Featured - The First Ten Years of Hepatitis A Surveillance Through Mandatory Reporting, France, 2006–2015

Hepatitis A surveillance has been conducted through mandatory reporting (MR) since November 2005, with the objectives of detecting clusters of cases to enable rapid control measures and estimating reported incidence rates. A case (IgM anti-HAV positive) must be reported to the Regional Health Agency using an MR form. This form collects sociodemographic and clinical information as well as details on risk exposures. For the period 2006–2015, 11,158 cases of hepatitis A were reported, representing an average annual reported incidence rate of 1.7 per 100,000 inhabitants. This incidence rate was 1.9 per 100,000 among men and 1.4 per 100,000 among women. A downward trend in this rate was observed starting in 2010 (see graph), among both men and women.The main risk factors were exposure to cases in the immediate social circle (46%) and travel outside mainland France (38%). Each year, the proportion of clustered cases remained relatively stable, ranging between 28% and 37%. Declining from 2010 onward, the annual incidence rate of reported cases gradually reached in 2015 that of a country with low endemicity for hepatitis A (1.1 per 100,000). The highest reported incidence rates were found among children under 15, the age group most affected due to the fecal-oral transmission of the virus, which is facilitated within families and children’s communities.Data collected by the DO and through investigations of clusters of cases enabled the development, in 2009, of vaccination recommendations for family members of a patient with hepatitis A and for communities living in conditions of poor hygiene. The downward trend in reported incidence observed since 2010 may be due to the impact of these vaccination recommendations. It should be noted, however, that since February 2017, several European countries, including France, have observed a significant increase in the number of hepatitis A cases, particularly affecting men who have sex with men (MSM).