title: Hepatitis A outbreak associated with a revolving sushi bar in Chiba, Japan: Application of molecular epidemiology.
abstract: OBJECTIVE
  The number of hepatitis A cases in Japan as well as in other developed countries has been progressively decreasing during the last several years. There is no universal hepatitis A vaccination program in Japan, and a hepatitis A virus (HAV) epidemic in Japan is not unlikely. In 2011, a hepatitis A outbreak associated with a revolving sushi bar occurred in Chiba, Japan. We aimed to analyze this outbreak.
  
  
  METHODS
  Twenty-seven patients associated with this outbreak were admitted to the National Hospital Organization Chiba Medical Center. Molecular epidemiologic investigations were conducted.
  
  
  RESULTS
  Twenty-six of the 27 patients had gone to the same revolving sushi bar, and then clinical symptoms appeared. HAV RNA was detected by reverse transcription polymerase chain reaction in 23 of the 27 (85.1%) patients whose sera had tested positive for anti-HAV immunoglobulin M. All isolates from this outbreak were clustered within subgenotype IA, displaying 100% sequence homology with each other in 232 bp from all 23 patients. All isolates belong to the IA-1 sublineage, which is endemic to Japan.
  
  
  CONCLUSIONS
  A revolving sushi bar was associated with a hepatitis A outbreak, and molecular epidemiological investigations proved useful.
authors: Department of Gastroenterology, National Hospital Organization Chiba Medical Center             Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba             Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan.
authors: Atsuko
authors: A
authors: Tominaga
authors: Tatsuo
authors: T
authors: Kanda
authors: Taro
authors: T
authors: Akiike
authors: Hiroshi
authors: H
authors: Komoda
authors: Kenji
authors: K
authors: Ito
authors: Asami
authors: A
authors: Abe
authors: Akiko
authors: A
authors: Aruga
authors: Satoru
authors: S
authors: Kaneda
authors: Masaaki
authors: M
authors: Saito
authors: Tomoko
authors: T
authors: Kiyohara
authors: Takaji
authors: T
authors: Wakita
authors: Koji
authors: K
authors: Ishii
authors: Osamu
authors: O
authors: Yokosuka
authors: Nobuyuki
authors: N
authors: Sugiura