1. Epidemiology of Hepatitis A in Ireland Last updated March 2017

2. Hepatitis A virus
Associated with poor hygiene and sanitation - primarily transmitted from person-to-person via the faecal-oral route
Incubation period commonly days (range 15-50)
Common source outbreaks due to contaminated food or water also occur
Acute disease – does not have a chronic form. Protective antibodies develop after infection
Vaccine preventable
Clinical severity tends to increase with age. Adults can experience severe illness lasting several months, whereas young children are frequently asymptomatic
The most common symptoms are fever, loss of appetite, nausea, fatigue and abdominal pain, followed within a few days by jaundice
In developed countries, hepatitis A is most commonly seen among travellers to endemic countries, household or sexual contacts of known cases, people who inject drugs (PWID) and men who have sex with men (MSM)

3. Number of notifications of hepatitis A, by sex, 1997-2016

4. Hepatitis A notification rate per 100,000 population, 1997-2016

5. Hepatitis A average annual notification rates per 100,000 population, by sex and age group,

6. Hepatitis A notification rates per 100,000 population, by sex and age group, 2016

7. Hepatitis A notification rates per 100,000 population, by HSE area and year, 2013-2016

8. Summary of hepatitis A cases notified in 2016
58% female (n=22, 1.0 per 100,000), 42% male (n=16, 0.7 per 100,000)
Highest notification rates in children aged <15 years
79% of cases (n=30) were associated with travel outside Ireland, either directly or, in the case of outbreaks, via an index case infected outside Ireland
The most common countries of infection for travel associated cases were Spain, Sudan, Egypt and Pakistan
Of the 8 cases infected in Ireland, 6 were sporadic cases and 2 were linked. No source of infection was identified for any of these cases
9 outbreaks with 24 associated cases were reported in The index case had travelled outside of Ireland for 8 of the outbreaks

9. Increase in hepatitis A in men who have sex with men (MSM) in EU in 2016
A number of European countries reported an increase in hepatitis A cases in MSM in 2016 and in 2017 to date
Three different strains of sub-genotype 1A were identified using RNA sequencing:
VRD_521_2016: initially identified in clusters of cases in the UK, a number of whom had travelled to Spain. Related to isolates previously identified in Central/South America
RIVM-HAV16-090: initially identified in cases infected at the Europride festival in Amsterdam. Related to isolates previously identified in Thailand and Cambodia
V : initially identified in Germany – clusters of cases in MSM in Frankfurt, Munich and Berlin since August 2016
Almost 300 cases with one of these strains were reported by 13 European countries between February 2016 and February For more information:
No cases of hepatitis A were reported in MSM in Ireland in Three have been reported to date in All had a history of recent travel outside Ireland. One has been sequenced to date and had an RNA sequence matching VRD_521_2016