Ongoing outbreak of hepatitis A in Italy: preliminary report as of 31 May 2013

Rizzo, Caterina; Alfonsi, Valeria; Bruni, Roberto; Busani, Luca; Ciccaglione, Anna Rita; Medici, Dario De; Pasquale, Simona Di; Equestre, Michele; Escher, Martina; Montano-Remacha, MC; Scavia, Gaia; Taffon, Stefania; Carraro, Valter; Franchini, S; Natter, B; Augschiller, M; Tosti, Maria Elena

doi:10.2807/1560-7917.es2013.18.27.20518

Cited by 35 publications

(11 citation statements)

References 7 publications

(3 reference statements)

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“…The tree includes, in addition to the study sequences, 10 GeneBank prototype sequences corresponding to genotypes IA, IB, IIA, IIB, IIIA, and IIIB, and IA and IB sequences previously detected in sewage samples in Italy (La Rosa et al 2014). In addition, the sequence KF182323, prototype of the Italian 2013 outbreak (Rizzo et al 2013), and still unpublished sequences from clinical cases collected during the epidemic, are reported. Study sequences grouped into two different clusters corresponding to genotypes IB and IA, according to BLAST analysis.…”

Section: Resultsmentioning

confidence: 98%

Hepatitis A and E Viruses in Wastewaters, in River Waters, and in Bivalve Molluscs in Italy

et al. 2015

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Several studies have reported the detection of hepatitis A (HAV) and E (HEV) virus in sewage waters, indicating a possibility of contamination of aquatic environments. The objective of the present study was to assess the occurrence of HAV and HEV in different water environments, following the route of contamination from raw sewage through treated effluent to the surface waters receiving wastewater discharges . Bivalve molluscan shellfish samples were also analyzed, as sentinel of marine pollution. Samples were tested by RT-PCR nested type in the VP1/2A junction for HAV, and in the ORF1 and ORF2 regions for HEV. Hepatitis A RNA was detected in 12 water samples: 7/21 (33.3%) raw sewage samples, 3/21 (14.3%) treated sewage samples, and 2/27 (7.4%) river water samples. Five sequences were classified as genotype IA, while the remaining 7 sequences belonged to genotype IB. In bivalves, HAV was detected in 13/56 samples (23.2%), 12 genotype IB and one genotype IA. Whether the presence of HAV in the matrices tested indicates the potential for waterborne and foodborne transmission is unknown, since infectivity of the virus was not demonstrated. HEV was detected in one raw sewage sample and in one river sample, both belonging to genotype 3. Sequences were similar to sequences detected previously in Italy in patients with autochthonous HEV (no travel history) and in animals (swine). To our knowledge, this is the first detection of HEV in river waters in Italy, suggesting that surface water can be a potential source for exposure .

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Section: Resultsmentioning

confidence: 98%

Hepatitis A and E Viruses in Wastewaters, in River Waters, and in Bivalve Molluscs in Italy

et al. 2015

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“…Italy is considered a country of low/intermediate HAV endemicity, with low endemicity in northern and central Italy, where only few, sporadic cases occur during the year, and intermediate endemicity in a number of areas, mainly located in southern Italy. From the beginning of 2013 however, Italy has been experiencing a nationwide outbreak [6]. …”

Section: Discussionmentioning

confidence: 99%

“…This hypothesis is strongly supported by the detection of the outbreak HAV strain in a sample of frozen mixed berries [6]. …”

Section: Introductionmentioning

confidence: 91%

Surveillance of hepatitis A virus in urban sewages and comparison with cases notified in the course of an outbreak, Italy 2013

et al. 2014

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BackgroundOver the past 20 years, Hepatitis A notifications in Italy have been in decline. Since the beginning of 2013 however, Italy has been experiencing a foodborne hepatitis A outbreak caused by genotype IA, involving hundreds of cases. Consumption of frozen mixed berries was deemed the potential vehicle of infection.We aimed to investigate the spread of hepatitis A virus (HAV) in Italy through the monitoring of urban sewages collected at Wastewater Treatment Plants (WTPs) and a subsequent comparison of environmental surveillance data with data from the clinical surveillance performed during the epidemic.MethodsThe study covered 15 months, from July 2012 to September 2013, comprising the outbreak and the preceding six months. Environmental surveillance consisted of the analysis of urban sewage samples collected at 19 WTPs in seven of the Italian regions most affected by the epidemic. HAV isolates were detected and typed using a nested RT-PCR targeting the VP1/2A junction. Parallel clinical surveillance was performed by the sentinel surveillance system for acute viral hepatitis (SEIEVA) and by the ministerial Central Task Force on Hepatitis A, established with the purpose of determining the source of the outbreak and adopting appropriate outbreak control strategies.ResultsA total of 38/157 wastewater samples (24.2%) were positive for HAV, 16 collected in 2012 and 22 in 2013. Several HAV strains were detected, including the IA variant implicated in the outbreak and isolated from clinical cases over the same period. The vast majority of sequences belonged to genotype IB. Interestingly however, although these included variants related to strains that had been involved in past Italian epidemics, none were detected in recent clinical samples, probably due to underreporting or asymptomatic circulation. Conversely, a number of sequences were identified in clinical samples that were not found in wastewaters.ConclusionsThe percentage of sewage samples detected as HAV-positive in this study are consistent with the classification of Italy as a country with low/intermediate endemicity. A combined environmental/clinical surveillance is able to provide a more complete picture of the spread of HAV and of the genotypes circulating in the population, allowing a better understanding of changes in disease trends.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-419) contains supplementary material, which is available to authorized users.

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“…In the French outbreak, 59 cases were identified, whereof 28 were hospitalized. Recently, frozen berries were identified as the culprit for hepatitis A outbreaks in Nordic countries and Italy [11,12]. Denmark, Finland, Norway, and Sweden reported 103 cases of hepatitis A between October 2012 and June 2013.…”

Section: Other Similar and Contrasting Cases In The Literaturementioning

confidence: 99%