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Increase in hepatitis A cases in the EU and UK could be partly due to food

Contaminated food could be playing a role in the rise in hepatitis A infections, according to European officials.

Hepatitis A virus (HAV) genotype IB clusters and outbreaks with four unique but related HAV sequences have been reported in six European countries and the United Kingdom.

More than 300 cases with identical or closely related HAV strains have been identified in Austria, Germany, Hungary, the Netherlands, Slovenia, Sweden, and the United Kingdom.

Epidemiological and microbiological data so far suggest human-to-human transmission and also contaminated food as potential sources of infection, the European Center for Disease Prevention and Control (ECDC) said.

Possible foodborne transmission should be investigated when several infections are reported in a short period. Increased vigilance to detect and investigate sporadic cases and clusters of cases with food safety authorities is essential, the ECDC said.

The agency warned that cases were reported in September, suggesting the chain of transmission may still be ongoing and more infections are likely.

In February, Hungary reported an outbreak of HAV genotype IB with the first case in December 2021. A total of 161 cases, mostly men but 22 women, have been confirmed with this strain. Some infected people were men who have sex with men, suggesting transmission between sexual contacts. Several patients were hospitalized.

berry souvenir
In July, a foodborne outbreak was linked to a restaurant in Hungary, where 16 people also fell ill with HAV IB infection. Some patients had cold soup made from frozen berries. This led to the recall of the Ardo Fruitberry blend, produced and packaged by a subcontractor of the group in Poland.

Countries included in a Rapid Alert System for Food and Feed (RASFF) reported as affected products shipped included Austria, Belgium, Croatia, Germany, Greece, Hong Kong, Ireland, the Netherlands, Romania, Spain, Sweden and the UK.

In the UK, no source of infection has been identified for 76 cases, but epidemiological investigations indicate possible foodborne infections and person-to-person transmission. Germany, the Netherlands and Sweden have nine infected cases that match the UK strain. No clear risk factors for infection, such as travel history or berry consumption, have been found.

HAV is highly transmissible through contaminated food and water and by the fecal-oral route between close contacts, with an average incubation period of four weeks, ranging from two to six weeks. The virus is resistant to preservation methods such as freezing.

Good hand hygiene, including washing hands thoroughly with soap after using the bathroom and before preparing or eating food, plays an important role in preventing the spread of hepatitis A.

Hepatitis A is spread when someone ingests the virus through close contact with an infected person or by having contaminated food or drink. Symptoms include liver inflammation, fever, loss of appetite, nausea, vomiting, diarrhea, muscle aches, and yellowing of the whites of the eyes and skin (jaundice).

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