Epidemiology and Infection

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

K. SCHENKEL a1c1, V. BREMER a1, C. GRABE a2, U. VAN TREECK a3, E. SCHREIER a4, M. HÖHNE a4, A. AMMON a1 and K. ALPERS a1
a1 Department for Infectious Diseases Epidemiology, Robert Koch-Institut, Berlin, Germany
a2 Local Health Department, Siegen, Germany
a3 Institute of Public Health, North Rhine-Westphalia, Münster, Germany
a4 Unit of Molecular Epidemiology of Viral Infections, Robert Koch-Institut, Berlin, Germany

Article author query
schenkel k   [PubMed][Google Scholar] 
bremer v   [PubMed][Google Scholar] 
grabe c   [PubMed][Google Scholar] 
van treeck u   [PubMed][Google Scholar] 
schreier e   [PubMed][Google Scholar] 
hohne m   [PubMed][Google Scholar] 
ammon a   [PubMed][Google Scholar] 
alpers k   [PubMed][Google Scholar] 


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 [gt-or-equal, slanted]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.

(Accepted February 2 2006)
(Published Online May 2 2006)

c1 Department for Infectious Diseases Epidemiology, Robert Koch-Institut, Berlin, Germany. (Email: schenkelk@rki.de)