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HAV outbreak in Israel traced to IV drug use
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Despite the success of a universal vaccination program for toddlers in Israel, hepatitis A virus was still circulating among the general population, an investigation of an outbreak in Tel-Aviv found.
Researchers attributed the outbreak to “close contacts with the endemic Palestinian population.”
HAV has a very low incidence in countries with routine childhood vaccination or high hygienic conditions.
“In such areas, outbreaks may occur as a result of introduction to high risk groups, i.e. intravenous drug users or men who have sex with men or by consumption of imported food products followed by further spread into the general population,” Yosef Manor, MD, of the central viral laboratory at the Israel Ministry of Health, Sheba Medical Center, Tel-Hashomer, and colleagues wrote. “Yet the origin of many cases remains obscure.”
Manor and colleagues investigated the outbreak of 75 cases of HAV in 2012 and 2013. The researchers obtained sewage and serum samples, performing viral sequencing on serum from patients with acute HAV from the Tel-Aviv outbreak (n = 12) and patients in hospitals in three other major cities (n = 31). Manor and colleagues also performed sequencing on 27 sewage samples from metropolitan Tel-Aviv, six from Gaza and 14 from three other cities. The mean age of the patients was 33.2 years. Four (5.3%) had been vaccinated for HAV, and 58 (77.3%) had been hospitalized.
Sixteen (59.2%) sewage samples from Tel-Aviv, as well as four (28.6%) from other cities in Israel and all six (100%) from Gaza contained HAV, Manor and colleagues wrote. Genotype IB, comprised 52 of the 53 sequenced samples, the researchers reported, and a phylogenetic analysis showed identical strains occurred in the Israeli and Palestinian populations. Manor and colleagues concluded that the outbreak had begun among IV drug users before spreading to the general population.
Researchers noted that there was no data available on the severity of individual cases except for the hospitalization rate (77.3%), and that the only data available on vaccination were self-reported from the patients.
“The study opened a window on a short period of time during the outbreak,” Manor and colleagues wrote. “Thus, we can only assume that this period represents the situation before or after the outbreak. A prolonged sewage survey and analysis of more clinical samples from all regions of Israel would provide more data and help to inform public health policies.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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