Increase in hepatitis A in tourists from Denmark, England, Germany, the Netherlands, Norway and Sweden returning from Egypt, November 2012 to March 2013.

Since November 2012, there has been an increase in reported cases of hepatitis A in tourists returning from Egypt in several European countries. As of 24 April, 80 HAV cases in travellers with symptom onset after 1 November 2012 visiting different areas in Egypt have been reported. Four cases from Norway, six cases from the Netherlands and five cases from England share an identical hepatitis A viral RNA sequence. This increase in cases suggests that vaccination recommendations for travellers to hepatitis A endemic countries should be reinforced. Since January 2013, six hepatitis A cases with travel history to Egypt during the incubation period (2–6 weeks after infection) were reported to the Norwegian Surveillance System for Communicable Diseases (MSIS). Typically, a single case of hepatitis A with travel history to Egypt is reported in Norway annually. Four of the six cases were genotyped and were found to be infected with the same genotype 1B hepatitis A virus (HAV)-strain. On 15 April 2013, the Norwegian Institute of Public Health posted an urgent inquiry on the Epidemic Intelligence Information System (EPIS) platform asking if any other European countries had observed an increase in HAV with travel history to Egypt in the same period. The genome sequence (N-terminal VP1 and VP1/P2A) shared by the four Norwegian cases was also provided at this time. Initially, four countries (Denmark, Germany, Netherlands and Sweden) responded that they had all observed an increased number of hepatitis A patients with travel history to Egypt. On 19 April 2013, an alert was also sent through the European Commission Early Warning and Response System (EWRS). Subsequently, an increase in HAV cases in tourists returning to England was also reported. A multinational investigation has been initiated in order to identify European Union/ European Economic Area (EU/EEA) countries with reported increases in HAV among travellers to Egypt, compare travel history among cases, and potentially identify any common exposures among travellers originating from different countries.