O'Sullivan MB. A Cluster of Hepatitis A Viral Infection in HSE South. Ir Med J 2017; 110:587. [PMID: 28952677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hepatitis A is an acute viral infection of the liver that produces clinical features ranging from asymptomatic infection to fulminant hepatitis1. The authors report a cluster of 5 serologically-confirmed cases of acute Hepatitis A Virus (HAV), all serum IgM positive for HAV Genotype 1A. This is on a background of only 2 other cases notified to HSE-South in 2016 to date, both travel related. There was a considerable delay in notification in two out of 5 cases. This case report highlights the importance of prompt notification of Hepatitis A, as timely notification would have facilitated prompt contact vaccination and might well have prevented illness in two subsequent household contacts.
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Affiliation(s)
- H A Ferris
- Department of Public Health, HSE South, Cork
| | - A Dillon
- Department of Public Health, HSE South, Cork
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Affiliation(s)
- Raymond S Koff
- University of Connecticut School of Medicine, 2420 Beacon St., Unit 402, Chestnut Hill, MA, 02467-1463, USA.
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Tosone G, Mascolo S, Bruni R, Taffon S, Equestre M, Tosti ME, Ciccaglione AR, Martucci F, Liberti A, Iannece MD, Orlando R. A family cluster of hepatitis A virus due to an uncommon IA strain circulating in Campania (southern Italy), not associated with raw shellfish or berries: a wake-up call to implement vaccination against hepatitis A? Infez Med 2016; 24:230-233. [PMID: 27668904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hepatitis A virus is a widely occurring disease, with different prevalence rates between countries in the North and West and those in the South and East. In Italy endemicity is low/medium, but not homogeneously distributed: in the northern/central regions a large hepatitis A outbreak due to genotype IA, related to the consumption of contaminated mixed frozen berries, occurred between 2013 and 2014, whereas in southern Italian regions recurrent outbreaks of hepatitis A, due to the IB genotype, still result from consumption of raw seafood. In 2014 an uncommon genotype IA strain was isolated from five patients (2 adults and 3 children) with hepatitis A, living in the surroundings of Naples (Campania) who did not have any of the most common risk factors for hepatitis A in Italy, such as consumption of raw shellfish or frozen berries, or travel to endemic countries. Moreover, based on the analysis of viral sequences obtained, this strain differed from several others in the national database, which had been recently isolated during Italian outbreaks. This case report reinforces the need to implement both information campaigns about the prevention of hepatitis A and vaccination programmes in childhood; in addition, it would be suitable to sequence strains routinely not only during large outbreaks of hepatitis A in order to obtain a more detailed national database of HAV strains circulating in Italy.
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Affiliation(s)
- Grazia Tosone
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, Viral Infection and AIDS Unit, University Federico II, Naples, Italy
| | - Silvia Mascolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, Viral Infection and AIDS Unit, University Federico II, Naples, Italy
| | - Roberto Bruni
- Department of Infectious, Parasitic and Immune-mediated Diseases, Viral Hepatitis Section, Istituto Superiore di Sanitá, Rome, Italy
| | - Stefania Taffon
- Department of Infectious, Parasitic and Immune-mediated Diseases, Viral Hepatitis Section, Istituto Superiore di Sanitá, Rome, Italy
| | - Michele Equestre
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanitá, Rome, Italy
| | - Maria Elena Tosti
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanitá, Rome, Italy
| | - Anna Rita Ciccaglione
- Department of Infectious, Parasitic and Immune-mediated Diseases, Viral Hepatitis Section, Istituto Superiore di Sanitá, Rome, Italy
| | - Fiorella Martucci
- Unit of Infectious Diseases, Azienda Ospedaliera dei Colli - Cotugno, Naples, Italy
| | - Alfonso Liberti
- Unit of Infectious Diseases, Azienda Ospedaliera dei Colli - Cotugno, Naples, Italy
| | - Maria Donata Iannece
- Unit of Infectious Diseases, Azienda Ospedaliera dei Colli - Cotugno, Naples, Italy
| | - Raffaele Orlando
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, Viral Infection and AIDS Unit, University Federico II, Naples, Italy
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Bruni R, Taffon S, Equestre M, Chionne P, Madonna E, Rizzo C, Tosti ME, Alfonsi V, Ricotta L, De Medici D, Di Pasquale S, Scavia G, Pavoni E, Losio MN, Romanò L, Zanetti AR, Morea A, Pacenti M, Palù G, Capobianchi MR, Chironna M, Pompa MG, Ciccaglione AR. Key Role of Sequencing to Trace Hepatitis A Viruses Circulating in Italy During a Large Multi-Country European Foodborne Outbreak in 2013. PLoS One 2016; 11:e0149642. [PMID: 26901877 PMCID: PMC4764681 DOI: 10.1371/journal.pone.0149642] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/03/2016] [Indexed: 12/15/2022] Open
Abstract
Background Foodborne 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. Methods Molecular characterization was carried out by PCR/sequencing (VP1/2A region), comparison with reference strains and phylogenetic analysis. Results A 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. Conclusions In 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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Affiliation(s)
- Roberto Bruni
