1. Hepatitis A Last updated August 2014

2. Hepatitis A virus Associated with poor hygiene and sanitation - primarily transmitted from person-to-person via the faecal-oral route Incubation period commonly 28-30 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 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, injecting drug users (IDU) and men who have sex with men (MSM)

3. Number of notifications of hepatitis A, 1988-2013

4. Number of notifications of hepatitis A, 2004-2013, by sex and age group (years)

5. Mean annual hepatitis A notification rates per 100,000 population, 2004-2013, by age group (years)

6. 2013 data In more detail

7. Number of notifications of hepatitis A, 2013, by sex and age group (years)

8. Summary of 2013 hepatitis A cases 50 cases notified 40% (n=20) were notified by the HSE-East, 24% (n=12) by the HSE-North East and 18% (n=9) by the HSE-South 54% (n=27) female, 46% (n=23) male Highest notification rates in adults aged 25-44 years 9 cases linked to travel outside of Ireland (18%) 35 cases were likely to have been infected in Ireland (70%) No data on country of infection available for the remaining 6 cases (12%)

9. Summary of 2013 hepatitis A outbreaks (1) 6 outbreaks, with a total of 41 cases, reported in 2013 This is an unusally high number of outbreaks and two of the outbreaks were relatively large Outbreak 1: multiple HSE areas, likely to have been associated with consumption of frozen berries. The hepatitis A genotype and sequence were identical to that in a large multi-national European outbreak, which was also associated with frozen berries. 23 adult cases (15 confirmed primary, 4 confirmed secondary, 2 possible primary, 1 possible secondary and 1 possible co-primary) Outbreak 2: HSE-NE, 6 adults and 4 children ill. Index case had travelled to Pakistan. Person to person transmission in Ireland

10. Summary of 2013 hepatitis A outbreaks (2) Outbreak 3: HSE-NW, 2 adults, 1 teenager ill, index case had travelled to Scotland during the incubation period but could also have been infected in Ireland, no source identified Outbreak 4: 2 HSE areas, 2 adults infected with identical hepatitis A genotype and sequence in Egypt Outbreak 5: HSE-East, 2 females, one adult, one child, country of infection was Ireland, no source identified Outbreak 6: 2 adult male cases, infection associated with frozen berries consumed in Italy. The hepatitis A genotype and sequence were identical to that in a large multi-national European outbreak, which was associated with frozen berries.

11. Geographic distribution of hepatitis A virus infection (Source CDC, Atlanta, USA)