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Surveillance Open Access
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Abstract

Background

European Union/European Economic Area (EU/EEA) countries annually report hepatitis A (HepA) notifications to The European Surveillance System (TESSy).

Aim

To describe EU/EEA HepA notifications from 2010 to 2019 and identify infection drivers and surveillance improvements.

Methods

We analysed demographic, clinical and transmission information of HepA confirmed cases from TESSy. We stratified countries by population susceptibility profile and performed time-series analysis to describe trends in notification rates, sex distribution and travel history.

Results

Twenty-nine EU/EEA countries reported 139,793 HepA cases. Six eastern EU countries reported > 60% of these cases. EU/EEA notification rate during the study period was 3.2 cases per 100,000 population (range 2.7–5.6). Notifications peaked in 2014 and 2017, with marked differences in case demographic characteristics. Notification trends varied across different country susceptibility groups. In 2017, the proportion of males (74%) and case median age (31 years) increased steeply, while no changes occurred in 2014. Travel history showed seasonal case peaks following the summer. More than 47,000 hospitalisations were reported. Annual case fatality was < 0.2% for all years. Information on travel history, hospitalisation, death and mode of transmission was suboptimal.

Discussion

Apart from some countries in its east, the EU/EEA is characterised by low HepA incidence baseline and susceptible to recurrent large cross-border outbreaks. Analysis of European surveillance data highlighted the need for stronger prevention policies for eastern EU countries, men who have sex with men and travellers. Improving surveillance data-quality will enhance knowledge on food-borne, and travel-related exposures to inform more effective and tailored regional prevention policies.

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/content/10.2807/1560-7917.ES.2023.28.19.2200575
2023-05-11
2024-12-26
/content/10.2807/1560-7917.ES.2023.28.19.2200575
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References

