Hepatitis A epidemy in children hospitalized at the Department of Pediatric Infectious Diseases, University Hospital, Brno, from March 2016 to March 2017


Authors: M. Malá 1;  V. Musil 1;  I. Čapovová 1;  L. Klapačová 1;  R. Ciupek 2;  J. Bednářová 3;  L. Krbková 1
Authors‘ workplace: Klinika dětských infekčních nemocí LF MU a FN Brno 1;  Protiepidemický odbor Krajské hygienické stanice Jihomoravského kraje se sídlem v Brně 2;  Oddělení klinické mikrobiologie, FN Brno 3
Published in: Čes-slov Pediat 2017; 72 (7): 388-395.
Category:

Overview

Objective:
To evaluate the epidemy of hepatitis A in children from 0 to 18 years admitted for compulsory isolation at the Department of Pediatric Infectious Diseases, University Hospital, Brno, between March 2016 and March 2017 from Brno and the South Moravian Region.

Methods:
A retrospective study evaluated pediatric patients (0–18 years) hospitalized for hepatitis A (VHA) confirmed by the serological positivity of anti-HAV IgM antibodies. We evaluated age, sex, contact with infection, interval from the beginning of clinical symptoms to date of admission, duration of hospitalization, clinical symptoms, vaccination against VHA.

Results:
61 patients (26 girls and 35 boys) were hospitalized with VHA diagnosis. The youngest patient was 12 months old, the oldest 18 years old. The mean age of patients was 6.63±4.48 years, median 6 years. The average length of hospitalization was 11.3±7.52 days. At the age of 1–3 years, 19.7% of patients were hospitalized, 27.9% at age 3–6, 31.1% at age 6–12, 21.3% at age 12–18. In 19.7% cases an inicteric form of VHA was present, in 63.9% an anicteric form, in 16.4% an inaparent form. Epidemiologically significant contact with the infection was recorded in 90.2% of cases. Contacts prevailed in the family or pre-school and school facilities. The most common symptoms were symptoms of the gastrointestinal system, icterus and subfebrilia or febrilia. The clinical course of VHA was benign, asymptomatic infections were numerous. In 98.4% of patients, the course of VHA was uncomplicated, the prolonged course with laboratory relapse was recorded in 1.6% of cases. 24.6% of patients were prophylactically vaccinated for up to one month prior admission.

Conclusion:
In 2016 and 2017, the largest epidemic of VHA occurred in SMR since 1989, cases from the SMR constituted a half of all cases in the Czech Republic. The anicteric form prevailed among children. The age groups represented the most in children (0–18 years) were children in pre-school and younger school age. Early vaccination of contacts is a very important precaution limiting the spread of the disease.

Key words:
hepatitis A, children, vaccination, icterus, isolation, epidemiology


Sources

1. Cristina J, Costa-Mattioli M. Genetic variability and molecular evolution of hepatitis A virus. Virus Res 2007; 127 (2): 151–157.

2. Harries M, Monazahian M, Wenzel J, et al. Foodborne hepatitis A outbreak associated with bakery products in northern Germany, 2012. Euro Surveill 2014; 19 (50): pii=20992. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20992.

3. Severi E, Verhoef L, Thornton 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): pii=21192. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21192.

4. Collier MG, Khudyakov YE, Selvage D, et al. Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study. Lancet Infect Dis 2014; 14 (10): 976–981.

5. Wenzel JJ, Schemmerer M, Oberkofler H, et al. Hepatitis A outbreak in Europe: Imported frozen berry mix suspected to be the source of at least one infection in Austria in 2013. Food Environ Virol 2014; 6 (4): 297–300.

6. Husa P. Virové hepatitidy A a E. Med praxi 2013; 10 (2): 78–80.

7. Blechová Z, Trojánek M, Kynčl J, et al. Clinical and laboratory features of viral hepatitis A in children. Wien Klin Wochenschr 2013; 125 (3–4): 83–90.

8. Faillon S, Martinot A, Hau I, et al. Impact of travel on the seroprevalence of hepatitis A in children. J Clin Virol 2013; 56 (1): 46–51.

9. Braccio S, Irwin A, Riordan A, et al. Acute infectious hepatitis in hospitalised children: a British Paediatric Surveillance Unit study. Arch Dis Child 2017; 102 (7): 628–632.

10. Vodák M, Helm R, Benda R. Protilátky proti viru hepatitidy A u zdravých osob. Čas Lék čes 1981; 120 (6): 152–154.

11. Cástková J, Benes C. Increase in hepatitis A cases in the Czech Republic in 2008 – an update. Euro Surveill 2009; 14 (3): pii=19091. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19091.

12. Kurkela S, Pebody R, Kafatos G, et al. Comparative hepatitis A seroepidemiology in 10 European countries. Epidemiol Infect 2012; 140 (12): 2172–2181.

