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Outbreak of hepatitis A in two federal states of Germany: bakery products as vehicle of infection

  • K. SCHENKEL (a1), V. BREMER (a1), C. GRABE (a2), U. VAN TREECK (a3), E. SCHREIER (a4), M. HÖHNE (a4), A. AMMON (a1) and K. ALPERS (a1)...

In April 2004, increased numbers of hepatitis A were noted in six neighbouring districts in Germany. Exploratory interviews showed that patients had consumed bakery products from company X where two employees had been diagnosed with hepatitis A in February. A case-control study of consumption of products of company X was carried out through telephone interviews. Altogether, 64 cases were identified. Fifty-two cases and 112 controls aged [ges ]16 years were included in the case-control study. In total, 46/52 cases and 37/112 controls had consumed company X products [odds ratio (OR) 15·5, 95% confidence interval (CI) 6·1–39·7]. Of these, 36/46 cases and 16/37 controls had consumed pastries (OR 4·7, 95% CI 1·8–12·3), 25/46 cases and 12/37 controls had consumed filled doughnuts (OR 2·5, 95% CI 1·0–6·1). Sequence analysis of the VP1-2A junction region indicated 100% strain homology between cases and an infected employee of company X. We recommended reinforcement of hygiene precautions, and consideration of a prolongation of compulsory work absence after post-exposure vaccination.

Corresponding author
Department for Infectious Diseases Epidemiology, Robert Koch-Institut, Berlin, Germany. (Email:
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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