  1. Lefeuvre C, Lefort C, Boyer F, Le Cam S, Mouna L, Roque-Afonso AM, et al. Transfusion-Transmitted Hepatitis A Virus, France, 2018. Emerg Infect Dis. 2022;28(1):219-23.  https://doi.org/10.3201/eid2801.210403  PMID: 34932935 
  2. Lemon SM, Ott JJ, Van Damme P, Shouval D. Type A viral hepatitis: A summary and update on the molecular virology, epidemiology, pathogenesis and prevention. J Hepatol. 2017;S0168-8278(17):32278. PMID:28887164
  3. Koff RS. Hepatitis A. Lancet. 1998;351(9116):1643-9.  https://doi.org/10.1016/S0140-6736(98)01304-X  PMID: 9620732 
  4. Severi E, Georgalis L, Pijnacker R, Veneti L, Turiac IA, Chiesa F, et al. Severity of the clinical presentation of hepatitis A in five European countries from 1995 to 2014. Int J Infect Dis. 2022;118:34-43.  https://doi.org/10.1016/j.ijid.2022.01.053  PMID: 35134558 
  5. Carrillo-Santisteve P, Tavoschi L, Severi E, Bonfigli S, Edelstein M, Byström E, et al. Seroprevalence and susceptibility to hepatitis A in the European Union and European Economic Area: a systematic review. Lancet Infect Dis. 2017;17(10):e306-19.  https://doi.org/10.1016/S1473-3099(17)30392-4  PMID: 28645862 
  6. European Centre for Disease Prevention and Control (ECDC). Hepatitis A virus in the EU/EEA, 1975-2014. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/hepatitis-a-virus-EU-EEA-1975-2014.pdf
  7. Beauté J, Westrell T, Schmid D, Müller L, Epstein J, Kontio M, et al. Travel-associated hepatitis A in Europe, 2009 to 2015. Euro Surveill. 2018;23(22):1700583.  https://doi.org/10.2807/1560-7917.ES.2018.23.22.1700583  PMID: 29871720 
  8. Cástková J, Benes C. Increase in hepatitis A cases in the Czech Republic in 2008 - an update. Euro Surveill. 2009;14(3):19091.  https://doi.org/10.2807/ese.14.03.19091-en  PMID: 19161729 
  9. Haywood B, Tedder RS, Beebeejaun K, Balogun K, Mandal S, Andrews N, et al. Oral fluid testing facilitates understanding of hepatitis A virus household transmission. Epidemiol Infect. 2019;147:e105.  https://doi.org/10.1017/S095026881900027X  PMID: 30869039 
  10. Hrivniaková L, Sláciková M, Kolcunová S. Hepatitis A outbreak in a Roma village in eastern Slovakia, August-November 2008. Euro Surveill. 2009;14(3):19093.  https://doi.org/10.2807/ese.14.03.19093-en  PMID: 19161727 
  11. Ndumbi P, Freidl GS, Williams CJ, Mårdh O, Varela C, Avellón A, et al. Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017. Euro Surveill. 2018;23(33):1700641.  https://doi.org/10.2807/1560-7917.ES.2018.23.33.1700641  PMID: 30131095 
  12. Sane J, MacDonald E, Vold L, Gossner C, Severi E, on behalf of the International Outbreak Investigation Team, 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 
  13. 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 
  14. European Parliament and Council of the European Union. Decision No 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious cross-border threats to health and repealing Decision No 2119/98/EC. Off J Eur Union L. 5 Nov 2013;L 293/1. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32013D1082
  15. European Centre for Disease Prevention and Control (ECDC). Long-term surveillance strategy 2014-2020 (revised). Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/LTSS-revised_0.pdf
  16. Gossner CM, Severi E. Three simultaneous, food-borne, multi-country outbreaks of hepatitis A virus infection reported in EPIS-FWD in 2013: what does it mean for the European Union? Euro Surveill. 2014;19(43):20941.  https://doi.org/10.2807/1560-7917.ES2014.19.43.20941  PMID: 25375903 
  17. European Centre for Disease Prevention and Control (ECDC). Surveillance Atlas of Infectious Diseases. Stockholm: ECDC; 2022. Available from: https://atlas.ecdc.europa.eu/public/index.aspx
  18. European Commission (EC). Commission implementing decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. Brussels: EC; 2018. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32018D0945&from=EN#page=10
  19. Eurostat. Datasets. Population on 1 January. Luxembourg: Eurostat. [Accessed: 6 Mar 2022]. Available from: https://ec.europa.eu/eurostat/web/products-datasets/-/tps00001
  20. Nordic Outbreak Investigation Team C. Joint analysis by the Nordic countries of a hepatitis A outbreak, October 2012 to June 2013: frozen strawberries suspected. Euro Surveill. 2013;18(27):20520.  https://doi.org/10.2807/1560-7917.ES2013.18.27.20520  PMID: 23870076 
  21. Friesema IH, Sonder GJ, Petrignani MW, Meiberg AE, van Rijckevorsel GG, Ruijs WL, et al. Spillover of a hepatitis A outbreak among men who have sex with men (MSM) to the general population, the Netherlands, 2017. Euro Surveill. 2018;23(23):1800265.  https://doi.org/10.2807/1560-7917.ES.2018.23.23.1800265  PMID: 29897040 
  22. Bruni R, Taffon S, Equestre M, Cella E, Lo Presti A, Costantino A, et al. Hepatitis a virus genotypes and strains from an endemic area of Europe, Bulgaria 2012-2014. BMC Infect Dis. 2017;17(1):497.  https://doi.org/10.1186/s12879-017-2596-1  PMID: 28705178 
  23. Bordi L, Rozera G, Scognamiglio P, Minosse C, Loffredo M, Antinori A, et al. Monophyletic outbreak of Hepatitis A involving HIV-infected men who have sex with men, Rome, Italy 2008-2009. J Clin Virol. 2012;54(1):26-9.  https://doi.org/10.1016/j.jcv.2012.01.009  PMID: 22341552 
  24. Stene-Johansen K, Tjon G, Schreier E, Bremer V, Bruisten S, Ngui SL, et al. Molecular epidemiological studies show that hepatitis A virus is endemic among active homosexual men in Europe. J Med Virol. 2007;79(4):356-65.  https://doi.org/10.1002/jmv.20781  PMID: 17311331 
  25. Savage RD, Rosella LC, Brown KA, Khan K, Crowcroft NS. Underreporting of hepatitis A in non-endemic countries: a systematic review and meta-analysis. BMC Infect Dis. 2016;16(1):281.  https://doi.org/10.1186/s12879-016-1636-6  PMID: 27297559 
  26. Friesema IH, Slegers-Fitz-James IA, Wit B, Franz E. Surveillance and characteristics of food-borne outbreaks in the Netherlands, 2006 to 2019. Euro Surveill. 2022;27(3):2100071.  https://doi.org/10.2807/1560-7917.ES.2022.27.3.2100071  PMID: 35057901 
  27. World Health Organization. WHO immunological basis for immunization series: module 18: hepatitis A, update 2019. Geneva: WHO; 2019. Available from: https://apps.who.int/iris/handle/10665/326501
  28. Gozlan Y, Bar-Or I, Volnowitz H, Asulin E, Rich R, Anis E, et al. Lessons from intensified surveillance of viral hepatitis A, Israel, 2017 and 2018. Euro Surveill. 2021;26(6):2000001.  https://doi.org/10.2807/1560-7917.ES.2021.26.6.2000001  PMID: 33573709 
  29. Riess M, Enkirch T, Sundqvist L, Lundberg Ederth J. High impact of molecular surveillance on hepatitis A outbreak case detection in Sweden: a retrospective study, 2009 to 2018. Euro Surveill. 2021;26(9):1900763.  https://doi.org/10.2807/1560-7917.ES.2021.26.9.1900763  PMID: 33663645 
  30. Ruscher C, Faber M, Werber D, Stark K, Bitzegeio J, Michaelis K, et al. Resurgence of an international hepatitis A outbreak linked to imported frozen strawberries, Germany, 2018 to 2020. Euro Surveill. 2020;25(37):1900670.  https://doi.org/10.2807/1560-7917.ES.2020.25.37.1900670  PMID: 32945256 
  31. Savicka O, Zeltmatis R, Storozenko J. Molecular epidemiology of hepatitis A outbreaks and sporadic cases, Latvia, 2017 to 2019. Euro Surveill. 2022;27(11):2100415.  https://doi.org/10.2807/1560-7917.ES.2022.27.11.2100415  PMID: 35301978 
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