As of 29 September 2022, 303 instances with similar or intently associated HAV strains have been recognized in Austria (7), Germany (8), Hungary (161), the Netherlands (8), Slovenia (35), Sweden (8), and the UK (76). At the moment obtainable epidemiological and microbiological knowledge counsel that human-to-human transmission has occurred, and presumably additionally transmission by way of contaminated meals.
On 15 February 2022, Hungary reported an outbreak of HAV genotype IB with the illness onset of the primary case in early December 2021. So far, 161 instances (139 males, 22 females) have been confirmed with this pressure within the Nationwide Hepatitis Reference Laboratory in Hungary. The weekly variety of reported hepatitis A instances have been declining since June 2022. A number of contaminated folks recognized themselves as males who’ve intercourse with males (MSM), suggesting potential transmission amongst sexual contacts. A number of sufferers have been hospitalised.
In July 2022, a foodborne outbreak was suspected with a hyperlink to a restaurant in Hungary, the place 16 folks fell in poor health with HAV IB an infection. Among the sufferers reported consuming chilly soup made with frozen berries. Within the UK, no clear supply of an infection has been recognized, however epidemiological investigations to date point out potential foodborne infections along with person-to-person transmission. Germany, the Netherlands, and Sweden have reported a complete of 9 instances contaminated with strains matching the sequences of the UK pressure. Investigations of those instances didn’t discover any clear danger components for an infection corresponding to a journey historical past or consumption of berries. Additional investigations are ongoing.
HAV is extremely transmissible by way of contaminated water, meals, and by way of the faecal–oral route amongst shut contacts (e.g. family contacts, sexual contacts, and contacts in day-care centres or colleges), with a median incubation interval of 4 weeks, starting from two to 6 weeks. The virus is extremely immune to environmental situations in addition to to a number of preservation strategies like acidification or freezing. Due to this fact, potential food-borne transmission must be investigated when a number of instances are reported inside a brief interval.
Practising good hand hygiene – together with totally washing arms with cleaning soap after utilizing the lavatory, altering nappies, and earlier than getting ready or consuming meals – performs an essential position in stopping the unfold of hepatitis A. Scaling up surveillance to detect and examine sporadic and clusters of instances presumably related to foodborne transmission in collaboration with meals security authorities is crucial.
MSM are prone to HAV an infection when participating in sexual practices that facilitate faecal-oral transmission of the virus. Hepatitis A vaccination, which is protected and extremely efficient, is the principle possibility for response within the context of the present circulation of HAV genotype IB amongst MSM. The World Well being Organisation and most EU/EEA international locations advocate hepatitis A vaccination for MSM.
Moreover vaccination, different choices can contribute to the prevention of transmission amongst MSM: using condoms for anal intercourse, which have the extra advantage of providing safety in opposition to different sexually transmitted infections and good private hygiene (e.g. washing arms and genital areas earlier than and after intercourse). For the availability of main prevention recommendation, authorities ought to contemplate participating with civil society, social media, media retailers and relationship apps to boost consciousness amongst MSM in regards to the danger of contracting HAV and the significance of vaccination. MSM who’ve already contracted the an infection must be referred to sexual well being companies for additional testing.