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. 2024 Sep 27;24(1):1044.
doi: 10.1186/s12879-024-09938-1.

Use of passive samplers as sewage surveillance tool to monitor a hepatitis A outbreak at a school in Amsterdam, the Netherlands, Oct 2022 - March 2023

Maarten de Jong  1 , Maarten F Schim van der Loeff  2   3 , Rémy Schilperoort  4 , Harry Vennema  5 , Charlie van der Weijden  2 , Jeroen Langeveld  4 , Matthijs Welkers  2   6 , Maria Prins  2   3 , Ana Maria de Roda Husman  5 , Ewout Fanoy  2 , Gertjan Medema  7
Affiliations

Use of passive samplers as sewage surveillance tool to monitor a hepatitis A outbreak at a school in Amsterdam, the Netherlands, Oct 2022 - March 2023

Maarten de Jong et al. BMC Infect Dis. .

Abstract

Background: Enteric hepatitis A virus (HAV) infections during childhood are often asymptomatic but may cause severe illness in adults. To improve public health surveillance we assessed the applicability of sewage monitoring during an HAV outbreak at a primary school.

Methods: Between October 19 and December 27, 2022, five symptomatic HAV cases were notified to the Public Health Service Amsterdam; all attended the same primary school. Passive samplers, small absorbent tools, were deployed in sewage near the school from November 14, 2022, to March 22, 2023. The absorbents were subjected to RNA extraction, HAV PCR testing, and, if positive, sequencing. PCR and sequencing were also performed on plasma and feces samples of HAV cases.

Results: In 22 out of 88 (25%) of sewage samples, HAV RNA was detected. All HAV-RNA-positive sewage samples until 8 February 2023 were subgenotype IB, matching the strain detected in all cases. Another strain of HAV (subgenotype IA) was detected in sewage from 15 February 2023 onwards, without associated cases.

Conclusions: Passive sampler-based sewage monitoring is an effective method to rapidly detect HAV shedding linked to diagnosed cases. It detects unnoticed viral infections and allows monitoring of outbreaks. This suggests that passive sampler-based monitoring is a promising tool supporting the public health response during HAV and other outbreaks.

Keywords: Hepatitis A virus; Outbreak detection; Passive samplers; Sewage monitoring; Sewage sampling.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Passive samplers used for sewage sampling around Amsterdam school, the Netherlands, November 2022 – March 2023. A 3-D printed torpedo passive sampler with cotton tips B Suspension cord C: Pen for reference
Fig. 2
Fig. 2
Schematics of sewage sampling locations around Amsterdam school, the Netherlands, November 2022 – March 2023. A Sewer manhole directly downstream of the school main building. B Sewer manhole directly downstream of the annex building. C Sewer pumping station district X. D Sewer pumping station district Y. E Sewer pumping station district Z. F Wastewater treatment plant (influent)
Fig. 3
Fig. 3
HAV concentrations and strain typing in sewage samples around Amsterdam school, November 2022 – March 2023. *Non-Detect
See this image and copyright information in PMC

References

    1. Collier MG, Tong X, Xu F. Hepatitis A hospitalizations in the United States, 2002–2011. Hepatology. 2015;61(2):481–5. - PubMed
    1. https://www.ecdc.europa.eu/sites/default/files/documents/HEPA_AER_2021.pdf. Last Accessed on 6 Nov 2023.
    1. Takuissu GR, Kenmoe S, Ebogo-Belobo JT, Kengne-Nde C, Mbaga DS, Bowo-Ngandji A, et al. Occurrence of hepatitis A virus in water matrices: a systematic review and meta-analysis. Int J Environ Res Public Health. 2023;20(2):1054. - PMC - PubMed
    1. Chatziprodromidou IP, Dimitrakopoulou ME, Apostolou T, Katopodi T, Charalambous E, Vantarakis A. Hepatitis A and E in the Mediterranean: a systematic review. Travel Med Infect Dis. 2022;47: 102283. - PubMed
    1. Khan OA, Heymann DL, American Public Health Association. Control of communicable diseases. Clinical practice. 21 ed. Washington, DC: American Public Health Association; 2020.

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