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
- * E-mail:
| | - Stefania Taffon
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Michele Equestre
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Paola Chionne
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Elisabetta Madonna
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Caterina Rizzo
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Maria Elena Tosti
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Valeria Alfonsi
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Lara Ricotta
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Dario De Medici
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Simona Di Pasquale
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Gaia Scavia
- Department of Veterinary Public Health and Food Safety, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Enrico Pavoni
- Reparto tecnologia acidi nucleici applicata agli alimenti, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, Brescia, Italy
| | - Marina Nadia Losio
- Reparto tecnologia acidi nucleici applicata agli alimenti, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, Brescia, Italy
| | - Luisa Romanò
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Anna Morea
- Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Monia Pacenti
- Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | | | - Maria Chironna
- Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Maria Grazia Pompa
- Directorate General for Preventive Health Care, Ministry of Health, Rome, Italy
| | - Anna Rita Ciccaglione
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità (ISS), Rome, Italy
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26
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Bui D, Brown HE, Harris RB, Oren E. Serologic Evidence for Fecal-Oral Transmission of Helicobacter pylori. Am J Trop Med Hyg 2016; 94:82-8. [PMID: 26598563 PMCID: PMC4710451 DOI: 10.4269/ajtmh.15-0297] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/19/2015] [Indexed: 12/27/2022] Open
Abstract
Helicobacter pylori infection is among the most prevalent infections in the world and a key cause of gastric diseases; however, its route of transmission remains unclear. This study aimed to assess the potential for fecal-oral transmission of H. pylori by leveraging its association with a disease with known etiology. Utilizing serology data from the National Health and Nutrition Examination Survey (NHANES 1999; N = 6,347), the association between H. pylori and hepatitis A virus (HAV), a sensitive indicator for fecal-oral exposure, was assessed. Survey-weighted kappa and multiple logistic regression were used to quantify the association between H. pylori and HAV after controlling for age, sex, race, poverty, birthplace, crowding, smoking, and alcohol use. Concordant serological results were found among 69.8% of participants (survey-weighted κ = 0.30, 95% confidence interval [CI] = 0.26, 0.35). The adjusted odds of H. pylori seropositivity were over two times higher after adjusting for confounders (odds ratio = 2.27, 95% CI = 1.79, 2.87). Results from this study suggest H. pylori and HAV infections are strongly associated. Since HAV is primarily transmitted through the fecal-oral route, fecal-oral transmission may be an important pathway for H. pylori spread.
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Affiliation(s)
- David Bui
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Heidi E Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Robin B Harris
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Eyal Oren
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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27
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Suzuki T, Ishii K. [Epidemiology of hepatitis A virus]. Nihon Rinsho 2015; 73 Suppl 9:571-575. [PMID: 26845999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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28
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Kawaguchi T, Torimura T. [Prevention for hepatitis A]. Nihon Rinsho 2015; 73 Suppl 9:593-598. [PMID: 26846003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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29
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Yatsuhashi H, Yamasaki K. [Clinical feature of viral hepatitis A]. Nihon Rinsho 2015; 73 Suppl 9:584-588. [PMID: 26846001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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30
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Chaudhry SA, Koren G. Hepatitis A infection during pregnancy. Can Fam Physician 2015; 61:963-964. [PMID: 26881283 PMCID: PMC4642904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
QUESTION Many of my patients are from Southeast Asia, where hepatitis A virus (HAV) infection is quite common. What precautions can I suggest my pregnant patients take before traveling to these areas and what is the risk of contracting HAV during pregnancy? ANSWER Hepatitis A virus is a water-borne pathogen transmitted by the fecal-oral route. To reduce the risk of contracting HAV while traveling to endemic areas, it is important to maintain hygienic practices such as hand washing with safe water, particularly before handling food, avoiding drinking water or using ice cubes of unknown purity, and avoiding eating unpeeled fruits and vegetables. An HAV vaccine is available and can be administered before traveling to endemic countries. Hepatitis A virus infection has a largely favourable expected outcome even during pregnancy. Infection occurring in the second or third trimester has been reported to be associated with preterm labour.
