An outbreak of hepatitis A virus infection in a secondary school in England with no undetected asymptomatic transmission among students

A. Wensley, E. Smout, S. L. Ngui, K. Balogun, P. Blomquist, M. Edelstein, R. Greenwood, S. Coles, K. Ingold, L. Sargeant, M. Gent, S. Padfield, G. J. Hughes

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Abstract

In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases of hepatitis A virus (HAV) infection in staff at a secondary school. Investigation revealed that an earlier case worked as a food handler in the school kitchen. Indirect transmission through food from the canteen was considered the most likely route of transmission. Cases were described according to setting of exposure. Oral fluid was obtained from students for serological testing. Environmental investigations were undertaken at settings where food handling was considered a potential transmission risk. Thirty-three confirmed cases were linked to the outbreak. All of those tested (n = 31) shared the same sequence with a HAV IB genotype. The first three cases were a household cluster and included the index case for the school. A further 19 cases (16 students, 3 staff) were associated with the school and consistent with indirect exposure to the food handler. One late onset case could not be ruled out as a secondary case within the school and resulted in vaccination of the school population. Five cases were linked to a bakery where a case from the initial household cluster worked as a food server. No concerns about hygiene standards were noted at either the school or the bakery. Oral fluid samples taken at the time of vaccination from asymptomatic students (n = 219, 11-16 years-old) showed no evidence of recent or current infection. This outbreak included household and foodborne transmission but limited (and possibly zero) person-to-person transmission among secondary school students. Where adequate hygiene exists, secondary transmission within older students may not occur.

Original languageEnglish
Article numbere6
JournalEpidemiology and Infection
Volume151
DOIs
Publication statusPublished - 11 Dec 2023

Bibliographical note

Funding Information: The work was entirely funded by Public Health England (now UK Health Security Agency) and partner organisations. No external funding was received.

Open Access: This is an Open Access article, distributed under the terms of
the Creative Commons Attribution- NonCommercial-NoDerivatives licence (http://
creativecommons.org/licenses/by-nc-nd/4.0), which permits non-commercial re-use, distribution, and reproduction in any medium, provided that no alterations are made and the original article is properly cited. The written permission of Cambridge University Press must be obtained prior to any commercial use and/or adaptation of the article.

Publisher Copyright: © The Author(s), 2022. Published by Cambridge University Press.

Citation: Wensley, A., Smout, E., Ngui, S., Balogun, K., Blomquist, P., Edelstein, M., . . . Hughes, G. (2023). An outbreak of hepatitis A virus infection in a secondary school in England with no undetected asymptomatic transmission among students. Epidemiology & Infection, 151, E6. doi:10.1017/S095026882200190X

DOI: 10.1017/S095026882200190X

Keywords

  • Epidemiology
  • hepatitis A
  • outbreaks
  • public health
  • vaccination (immunisation)

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