Almost 40 people were part of a hepatitis A outbreak in Germany that was linked to dates from Morocco last year. France, the United Kingdom, the Netherlands and Sweden reported 18 cases between them.

The 39 patients in Germany fell ill between April and August. Thirty were imported cases and nine people were not abroad during the incubation period.

Results of a case-control study and findings from surveys of people who had not been abroad indicated the outbreak was caused by contaminated dates. Results strongly suggested dried dates sold loosely at markets in Morocco.

Hepatitis A is a viral infection passed from person to person by eating food or drinking water contaminated with the virus. Symptoms usually develop around four weeks after being infected and include mild fever, joint and muscle pain, feeling and being sick, diarrhea, loss of appetite and stomach pain. This can be followed by dark-colored urine, itchiness and yellowing of the skin and whites of the eyes, which is called jaundice.

People ill in France, UK, Netherlands and Sweden Of nine cases infected in Germany, five could be interviewed. None of them indicated a stay abroad in the two months preceding illness. All five reported eating food brought from Morocco and had eaten dates; consumption of figs and nuts was reported by one person.

RKI, WHO and GOARN
Meanwhile, the World Health Organization has designated the Information Centre for International Health Protection (INIG) at the Robert Koch Institute (RKI) as a WHO Collaborating Centre for the Global Outbreak alert and Response Network (GOARN).

In the next four years, RKI will work with national and international partners to support WHO in identifying and addressing global health threats. RKI will deliver advice to the WHO, support implementation of GOARN projects, devise and test training activities, foster knowledge-sharing and help develop the network.

The GOARN includes more than 220 institutions from 75 countries that focus on rapid disease outbreak detection and response and is coordinated by WHO.