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Dhankhar P, Nwankwo C, Pillsbury M, Lauschke A, Goveia MG, Acosta CJ, Elbasha EH. Public Health Impact and Cost-Effectiveness of Hepatitis A Vaccination in the United States: A Disease Transmission Dynamic Modeling Approach. Value Health 2015; 18:358-367. [PMID: 26091589 DOI: 10.1016/j.jval.2015.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/02/2015] [Accepted: 02/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the population-level impact and cost-effectiveness of hepatitis A vaccination programs in the United States. METHODS We developed an age-structured population model of hepatitis A transmission dynamics to evaluate two policies of administering a two-dose hepatitis A vaccine to children aged 12 to 18 months: 1) universal routine vaccination as recommended by the Advisory Committee on Immunization Practices in 2006 and 2) Advisory Committee on Immunization Practices's previous regional policy of routine vaccination of children living in states with high hepatitis A incidence. Inputs were obtained from the published literature, public sources, and clinical trial data. The model was fitted to hepatitis A seroprevalence (National Health and Nutrition Examination Survey II and III) and reported incidence from the National Notifiable Diseases Surveillance System (1980-1995). We used a societal perspective and projected costs (in 2013 US $), quality-adjusted life-years, incremental cost-effectiveness ratio, and other outcomes over the period 2006 to 2106. RESULTS On average, universal routine hepatitis A vaccination prevented 259,776 additional infections, 167,094 outpatient visits, 4781 hospitalizations, and 228 deaths annually. Compared with the regional vaccination policy, universal routine hepatitis A vaccination was cost saving. In scenario analysis, universal vaccination prevented 94,957 infections, 46,179 outpatient visits, 1286 hospitalizations, and 15 deaths annually and had an incremental cost-effectiveness ratio of $21,223/quality-adjusted life-year when herd protection was ignored. CONCLUSIONS Our model predicted that universal childhood hepatitis A vaccination led to significant reductions in hepatitis A mortality and morbidity. Consequently, universal vaccination was cost saving compared with a regional vaccination policy. Herd protection effects of hepatitis A vaccination programs had a significant impact on hepatitis A mortality, morbidity, and cost-effectiveness ratios.
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Affiliation(s)
- Praveen Dhankhar
- Merck & Co., Inc., Kenilworth, NJ, USA; Complete HEOR Solutions, North Wales, PA, USA
| | | | | | - Andreas Lauschke
- Merck & Co., Inc., Kenilworth, NJ, USA; Lauschke Consulting, Morris Plains, NJ, USA
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Sahai S, Mishra V, Ganga D, Jatav OP. Viral Hepatitis in Pregnancy--A study of its Effect on Maternal and Foetal Outcome. J Assoc Physicians India 2015; 63:28-33. [PMID: 26591124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND AIMS The outcome of Hepatitis during pregnancy has been observed to be widely different by various authors, ranging from the benign to fatal. A poor outcome has increasingly been observed in pregnant women suffering from Hepatitis in Central India. Hence, this study was undertaken to study the incidence, causative organisms and chief prognostic factors affecting the outcome of viral hepatitis in pregnant women. METHODS Sixty-eight pregnant women reporting to the hospital with jaundice were enrolled as cases and their Haematological, Biochemical and Viral profiles were studied. Sixteen non- pregnant women were enrolled as controls and a similar workup was done. A comparison was done between the two groups We also divided the cases into two groups--survivors and non- survivors and tried to find out the factors predicting mortality. The unpaired student t test and chi square test were used to find out whether the differences were statistically significant. RESULTS Viral Hepatitis in pregnancy caused a very high maternal mortality (19.1%) and foetal wastage (42.6%). Hepatitis E virus was the commonest causative organism (77.9%) responsible for viral hepatitis during pregnancy. It also caused the highest maternal mortality due to fulminant hepatic failure. Maternal mortality was significantly higher in those women presenting with features of encephalopathy, SIRS, high bilirubin levels and prolonged prothrombin time. Vertical transmission was noted in Hepatitis B and E. CONCLUSIONS Hepatitis E is the chief causative organism causing fulminant hepatic failure in pregnant women in Central India. It lead to very high rates of maternal mortality and foetal wastage.
