TY - JOUR
T1 - Lessons from intensified surveillance of viral hepatitis a, Israel, 2017 and 2018
AU - Gozlan, Yael
AU - Bar-Or, Itay
AU - Volnowitz, Hadar
AU - Asulin, Efrat
AU - Rich, Rivka
AU - Anis, Emilia
AU - Shemer, Yonat
AU - Cohen, Moran Szwarcwort
AU - Dahary, Etti Levy
AU - Schreiber, Licita
AU - Goldiner, Ilana
AU - Rozenberg, Orit
AU - Picard, Orit
AU - Savion, Michal
AU - Fuchs, Inbal
AU - Mendelson, Ella
AU - Mor, Orna
N1 - Publisher Copyright:
© 2021 European Centre for Disease Prevention and Control (ECDC). All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85101448014&partnerID=8YFLogxK
U2 - 10.2807/1560-7917.ES.2021.26.6.2000001
DO - 10.2807/1560-7917.ES.2021.26.6.2000001
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 33573709
AN - SCOPUS:85101448014
SN - 1025-496X
VL - 26
JO - Eurosurveillance
JF - Eurosurveillance
IS - 6
ER -