title: Foodborne hepatitis A outbreak associated with bakery products in northern Germany, 2012.
abstract: In October 2012, a hepatitis A (HA) outbreak with 83 laboratory-confirmed cases occurred in Lower Saxony. We defined primary outbreak cases as people with laboratory-confirmed HA and symptom onset between 8 October and 12 November 2012, residing in or visiting the affected districts. Secondary outbreak cases were persons with symptom onset after 12 November 2012 and close contact with primary cases. We identified 77 primary and six secondary cases. We enrolled 50 primary cases and 52 controls matched for age and sex, and found that 82% of cases and 60% of controls had consumed products from a particular bakery (OR=3.09; 95% CI: 1.15–8.68). Cases were more likely to have eaten sweet pastries (OR=5.74; 95% CI: 1.46–22.42). Viral isolates from five selected cases and three positively tested surfaces in the bakery had identical nucleotide sequences. One additional identical isolate derived from a salesperson of the bakery suffering from a chronic disease that required immunosuppressive treatment. Epidemiological and laboratory findings suggested that the salesperson contaminated products while packing and selling. Future risk assessment should determine whether food handlers with chronic diseases under immunosuppressive treatment could be more at risk of contaminating food and might benefit from HAV immunisation.
authors.affiliation: Department for Infectious Disease Epidemiology, Governmental Institute of Public Health of Lower Saxony, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Harries
authors.forename: M
authors.initials: M
authors.lastname: Monazahian
authors.forename: J
authors.initials: J
authors.lastname: Wenzel
authors.forename: W
authors.initials: W
authors.lastname: Jilg
authors.forename: M
authors.initials: M
authors.lastname: Weber
authors.forename: J
authors.initials: J
authors.lastname: Ehlers
authors.forename: J
authors.initials: J
authors.lastname: Dreesman
authors.forename: E
authors.initials: E
authors.lastname: Mertens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001483:Base Sequence; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005243:Feces / Q000821:virology; D005506:Food Contamination / Q000706:statistics & numerical data*; D005516:Food Microbiology; D005858:Germany / Q000453:epidemiology; D006506:Hepatitis A / Q000097:blood / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D006507:Hepatovirus / Q000235:genetics* / Q000302:isolation & purification*; D006801:Humans; D007124:Immunoenzyme Techniques; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011159:Population Surveillance; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult