Hepatitis A outbreak in Czechia: the risks, the precautions and the outlooks
The hepatitis A outbreak in Czechia is far from abating. Doctors have recorded close to 3,000 cases of the highly infectious disease this year, which is twenty times more than last year and the highest figure in 30 years. How serious is the situation, what is being done and what are the outlooks?
Hepatitis A started spreading in the Czech Republic in the spring and summer of this year when the number of cases saw a significant increase. With the arrival of autumn doctors were ringing alarm bells and urging broad vaccination among high-risk groups. By the end of November, the National Institute of Public Health had recorded 2,880 cases of hepatitis A, the highest incidence in thirty years. Thirty-one people succumbed to the disease, compared to just two last year.
The city of Prague is the worst affected –registering more than 40 percent of all infections – and nearly 50 new cases in the past week alone. Chief Public Health Officer Barbora Macková says the statistics give reason for concern.
“What’s different compared to the situation, say, fourteen days or a month ago is that the disease is now spreading to other regions of the Czech Republic as well, even if only gradually. We are seeing it in Moravia-Silesia, but the highest incidence is still in Prague and the Central Bohemian Region.”
Cases are being reported in all age groups, from the youngest children to seniors,” according to the National Institute of Public Health. The most common occurrence is in the age groups 35–39 (316 cases), 40–44 (272 cases), and 30–34 (257 cases). Among children, the highest number of cases is recorded in the 5–9 age group.
According to health experts, people over 65 are more often protected because they experienced a major epidemic in the late 1970s and have antibodies.
Roughly one-fifth of those infected are people engaged in risky behaviour, such as drug users, alcoholics, or the homeless.
Barbora Macková points out one distinct difference when comparing this outbreak to previous ones.
“What’s different compared to previous epidemics — for example in the 1970s or 1990s — is that back then the source of infection was usually some vehicle. In the 1970s it was food, specifically frozen strawberries. This time it’s different in that there are several sources, and the disease is not caused by contact with one such vehicle, but is transmitted through person-to-person contact.”
Both neighbouring Germany and Poland have issued travel warnings to their nationals who are planning to visit the Czech Republic, recommending vaccination and increased hygiene. The Czech health authorities have issued a similar recommendation to Czech citizens. So where should one be particularly careful?
“The highest-risk environments are places where many people gather and everyone touches the same surfaces. That means any means of public transport. And places like Christmas markets where lots of people gather together. So it is extremely important, especially during the Christmas season when people meet at markets and at other events, to pay increased attention to the threat of infection, to wash their hands, use disinfectants and, if possible, get vaccinated, because that is the easiest protection against the disease.
"The way it is most often transmitted is that you touch a surface where the virus is present and then consume food without thoroughly washing your hands. The virus is extremely resilient and can stay on a surface for several days and I am sorry to say that the cold weather is of no help, because it actually helps the virus to survive for even longer.“
Prague has stepped up regular cleaning of its public transport vehicles and stations in response to the outbreak. An information campaign has also been launched to promote prevention, with leaflets providing health advice displayed in trams and at metro entrances. The organizers of Christmas markets and other outdoor gatherings are also taking precautions – offering disinfectants in every stall.
Despite these precautions -can we expect the problem to get worse? Barbora Macková again:
“I believe not at the same intensity, but given the characteristics of the virus and the disease — the long incubation period of up to 50 days, the mode of transmission, increased travel during the holidays and asymptomatic individuals, we can expect to be dealing with increased incidence elsewhere in the country as well. ”
The numbers of those infected are already reason for concern, but how many people may be infected with hepatitis A at this point and be completely unaware of it?
“The models of working that out differ, but the general assumption among health experts is that the number of asymptomatic individuals is roughly the same as the number of confirmed cases. So that presents an additional risk. Usually it is children who are asymptomatic, which is why the disease spreads so fast in schools. This year’s epidemic is different because we have a high number of adult patients who are rarely asymptomatic, although it does happen sometimes.”
Many Czechs have responded to the appeal to get vaccinated, which has resulted in a vaccine shortage in many regions. Chief Public Health Officer Barbora Macková says there is an all out effort to resolve this.
“At the moment vaccines should be significantly more available. We are urgently addressing the issue. I’d like to point out that this year, three times more vaccines have been administered than we were used to. I’m glad for that, and we are working by every available means to supply and secure additional vaccine deliveries for the Czech Republic. At this moment we are having 30,000 to 50,000 vaccines delivered which should cover the rest of this year and we are making sure that we prepare for an increased demand next year as well.”
