Since January and up until Tuesday this week, 138 new cases of Hepatitis A had been reported in this country, reflecting a trend also noted in 12 other European countries.
In Portugal, the vast majority of new cases have been registered in Greater Lisbon, spurring health authorities to take measures such as free vaccinations (see story, page 20), in a bid to curb the spread.
This current outbreak will only be considered ‘under control’ when no new cases are reported for 50 consecutive days.
At present, between five and eight new patients are emerging every day.
One death related to Hepatitis A has been recorded in this country, although it is unconnected to the recent outbreak.
On Tuesday this week, Portugal’s health chiefs said they are “concerned” about the possibility that the current surge could still be uncontained by the time the annual summer festivals come around, because, as newspaper Público cited, “at these events there is an increase in sexual practices and sanitation conditions are bad, which increases the risk of transmission of infection by this virus.”
Every year, tens of thousands of people from Portugal and abroad enjoy the vast line-up of summer events that lend a touch of hedonism to the season’s heat.
The worry was voiced during a press conference staged in Lisbon by the head of the National Health Board (DGS), Francisco George, alongside his Spanish counterpart, Elena Andradas, to address the current scenario of the Hepatitis A outbreak in the Iberian Peninsula.
Their meeting also served to draw up common strategies to deal with the issue.
One of their main concerns is an upcoming event in Madrid, in June, the LGBT World Pride parade, which more than two million people are expected to attend.
Speaking to journalists Elena Andradas said that since last November there have been over 1,000 cases of Hepatitis A confirmed in Spain, and the country has run out of vaccinations.
According to Público, Portugal and Spain are looking into jointly purchasing vaccinations from other counties such as China or South America.
Here, around 12,000 vaccinations are still available, which will be distributed around Lisbon and to health centres in the North, Centre, the Alentejo and the Algarve.
The health chiefs are further pondering the possibility of using paediatric dosages of the
vaccinations.
The DGS has, in the meantime, asked pharmacies to give back some of the doses that comprise national stock, saying “it does not make sense that people continue to try to acquire vaccines in these establishments.”
“Vaccines have to be administered judiciously, in light of the principle that those who need to be vaccinated are, and those who don’t, are not”, Francisco George emphasised.
Three priority groups have been identified: people who have had contact with patients (cohabitants and sexual partners, in the last 15 days), men who have unprotected anal or oro-anal sex with other men, and also travellers visiting areas where the disease is more prevalent.
The Director-General of Health admitted he does not know when this outbreak will be controlled, because the incubation period is long – “it can go up to 50 days.”
To be declared controlled it is necessary to “have a minimum of 50 days without new cases”, Francisco George reiterated.
As well as being spread via faecal-oral transmission, Hepatitis A can also be caught by drinking contaminated water and food, and is usually a benign disease meaning fatalities caused by it are rare.
Prior to the outbreak Portugal generally registered between two and three dozen cases of Hepatitis A per year.
Earlier this year, in February, the European Centre for Disease Prevention and Control (ECDC) issued an update in which it said “between February 2016 and February 2017, three clusters involving 287 confirmed cases of hepatitis A (HAV) have been reported across 13 EU countries: Austria, Belgium, Denmark, Finland, France, Germany, Italy, Ireland, the Netherlands, Portugal, Spain, Sweden and the United Kingdom.
“Each of the three clusters involves cases across seven to ten EU Member States. As reporting of cases is limited to those attending healthcare facilities and for those cases for which sequencing was performed, the actual numbers are likely to be higher than what has been reported so far.”
The ECDC elaborated that most of the notified cases were among men who have sex with men (MSM) who had not been vaccinated against HAV.
“In addition, nine cases were identified among women.”
Sexual transmission is considered to be the main transmission mode in the three identified clusters, the ECDC said, adding further transmission resulting from these clusters may be prevented by vaccination of MSM and post-exposure prophylaxis among identified contacts and household members.
“The ECDC guidance for HIV and STI prevention among men who have sex with men encourages Member States to offer and promote vaccination of MSM against hepatitis A. Information on vaccine availability should be included in health promotion programmes targeting MSM, particularly at sex venues.”
Hepatitis A is described as “an acute infectious disease of the liver caused by the hepatitis A virus (…) The disease is highly transmissible through faecal-oral route. Hepatitis A is often asymptomatic or mild (…) Up to 90% of hepatitis A infections in children present no symptoms.”
According to the ECDC, in adults, the onset of illness is usually abrupt with fever, loss of appetite, nausea and vomiting. Jaundice is the predominant symptom.
Symptoms may last between one to two weeks, or up to months. Around 15 percent of patients have prolonged or relapsing symptoms over a six-to- nine month period.