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OUTBREAK DISPATCHES Hepatitis a Is the Most Common Type of Viral

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OUTBREAK DISPATCHES Hepatitis a Is the Most Common Type of Viral O UTBREAK DISPATCHES CURRENT OUTBREAK OF HEPATITIS A IN BULGARIA, 2006 Figure 3 Number of cases of acute hepatitis in Plovdiv region, weeks 1 M Kojouharova1, Editorial team2 - 37, 2005 and 2006 1 National Center of Infectious and Parasitic Diseases, Sofi a, Bulgaria 200 2 Eurosurveillance editorial offi ce 180 2006 2005 160 Published online 5 October 2006. 140 Citation: Euro Surveill 2006;11(10):E061005.1. 120 Available from: 100 http://www.eurosurveillance.org/ew/2006/061005.asp#1 80 Number of cases 60 Hepatitis A is the most common type of viral hepatitis in Bulgaria, 40 and accounts for more than 75% of all cases of viral hepatitis. Bulgaria 20 is a country with intermediate endemicity of hepatitis A viral (HAV) 0 infection. Between 1984 and 2005, incidence has varied between 1 3 5 7 9 1113151719212325272931333537 Week number 27 – 80 cases per 100 000 population during non-epidemic periods, but Figure 4 has reached 234 cases / 100 000 during epidemic periods. Since 1983, Weekly number of cases of acute viral hepatitis in all acute cases of jaundice due to hepatitis A virus have been subject to Stolipinovo, Plovdiv, June – September 2006 mandatory notification in Bulgaria. Since 2005, the European Union 120 case definition and case classification have been adopted. Since the beginning of 2006, 4793 viral hepatitis cases have been 100 reported in Bulgaria (1498 cases more than the same period in 2005, when a total of 3295 cases occurred) (Figure 1). The increase of 80 viral hepatitis incidence in 2006 is related mainly to two hepatitis A outbreaks in the regions of Sofia and Plovdiv. 60 40 Outbreak in Sofia Region, 2006: probably waterborne Number of cases The first outbreak occurred in Svoge municipality (Sofia region) in 20 July – August 2006, and was probably associated with contamination of the drinking water supply. The incidence in the area has now 0 1234567891011121314 returned to pre-outbreak levels (Figure 2). Weeks from June-September 2006 Outbreak in Plovdiv, 2006 The majority of the recent cases (975) occurred in Plovdiv, and The second hepatitis A outbreak began at the end of June 2006 in 794 (81%) of these occurred in two neighbourhoods where people Plovdiv, a city in southern central Bulgaria. Since the beginning of belonging to the Roma ethnic minority live: Stolipinovo (701 cases) the year, 1727 cases of acute jaundice due to hepatitis A virus have and Sheker Mahala (93 cases). In Stolipinovo, 75% of cases were been reported in the Plovdiv region, including 1393 cases notified in children aged 1-9 years, and since the beginning of September, between 23 June and 26 September 2006. This compares with 179 an average of over 80 cases has been notified each week (Figure 4). cases reported during the same period in 2005 (Fig. 3) One hundred and ninety patients are currently admitted to hospital. Figure 1 Hepatitis A virus infection has been confirmed by serological tests Weekly number of cases of acute viral hepatitis in Bulgaria, on samples from the majority of patients admitted. 2005 and 2006 Sanitation and hygiene conditions in the Plovdiv area are poor, and include 350 illegal dung hills, a substandard sewage system, and an irregular water supply. 2006 2005 300 In response to the outbreak, the Bulgarian government is releasing emergency funds to help improve sanitation and food safety [1]. 250 The Bulgarian Ministry of Health, in collaboration with Roma 200 non-governmental organisations, launched an immunisation 150 campaign against hepatitis A in Plovdiv on 13 September 2006. The Number of cases 100 immunisation campaign is targeting all children 2 to 18 years of age, living in Stolipinovo neighbourhoods. 50 Hepatitis A viral infections occur worldwide. In highly endemic 0 1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738 regions (such as Africa, Asia, and Central and South America) outbreaks Week number of disease are uncommon because infection occurs during early Figure 2 childhood, when it is mostly asymptomatic. Outbreaks of symptomatic Number of cases of acute hepatitis in Sofia region, 2005 and 2006 disease are more common in countries where the economy is in transition, 60 2006 as a decrease in hepatitis A circulation increases the susceptibility of the 2005 50 population, and increases the proportion of symptomatic cases [2]. This is currently being seen in some eastern European countries such 40 as Bulgaria, and in some regions of southern Europe. 30 20 References: Number of cases 1. WHO Regional Office for Europe. Hepatitis A in Bulgaria, Plovdiv City. 5 10 September 2006 (http://www.euro.who.int/surveillance/outbreaks/20060905_1) 0 2. WHO. Hepatitis A factsheet. (http://www.who.int/csr/disease/hepatitis/ 1 5 91317212529333741454953 HepatitisA_whocdscsredc2000_7.pdf) Week number 276 EUROSURVEILLANCE VOL.11 Issues 10-12 Oct-Dec 2006.
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