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. 2009 Nov;15(11):1760-8.
doi: 10.3201/eid1511.090214.

Epidemiology of hepatitis A virus infections, Germany, 2007-2008

Mirko S Faber  1 , Klaus Stark, Susanne C Behnke, Eckart Schreier, Christina Frank
Affiliations

Epidemiology of hepatitis A virus infections, Germany, 2007-2008

Mirko S Faber et al. Emerg Infect Dis. 2009 Nov.

Abstract

Approximately 60% of hepatitis A virus infections in Germany occur in persons without a travel history to disease-endemic areas and for whom sources of infection are unknown. Recommendation of pretravel vaccination fails to prevent the remaining imported infections. Using enhanced surveillance in 2007-2008, we analyzed epidemiologic patterns of hepatitis A in Germany and appropriateness and adequacy of current immunization recommendations. Young patients with a migration background who had visited friends and family in their ancestral countries accounted for most imported cases. Phylogenetic analysis showed high diversity of sequence data and clustering of strains with similar regions of origin or patient migration backgrounds. Virologic findings are compatible with those of low-incidence countries, where virtually all infections are directly or indirectly imported from other regions. Germans with a migration background are seen as a special risk group so far insufficiently reached by pretravel vaccination advice.

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Figures

Figure 1
Figure 1
Reported cases of hepatitis virus A infection (n = 679) by month of onset and patient age group (y), Germany, 2007–2008. A) Imported cases. B) Nonimported cases.
Figure 2
Figure 2
Age distribution (y) of persons with hepatitis A virus (HAV) infection by migration background and country where HAV infection was acquired (n = 520 with all 3 factors known), Germany, 2007–2008.
Figure 3
Figure 3
Neighbor-joining phylogenetic tree of a 348-bp section of the viral capsid protein 1//2A junction region of hepatitis A virus (HAV) constructed by using the Kimura 2-parameter distance model. Place of infection (A), migration background (B), and age of case-patients (■, 0–9 y; ■■, 10–19 y; ■■■, 20–39 y; ■■■■, 40–59 y; ■■■■■, >60 y) (C) are shown for each HAV isolate. Linked cases as judged by health departments are indicated by brackets. HAV subgenotypes are indicated by roman numerals and letters. Scale bar indicates nucleotide substitutions per site.
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References

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