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MESH Headings
- Abortion, Spontaneous/epidemiology
- Adult
- Brain Diseases/epidemiology
- Brain Diseases/virology
- Female
- Hepatitis A/epidemiology
- Hepatitis A/mortality
- Hepatitis A/transmission
- Hepatitis B/epidemiology
- Hepatitis B/mortality
- Hepatitis B/transmission
- Hepatitis C/epidemiology
- Hepatitis C/mortality
- Hepatitis C/transmission
- Hepatitis E/epidemiology
- Hepatitis E/mortality
- Hepatitis E/transmission
- Hepatitis, Viral, Human/mortality
- Hepatitis, Viral, Human/transmission
- Hepatitis, Viral, Human/virology
- Humans
- India
- Infectious Disease Transmission, Vertical/statistics & numerical data
- Maternal Mortality
- Pregnancy
- Pregnancy Complications, Infectious/mortality
- Pregnancy Complications, Infectious/virology
- Prognosis
- Prospective Studies
- Systemic Inflammatory Response Syndrome/epidemiology
- Systemic Inflammatory Response Syndrome/virology
- Young Adult
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33
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Persson H, Nasta F, Svensson I, Widerström M. [Unexpectedly high proportion of preschool children immune to hepatitis A virus. Contact tracing investigation shows the need for vaccination prior to traveling abroad]. Lakartidningen 2014; 111:2224-2226. [PMID: 25462320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hepatitis A (HAV) is a low incidence infectious disease in Sweden, and a majority of cases in this country are acquired abroad, although domestic cases are not uncommon in the day care setting. We investigated an outbreak of hepatitis A in two day care centres and found that a large proportion (23%) of the 113 unvaccinated preschool children were immune to HAV. This observation indicates that there may have been sub-clinical cases of HAV at the two centres. The results of our study underscore the importance of HAV vaccination in preschool children prior to travel to areas where this disease is common. The findings also highlight the need for up-to-date national seroepidemiological data on HAV immunity in different age groups in Sweden. Studies aimed at obtaining such information could also provide a basis for deciding whether targeted vaccination strategies against HAV are needed in the day care setting.
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Affiliation(s)
- Hanna Persson
- Östersunds sjukhus - AT-läkare Östersund, Sweden Östersunds sjukhus - ÁT-läkare Östersund, Sweden
| | - Federico Nasta
- Östersunds sjukhus - Barn- och ungdomskliniken Östersund, Sweden Mittuniversitet - Omvårdnad och medicinsk vetenskap Östersund, Sweden
| | - Ingrid Svensson
- Jämtland County Council - Department of Communicable Disease Control and Prevention Östersund, Sweden Jämtland County Council - Department of Communicable Disease Control and Prevention Östersund, Sweden
| | - Micael Widerström
- Jämtland County Council - Department of Communicable Disease Control and Prevention Östersund, Sweden Jämtland County Council - Department of Communicable Disease Control and Prevention Östersund, Sweden
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34
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Widell A. [Outbreak of hepatitis A in a preschool--fresh seroprevalence data needed]. Lakartidningen 2014; 111:2214. [PMID: 25462321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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35
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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 Environ Virol 2014; 6:297-300. [PMID: 25183415 PMCID: PMC4228166 DOI: 10.1007/s12560-014-9165-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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36
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Cabrera-Gaytán DA, Nava-Martínez ML, Ontiveros D, Niebla-Fuentes MR, Grajales-Muñiz C, Rojas-Mendoza T. [Experience on the management of a hepatitis A outbreak in a children daycare center]. Rev Med Inst Mex Seguro Soc 2014; 52:630-636. [PMID: 25354056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Since hepatitis A virus is transmitted via the fecal-oral route, outbreaks in nurseries are favored by constant diaper changes and failures in hygienic measures. The purpose of this investigation was to describe an outbreak of hepatitis A between November 2012 and February 2013 at a nursery in Mexicali, Baja California, as well as the measures adopted for its control. METHODS A descriptive study was conducted on the outbreak and the control measures, calculating the rates of attack and establishing proportions using the Wilson's scale. Pupils, workers or family members with symptoms consistent with hepatitis A were considered to be suspected cases. First-occurrence hepatitis A records were reviewed on the Weekly Disease Surveillance Report at the involved medical units and on the nursery's infirmary records. RESULTS The global attack rate was 13.1 %, and in those captive in the nursery, 9.5 %. Jaundice, biliuria and abdominal pain were the most important clinical data. There were no deaths or hospitalizations. The outbreak lasted 86 days. Control measures were based on epidemiological surveillance reinforcement and preventive hygienic measures. CONCLUSIONS The outbreak showed a spreading trend, it affected mainly children and showed the importance of health education and epidemiological surveillance maintenance, extensive to the familial setting.
