Browsing by Author "Ciccaglione, A.R."
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- Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017Publication . Ndumbi, P.; Freidl, G.S.; Williams, C.J.; Mårdh, O.; Varela, C.; Avellón, A.; Friesema, I.; Vennema, H.; Beebeejaun, K.; Ngui, S.L.; Edelstein, M.; Smith-Palmer, A.; Murphy, N.; Dean, J.; Faber, M.; Wenzel, J.; Kontio, M.; Müller, L.; Midgley, S.E.; Sundqvist, L.; Ederth, J.L.; Roque-Afonso, A.M.; Couturier, E.; Klamer, S.; Rebolledo, J.; Suin, V.; Aberle, S.W.; Schmid, D.; De Sousa, R.; Augusto, G.F.; Alfonsi, V.; Del Manso, M.; Ciccaglione, A.R.; Mellou, K.; Hadjichristodoulou, C.; Donachie, A.; Borg, M.L.; Sočan, M.; Poljak, M.; Severi, E.; Members Of The European Hepatitis A Outbreak Investigation TeamBetween 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16-25801 and RIVM-HAV16-090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16-090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour.
- Improving preparedness to respond to cross-border hepatitis A outbreaks in the European Union/European Economic Area: towards comparable sequencing of hepatitis A virusPublication . Enkirch, T.; Severi, E.; Vennema, H.; Thornton, L.; Dean, J.; Borg, M.L.; Ciccaglione, A.R.; Bruni, R.; Christova, I.; Ngui, S.L.; Balogun, K.; Němeček, V,; Kontio, M; Takács, M; Hettmann, A; Korotinska, R; Löve, A; Avellón, A; Muñoz-Chimeno, M; de Sousa, R; Janta, D; Epštein, J; Klamer, S; Suin, V; Aberle, SW; Holzmann, H; Mellou, K; Ederth, JL; Sundqvist, L; Roque-Afonso, AM; Filipović, SK,; Poljak, M; Vold, L; Stene-Johansen, K; Midgley, S; Fischer, TK; Faber, M; Wenzel, JJ; Takkinen, J; Leitmeyer, KSequence-based typing of hepatitis A virus (HAV) is important for outbreak detection, investigation and surveillance. In 2013, sequencing was central to resolving a large European Union (EU)wide outbreak related to frozen berries. However, as the sequenced HAV genome regions were only partly comparable between countries, results were not always conclusive. Aim: The objective was to gather information on HAV surveillance and sequencing in EU/European Economic Area (EEA) countries to find ways to harmonise their procedures, for improvement of cross-border outbreak responses. Methods: In 2014, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on HAV surveillance practices in EU/EEA countries. The survey enquired whether a referral system for confirming primary diagnostics of hepatitis A existed as well as a central collection/storage of hepatitis A cases’ samples for typing. Questions on HAV sequencing procedures were also asked. Based on the results, an expert 2 www.eurosurveillance.org consultation proposed harmonised procedures for cross-border outbreak response, in particular regarding sequencing. In 2016, a follow-up survey assessed uptake of suggested methods. Results: Of 31 EU/ EEA countries, 23 (2014) and 27 (2016) participated. Numbers of countries with central collection and storage of HAV positive samples and of those performing sequencing increased from 12 to 15 and 12 to 14 respectively in 2016, with all countries typing an overlapping fragment of 218 nt. However, variation existed in the sequenced genomic regions and their lengths. Conclusions: While HAV sequences in EU/EEA countries are comparable for surveillance, collaboration in sharing and comparing these can be further strengthened.
- Standardising surveillance of hepatitis E virus infection in the EU/EEA: a review of national practices and suggestions for the way forwardPublication . Adlhoch, C.; Mand'áková, Z.; Ethelberg, S.; Epštein, J.; Rimhanen-Finne, R.; Figoni, J.; Baylis, S.A.; Faber, M.; Mellou, K.; Murphy, N.; O'Gorman, J.; Tosti, M.E.; Ciccaglione, A.R.; Hofhuis, A.; Zaaijer, H.; Lange, H.; de Sousa, R.; Avellón, A.; Sundqvist, L.; Said, B.; Ijaz, S.Background: Hepatitis E virus (HEV) infection is not notifiable at EU/EEA level, therefore surveillance relies on national policies only. Between 2005 and 2015, more than 20,000 cases were reported in EU/EEA countries. HEV testing is established in 26 countries and 19 countries sequence HEV viruses. Objective and study design: WHO's European Action plan for viral hepatitis recommends harmonised surveillance objectives and case definitions. ECDC's HEV expert group developed minimal and optimal criteria for national hepatitis E surveillance to support EU/EEA countries in enhancing their capacity and to harmonise methods. Results: The experts agreed that the primary objectives of national surveillance for HEV infections should focus on the basic epidemiology of the disease: to monitor the incidence of acute cases and chronic infections. The secondary objectives should be to describe viral phylotypes or subtypes and to identify potential clusters/outbreaks and possible routes of transmission. Seventeen of 20 countries with existing surveillance systems collect the minimal data set required to describe the epidemiology of acute cases. Eleven countries test for chronic infections. Twelve countries collect data to identify potential clusters/outbreaks and information on possible routes of transmission. Discussion: Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.