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Abstract

Background

Travel to countries with high or intermediate hepatitis A virus (HAV) endemicity is a risk factor for infection in residents of countries with low HAV endemicity. The objective of this study was to estimate the risk for hepatitis A among European travellers using surveillance and travel denominator data. We retrieved hepatitis A surveillance data from 13 European Union (EU)/ European Economic Area (EEA) countries with comprehensive surveillance systems and travel denominator data from the Statistical Office of the European Union. A travel-associated case of hepatitis A was defined as any case reported as imported. From 2009 to 2015, the 13 countries reported 18,839 confirmed cases of hepatitis A, of which 5,233 (27.8%) were travel-associated. Of these, 39.8% were among children younger than 15 years. The overall risk associated with travel abroad decreased over the period at an annual rate of 3.7% (95% confidence interval (CI): 0.7–2.7) from 0.70 cases per million nights in 2009 to 0.51 in 2015. The highest risk was observed in travellers to Africa (2.11 cases per million nights). Cases more likely to be reported as travel-associated were male and of younger age (< 25 years). Travel is still a major risk factor for HAV infection in the EU/EEA, although the risk of infection may have slightly decreased in recent years. Children younger than 15 years accounted for a large proportion of cases and should be prioritised for vaccination.

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/content/10.2807/1560-7917.ES.2018.23.22.1700583
2018-05-31
2024-11-25
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.22.1700583
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References

  1. Havelaar AH, Kirk MD, Torgerson PR, Gibb HJ, Hald T, Lake RJ, et al. World Health Organization global estimates and regional comparisons of the burden of foodborne disease in 2010. PLoS Med. 2015;12(12):e1001923.  https://doi.org/10.1371/journal.pmed.1001923  PMID: 26633896 
  2. Koff RS. Hepatitis A. Lancet. 1998;351(9116):1643-9.  https://doi.org/10.1016/S0140-6736(98)01304-X  PMID: 9620732 
  3. Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016;388(10049):1081-8.  https://doi.org/10.1016/S0140-6736(16)30579-7  PMID: 27394647 
  4. Jacobsen KH, Wiersma ST. Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine. 2010;28(41):6653-7.  https://doi.org/10.1016/j.vaccine.2010.08.037  PMID: 20723630 
  5. Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58(3):593-608.  https://doi.org/10.1016/j.jhep.2012.12.005  PMID: 23419824 
  6. Gossner CM, Severi E, Danielsson N, Hutin Y, Coulombier D. Changing hepatitis A epidemiology in the European Union: new challenges and opportunities. Euro Surveill. 2015;20(16):21101.  https://doi.org/10.2807/1560-7917.ES2015.20.16.21101  PMID: 25953274 
  7. European Centre for Disease Prevention and Control (ECDC). Hepatitis A virus in the EU/EEA, 1975-2014. A systematic review of seroprevalence and incidence comprising European surveillance data and national vaccination recommendations. Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/en/publications-data/hepatitis-virus-eueea-1975-2014
  8. Kumbang J, Ejide S, Tedder RS, Ngui SL. Outbreak of hepatitis A in an extended family after importation by non-immune travellers. Epidemiol Infect. 2012;140(10):1813-20.  https://doi.org/10.1017/S0950268811002561  PMID: 22142642 
  9. Sane J, MacDonald E, Vold L, Gossner C, Severi E, on behalf of the International Outbreak Investigation Team. Multistate foodborne hepatitis A outbreak among European tourists returning from Egypt--need for reinforced vaccination recommendations, November 2012 to April 2013. Euro Surveill. 2015;20(4):21018.  https://doi.org/10.2807/1560-7917.ES2015.20.4.21018  PMID: 25655054 
  10. Klevens RM, Miller JT, Iqbal K, Thomas A, Rizzo EM, Hanson H, et al. The evolving epidemiology of hepatitis a in the United States: incidence and molecular epidemiology from population-based surveillance, 2005-2007. Arch Intern Med. 2010;170(20):1811-8.  https://doi.org/10.1001/archinternmed.2010.401  PMID: 21059974 