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Montano-Remacha C, Ricotta L, Alfonsi V, Bella A, Tosti M, Ciccaglione A, Bruni R, Taffon S, Equestre M, Losio M, Carraro V, Franchini S, Natter B, Augschiller M, Foppa A, Gualanduzzi C, Massimiliani E, Finarelli A, Borrini B, Gallo T, Cozza V, Chironna M, Prato R, Rizzo C. Hepatitis A outbreak in Italy, 2013: a matched case-control study. Euro Surveill 2014; 19:20906. [PMID: 25259533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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38
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WU JB, LI XL, ZHANG J, XU D, ZHU JJ, ZHOU BS. Source identification through social networks in an epidemiological investigation of a hepatitis A outbreak at an elementary school in Anhui province, China. Epidemiol Infect 2014; 142:1450-8. [PMID: 24047565 PMCID: PMC9151190 DOI: 10.1017/s0950268813002331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/06/2013] [Accepted: 08/28/2013] [Indexed: 11/06/2022] Open
Abstract
In May 2011, the Center for Disease Control and Prevention of a Chinese county found a rapid increase in the number of hepatitis A case notification; these were traced to an outbreak in an elementary school. Twenty-eight cases aged between 7 and 13 years with onset between 7 May and 8 June were serologically confirmed. Network method was conducted to reconstruct an outbreak network and to quantify the relative importance of those involved in the outbreak. A case-control study was used to study the association between the outbreak and putative risk factors. The network analysis suggested this was a disseminated outbreak originating from a 4-year-old boy with propagated spread. Evidence from the case-control study supported consumption of well water as a potential risk factor; however, this was unable to be established through field investigation. Outbreak networks can be used to identify the possible source of infectious disease outbreak, especially when the environmental investigation information is negative or not available.
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Affiliation(s)
- J. B. WU
- Center for Disease Control and Prevention of Anhui Province, Hefei, China
| | - X. L. LI
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - J. ZHANG
- Center for Disease Control and Prevention of Anhui Province, Hefei, China
| | - D. XU
- Center for Disease Control and Prevention of Anhui Province, Hefei, China
| | - J. J. ZHU
- Center for Disease Control and Prevention of MengCheng County, Anhui Province, Bozhou, China
| | - B. S. ZHOU
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
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39
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Burgess C, Peace A, Everett R, Allegri B, Garman P. Computational modeling of interventions and protective thresholds to prevent disease transmission in deploying populations. Comput Math Methods Med 2014; 2014:785752. [PMID: 25009579 PMCID: PMC4070471 DOI: 10.1155/2014/785752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/05/2014] [Accepted: 05/07/2014] [Indexed: 01/05/2023]
Abstract
Military personnel are deployed abroad for missions ranging from humanitarian relief efforts to combat actions; delay or interruption in these activities due to disease transmission can cause operational disruptions, significant economic loss, and stressed or exceeded military medical resources. Deployed troops function in environments favorable to the rapid and efficient transmission of many viruses particularly when levels of protection are suboptimal. When immunity among deployed military populations is low, the risk of vaccine-preventable disease outbreaks increases, impacting troop readiness and achievement of mission objectives. However, targeted vaccination and the optimization of preexisting immunity among deployed populations can decrease the threat of outbreaks among deployed troops. Here we describe methods for the computational modeling of disease transmission to explore how preexisting immunity compares with vaccination at the time of deployment as a means of preventing outbreaks and protecting troops and mission objectives during extended military deployment actions. These methods are illustrated with five modeling case studies for separate diseases common in many parts of the world, to show different approaches required in varying epidemiological settings.
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Affiliation(s)
| | | | | | | | - Patrick Garman
- Military Vaccine Agency (MILVAX), Defense Health Headquarters, Falls Church, VA 22042, USA
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40
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Parker JA, Kurien TT, Huppatz C. Hepatitis A outbreak associated with kava drinking. Commun Dis Intell (2018) 2014; 38:E26-E28. [PMID: 25409352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hepatitis A is caused by the hepatitis A virus (HAV), with transmission occurring through the faecal-oral route. In May 2013, a case of hepatitis A infection was reported to a Western Australian regional public health unit, with infection acquired in Fiji. Following this, 2 further cases were linked to the index case by kava drinking and 1 further case was a household contact of a secondary case. This outbreak highlights that the preparation of kava drink and/or the use of a common drinking vessel could be a vehicle for the transmission of HAV.
