Almost 30 cases of Hepatitis A have been reported in North Yorkshire since June 19.

Public Health England (PHE) Yorkshire and the Humber, North Yorkshire County Council and National Health Service organizations are investigating the outbreak in Ripon with 29 patients.

At least 20 infections have been confirmed connected with Outwood Academy. PHE is reviewing food eaten in the school canteen as part of the search to find the outbreak source. A vaccination session is set for today at the school with a second event planned at an as yet unannounced time. Cases have also been identified in the community.

Dr. Suzanne Coles, consultant in Communicable Disease Control at PHE Yorkshire and the Humber, said reports of new cases of illness connected are slowing. However, it can take well more than a month after exposure for symptoms to develop.

Risk remains low
One of the patients attends Middleham Church of England Primary School. Children at the school were offered post-exposure vaccination. Pupils at Spennithorne Church of England VC Primary School were also offered the vaccination because they recently took part in shared activities with the other school.

“I understand that the confirmation of further cases in the community may be of concern, but it’s important to remember that the risk remains low. NHS services are identifying cases of hepatitis A and providing care promptly and those affected are recovering. Their household contacts are being followed up to reduce the risk of the infection spreading. Hepatitis A is usually a mild illness, though it can be more serious in adults. GPs in North Yorkshire remain vigilant to (identify) further cases,” said Coles.

“Parents of children at the schools wher vaccination is to be offered have been informed of the recent case at Middleham Primary School and symptoms of Hepatitis A so they can be alert to signs and symptoms of the infection. In particular, jaundice, a condition which causes the skin and the whites of the eyes to turn yellow, could indicate infection with Hepatitis A.”

Coles added no cases had been notified with links to “So! Bar and Eats, Ripon” following confirmation of an infected food handler there. Anyone who ate at the restaurant from June 8 to 23 should be aware of hepatitis A symptoms, which can take up to 50 days to develop.

Symptoms of infection include mild fever, joint and muscle pain, feeling and being sick, diarrhea, loss of appetite and stomach pain. Illness can develop up to seven weeks after contact with an infectious person.

Hand hygiene focus
Dr. Lincoln Sargeant, director of Public Health at North Yorkshire County Council, said: “It’s encouraging that in recent weeks, the outbreak of hepatitis A has slowed down but we cannot become complacent and the possibility of further cases throughout the summer remains.”

Public health experts in North Yorkshire have launched a hand hygiene campaign to prevent illness. Advice includes washing hands after handling raw foods like chicken, meat and vegetables, before eating or handling ready to eat food, and after contact with animals, including pets.

It looks at how handwashing with soap and water can prevent the virus, particularly after going to the toilet or changing a diaper, and before preparing food.

Local businesses were told of the importance of good food handling practices and hygiene standards, as hepatitis A can be passed by eating food or drinking water containing the virus. People with suspected hepatitis A were reminded not to prepare or serve food for others.

Dr. Mike Gent, deputy director at PHE Yorkshire and the Humber, said washing hands properly removes dirt, viruses and bacteria to stop them spreading to other people and objects like food, which can spread illnesses, including hepatitis A.

“Whether you’re an adult or a child — hands are easily contaminated with (microscopic amounts of) fecal bacteria when going to the toilet and this can be easily spread on to other things you touch, including food. Unfortunately, not all people consistently wash their hands after going to the toilet or before handling food and children often require supervision to ensure they’re handwashing effectively,” he said.

Mapping Hepatitis E
Meanwhile, researchers at the Ecole Polytechnique Fédérale de Lausanne (EPFL) have created a world map of regions with the highest prevalence of the hepatitis E virus (HEV).

The team hopes the map, which is available online, will help governments and NGOs design more effective prevention campaigns based on reliable data. The work was published in the journal Scientific Reports.

In Europe, China, Japan and North America, most people catch HEV by eating undercooked pork, and resulting disease is generally not fatal. In Mexico, India, Africa and most Asian countries, HEV is contracted by coming into contact with water from a river or well contaminated with fecal matter.

In developing countries, the waterborne transmission of HEV, caused by genotypes 1 (HEV-1) and 2 (HEV-2), leads to the onset of large outbreaks. Researchers mapped the geographical regions at higher risk of HEV epidemics and conditions most favorable for transmission of the virus.

EPFL scientists compiled data on all Hepatitis E epidemics worldwide since 1980 and on environmental statistics like temperature, soil wetness and rainfall over the same period. They factored in geographical location, population density and how much river water evaporates during a drought.