EPI-aktuellt no 37, 2004, referred to a recent European hepatitis A outbreak.
In August 2004 The Robert Koch Institute issued a European Early Warning regarding tourists contracting hepatitis A in Egypt. This outbreak affected several European countries. Germany, the worst affected country, now has a total in excess of 300 cases. Sweden acquired a total of 10 cases.

Germany requested international involvement in a case control study. It was felt that too many Swedes would be vaccinated for Hepatitis A for us to supply enough controls and participate in the study.

To ascertain that this was so, we contacted the Swedish tourists who had been staying at the site of interest during the suspected time of exposure. The results of this survey are below.

In total 117 Swedish Tourists (cases and non cases) went to the Egyptian site of interest during the suspected time of exposure.

112 (96%) have been contacted. It is unlikely that we will be able to contact the remaining 4%. None of the 4% have been notified as cases.

74 (66%) of those contacted reported to have been vaccinated.
38 (34%) were not vaccinated

10/38 have been notified, via SmiNet, as contracting Hepatitis A, giving an attack rate in the non-vaccinated group of 26%. None of the cases had taken prophylaxis.

Tourists represent a high-risk group for contracting Hepatitis A and should be encouraged to review country specific health regulations prior to their trip.

I would like to acknowledge the help of the 15 Swedish County Medical Officers, and their staff, for their help in the completion of this survey.

/Stephen Martin