Epidemiological investigation on hepatitis A virus infection outbreak in the area of Rzeszow city during the years 2017/18

Aim of the study
To define the threats and epidemiological differences between outbreaks of hepatitis A (HA) in adults and children, and to assess the efficiency of implemented prophylaxis. We also present a summary of treatment and sick leave costs as compared to the predicted money-load in the case of properly initiated prophylaxis in hepatitis A virus (HAV)-exposed persons.

Material and methods
The cause of two outbreaks was contamination related to food mishandling by a person infected with HAV. Especially health-threatening was exposure to the infection of 137 pre-school children. A second outbreak caused by the same source was observed among 25 exposed adults. On the basis of medical documentation we determined costs related to hospitalization and sickness leave absence at work, comparing it with money load related to implementation of required prophylaxis in both groups of people exposed to risk of HAV infection.

Results
As a consequence of exposure in the kindergarten area, an infection was confirmed in 32 patients from the first and subsequent generations and 7 cases were observed in the second outbreak. Costs of hospitalization and related to the sick leave were estimated to double the predicted costs of prophylaxis.

Conclusions
In the case of lack of proper hand hygiene of a food handler with HA or in the case of food-borne exposure of children to HAV it is necessary to apply post-exposure prophylaxis. Costs of the prophylaxis are significantly lower than costs of HA. Both outbreaks underwent self-limitation with longer course of morbidity and larger number in the case of the kindergarten focus.