An outbreak of Hepatitis A continues to spread in Europe, with Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden and the United Kingdom affected since June 2016.
The most recent ECDC update of 28th April 2017 reported 674 cases since the start of the outbreak. Of 665 cases where gender was recorded, 531 (95%) were male and where age was recorded, 558 were aged 15 - 50 years. Eighty-three percent of cases where sexual orientation was recorded were men who have sex with men (MSM). Travel to the European countries listed above is visible in the epidemiology of the outbreak.
There are three clusters of infection, the largest involving strain VRD_521_2016 (336 cases) which was first reported in the UK in December 2016. Where travel history was recorded, 43 cases (20%) travelled abroad during the incubation period, 35 in the EU. Eighteen of these travelled to Spain.
Two hundred and eighty-six cases involved strain RIVM-HAV16-090, first reported in the Netherlands in October 2016. Sixty -three (29%) of those who gave a travel history had been abroad during the incubation period. Forty-nine travelled in the EU, and of these 27 travelled to Spain and five to Germany.
Seventy cases involved strain V16-25801, first reported by Germany in January 2017. Ten cases (20%) of those who gave a travel history had been abroad during the incubation period; 7 of these within the EU.
It is likely that the outbreak will continue to spread and that the number of reported cases is an underestimate. The high proportion of MSM in the current outbreak is notable, as is the apparently low involvement of food- and water-borne transmission.
(Via European Centres for Disease Control - accessed 12/05/2017)
Advice for travellers
Hepatitis A is spread by the faecal-oral route, usually through contaminated food and water, but transmission by person-to-person sexual contact is likely the main route of transmission in this setting. Vaccination against hepatitis A should be offered to at-risk MSM, regardless of whether they are travelling to or going to reside in areas of high or intermediate prevalence. Advice on maintaining good personal hygiene and taking care with food and drink is also warranted.