TY - JOUR AU - Petrignani, Mariska AU - Verhoef, Linda AU - Vennema, Harry AU - van Hunen, Rianne AU - Baas, Dominique AU - van Steenbergen, Jim AU - Koopmans, Marion P.G. T1 - Underdiagnosis of Foodborne Hepatitis A, the Netherlands, 2008–2010 T2 - Emerging Infectious Disease journal PY - 2014 VL - 20 IS - 4 SP - 596 SN - 1080-6059 AB - Outbreaks of foodborne hepatitis A are rarely recognized as such. Detection of these infections is challenging because of the infection’s long incubation period and patients’ recall bias. Nevertheless, the complex food market might lead to reemergence of hepatitis A virus outside of disease-endemic areas. To assess the role of food as a source of infection, we combined routine surveillance with real-time strain sequencing in the Netherlands during 2008–2010. Virus RNA from serum of 248 (59%) of 421 reported case-patients could be sequenced. Without typing, foodborne transmission was suspected for only 4% of reported case-patients. With typing, foodborne transmission increased to being the most probable source of infection for 16%. We recommend routine implementation of an enhanced surveillance system that includes prompt forwarding and typing of hepatitis A virus RNA isolated from serum, standard use of questionnaires, data sharing, and centralized interpretation of data. KW - foodborne diseases KW - hepatitis A virus KW - epidemiology KW - molecular typing KW - public health KW - the Netherlands KW - enhanced surveillance KW - viruses KW - Food Safety DO - 10.3201/eid2004.130753 UR - https://wwwnc.cdc.gov/eid/article/20/4/13-0753_article ER - End of Reference