Health officials reported an outbreak of hepatitis in Europe in June-July 2016 starting in England, Italy, and Spain. Since then, disease activity has consistently increased and spread to 12 countries – Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Norway, the Netherlands, Portugal, Slovenia, and Sweden (map). According to the European Center for Disease Prevent and Control (ECDC), fewer than 50 confirmed cases were reported each month June-November 2016, and roughly 55 confirmed cases were reported December 2016. Monthly cases increased significantly January-March 2017, with roughly 210 confirmed cases reported in January, at least 220 confirmed in February, and more than 375 in March. Health officials reported only 75 cases in April; however, this data is likely incomplete due to delayed reporting from EU countries to the ECDC, which prevents an accurate assessment of recent disease activity. Furthermore, the true extent of disease activity in Europe is likely higher than reported, since many infected individuals are asymptomatic or experience mild symptoms and do not seek medical attention.
Hepatitis Outbreak Overview
As of May 17, the ECDC has reported 1,173 confirmed hepatitis A cases in Europe since June 2016, with most of the cases being transmitted due to unsafe sexual practices among men who have sex with men (MSM). Of the 15 countries affected, Italy and Spain have reported the highest number of hepatitis A cases. According to the most recent and complete data available, health officials in Italy reported more than 580 hepatitis A cases August 2016-February 2017, with the highest number of cases identified in Lazio (map). As of April 30, health officials in Spain reported more than 1,580 suspected and confirmed cases of hepatitis A since the start of 2017; this is seven times higher than the number reported during the same period in 2016, when officials identified only 226 cases. Disease activity during 2017 in Spain has been reported throughout most of the country, including the city of Melilla, Balearic Islands, and Canary Islands; however, the autonomous community of Andalucía reported the highest number of hepatitis A cases Jan. 1-April 30 with 450 cases, followed by Madrid (230 cases) and Comunidad Valenciana (118 cases) (map).
Increased Hepatitis Risk in June
The WorldPride 2017 festival will be taking place in Madrid, Spain from June 23-July 2. This will be the 40th anniversary of the festival; as such, participants are likely to travel from many countries and large crowds are expected. Mass public events like the WorldPride festival pose various health risks for host and home countries, as well as to individual visitors. These health risks arise mainly from having a large number of people in confined spaces, which increases the probability of infectious diseases spreading in the host country and the respective countries of the returning participants. In the case of WorldPride, health officials are encouraging all visitors to the city and the festival, especially MSM, to practice safe sex. This advice applies to any of the Pride events scheduled to occur in cities throughout the world as the risk of infection or further spread of hepatitis A is not limited to Madrid.
Health officials urge all individuals, especially MSM, who plan to attend the festivals to practice safe sex and ensure they are vaccinated against hepatitis A and, if not, to receive the immunization. However, according the ECDC, there is a global shortage of hepatitis A vaccines, which could make it difficult to obtain. All individuals should vigilantly practice basic health precautions, including maintaining hand hygiene, and consider avoiding street vendors. Additional cases of hepatitis A will likely be reported in the coming weeks. Hepatitis A activity will likely increase and potentially spread following Pride festivals throughout Europe, as large crowds congregate and later return to their home countries.