Published On: Sun, Jul 14th, 2013

Ireland hepatitis A strain identical to one found in Italy outbreak: ECDC

The ongoing outbreak of Hepatitis A virus (HAV) infection that has affected travelers to Italy from Germany, the Netherlands and Poland, as well as local residents in Italy, may now be affecting Ireland, according to a European Centre for Disease and Prevention Control (ECDC) Rapid Outbreak Assessment.

European Union Map Image/CIA

European Union Map

According to the report, since 1 January 2013, 15 laboratory-confirmed cases of hepatitis A virus (HAV) infection have been reported in Germany, the Netherlands and Poland. All cases have a history of travel to the autonomous provinces of Trento and Bolzano in northern Italy during the exposure period.

During the same period, Italy experienced an increase in cases of HAV infection, both in province of Trento and at national level. In the first six months of 2013, Italy reported more than 200 cases in excess of the mean number of cases reported in the same period for the last three years. This increase in cases is likely to be associated with this outbreak.

Three cases of HAV have been reported in Ireland; however, none of the three has any travel history to Italy. Nor have they had any contact with other HAV cases. Isolates of the virus from the three Irish cases reveal an identical sequence to that found in the Italian outbreak.

After the food investigation into the Italian outbreak, it was discovered that mixed frozen berries are the likely source of the outbreak. In May, an Italian distributor of mixed frozen berries withdrew its product from the market after its packages were discovered to be contaminated with the virus.

According to the ECDC, HAV disease is often asymptomatic or mild, particularly in children under five years old, is highly transmissible with an average incubation period of 28 to 30 days (range 15–50 days). In adults, the onset of illness is usually abrupt with fever, malaise and abdominal discomfort. Jaundice is the predominant symptom. Symptoms may last from one or two weeks to months. Prolonged, relapsing hepatitis for up to one year occurs in 15% of cases. No chronic infection is known to occur and infection confers lifelong immunity.

The case-fatality ratio is low (0.1–0.3%) but might be higher (1.8%) in adults over 50 years of age or persons with underlying chronic liver disease. The maximum infectivity is in the second half of the incubation period (i.e. while asymptomatic) and most cases are considered non-infectious after the first week of jaundice.

HAV can be transmitted through contaminated water, food and via the fecal–oral route among close contacts (e.g. household contacts, sexual contacts, in daycare centres or schools). The following risk factors or risk groups have also been associated with illness in outbreaks: use of contaminated blood products people who inject drugs or use other illicit drugs , men having sex with men (MSM) , and homeless people.

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About the Author

- Writer, Co-Founder and Executive Editor of The Global Dispatch. Robert has been covering news in the areas of health, world news and politics for a variety of online news sources. He is also the Editor-in-Chief of the website, Outbreak News Today and hosts the podcast, Outbreak News Interviews on iTunes, Stitcher and Spotify Robert is politically Independent and a born again Christian Follow @bactiman63

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