13. Beran J, Douda P, Rychlý R. Seroprevalence of viral hepatitis A in the Czech Republic. Eur J Epidemiol 1999; 15 (9): 805–808.

14. Bouwknegt M, Verhaelen K, Rzeżutka A, et al. Quantitative farm-to-fork risk assessment model for norovirus and hepatitis A virus in European leafy green vegetable and berry fruit supply chains. Int J Food Microbiol 2015; 198: 50–58.

15. Sánchez G, Pintó RM, Vanaclocha H, et al. Molecular characterization of hepatitis a virus isolates from a transcontinental shellfish-borne out-break. J Clin Microbiol 2002; 40 (11): 4148–4155.

16. Boxman ILA, Verhoef L, Vennema H, et al. International linkage of two food-borne hepatitis A clusters through traceback of mussels, the Netherlands, 2012. Euro Surveill 2016; 21 (3): pii=30113. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21356.

17. Sattar SA, Jason T, Bidawid S, et al. Foodborne spread of hepatitis A: Recent studies on virus survival, transfer and inactivation. Can J Infect Dis 2000; 11 (3): 159–163.

18. Petrignani M, Verhoef L, Vennema H, et al. Underdiagnosis of foodborne hepatitis A, The Netherlands, 2008–2010 (1.). Emerg Infect Dis 2014; 20 (4): 596–602.

19. Kožíšek F, Jeligová H, Dvořáková A. Epidemický výskyt vodou přenosných chorob v České republice za období 1995 až 2005. Epidemiol Mikrobiol Imunol 2009; 58 (3): 124–131.

20. Çetinkaya B, Tezer H, Özkaya Parlakay A, et al. Evaluation of pediatric patients with hepatitis A. J Infect Dev Ctries 2014; 8 (3): 326–330.

21. Raabe VN, Sautter C, Chesney M, et al. Hepatitis a screening for internationally adopted children from hepatitis A endemic countries. Clin Pediatr 2014; 53 (1): 31–37.

22. Galmes-Truyols A, Gimenez-Duran J, Nicolau-Riutort A, et al. Outbreak of hepatitis A in a nursery school. BioMed Res Int 2013; 2013: 684908. doi: 10.1155/2013/684908.

23. Trmal J, Beneš C, Trnková M. Rozdíly v incidenci virové hepatitidy A a E v České republice. Epidemiol Mikrobiol Imunol 2013; 62 (1): 19–25.

24. Kumar KJ, Kumar HCK, Manjunath VG, et al. Hepatitis A in children – clinical course, complications and laboratory profile. Indian J Pediatr 2014; 81 (1): 15–19.

25. Averhoff F, Shapiro CN, Bell BP, et al. Control of hepatitis A through routine vaccination of children. JAMA 2001; 286 (23): 2968–2973.

26. Bonanni P, Franzin A, Staderini C, et al. Vaccination against hepatitis A during outbreaks starting in schools: what can we learn from experiences in central Italy? Vaccine 2005; 23 (17–18): 2176–2180.

27. Martínez A, Broner S, Sala MR, et al. Changes in the epidemiology of hepatitis A outbreaks 13 years after the introduction of a mass vaccination program. Hum Vaccines Immunother 2015; 11 (1): 192–197.

28. D’Andrea L, Pérez-Rodríguez FJ, de Castellarnau M, et al. Hepatitis A virus genotype distribution during a decade of universal vaccination of preadolescents. Int J Mol Sci 2015; 16 (4): 6842–6854.

29. Mellou K, Sideroglou T, Papaevangelou V, et al. Considerations on the current universal vaccination policy against hepatitis A in Greece after recent outbreaks. PloS One 10 (1): e0116939. https://doi.org/10.1371/journal.pone.0116939.

30. Papaevangelou V, Alexopoulou Z, Hadjichristodoulou C, et al. Time trends in pediatric hospitalizations for hepatitis A in Greece (1999-2013): Assessment of the impact of universal infant immunization in 2008. Hum Vaccines Immunother 2016; 12 (7): 1852–1856.

31. Mellou K, Chrisostomou A, Sideroglou T, et al. Hepatitis A among refugees, asylum seekers and migrants living in hosting facilities, Greece, April to December 2016. Euro Surveill 2017; 22 (4) pii=30448. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22699.

32. Michaelis K, Wenzel JJ, Stark K, et al. Hepatitis A virus infections and outbreaks in asylum seekers arriving to Germany, September 2015 to March 2016. Emerg Microbes Infect 2017; 6 (4): e26. http://www.nature.com/emi/journal/v6/n4/full/emi201711a.html.

Labels
Neonatology Paediatrics General practitioner for children and adolescents
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