Lessons from intensified surveillance of viral hepatitis A, Israel, 2017 and 2018
Open Access
- 11 February 2021
- journal article
- research article
- Published by European Centre for Disease Control and Prevention (ECDC) in Eurosurveillance
- Vol. 26 (6), 2000001
- https://doi.org/10.2807/1560-7917.es.2021.26.6.2000001
Abstract
Introduction Universal vaccination of toddlers has led to very low hepatitis A (HAV) endemicity in Israel. However, sporadic outbreaks still occur, necessitating better surveillance. Aim To implement a comprehensive HAV surveillance programme. Methods In 2017 and 2018, sera from suspected HAV cases that tested positive for anti-HAV IgM antibodies were transferred to the Central Virology Laboratory (CVL) for molecular confirmation and genotyping. Sewage samples were collected in Israel and Palestine* and were molecularly analysed. All molecular (CVL), epidemiological (District Health Offices and Epidemiological Division) and clinical (treating physicians) data were combined and concordantly assessed. Results Overall, 146 cases (78 in 2017 and 68 in 2018, median age 34 years, 102 male) and 240 sewage samples were studied. Most cases (96%) were unvaccinated. In 2017, 89% of cases were male, 45% of whom were men who have sex with men (MSM). In 2018, 49% were male, but only 3% of them were MSM (p < 0.01). In 2017, 82% of cases and 63% of sewage samples were genotype 1A, phylogenetically associated with a global MSM-HAV outbreak. In 2018, 80% of cases and 71% of sewage samples were genotype 1B, related to the endemic strain previously identified in Israel and Palestine*. Environmental analysis revealed clustering of sewage and cases’ sequences, and country-wide circulation of HAV. Conclusions Molecular confirmation of HAV infection in cases and analysis of environmental samples, combined with clinical and epidemiological investigation, may improve HAV surveillance. Sequence-based typing of both clinical and sewage-derived samples could assist in understanding viral circulation.Keywords
This publication has 26 references indexed in Scilit:
- Ongoing hepatitis A among men who have sex with men (MSM) linked to outbreaks in Europe in Tel Aviv area, Israel, December 2016 – June 2017Eurosurveillance, 2017
- Evidence for Hepatitis A virus endemic circulation in Israel despite universal toddlers' vaccination since 1999 and low clinical incidence in all age groupsThe Journal of Infectious Diseases, 2016
- Detection of Pathogenic Viruses in Sewage Provided Early Warnings of Hepatitis A Virus and Norovirus OutbreaksApplied and Environmental Microbiology, 2014
- Surveillance of hepatitis A virus in urban sewages and comparison with cases notified in the course of an outbreak, Italy 2013BMC Infectious Diseases, 2014
- Intensified environmental surveillance supporting the response to wild poliovirus type 1 silent circulation in Israel, 2013Eurosurveillance, 2014
- Viral hepatitis: Global goals for vaccinationJournal of Clinical Virology, 2012
- Hepatitis A Vaccine RecommendationsPEDIATRICS, 2007
- Stable Growth of Wild-Type Hepatitis A Virus in Cell CultureJournal of Virology, 2006
- Diagnosis of Hepatitis A Virus Infection: a Molecular ApproachClinical Microbiology Reviews, 2006