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Epidemiol Health > Accepted Articles
Epidemiology and Health 2022;e2022003.
DOI: https://doi.org/10.4178/epih.e2022003    [Accepted] Published online Dec 29, 2021.
An outbreak of hepatitis A associated with salted clams in Busan, Korea
Hyunjin Son2  , Miyoung Lee3  , Youngduck Eun3  , Wonseo Park3  , Kyounghee Park3  , Sora Kwon3  , Seungjin Kim4  , Changhoon Kim1,3 
1Department of Preventive Medicine, College of Medicine, Pusan National University, Busan, Korea
2Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, Korea
3Busan Center for infectious Disease Control and Prevention, Busan National University Hospital, Busan, Korea
4Korea Disease Control and Prevention Agency, Cheongju, Korea
Correspondence  Changhoon Kim ,Tel: +82-51-240-7474, Email: kchprev@gmail.com
Received: Aug 11, 2021  Accepted after revision: Nov 19, 2021
Abstract
Objectives:
In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Busan. The current study presents the results of an epidemiological investigation and outlines the supplementary measures that would help with hepatitis A control.
Method:
A cohort study was conducted for all 2,865 customers who visited restaurant A from June to July. Using a standardized questionnaire, participants reported the presence of hepatitis A symptoms and whether they had consumed any of 19 food items. As for participants who had visited public health centers, their specimens were collected.
Results:
From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The epidemic curve was unimodal, and the median number of days from the restaurant visit to symptom onset was 31 days. A genotype analysis indicated that 89 of 90 tested patients had hepatitis A virus (HAV) genotype 1A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times (95% confidence interval [CI], 9.22–510.87). In an unopened package of salted clams found and secured through traceback investigation, HAV genotype 1A was detected.
Conclusions:
To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams; the food sampling test standards for salted clams should also be expanded. Furthermore, a laboratory surveillance system based on molecular genetics should be established to detect outbreaks earlier.
Keywords: Hepatitis A, Salted clams, Food-borne outbreak, Korea


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