Published Date: 2006-10-05 00:00:00
Subject: PRO/EDR> Hepatitis A - Bulgaria (05)
Archive Number: 20061005.2854

HEPATITIS A - BULGARIA (05)
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Date: Thu 5 Oct 2006
From: ProMED-mail <promed@ppromedmail.org>
Source: Eurosurveillance weekly release, Volume 11, Issue 10, Thu 5 Oct
2006 [edited]
<http://www.eurosurveillance.org/ew/2006/061005.asp#1>

Hepatitis A is the most common type of viral hepatitis in Bulgaria, and
accounts for more than 75 percent of all cases of viral hepatitis. Bulgaria
is a country with intermediate endemicity of hepatitis A viral (HAV)
infection. Between 1984 and 2005, incidence has varied between 27 and 80
cases per 100 000 population during non-epidemic periods, but has reached
234 cases per 100 000 during epidemic periods. Since 1983, all acute cases
of jaundice due to hepatitis A virus have been subject to mandatory
notification in Bulgaria. Since 2005, the European Union case definition
and case classification have been adopted.
Since the beginning of 2006, 4793 viral hepatitis cases have been reported
in Bulgaria (1498 cases more than the same period in 2005, when a total of
3295 cases occurred) [The weekly number of cases of acute viral hepatitis
in Bulgaria during the years 2005 and 2006 are presented in the form of a
histogram in the original text showing the dramatic increase in cases
during 2006 from week 29 onwards.]
Outbreak in the Sofia Region, 2006: probably waterborne
-------------------------------------------------------
The 1st outbreak occurred in the Svoge municipality (Sofia region) in July
-- August 2006, and was probably associated with contamination of the
drinking water supply. The incidence in the area has now returned to
pre-outbreak levels. [Illustrated by a figure in the original text
comparing the corresponding figures in the Sofia region for 2005 and 2006.]
Outbreak in Plovdiv, 2006
-------------------------
[An earlier] hepatitis A outbreak began at the end of June 2006 in Plovdiv,
a city in south-central Bulgaria. Since the beginning of the year, 1727
cases of acute jaundice due to hepatitis A virus have been reported in the
Plovdiv region, including 1393 cases notified between 23 Jun and 26 Sep
2006. This compares with 179 cases reported during the same period in 2005.
[The number of cases of acute hepatitis A in the Plovdiv region, for the
weeks 1 to 37, throughout the years 2005 and 2006, are presented as a
figure in the original text.]
The majority of the recent cases (975) occurred in Plovdiv, and 794 (81
percent) of these occurred in 2 neighbourhoods where people belonging to
the Roma ethnic minority live: Stolipinovo (701 cases) and Sheker Mahala
(93 cases). In Stolipinovo, 75 percent of cases were in children aged 1-9
years, and since the beginning of September, an average of over 80 cases
has been notified each week. [The weekly number of cases of acute viral
hepatitis A in Stolipinovo, Plovdiv, during the period June to September
2006 are illustrated by a figure in the original text.] Currently 190
patients have been admitted to hospital. Hepatitis A virus infection has
been confirmed by serological tests on samples from the majority of
patients admitted.
Sanitation and hygiene conditions in the Plovdiv area are poor, and include
illegal dung hills, a substandard sewage system, and an irregular water
supply. In response to the outbreak, the Bulgarian government is releasing
emergency funds to help improve sanitation and food safety (1).
The Bulgarian Ministry of Health, in collaboration with Roma
non-governmental organisations, launched an immunisation campaign against
hepatitis A in Plovdiv on 13 Sep 2006. The immunisation campaign is
targeting all children 2 to 18 years of age, living in Stolipinovo
neighbourhoods.
Hepatitis A viral infections occur worldwide. In highly endemic regions
(such as Africa, Asia, and Central and South America) outbreaks of disease
are uncommon because infection occurs during early childhood, when it is
mostly asymptomatic. Outbreaks of symptomatic disease are more common in
countries where the economy is in transition, as a decrease in hepatitis A
circulation increases the susceptibility of the population, and increases
the proportion of symptomatic cases (2). This is currently being seen in
some eastern European countries such as Bulgaria, and in some regions of
southern Europe.
References
----------
1. WHO Regional Office for Europe. Hepatitis A in Bulgaria, Plovdiv City. 5
Sep 2006 (<http://www.euro.who.int/surveillance/outbreaks/20060905_1>)
2. WHO. Hepatitis A factsheet.
(<http://www.who.int/csr/disease/hepatitis/HepatitisA_whocdscsredc2000_7.pdf>)
(By M Kojouharova (mkojouharova@ncipd.netbg.com), National Center of
Infectious and Parasitic Diseases, Sofia, Bulgaria; and the Edittorial
team, Eurosurveillance editorial office)
--
ProMED-mail
<promed@promedmail.org>

See Also

Hepatitis - Bulgaria (04) 20060928.2772
Hepatitis - Bulgaria (03) 20060925.2740
Hepatitis - Bulgaria : HAV identified 20060911.2575
Hepatitis - Bulgaria: RFI 20060831.2477
.............................mpp/cp/pg/dk

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