Clusters of autochthonous hepatitis A cases in a low endemicity area

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Abstract
At the University Hospital of Besançon (département of Doubs, France), an unusually high number of patients were hospitalized for hepatitis A during the 1999–2000 period, some of whom had not travelled abroad. This prompted us to conduct an investigation on a population basis and search for clusters of cases possibly related to local sources of contamination. Accordingly, case definition was restricted to autochthonous cases. During the 1999–2002 period, 45 autochthonous cases were classified as possibly originating from local environmental sources. A space–time scan statistic detected one most likely cluster (standardized incidence ratio 20·63, 95% confidence interval 10·6–37·1), consisting of 11 persons (of whom five children had attended the same swimming pool). It remained significant in a sensitivity analysis, strongly supporting the hypothesis of an environmental source of contamination. This study reveals the necessity of regular surveillance for hepatitis A and raises the issue of virological surveys of pool waters.