Joint ECDC-EFSA rapid outbreak assessment: Outbreak of hepatitis A virus infection in residents and travellers to Italy

Risk assessment

Since 1 January 2013 there have been 15 laboratory-confirmed cases of hepatitis A (HAV) infection reported in Germany, the Netherlands and Poland. All cases had travelled to the provinces of Trento and Bolzano in northern Italy during the exposure period. During the same period Italy has also experienced an increase in cases of HAV infection. As the cases do not have a travel history outside the EU within their period of potential exposure, this strongly suggests an outbreak involving several EU Member States, with exposure currently occurring in one EU Member State.

Executive summary

Since 1 January 2013, 15 laboratory-confirmed cases of hepatitis A have been reported in Germany, the Netherlands and Poland. All cases had travelled to northern Italy during the exposure period. As the cases do not have a travel history outside the EU within their period of potential exposure, this strongly suggests an outbreak involving several EU Member States, with exposure currently occurring in one EU Member State.

The descriptive epidemiology points at a continuous common source of infection. Preliminary epidemiological and environmental investigations indicate mixed frozen berries as the most likely vehicle of infection for this outbreak. A large number of cases reported consumption of berries prior to disease onset. In addition, HAV was isolated from a pack of mixed frozen berries at the residence of one of the cases.

According to the available information, it is likely that additional cases will be identified and reported. ECDC, EFSA and the European Commission, in cooperation with the affected countries, will continue to closely monitor this event and will update the risk assessment as soon as new, relevant information becomes available.