Laboratory reports of hepatitis A infections in England and Wales: July to September 2020
Updated 10 May 2023
Applies to England and Wales
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There were a total of 32 laboratory reports of new patients with hepatitis A reported during the third quarter of 2020 (July to September 2020) after exclusion of patients with samples sent to the Virus Reference Department (VRD) that were not confirmed as having had a recent hepatitis A virus (HAV) infection as well as inclusion of additional patients confirmed by the VRD (see table 1 and figure 1).
This was a 30.4% decrease on the reports in the first quarter of 2020 (n=46); 28 patients were reported through the Second Generation Surveillance System (SGSS), after excluding corrections and before including the additional 4 confirmed cases identified by the VRD (figure 1).
Table 1. Laboratory reports of hepatitis in England and Wales, July to September 2020
| Age group | Females | Males | Unknown | Total |
|---|---|---|---|---|
| Less than 1 year | 0 | 0 | 0 | 0 |
| 1 to 4 years | 4 | 1 | 0 | 5 |
| 5 to 9 years | 2 | 1 | 0 | 3 |
| 10 to 14 years | 0 | 3 | 0 | 3 |
| 15 to 24 years | 1 | 3 | 0 | 4 |
| 25 to 34 years | 1 | 2 | 0 | 3 |
| 35 to 44 years | 3 | 2 | 0 | 5 |
| 45 to 54 years | 1 | 2 | 0 | 3 |
| 55 to 64 years | 2 | 2 | 0 | 4 |
| 65 years and over | 2 | 0 | 0 | 2 |
| Unknown | 0 | 0 | 0 | 0 |
| Total | 16 | 16 | 0 | 32 |
Notes: From Q1 2020, the central number of cases presented excludes false positives and includes additional cases identified by the VRD. Hence, numbers are not directly comparable to previous quarters. False positives are more likely in older age groups.
The London UK Health Security Agency (UKHSA) region accounted for 28% (n=9) of reports, followed by 19% (n=6) from the East of England region. Age group and sex were well reported (100% complete) (table 1). There were 5 (16%) reports among those aged 1 to 4 years of age and 4 (13%) each in the 15 to 24 years and 55 to 64 years age groups. There were 5 (16%) reports among those aged between 35 and 44 years. Both males and females accounted for 50% each of overall reports (n=16).
The following flowchart shows there were 64 reports of new patients with hepatitis A reported through the SGSS. There was one correction (laboratories informing the VRD that reports were false positives or due to reporting issues, or quality controls), leaving 63 laboratory reports of new patients through SGSS. Samples from 63 patients were sent to VRD for confirmation and 35 cases were not confirmed. After excluding non-confirmed cases, 28 cases remained. Four cases were confirmed in VRD but not reported through SGSS, giving a total of 32 new cases identified through SGSS or VRD in Q3 2020.
Figure 1. Flowchart of laboratory reports of hepatitis A by age and confirmation status by the VRD (England and Wales), July to September 2020
Figure 2. Laboratory reports of hepatitis A by age and sex in England and Wales, January 2002 to September 2020
Notes: All figures are provisional and subject to change as records are updated. From Q1 2020, the central number of cases presented excludes false positives and includes additional cases identified by the VRD. Hence, numbers are not directly comparable to previous quarters. False positives are more likely in older age groups.
Reference laboratory confirmation and phylogeny of hepatitis A infections
Of the 28 patients notified as having acute HAV infection during the third quarter of 2020, 22 had samples forwarded to the VRD for genotyping. In addition, 4 patients were confirmed to have acute HAV infection that had not been reported through the laboratory reporting system – although all the English cases were recorded in HPZone.
A total of 25 patient samples could be genotyped over this period: 10 were genotype IA (40%), 7 were genotype IB (28%) and 8 were genotype genotype IIIA (40%).
The resulting data is presented below as a phylogenetic tree (figure 3) where each sequence is represented by a dot followed by the patient region, and the week of sampling in brackets. Of the genotyped samples, 18 were associated with travel (72%) and 7 had no travel history (28%).
Figure 3. Phylogenetic tree of genotype IA, IB, and IIIA sequences July to September 2020 (n=25)
