Key result
In a hepatitis A outbreak linked to an infected food handler, oral fluid testing of 219 asymptomatic secondary school students showed zero cases of undetected asymptomatic transmission.
Why the study?
In June 2019, health authorities were notified of hepatitis A virus infection cases in staff at a secondary school, prompting an outbreak and transmission investigation.
Observational (n=252)
This outbreak investigation demonstrates that HAV transmission in a secondary school setting was primarily foodborne with no evidence of asymptomatic person-to-person transmission among older students.
This is the authors' abstract. We don't add key points for this paper.
In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases of hepatitis A virus (HAV) infection in staff at a secondary school. Investigation revealed that an earlier case worked as a food handler in the school kitchen. Indirect transmission through food from the canteen was considered the most likely route of transmission. Cases were described according to setting of exposure. Oral fluid was obtained from students for serological testing. Environmental investigations were undertaken at settings where food handling was considered a potential transmission risk. Thirty-three confirmed cases were linked to the outbreak. All of those tested (n = 31) shared the same sequence with a HAV IB genotype. The first three cases were a household cluster and included the index case for the school. A further 19 cases (16 students, 3 staff) were associated with the school and consistent with indirect exposure to the food handler. One late onset case could not be ruled out as a secondary case within the school and resulted in vaccination of the school population. Five cases were linked to a bakery where a case from the initial household cluster worked as a food server. No concerns about hygiene standards were noted at either the school or the bakery. Oral fluid samples taken at the time of vaccination from asymptomatic students (n = 219, 11–16 years-old) showed no evidence of recent or current infection. This outbreak included household and foodborne transmission but limited (and possibly zero) person-to-person transmission among secondary school students. Where adequate hygiene exists, secondary transmission within older students may not occur.
Answers are grounded in this paper and cite their sources.
Supports prioritizing foodborne sources in school HAV outbreaks; hypothesis-generating for limited asymptomatic transmission among secondary students.
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Wensley et al. (2022) conducted an observational in Hepatitis A virus (HAV) infection (n=252). Hepatitis A virus exposure via infected food handler was evaluated on Serological evidence of recent or current asymptomatic HAV infection among students. In a hepatitis A outbreak linked to an infected food handler, oral fluid testing of 219 asymptomatic secondary school students showed zero cases of undetected asymptomatic transmission.
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