Improving preparedness to respond to cross-border hepatitis a outbreaks in the European union/European economic area: Towards comparable sequencing of hepatitis a virus

Theresa Enkirch*, Ettore Severi, Harry Vennema, Lelia Thornton, Jonathan Dean, Maria Louise Borg, Anna Rita Ciccaglione, Roberto Bruni, Iva Christova, Siew Lin Ngui, Koye Balogun, Vratislav Nemecek, Mia Kontio, Mária Takács, Andrea Hettmann, Rita Korotinska, Arthur Löve, Ana Avellón, Milagros Muñoz-Chimeno, Rita de SousaDenisa Janta, Jevgenia Epštein, Sofieke Klamer, Vanessa Suin, Stephan W. Aberle, Heidemarie Holzmann, Kassiani Mellou, Josefine Lundberg Ederth, Lena Sundqvist, Anne Marie Roque-Afonso, Sanja Kurecic Filipovic, Mario Poljak, Line Vold, Kathrine Stene-Johansen, Sofie Midgley, Thea Kølsen Fischer, Mirko Faber, Jürgen J. Wenzel, Johanna Takkinen, Katrin Leitmeyer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Introduction: Sequence-based typing of hepatitis A virus (HAV) is important for outbreak detection, investigation and surveillance. In 2013, sequencing was central to resolving a large European Union (EU)- wide outbreak related to frozen berries. However, as the sequenced HAV genome regions were only partly comparable between countries, results were not always conclusive. Aim: The objective was to gather information on HAV surveillance and sequencing in EU/European Economic Area (EEA) countries to find ways to harmonise their procedures, for improvement of cross-border outbreak responses. Methods: In 2014, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on HAV surveillance practices in EU/EEA countries. The survey enquired whether a referral system for confirming primary diagnostics of hepatitis A existed as well as a central collection/storage of hepatitis A cases’ samples for typing. Questions on HAV sequencing procedures were also asked. Based on the results, an expert consultation proposed harmonised procedures for cross-border outbreak response, in particular regarding sequencing. In 2016, a follow-up survey assessed uptake of suggested methods. Results: Of 31 EU/ EEA countries, 23 (2014) and 27 (2016) participated. Numbers of countries with central collection and storage of HAV positive samples and of those performing sequencing increased from 12 to 15 and 12 to 14 respectively in 2016, with all countries typing an overlapping fragment of 218 nt. However, variation existed in the sequenced genomic regions and their lengths. Conclusions: While HAV sequences in EU/EEA countries are comparable for surveillance, collaboration in sharing and comparing these can be further strengthened.

Original languageEnglish
Article number1800397
Issue number28
Publication statusPublished - Jul 2019

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© 2019, European Centre for Disease Prevention and Control (ECDC). All rights reserved.


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