  11. WHO position paper on hepatitis A vaccines – June 2012. Wkly Epidemiol Rec. 2012;87(28/29):261-76. PMID: 22905367 
  12. Pedersini R, Marano C, De Moerlooze L, Chen L, Vietri J. HAV & HBV vaccination among travellers participating in the National Health and Wellness Survey in five European countries. Travel Med Infect Dis. 2016;14(3):221-32.  https://doi.org/10.1016/j.tmaid.2016.03.008  PMID: 27000975 
  13. Askling HH, Rombo L, Andersson Y, Martin S, Ekdahl K. Hepatitis A risk in travelers. J Travel Med. 2009;16(4):233-8.  https://doi.org/10.1111/j.1708-8305.2009.00307.x  PMID: 19674261 
  14. Sane J, de Sousa R, van Pelt W, Petrignani M, Verhoef L, Koopmans M. Risk of hepatitis A decreased among Dutch travelers to endemic regions in 2003 to 2011. J Travel Med. 2015;22(3):208-11.  https://doi.org/10.1111/jtm.12181  PMID: 25530483 
  15. European Centre for Disease Prevention and Control (ECDC). Hepatitis A. Annual epidemiological report 2014. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/en/publications-data/hepatitis-annual-epidemiological-report-2016-2014-data
  16. European Commission. Commission Implementing Decision 2012/506/EU of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. Official Journal of the European Union. Luxembourg: Publications Office of the European Union; 27.9.2012:L262. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:262:0001:0057:EN:PDF
  17. Annual data on trips of EU residents. Luxembourg: Eurostat. [Accessed: 15 Nov 2017. Available from: http://ec.europa.eu/eurostat/cache/metadata/de/tour_dem_esms.htm
  18. Methodological manual for tourism statistics. Version 3.1. 2014 edition. Luxembourg: Eurostat; 2015. Available from: http://ec.europa.eu/eurostat/web/products-manuals-and-guidelines/-/KS-GQ-14-013
  19. Nielsen US, Larsen CS, Howitz M, Petersen E. Hepatitis A among Danish travellers 1980-2007. J Infect. 2009;58(1):47-52.  https://doi.org/10.1016/j.jinf.2008.10.010  PMID: 19059649 
  20. Severi E, Verhoef L, Thornton L, Guzman-Herrador BR, Faber M, Sundqvist L, et al. Large and prolonged food-borne multistate hepatitis A outbreak in Europe associated with consumption of frozen berries, 2013 to 2014. Euro Surveill. 2015;20(29):21192.  https://doi.org/10.2807/1560-7917.ES2015.20.29.21192  PMID: 26227370 
  21. Neave PE, Heywood AE, Gibney KB, Leder K. Imported infections: What information should be collected by surveillance systems to inform public health policy? Travel Med Infect Dis. 2016;14(4):350-9.  https://doi.org/10.1016/j.tmaid.2016.05.007  PMID: 27235839 
  22. Heywood AE, Zwar N, Forssman BL, Seale H, Stephens N, Musto J, et al. The contribution of travellers visiting friends and relatives to notified infectious diseases in Australia: state-based enhanced surveillance. Epidemiol Infect. 2016;1-10. PMID: 27574034 
  23. Warne B, Weld LH, Cramer JP, Field VK, Grobusch MP, Caumes E, et al. Travel-related infection in European travelers, EuroTravNet 2011. J Travel Med. 2014;21(4):248-54.  https://doi.org/10.1111/jtm.12120  PMID: 24750378 
  24. Bacaner N, Stauffer B, Boulware DR, Walker PF, Keystone JS. Travel medicine considerations for North American immigrants visiting friends and relatives. JAMA. 2004;291(23):2856-64.  https://doi.org/10.1001/jama.291.23.2856  PMID: 15199037 
  25. Barnett ED, MacPherson DW, Stauffer WM, Loutan L, Hatz CF, Matteelli A, et al. The visiting friends or relatives traveler in the 21st century: time for a new definition. J Travel Med. 2010;17(3):163-70.  https://doi.org/10.1111/j.1708-8305.2010.00411.x  PMID: 20536884 
  26. Diamond C, Thiede H, Perdue T, Secura GM, Valleroy L, Mackellar D, et al. Viral hepatitis among young men who have sex with men: prevalence of infection, risk behaviors, and vaccination. Sex Transm Dis. 2003;30(5):425-32.  https://doi.org/10.1097/00007435-200305000-00009  PMID: 12916134 
