title: Underdiagnosis of foodborne hepatitis A, The Netherlands, 2008-2010(1.).
abstract: Outbreaks of foodborne hepatitis A are rarely recognized as such. Detection of these infections is challenging because of the infection's long incubation period and patients' recall bias. Nevertheless, the complex food market might lead to reemergence of hepatitis A virus outside of disease-endemic areas. To assess the role of food as a source of infection, we combined routine surveillance with real-time strain sequencing in the Netherlands during 2008-2010. Virus RNA from serum of 248 (59%) of 421 reported case-patients could be sequenced. Without typing, foodborne transmission was suspected for only 4% of reported case-patients. With typing, foodborne transmission increased to being the most probable source of infection for 16%. We recommend routine implementation of an enhanced surveillance system that includes prompt forwarding and typing of hepatitis A virus RNA isolated from serum, standard use of questionnaires, data sharing, and centralized interpretation of data.
authors.forename: Mariska
authors.initials: M
authors.lastname: Petrignani
authors.forename: Linda
authors.initials: L
authors.lastname: Verhoef
authors.forename: Harry
authors.initials: H
authors.lastname: Vennema
authors.forename: Rianne
authors.initials: R
authors.lastname: van Hunen
authors.forename: Dominique
authors.initials: D
authors.lastname: Baas
authors.forename: Jim E
authors.initials: JE
authors.lastname: van Steenbergen
authors.forename: Marion P G
authors.initials: MP
authors.lastname: Koopmans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D006506:Hepatitis A / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D030041:Hepatitis A virus / Q000235:genetics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012367:RNA, Viral / Q000235:genetics; D055815:Young Adult
chemical_list: D012367:RNA, Viral
keywords: enhanced surveillance; epidemiology; foodborne diseases; hepatitis A virus; molecular typing; public health; the Netherlands; viruses