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Surveillance Open Access
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Abstract

Background

Swedish hepatitis A surveillance includes sequence-based typing, but its contribution to outbreak detection in relation to epidemiological investigations has not been fully evaluated.

Aim

To evaluate the role of sequence-based typing in hepatitis A outbreak detection and to describe the hepatitis A epidemiology in Sweden to improve surveillance.

Methods

We retrospectively investigated hepatitis A virus sequences of 447 cases notified in Sweden 2009–18. We performed a phylogenetic analysis of evolutionary distances to identify cases with similar virus sequences (≥ 459/460 identical nt in the VP1/P2A junction). Unique sequences, dyads and sequence-based clusters (SBCs) were identified. We linked non-sequenced cases by epidemiological information and retrospectively assessed the value of typing for outbreak identification.

Results

Fifty-five percent (n = 542/990) of the notified hepatitis A cases were referred to the Public Health Agency of Sweden for typing and 447 (45%) were sequenced successfully. Subgenotypes included IA (42.5%, n = 190), IB (42.7%, n = 191) and IIIA (14.8%, n = 66). Phylogenetic analysis identified 154 unique sequences, 33 dyads (66 cases) and 34 SBCs (227 cases). The combination of molecular and epidemiological data revealed 23 potential outbreaks comprising 201 cases. Cases were linked by sequence (59%, n = 118), epidemiological data (11%, n = 23) or both (30%, n = 60). Typing was needed to identify 15 of 23 potential outbreak signals.

Conclusion

Sequence-based typing contributed substantially to detecting clustering cases and identifying outbreaks in Sweden. The results show routine sequence-based typing detects outbreaks, promotes timely outbreak investigations and facilitates international collaboration.

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/content/10.2807/1560-7917.ES.2021.26.9.1900763
2021-03-04
2021-04-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2021.26.9.1900763
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References

