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Published Date: 2012-02-12 12:57:33
Subject: PRO> Hepatitis A - The Netherlands (02): possible food-borne outbreak
Archive Number: 20120212.1039877

HEPATITIS A - THE NETHERLANDS (02): POSSIBLE FOOD-BORNE OUTBREAK
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Date: Sat 11 Feb 2012
From: "Dr.Steve Berger" 


Comment on: hepatitis A  virus infection in the Netherlands (Pr0MED archive no. 20120211.1039190)
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Rates of Hepatitis A in the Netherlands and bordering countries have been decreasing since the 1990's; see graph: http://www.gideononline.com/wp/wp-content/uploads/Netherlands-HepA.png

The following background data are abstracted from the Gideon e-books series. [2,3] . 

Time and Place:
 - Hepatitis A has been a notifiable disease in the Netherlands since 1951.
 - Disease rates peak during October, largely due to increased number of  cases acquired abroad.
 - During 1993 to 2002, 64.4 percent of all cases were autochthonous, 6.5 percent imported from Turkey and 11.5 percent from Morocco.
 - The disease incidence among children of Turkish and Moroccan descent declined from 70.3 per 100 000 in 2000, to 13.5 per 100 000 in 2005.
 - During 1992 to 2006, 1697 cases were reported among MSM visiting STD clinics (mean rate 97 per 100 000 population).

Prevalence surveys:
 - 1.1 percent of dates and 0 percent of fig samples (viral RNA, 2011 publication)

Seroprevalence surveys:
 - 33.8 percent of the general population -- including (age group 15 to 49 years) 90.9 percent of Turks, 95.8 percent of Moroccans, 20.1 percent of native Dutch and 25 percent of other Western people (2000 publication).
 - 34 percent of the general population during 1995 to 1996; 39 percent during 2006 to 2007, 41 percent of blood donors and 33.8 percent of the general population (1995 to 1996), less than 10 percent below age 35; 25 percent at 35 years; 85 percent at 79 years.
     
Notable outbreaks:
 - 1977 - An outbreak (20 cases) in Amsterdam was caused by contaminated meat sold at a butcher shop.
 - 1991 to 1993 - An outbreak (37 cases) was reported among MSM in Amsterdam.
 - 1996 - An outbreak (41 cases) was reported in Heerlen.
 - 1998 - An outbreak in Rotterdam was associated with MSM who frequented 'gay bars.'
 - 1999 - An outbreak (11 cases or more) in Nijmengen involved 2 schools and a nursery.
 - 2004 - An outbreak (351 cases) was caused by contaminated orange juice served to tourists at a hotel in Egypt.  271 primary (and 7 secondary) cases were reported among Germans, 18 primary (13 secondary - from a food handler) cases Austrians, 10 Swedes, 9 Danes, 9 Dutch, 6 Belgian, 5 British, 2 Italian and 1 Swiss.
 - 2004 - An outbreak (30 cases) was reported among homeless and drug users in Rotterdam.
 - 2005 to 2006 - An outbreak (30 cases) was reported among elementary school children in Noord-Kennemerland region.
 - 2009 to 2010 - An outbreak (11 cases) was associated with consumption of semi-dried tomatoes.

References:
1. Gideon graph tool at: http://www.GIDEONonline.com/wp/wp-content/uploads/Gideon-Graphs.pps
2. Berger SA. Infectious Diseases of the Netherlands, 2012.  502 pp, 144 graphs, 2091 references. Gideon e-books: http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-netherlands/
3. Berger SA. Hepatitis A: Global Status, 2012.  166 pp, 180 graphs, 1180 references. Gideon e-books: http://www.gideononline.com/ebooks/disease/hepatitis-a-global-status/

--
Communicated by:
Steve Berger
Geographic Medicine
Tel Aviv Medical Center


[ProMED-mail thanks Professor Berger for provision of these data. As always the primary references can be obtained from him on request. - Mod.CP]

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