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Abstract

This report describes an outbreak investigation starting with two closely related suspected food-borne clusters of Dutch hepatitis A cases, nine primary cases in total, with an unknown source in the Netherlands. The hepatitis A virus (HAV) genotype IA sequences of both clusters were highly similar (459/460 nt) and were not reported earlier. Food questionnaires and a case–control study revealed an association with consumption of mussels. Analysis of mussel supply chains identified the most likely production area. International enquiries led to identification of a cluster of patients near this production area with identical HAV sequences with onsets predating the first Dutch cluster of cases. The most likely source for this cluster was a case who returned from an endemic area in Central America, and a subsequent household cluster from which treated domestic sewage was discharged into the suspected mussel production area. Notably, mussels from this area were also consumed by a separate case in the United Kingdom sharing an identical strain with the second Dutch cluster. In conclusion, a small number of patients in a non-endemic area led to geographically dispersed hepatitis A outbreaks with food as vehicle. This link would have gone unnoticed without sequence analyses and international collaboration.

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/content/10.2807/1560-7917.ES.2016.21.3.30113
2016-01-21
2024-11-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.3.30113
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International linkage of two food-borne hepatitis A clusters through traceback of mussels, the Netherlands, 2012
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Ingeborg+L.A.+Boxman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Boxman Ingeborg L.A.</a>, <a href="/search?value1=Linda+Verhoef&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Verhoef Linda</a>, <a href="/search?value1=Harry+Vennema&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vennema Harry</a>, <a href="/search?value1=Siew-Lin+Ngui&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ngui Siew-Lin</a>, <a href="/search?value1=Ingrid+H.M.+Friesema&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Friesema Ingrid H.M.</a>, <a href="/search?value1=Chris+Whiteside&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Whiteside Chris</a>, <a href="/search?value1=David+Lees&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lees David</a>, <a href="/search?value1=Marion+Koopmans&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Koopmans Marion</a></span>. International linkage of two food-borne hepatitis A clusters through traceback of mussels, the Netherlands, 2012. <a href="/content/ecdc">Euro Surveill.</a> 2016;21(3):pii=30113. <a href="https://doi.org/10.2807/1560-7917.ES.2016.21.3.30113" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2016.21.3.30113</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 01 Dec 2014;&nbsp;&nbsp; <span class="generated">Accepted</span>: 04 May 2015 </span> </p>
/content/10.2807/1560-7917.ES.2016.21.3.30113
/content/10.2807/1560-7917.ES.2016.21.3.30113
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