  1. Enkirch T, Eriksson R, Persson S, Schmid D, Aberle SW, Löf E, et al. Hepatitis A outbreak linked to imported frozen strawberries by sequencing, Sweden and Austria, June to September 2018. Euro Surveill. 2018;23(41).  https://doi.org/10.2807/1560-7917.ES.2018.23.41.1800528  PMID: 30326994 
  2. Gillesberg Lassen S, Soborg B, Midgley SE, Steens A, Vold L, Stene-Johansen K, et al. Ongoing multi-strain food-borne hepatitis A outbreak with frozen berries as suspected vehicle: four Nordic countries affected, October 2012 to April 2013. Euro Surveill. 2013;18(17):20467. PMID: 23647625 
  3. Nordic Outbreak Investigation Team.Joint analysis by the Nordic countries of a hepatitis A outbreak, October 2012 to June 2013: frozen strawberries suspected. Euro Surveill. 2013;18(27).  https://doi.org/10.2807/1560-7917.ES2013.18.27.20520 
  4. Ndumbi P, Freidl GS, Williams CJ, Mårdh O, Varela C, Avellón A, et al. Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017. Euro Surveill. 2018;23(33).  https://doi.org/10.2807/1560-7917.ES.2018.23.33.1700641  PMID: 30131095 
  5. Scavia G, Alfonsi V, Taffon S, Escher M, Bruni R, Medici D, et al. A large prolonged outbreak of hepatitis A associated with consumption of frozen berries, Italy, 2013-14. J Med Microbiol. 2017;66(3):342-9.  https://doi.org/10.1099/jmm.0.000433  PMID: 28086079 
  6. Fitzgerald M, Thornton L, O’Gorman J, O’Connor L, Garvey P, Boland M, et al. Outbreak of hepatitis A infection associated with the consumption of frozen berries, Ireland, 2013--linked to an international outbreak. Euro Surveill. 2014;19(43):20942.  https://doi.org/10.2807/1560-7917.ES2014.19.43.20942  PMID: 25375902 
  7. Severi E, Verhoef L, Thornton L, Guzman-Herrador BR, Faber M, Sundqvist L, et al. Large and prolonged food-borne multistate hepatitis A outbreak in Europe associated with consumption of frozen berries, 2013 to 2014. Euro Surveill. 2015;20(29):21192.  https://doi.org/10.2807/1560-7917.ES2015.20.29.21192  PMID: 26227370 
  8. Boxman IL, Verhoef L, Vennema H, Ngui SL, Friesema IH, Whiteside C, et al. International linkage of two food-borne hepatitis A clusters through traceback of mussels, the Netherlands, 2012. Euro Surveill. 2016;21(3):30113.  https://doi.org/10.2807/1560-7917.ES.2016.21.3.30113  PMID: 26836217 
  9. MacDonald E, Steens A, Stene-Johansen K, Gillesberg Lassen S, Midgley S, Lawrence J, et al. Increase in hepatitis A in tourists from Denmark, England, Germany, the Netherlands, Norway and Sweden returning from Egypt, November 2012 to March 2013. Euro Surveill. 2013;18(17):20468. PMID: 23647624 
  10. Gassowski M, Michaelis K, Wenzel JJ, Faber M, Figoni J, Mouna L, et al. Two concurrent outbreaks of hepatitis A highlight the risk of infection for non-immune travellers to Morocco, January to June 2018. Euro Surveill. 2018;23(27).  https://doi.org/10.2807/1560-7917.ES.2018.23.27.1800329  PMID: 29991381 
  11. Tavoschi L, Severi E, Carrillo Santisteve P, Lopalco P. Hepatitis A in the EU/EEA: The case for scaling up prevention. Vaccine. 2018;36(19):2501-3.  https://doi.org/10.1016/j.vaccine.2018.02.100  PMID: 29628152 
  12. Lemon SM, Ott JJ, Van Damme P, Shouval D. Type A viral hepatitis: A summary and update on the molecular virology, epidemiology, pathogenesis and prevention. J Hepatol. 2017;S0168-8278(17)32278-X. PMID: 28887164 
  13. Matheny SC, Kingery JE, Hepatitis A, Hepatitis A. Hepatitis A. Am Fam Physician. 2012;86(11):1027-34, quiz 1010-2. PMID: 23198670 
  14. Kroneman A, de Sousa R, Verhoef L, Koopmans MPG, Vennema H, On Behalf Of The HAVNet Network. Usability of the international HAVNet hepatitis A virus database for geographical annotation, backtracing and outbreak detection. Euro Surveill. 2018;23(37).  https://doi.org/10.2807/1560-7917.ES.2018.23.37.1700802  PMID: 30229723 
  15. Nainan OV, Xia G, Vaughan G, Margolis HS. Diagnosis of hepatitis a virus infection: a molecular approach. Clin Microbiol Rev. 2006;19(1):63-79.  https://doi.org/10.1128/CMR.19.1.63-79.2006  PMID: 16418523 
  16. Werber D, Michaelis K, Hausner M, Sissolak D, Wenzel J, Bitzegeio J, et al. Ongoing outbreaks of hepatitis A among men who have sex with men (MSM), Berlin, November 2016 to January 2017 - linked to other German cities and European countries. Euro Surveill. 2017;22(5).  https://doi.org/10.2807/1560-7917.ES.2017.22.5.30457  PMID: 28183391 
  17. Bruni R, Taffon S, Equestre M, Chionne P, Madonna E, Rizzo C, et al. Key Role of Sequencing to Trace Hepatitis A Viruses Circulating in Italy During a Large Multi-Country European Foodborne Outbreak in 2013. PLoS One. 2016;11(2):e0149642.  https://doi.org/10.1371/journal.pone.0149642  PMID: 26901877 
  18. Guzman-Herrador BR, Panning M, Stene-Johansen K, Borgen K, Einöder-Moreno M, Huzly D, et al. Importance of molecular typing in confirmation of the source of a national hepatitis A virus outbreak in Norway and the detection of a related cluster in Germany. Arch Virol. 2015;160(11):2823-6.  https://doi.org/10.1007/s00705-015-2531-y  PMID: 26249822 
  19. Enkirch T, Severi E, Vennema H, Thornton L, Dean J, Borg ML, et al. Improving preparedness to respond to cross-border hepatitis A outbreaks in the European Union/European Economic Area: towards comparable sequencing of hepatitis A virus. Euro Surveill. 2019;24(28).  https://doi.org/10.2807/1560-7917.ES.2019.24.28.1800397  PMID: 31311618 
  20. National Institute for Public Health and the Environment (RIVM). HAVNet. Bilthoven: RIVM. [Accessed: 31 Oct 2019]. Available from: www.havnet.nl
  21. European Commission. Commission implementing decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 6 Jul 2018. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32018D0945&from=EN#page=29
  22. Saitou N, Nei M. The neighbor-joining method: a new method for reconstructing phylogenetic trees. Mol Biol Evol. 1987;4(4):406-25. PMID: 3447015 
  23. Tamura K, Nei M. Estimation of the number of nucleotide substitutions in the control region of mitochondrial DNA in humans and chimpanzees. Mol Biol Evol. 1993;10(3):512-26. PMID: 8336541 
  24. European Centre for Disease Prevention and Control (ECDC). Hepatitis A virus in the EU/EEA, 1975-2014. Technical Report. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/en/publications-data/hepatitis-virus-eueea-1975-2014
  25. Carrillo-Santisteve P, Tavoschi L, Severi E, Bonfigli S, Edelstein M, Byström E, et al. Seroprevalence and susceptibility to hepatitis A in the European Union and European Economic Area: a systematic review. Lancet Infect Dis. 2017;17(10):e306-19.  https://doi.org/10.1016/S1473-3099(17)30392-4  PMID: 28645862 
  26. Gossner CM, Severi E, Danielsson N, Hutin Y, Coulombier D. Changing hepatitis A epidemiology in the European Union: new challenges and opportunities. Euro Surveill. 2015;20(16):21101.  https://doi.org/10.2807/1560-7917.ES2015.20.16.21101  PMID: 25953274 
  27. Petrignani M, Verhoef L, Vennema H, van Hunen R, Baas D, van Steenbergen JE, et al. Underdiagnosis of foodborne hepatitis A, The Netherlands, 2008-2010(1.). Emerg Infect Dis. 2014;20(4):596-602.  https://doi.org/10.3201/eid2004.130753  PMID: 24655539 
  28. Persson H, Nasta F, Svensson I, Widerström M. Oväntat hög andel förskolebarn immuna mot hepatit A-virus - Smittspårningsutredning visar på behovet av vaccination inför utlandsresor. [Unexpectedly high proportion of preschool children immune to hepatitis A virus. Contact tracing investigation shows the need for vaccination prior to traveling abroad]. Swedish. Lakartidningen. 2014;111(49-50):2224-6. PMID: 25462320 
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