title: Clusters of autochthonous hepatitis A cases in a low endemicity area.
abstract: At the University Hospital of Besançon (département of Doubs, France), an unusually high number of patients were hospitalized for hepatitis A during the 1999-2000 period, some of whom had not travelled abroad. This prompted us to conduct an investigation on a population basis and search for clusters of cases possibly related to local sources of contamination. Accordingly, case definition was restricted to autochthonous cases. During the 1999-2002 period, 45 autochthonous cases were classified as possibly originating from local environmental sources. A space-time scan statistic detected one most likely cluster (standardized incidence ratio 20.63, 95% confidence interval 10.6-37.1), consisting of 11 persons (of whom five children had attended the same swimming pool). It remained significant in a sensitivity analysis, strongly supporting the hypothesis of an environmental source of contamination. This study reveals the necessity of regular surveillance for hepatitis A and raises the issue of virological surveys of pool waters.
authors.affiliation: Department of Public Health, Biostatistics and Epidemiology Unit, Faculty of Medicine, Besançon, France.
authors.forename: H
authors.initials: H
authors.lastname: Guis
authors.forename: S
authors.initials: S
authors.lastname: Clerc
authors.forename: B
authors.initials: B
authors.lastname: Hoen
authors.forename: J F
authors.initials: JF
authors.lastname: Viel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D005602:France / Q000453:epidemiology; D006506:Hepatitis A / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged