Central Virology Laboratory, Ministry Of Health, Sheba Medical Center, Ramat-Gan, Israel.
Public Health Services, Ministry Of Health, Jerusalem, Israel.
Euro Surveill. 2021 Feb;26(6). doi: 10.2807/1560-7917.ES.2021.26.6.2000001.
IntroductionUniversal vaccination of toddlers has led to very low hepatitis A (HAV) endemicity in Israel. However, sporadic outbreaks still occur, necessitating better surveillance.AimTo implement a comprehensive HAV surveillance programme.MethodsIn 2017 and 2018, sera from suspected HAV cases that tested positive for anti-HAV IgM antibodies were transferred to the Central Virology Laboratory (CVL) for molecular confirmation and genotyping. Sewage samples were collected in Israel and Palestine* and were molecularly analysed. All molecular (CVL), epidemiological (District Health Offices and Epidemiological Division) and clinical (treating physicians) data were combined and concordantly assessed.ResultsOverall, 146 cases (78 in 2017 and 68 in 2018, median age 34 years, 102 male) and 240 sewage samples were studied. Most cases (96%) were unvaccinated. In 2017, 89% of cases were male, 45% of whom were men who have sex with men (MSM). In 2018, 49% were male, but only 3% of them were MSM (p < 0.01). In 2017, 82% of cases and 63% of sewage samples were genotype 1A, phylogenetically associated with a global MSM-HAV outbreak. In 2018, 80% of cases and 71% of sewage samples were genotype 1B, related to the endemic strain previously identified in Israel and Palestine*. Environmental analysis revealed clustering of sewage and cases' sequences, and country-wide circulation of HAV.ConclusionsMolecular confirmation of HAV infection in cases and analysis of environmental samples, combined with clinical and epidemiological investigation, may improve HAV surveillance. Sequence-based typing of both clinical and sewage-derived samples could assist in understanding viral circulation.
引言
儿童普遍接种疫苗使得以色列甲型肝炎（HAV）的地方性流行率非常低。然而，仍会发生散发性暴发，因此需要更好的监测。
目的
实施全面的 HAV 监测计划。
方法
2017 年和 2018 年，从甲型肝炎 IgM 抗体检测呈阳性的疑似 HAV 病例中转移血清至中央病毒学实验室（CVL）进行分子确认和基因分型。在以色列和巴勒斯坦*收集污水样本，并进行分子分析。所有分子（CVL）、流行病学（地区卫生办公室和流行病学司）和临床（治疗医生）数据均结合并一致评估。
结果
总共研究了 146 例病例（2017 年 78 例，2018 年 68 例，中位年龄 34 岁，102 例男性）和 240 个污水样本。大多数病例（96%）未接种疫苗。2017 年，89%的病例为男性，其中 45%为男男性行为者（MSM）。2018 年，49%为男性，但其中只有 3%为 MSM（p<0.01）。2017 年，82%的病例和 63%的污水样本为 1A 基因型，与全球 MSM-HAV 暴发相关。2018 年，80%的病例和 71%的污水样本为 1B 基因型，与以前在以色列和巴勒斯坦*发现的地方性株相关。环境分析显示污水和病例序列聚类，并显示 HAV 在全国范围内传播。
结论
对病例进行 HAV 感染的分子确认和对环境样本进行分析，结合临床和流行病学调查，可能会改善 HAV 监测。对临床和污水样本进行基于序列的分型可以帮助了解病毒传播。
Zotero 插件
