title: Outbreak of hepatitis A in two federal states of Germany: bakery products as vehicle of infection.
abstract: In April 2004, increased numbers of hepatitis A were noted in six neighbouring districts in Germany. Exploratory interviews showed that patients had consumed bakery products from company X where two employees had been diagnosed with hepatitis A in February. A case-control study of consumption of products of company X was carried out through telephone interviews. Altogether, 64 cases were identified. Fifty-two cases and 112 controls aged >or=16 years were included in the case-control study. In total, 46/52 cases and 37/112 controls had consumed company X products [odds ratio (OR) 15.5, 95% confidence interval (CI) 6.1-39.7]. Of these, 36/46 cases and 16/37 controls had consumed pastries (OR 4.7, 95% CI 1.8-12.3), 25/46 cases and 12/37 controls had consumed filled doughnuts (OR 2.5, 95% CI 1.0-6.1). Sequence analysis of the VP1-2A junction region indicated 100% strain homology between cases and an infected employee of company X. We recommended reinforcement of hygiene precautions, and consideration of a prolongation of compulsory work absence after post-exposure vaccination.
authors.affiliation: Department for Infectious Diseases Epidemiology, Robert Koch-Institut, Berlin, Germany. schenkelk@rki.de
authors.forename: K
authors.initials: K
authors.lastname: Schenkel
authors.forename: V
authors.initials: V
authors.lastname: Bremer
authors.forename: C
authors.initials: C
authors.lastname: Grabe
authors.forename: U
authors.initials: U
authors.lastname: Van Treeck
authors.forename: E
authors.initials: E
authors.lastname: Schreier
authors.forename: M
authors.initials: M
authors.lastname: Höhne
authors.forename: A
authors.initials: A
authors.lastname: Ammon
authors.forename: K
authors.initials: K
authors.lastname: Alpers
mesh_terms: D016022:Case-Control Studies; D003625:Data Collection; D004196:Disease Outbreaks; D005516:Food Microbiology; D005517:Foodborne Diseases; D005858:Germany / Q000453:epidemiology; D006506:Hepatitis A / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D006507:Hepatovirus / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D006920:Hygiene; D007407:Interviews as Topic