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Affiliation(s)
- Jo-Anne Parker
- Senior Public Health Nurse, Western Australian Country Health Service, Kalgoorlie, Western Australia
| | - Thomas T Kurien
- Senior Medical Officer, Western Australian Country Health Service, Kalgoorlie, Western Australia
| | - Clare Huppatz
- Public Health Physician, Western Australian Country Health Service, Kalgoorlie, Western Australia
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41
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Abstract
BACKGROUND AND OBJECTIVES Emerging infections abroad pose a threat to the safety of blood, donated by travelling blood donors. In this study, the yield of donor deferral after travelling was evaluated, by comparing the estimated numbers of infected donors returning from various affected areas. METHODS A deterministic model was applied to calculate the number of infected donors, returning from six areas affected by outbreaks: Greece - Macedonia (West Nile fever), Italy - Emilia Romagna (West Nile fever), Thailand (chikungunya), Latvia (hepatitis A), central Turkey (Sicilian sandfly fever) and Italy - Tuscany (Toscana sandfly fever). RESULTS The estimated number of infections among returning blood donors was surprisingly low, ranging from 0·32 West Nile virus-infected donors per year returning from Macedonia (Greece) to approximately 0·005 infected donors per year returning respectively from Tuscany (sandfly fever), Latvia (hepatitis A) and central Turkey (sandfly fever). CONCLUSION The yield of the temporary exclusion of blood donors travelling to a specific, affected area is low, but the continuous monitoring of emerging infections and the timely assessment of new threats are laborious and imperfect. Safety measures may be instituted after the greatest threat of a new outbreak has passed. A general deferral of travelling donors may be more appropriate than targeted measures. It can be argued that all donors who stayed outside their country or continent of residency should be deferred for 4 weeks.
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Affiliation(s)
- R W Lieshout-Krikke
- Sanquin Blood Supply Foundation, Department of Blood-borne infections, Amsterdam, The Netherlands
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42
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Rachiotis G, Papagiannis D, Thanasias E, Dounias G, Hadjichristodoulou C. Hepatitis A virus infection and the waste handling industry: a seroprevalence study. Int J Environ Res Public Health 2012; 9:4498-503. [PMID: 23222205 PMCID: PMC3546774 DOI: 10.3390/ijerph9124498] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 11/25/2012] [Accepted: 11/26/2012] [Indexed: 11/16/2022]
Abstract
Waste collectors have a theoretical risk of Hepatitis A virus infection. The aim of the study was to assess the prevalence and risk factors of hepatitis A virus infection (HAV) among municipal solid waste workers (MSWWs) in a municipality of central Greece. A seroprevalence study of HAV was conducted among 208 employees (100 waste collectors and 108 municipal gardeners) of a municipality in central Greece. Total antibodies against HAV were measured and information regarding potential risk factors was collected through a face to face interview. The prevalence of HAV infection among the municipal waste collectors was 61% vs. 27% among municipal gardeners. Logistic regression analysis showed that exposure to waste (OR = 2.87; 95% CI = 1.24-6.62) and age (OR = 22.57; 95% CI = 7.29-69.88) were independently associated with the anti-HAV positivity. Moreover, waste collectors who reported smoking/drinking/eating during waste collection were at higher risk of HAV infection (RR = 2.84; 95% CI = 1.73-4.63). Stratified analysis among municipal waste collectors indicated an independent association between eating/smoking/ drinking during waste collection and anti-HAV (+) (OR = 3.85; 95% CI = 1.34-11.06). Occupational exposure to waste is a potential risk factor for HAV infection. Smoking/eating/drinking during waste collection could be the mode of hepatitis A virus transmission among municipal waste collectors.
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Affiliation(s)
- George Rachiotis
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larissa 41222, Greece; E-Mails: (G.R.); (D.P.); (E.T.)
| | - Dimitrios Papagiannis
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larissa 41222, Greece; E-Mails: (G.R.); (D.P.); (E.T.)
| | - Efthimios Thanasias
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larissa 41222, Greece; E-Mails: (G.R.); (D.P.); (E.T.)
| | - George Dounias
- Department of Occupational and Industrial Hygiene, National School of Public Health, Athens 115-21, Greece; E-Mail:
| | - Christos Hadjichristodoulou
- Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larissa 41222, Greece; E-Mails: (G.R.); (D.P.); (E.T.)