  27. Wasley A, Samandari T, Bell BP. Incidence of hepatitis A in the United States in the era of vaccination. JAMA. 2005;294(2):194-201.  https://doi.org/10.1001/jama.294.2.194  PMID: 16014593 
  28. Mellou K, Chrisostomou A, Sideroglou T, Georgakopoulou T, Kyritsi M, Hadjichristodoulou C, et al. Hepatitis A among refugees, asylum seekers and migrants living in hosting facilities, Greece, April to December 2016. Euro Surveill. 2017;22(4):30448.  https://doi.org/10.2807/1560-7917.ES.2017.22.4.30448  PMID: 28181904 
  29. Michaelis K, Wenzel JJ, Stark K, Faber M. Hepatitis A virus infections and outbreaks in asylum seekers arriving to Germany, September 2015 to March 2016. Emerg Microbes Infect. 2017;6(4):e26.  https://doi.org/10.1038/emi.2017.11  PMID: 28442750 
  30. Tjon G, Xiridou M, Coutinho R, Bruisten S. Different transmission patterns of hepatitis A virus for two main risk groups as evidenced by molecular cluster analysis. J Med Virol. 2007;79(5):488-94.  https://doi.org/10.1002/jmv.20821  PMID: 17385681 
  31. Suijkerbuijk AW, Lindeboom R, van Steenbergen JE, Sonder GJ, Doorduyn Y. Effect of hepatitis A vaccination programs for migrant children on the incidence of hepatitis A in The Netherlands. Eur J Public Health. 2009;19(3):240-4.  https://doi.org/10.1093/eurpub/ckn145  PMID: 19174503 
  32. Freedman DO, Chen LH, Kozarsky PE. Medical considerations before international travel. N Engl J Med. 2016;375(3):247-60.  https://doi.org/10.1056/NEJMra1508815  PMID: 27468061 
  33. European Centre for Disease Prevention and Control (ECDC). Hepatitis A outbreak in the EU/EEA mostly affecting men who have sex with men. Third update, 28 June 2017. Rapid risk assessment. Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/en/publications-data/rapid-risk-assessment-hepatitis-outbreak-eueea-mostly-affecting-men-who-have-sex
  34. Crowcroft NS. What causes hepatitis A in travellers to endemic countries? Travel is necessary but not sufficient--a risk factor, not a cause. Epidemiol Infect. 2012;140(10):1821-2.  https://doi.org/10.1017/S0950268812000064  PMID: 22300866 
Travel-associated hepatitis A in Europe, 2009 to 2015
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Julien+Beaut%C3%A9&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Beauté Julien</a>, <a href="/search?value1=Therese+Westrell&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Westrell Therese</a>, <a href="/search?value1=Daniela+Schmid&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schmid Daniela</a>, <a href="/search?value1=Luise+M%C3%BCller&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Müller Luise</a>, <a href="/search?value1=Jevgenia+Epstein&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Epstein Jevgenia</a>, <a href="/search?value1=Mia+Kontio&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kontio Mia</a>, <a href="/search?value1=Elisabeth+Couturier&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Couturier Elisabeth</a>, <a href="/search?value1=Mirko+Faber&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Faber Mirko</a>, <a href="/search?value1=Kassiani+Mellou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mellou Kassiani</a>, <a href="/search?value1=Maria-Louise+Borg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Borg Maria-Louise</a>, <a href="/search?value1=Ingrid+Friesema&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Friesema Ingrid</a>, <a href="/search?value1=Line+Vold&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vold Line</a>, <a href="/search?value1=Ettore+Severi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Severi Ettore</a></span>. Travel-associated hepatitis A in Europe, 2009 to 2015. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(22):pii=1700583. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.22.1700583" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.22.1700583</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 22 Aug 2017;&nbsp;&nbsp; <span class="generated">Accepted</span>: 25 Jan 2018 </span> </p>
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