An employee at The Back Corner, an entertainment venue at 1413 5th Avenue North in Nashville, Tennessee, has been diagnosed with hepatitis A, according to the Nashville Public Health Department. The Metro Public Health Department (MPDH) is issuing a public notice and will offer free hepatitis A vaccinations to customers who visited that facility on June 28, 29, or 30, 2018
On 2 May 2018, Denmark reported a cluster of hepatitis A virus (HAV) infections with the subgenotype IA strain DK2018_231, through the European Centre for Disease Prevention and Control (ECDC)’s Epidemic Intelligence Information System (EPIS) for food- and waterborne diseases and zoonoses (FWD). One of the three confirmed cases had travelled to Morocco. In response, five additional European Union (EU) countries (France, Germany, the Netherlands, Spain and the United Kingdom (UK)) reported cases (n = 20) infected with the same strain between 21 January and 10 April 2018. Concurrently, Germany reported to EPIS that it observed more cases of hepatitis A with travel history to Morocco than expected, compared with the same period in the previous 5 years. Molecular analysis of the HAV VP1/P2A region revealed an unrelated cluster of the HAV subgenotype IB strain V18–16428. Cases infected with this unrelated strain were also reported from France, the Netherlands, Sweden and UK.
The appearance of clusters with a link to Morocco triggered further epidemiological investigations.
The occurrence of the two concurrent HAV clusters in the first 6 months of 2018 serve as a reminder of the risk of contracting hepatitis A in Morocco, a country with intermediate endemicity [4,5]. HAV subgenotypes IA and IB are known to circulate in Morocco and strain DK2018_231 has been observed in sporadic cases with travel history to Morocco in previous years [6–8]. Despite the different characteristics of the two reported clusters, cases with a travel history to Morocco feature in both. In a recent study of European travellers, Turkey, Egypt and Morocco were listed as the top three destinations for acquiring travel-associated hepatitis A and accounted for one third of cases in the period 2009–15 . The epidemiological link to Morocco is more apparent in cluster IB, where the majority of cases had confirmed travelling to Morocco and all interviewed autochthonous cases had reported consuming food items brought home from there.
In the IA cluster, only three cases had travelled to Morocco. However, the large proportion of autochthonous cases and their spatial distribution in this cluster suggest that an imported food item may have served as the vehicle in this outbreak. Large food-borne hepatitis A outbreaks from frozen berries and semi-dried tomatoes have previously affected European countries, further indicating that imported contaminated food products pose a risk to the increasingly susceptible general population in Europe [10–13].
The outbreaks described here illustrate the increased risk that non-immune travellers face when visiting HAV-endemic areas like Morocco. All of the eight countries where cases occurred have explicit recommendations of hepatitis A vaccination for travel to endemic countries, in accordance with World Health Organization (WHO) recommendations [14,15]. Yet it appears that it is not uncommon for people to travel unvaccinated to HAV-endemic countries. An outbreak investigation of hepatitis A in travellers to Egypt between 2012 and 2013 found a high proportion of travellers who were not immunised before travelling [16,17]. Interviews with the German cases have rendered similar results, suggesting that there may be an information gap regarding both the risk of hepatitis A and the availability of a safe and effective vaccine.
Thirteen people in Sweden have been infected by Hepatitis A virus linked to frozen strawberries from Poland.
Eleven confirmed and two suspected cases come are reported from four Swedish counties, Skåne, Blekinge, Kalmar and Gävleborg.
Nine women and four men aged 11 to 92 are affected. The most recent person to fall ill had symptoms begin on June 18.
The Public Health Agency of Sweden (Folkhälsomyndigheten), the National Food Agency (Livsmedelsverket) and local authorities are involved in the investigation. They traced the source of Hepatitis A virus (HAV) infection to frozen strawberries from Poland and informed Polish authorities of their findings.
All of the cases had smoothies or a dessert containing frozen imported strawberries that were not heated prior to consumption. The strawberries were not sold directly to consumers.
Patrons who ate at Hardee’s restaurant on Little Rock Road in Charlotte between June 13 and 23 should receive a hepatitis A vaccination as soon as possible.
Director Gibbie Harris announced today that the outbreak identified by the State and Centers for Disease Control (CDC) earlier this month in Mecklenburg County has led to five additional cases since June 6, including a Hardee’s employee diagnosed Monday.
“After consulting with the State today, we are recommending a vaccination for exposed employees and patrons who ate at the 2604 Little Rock Road location between June 13 and 23,” Harris said. “According to the CDC, the vaccine must be given within 14 days of exposure for the vaccine to be effective.”
People who dined at Hardees on Little Rock Road on June 13 and 14 are strongly urged to get a vaccination in the next two days.
“Metro Public Health Department staff, working with multiple community partners, continue to plan additional opportunities to offer the hepatitis A vaccine to the at-risk communities,” said Rachel Franklin, Interim Director of Communicable Disease and Emergency Preparedness. “This week we added three vaccination clinics to reach people experiencing homelessness. Our staff vaccinated nearly 200 among the at-risk group at last weekend’s PRIDE Festival and we are planning additional locations to offer the vaccine in the coming weeks to reach the MSM community.”
The Health Department has worked with the Metropolitan Homelessness Commission staff on a hepatitis A vaccine campaign to reach the homeless. That initial vaccination effort began June 18 and will run through July 6. The Health Department added three additional locations since last week, including the Room in the Inn and the Nashville Rescue Mission. The homeless outreach is in addition to the ongoing vaccination efforts at MPHD clinics and Neighborhood Health clinics.
Hepatitis A is the only common foodborne disease preventable by vaccine. It is one of five hepatitis viruses that infect the liver. While hepatitis B and C can turn into chronic hepatitis, hepatitis A generally does not; although it can lead to liver failure and death.Hepatitis A is rare in the United States, with 30,000 to 50,000 cases occurring each year. However, in most other countries, poorer sanitation systems lead to easier transmission of the disease, and therefore more cases.
Hepatitis A is a contagious disease. It travels in feces, and can spread from person to person, or can be contracted from food or water. In cases of contaminated food, it is usually the person preparing the food who contaminates it. The food handler will probably not know they have the virus, since the virus is most likely to be passed on in the first two weeks of illness, before a person begins to show symptoms.