- Author to whom correspondence should be addressed; E-Mail:
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43
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Yano K. [Other viral food poisoning (hepatitis A and E)]. Nihon Rinsho 2012; 70:1386-1390. [PMID: 22894078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hepatitis A and E viruses are spread via the fecal-oral route. In the endemic area, restaurant and school outbreaks due to contaminated water or food have been reported. The clinical signs and symptoms in patients with typical hepatitis A and E are similar to those seen with other forms of acute viral hepatitis. Hepatitis A tends to be more severe when acquired at older ages. Hepatitis E appears to be relatively severe compared with hepatitis A. Although both hepatitis are self-limited illness, severe hepatits are rarely observed. Hepatitis A and E can be prevented by improved sanitary conditions, handwashing, heating foods appropriately. Avoidance of water and foods from endemic areas is also effective.
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Affiliation(s)
- Kunio Yano
- Department of Infectious Diseases, Hamamatsu Medical Center
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44
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Yao K, Yu FX, Li L, Feng H, Li H, Zhang XY, Yin F, Zhu CR. [Long term effectiveness of vaccination of Hepatitis A]. Sichuan Da Xue Xue Bao Yi Xue Ban 2012; 43:200-205. [PMID: 22650031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To develop a dynamic model of Hepatitis A transmission in order to predict the long-term effectiveness of Hepatitis A vaccination on 18 months old infants and 2 to 18 years old children. METHODS A dynamic model of HA (S-E-I-R-V) was developed using the software Berkeley-Madonna. The parameters required for the model derived from literature. A sensitivity analysis was performed to assess the stability of the model through changing parameters. RESULTS During the period of 2010 to 2030, the cumulative cases of Hepatitis A would reach 7.8 million with an incidence of 38.8 per 100,000 without vaccination. With 38% to 57% coverage of vaccination in children of 1.5-18 years old, the cumulative cases would decrease to 4.36-4.75 million with an incidence of 17.5-19.4 per 100,000. The vaccination was predicted to reduce 3.06-3.45 million Hepatitis A cases with an incidence reduction of 19.4-21.3 per 100,000. This suggests that Hepatitis A vaccination would achieve a 54% decrease in incidence of Hepatitis A. The sensitivity analysis showed that the coverage of vaccination had a significant impact on the incidence of Hepatitis A. By 2030, the incidence of Hepatitis A would decrease from 19.4 per 100,000 to 16.0 per 100,000 when the vaccination coverage increases from 38% to 90%. CONCLUSION Hepatitis A vaccination can effectively prevent and control the incidence of Hepatitis A.
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Affiliation(s)
- Ke Yao
- Department of Health Statistics, West China School of Public Health, Sichuan University, Chengdu 610041, China
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45
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Torner N, Broner S, Martinez A, Tortajada C, Garcia de Olalla P, Barrabeig I, Sala M, Camps N, Minguell S, Alvarez J, Ferrús G, Torra R, Godoy P, Dominguez A. Factors associated to duration of hepatitis a outbreaks: implications for control. PLoS One 2012; 7:e31339. [PMID: 22355358 PMCID: PMC3280286 DOI: 10.1371/journal.pone.0031339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 01/06/2012] [Indexed: 11/24/2022] Open
Abstract
Even though hepatitis A mass vaccination effectiveness is high, outbreaks continue to occur. The aim of this study was to investigate the association between duration and characteristics of hepatitis A outbreaks. Hepatitis A (HA) outbreaks reported between 1991 and 2007 were studied. An outbreak was defined as ≥2 epidemiologically-linked cases with ≥1 case laboratory-confirmed by detection of HA immunoglobulin M (IgM) antibodies. Relationships between explanatory variables and outbreak duration were assessed by logistic regression. During the study period, 268 outbreaks (rate 2.45 per million persons-year) and 1396 cases (rate 1.28 per 10(5) persons-year) were reported. Factors associated with shorter duration were time to intervention (OR = 0.96; 95% CI: 0.94-0.98) and school setting (OR = 0.39; 95% CI: 0.16-0.92). In person-to-person transmission outbreaks only time to intervention was associated with shorter outbreak duration (OR = 0.96; 95% CI: 0.95-0.98). The only variables associated with shorter outbreak duration were early administration of IG or vaccine and a school setting. Timely reporting HA outbreaks was associated with outbreak duration. Making confirmed HA infections statutory reportable for clinical laboratories could diminish outbreak duration.
