Hepatitis A in Portugal – epidemiological overview of incidence in the last decade

Fonseca, Yasmin; Almeida, Ana; Almeida Santos, João

http://hdl.handle.net/10400.18/8879

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Authors

Fonseca, Yasmin

Almeida, Ana

Almeida Santos, João

Abstract(s)

Background. Hepatitis A is an acute liver disease with faecal-oral transmission caused by a hepatotrophic picornavírus - Hepatitis A Virus (HAV). Food contamination with HAV can occur at any time: cultivation, harvesting, processing, handling and even after cooking.1,2 Food and water contamination happens more frequently in developing countries where the disease is common but can also happen in developed countries. Although uncommon, foodborne outbreaks have occurred due to people consuming contaminated fresh and frozen imported food products. Therefore, monitoring the disease is an essential tool for the early implementation of preventive measures, applying the One Health approach to both the human and environmental dimensions to mitigate the impact that an outbreak may have on the population.3 Methods. Retrospective observational study, which analyses the incidence of reported cases of Hepatitis A in Portugal between 2012 and 2022. Data presented were collected from the Directorate-General for Health (DGS) and the European Center for Disease Prevention and Control (ECDC). Descriptive statistics were performed using Microsoft Excel® software. Results. Portugal had 806 cases of Hepatitis A between 2012 and 2022, the majority of which were male (n=597, 74.1%), aged between 25 and 44 years (n=397; 49.3%). Between 2012 and 2016, there was a gradual increase in incidence, from 0.1 in 2012 to 0.5 per 100 000 population in 2016. In 2017, there was a peak in incidence (4.7 per 100 000 population), corresponding to an outbreak of Hepatitis A that year. After 2017, the incidence gradually decreased. However, it never reached values lower than those of 2012, even during the years of the COVID-19 pandemic. During the study period, the incidence in men and women was similar, except between 2016 and 2019, where the incidence in men was higher. In terms of age, the incidence of Hepatitis A by age group showed high heterogeneity over the years, without a predominance. Conclusions. In Portugal, the incidence, except for 2017, was relatively low. However, most diagnoses occur in adults when the disease can present greater severity, with consequences in terms of morbidity and mortality. The decrease in incidence is a good indicator of improved hygiene and sanitary conditions, but it increases the possibility of outbreaks since the population tends to see its natural immunity against the disease reduced. It is essential to monitor the incidence of the disease in the population of Portugal to develop timely public health strategies to control potential outbreaks of Hepatitis A. Strategies to be implemented must take into account not only the human dimension in terms of prevention with vaccination, diagnosis and treatment of the disease but also measures in the environmental dimension, since transmission of the disease occurs via the faecal-oral route, it is essential to implement legislation and measures that promote food and water safety and alert the population to risk behaviours. References. 1Hofmeister MG, Foster MA, Teshale EH. Epidemiology and Transmission of Hepatitis A Virus and Hepatitis E Virus Infections in the United States. 2019. 2Castaneda D, Gonzalez AJ, Alomari M, et al. From hepatitis A to E: A critical review of viral hepatitis. World J Gastroenterol 2021; 27: 1691–1715. 3Jefferies M, Rauff B, Rashid H, et al. Update on global epidemiology of viral hepatitis and preventive strategies. Australia World J Clin Cases 2018; 6:589–599.