Outbreak of hepatitis A in an extended family after importation by non-immune travellers

• Published in: Epidemiology and infection Vol. 140; no. 10; pp. 1813 - 1820
• Main Authors: KUMBANG, J., EJIDE, S., TEDDER, R. S., NGUI, S. L.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01-10-2012
• Subjects: Adolescent; Adult; Asymptomatic infection; Biological and medical sciences; Child; Child, Preschool; Children; Disease Outbreaks; Disease prevention; England - epidemiology; Epidemics; Families; Families & family life; Family; Family Health; Female; Food; Fundamental and applied biological sciences. Psychology; Genotype; Genotypes; Hepatitis; Hepatitis A; Hepatitis A - epidemiology; Hepatitis A Antibodies - blood; Hepatitis A virus; Hepatitis A virus - classification; Hepatitis A virus - isolation & purification; Households; Human viral diseases; Humans; Immunization; Immunoglobulin M - blood; Infections; Infectious diseases; Male; Medical sciences; Microbiology; Pakistan - epidemiology; RNA; RNA, Viral - genetics; Travel; Viral diseases; Viral hepatitis; Viruses; Weddings; England; Pakistan; United Kingdom > UK; United States > US; Hepatitis A; outbreaks; Infection; Viral hepatitis A; Digestive diseases; Hepatic disease; Epidemiology; Viral disease
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268811002561

The incidence of hepatitis A in England has declined in recent years, but travel-related cases and imported infections remain a challenge. We report an outbreak of hepatitis A in an extended family where two primary cases were infected while in Pakistan and two secondary cases were infected in England. All four were infected by the same genotype IIIA virus. Testing of the children in the extended family by dried blood spots (DBS) determined that three had evidence of recent past infections (anti-HAV IgM positive), one had a current asymptomatic infection (anti-HAV IgM and HAV RNA positive) and one was incubating the virus (anti-HAV IgM negative, HAV RNA positive). HAV RNA from the DBS was identical to the adult cases. This outbreak demonstrates secondary spread of hepatitis A by asymptomatic children after importation from abroad and highlights the importance of preventing travel-associated hepatitis A infection.