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Affiliation(s)
- Nuria Torner
- Department of Health. Generalitat of Catalonia. Barcelona, Spain.
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46
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Triassi M, Ottaiano E, Diana MV, Pennino F, Avolio S, Dattilo W, Simonetti A. [Epidemiologic situation of viral hepatitis type A in Campania: perspectives of prevention and control of infections at the local level]. Ann Ig 2012; 24:73-80. [PMID: 22670339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In the Region Campania (South Italy) the Hepatitis A infection reveals to be very present, despite of worldwide decreasing trend. Particularly Naples has a high incidence pathology as compared with other regional districts: the propose of this work is analysing the reasons by analysis of small but representative sample of this pathology. Health District of ASL Napoli 1 Center provides us with the notifications of this disease. The cases disease are attributable to consumption of contaminated shellfish purchased from mainly non-authorized dealers present on all city territory. A properly educational, of the population, increased repression control of dealers, careful monitoring of illegal dumping, can reduce the incidence of EVA in city live Naples.
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Affiliation(s)
- M Triassi
- Dipartimento di Scienze Mediche Preventive, Università degli Studi di Napoli Federico II
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47
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Dabrowska MM, Nazzal K, Wiercinska-Drapalo A. Hepatitis A and hepatitis A virus/HIV coinfection in men who have sex with men, Warsaw, Poland, September 2008 to September 2009. Euro Surveill 2011; 16:19950. [PMID: 21903035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
We describe the epidemiology and characteristics of hepatitis A among men who have sex with men (MSM)who had been hospitalised due to the infection in Warsaw, Poland, from September 2008 to September 2009. A total of 50 men were analysed; their median age was 28 years (range: 17–43). None had travelled to hepatitis A-endemic regions during the six months before hospitalisation nor had they been vaccinated against hepatitis A. Of the 50 men, 40 had been tested before hospitalisation or on admission for the presence of anti-HIV antibodies: six were coinfected with HIV.The six HIV-positive MSM were significantly older than those who were HIV negative – median age: 37 years(range: 26–43) versus 28 years (range: 17–43); p=0.02.No difference in disease severity or the duration of hospitalisation was observed, however, between the two groups. Our study underlines the need to screen MSM for hepatitis A and to vaccinate them against hepatitis A. Given the ages of the MSM in our study,we recommend that this be carried out in Poland when the MSM are aged 20–35 years. This should apply not only to MSM with multiple casual partners but also to those in monogamous relationships.
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Affiliation(s)
- M M Dabrowska
- Department of Hepatology and Acquired Immunodeficiences, Warsaw Medical University, Warsaw, Poland.
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48
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Gallot C, Grout L, Roque-Afonso AM, Couturier E, Carrillo-Santisteve P, Pouey J, Letort MJ, Hoppe S, Capdepon P, Saint-Martin S, De Valk H, Vaillant V. Hepatitis A associated with semidried tomatoes, France, 2010. Emerg Infect Dis 2011; 17:566-7. [PMID: 21392466 PMCID: PMC3166027 DOI: 10.3201/eid1703.101479] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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49
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Abstract
Infection with hepatitis viruses can lead to acute hepatitis with the risk of developing liver failure. Chronic viral hepatitis may evolve into liver cirrhosis and hepatocellular carcinoma. Thus, prevention of viral hepatitis and its sequels is essential. Vaccination against hepatitis A is successful in almost all individuals. Protective antibodies maintain for at least 20 years. Booster vaccinations are not necessary. Since the introduction of hepatitis A vaccines, the incidence of new HAV-infections has declined significantly. Hepatitis B vaccines are safe and highly effective. Special populations such as dialysis patients or immunocompromised patients require special vaccine schedules. New vaccines with improved adjuvants are currently being tested in clinical trials. So far there is no hepatitis C vaccine on the horizon. Prophylaxis of HCV-infections relies primarily on hygiene measures. Early therapy of acute hepatitis C can prevent chronic hepatitis C. HDV-infection can only be established if HBsAg is present. Thus, prevention of hepatitis B or elimination of HBsAg means prevention of hepatitis delta. Hepatitis E vaccines have been evaluated in phase III studies. The development of HEV vaccines becomes more relevant since chronic HEV infections have been reported in immunosuppressed individuals.
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Affiliation(s)
- M Cornberg
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, Hannover, Germany.
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The smoldering epidemic. The number of new cases of hepatitis C is down, but millions are chronically infected and may not know it. Harv Health Lett 2010; 35:1-3. [PMID: 20939121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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