World Health Organization , 2012. WHO position paper on hepatitis A vaccine. Wkly Epidemiol Rec 87: 15.
Lemon SM , Ott JJ , Van Damme P , Shouval D , 2017. Type A viral hepatitis: a summary and update on the molecular virology, epidemiology, pathogenesis and prevention. J Hepatol 68: 167–184.
Raihan R , 2016. Hepatitis in Malaysia: past, present, and future. Euroasian J Hepatogastroenterol 6: 52–55.
WHO , 2018. Malaysia: Highlights Based on Country Reported GLAAS 2016/2017 Data. Available at: https://www.who.int/water_sanitation_health/monitoring/investments/country-highlights-2017/malaysia-glaas2017-country-highlight20181115.pdf?ua=1. Accessed April 11, 2021.
Murphy A , Rajahram GS , Jilip J , Maluda M , William T , Hu W , Reid S , Devine GJ , Frentiu FD , 2020. Incidence and epidemiological features of dengue in Sabah, Malaysia. PLoS Negl Trop Dis 14: e0007504.
Malaysia MoH , 2006. Garis Panduan Umum Pengurusan Wabak Penyakit - Penyakit Bawaan Makanan dan Air di Malaysia Jlid 1 - FWBD UMU GP 001 (pindaan_2006). Available at: https://www.moh.gov.my/index.php/pages/view/118?mid=48. Accessed April 12, 2021.
Tominaga A et al.2012. Hepatitis A outbreak associated with a revolving sushi bar in Chiba, Japan: application of molecular epidemiology. Hepatol Res 42: 828–834.
Barzaga BN , 2000. Hepatitis A shifting epidemiology in south-east Asia and China. Vaccine 18: S61–S64.
Wang Z , Chen Y , Xie S , Lv H , 2016. Changing epidemiological characteristics of hepatitis A in Zhejiang Province, China: increased susceptibility in adults. PLoS One 11: e0153804.
Smith CR , Kershaw T , Johnson K , Meghnath K , 2019. An outbreak of hepatitis A in Canada: the use of a control bank to conduct a case-control study. Epidemiol Infect 147: e300.
Yusoff FA , Rahman RA , May LH , Budart SB , Sulaiman LH , 2015. Investigation of hepatitis A outbreak in district of Manjung, Perak, Malaysia, October 2012. Western Pac Surveill Response J 6: 27–31.
Sowmyanarayanan TV , Mukhopadhya A , Gladstone BP , Sarkar R , Kang G , 2008. Investigation of a hepatitis A outbreak in children in an urban slum in Vellore, Tamil Nadu, using geographic information systems. Indian J Med Res 128: 32–37.
Desenclos JA , Klontz KC , Wilder MH , Gunn RA , 1992. The protective effect of alcohol on the occurrence of epidemic oyster-borne hepatitis A. Epidemiol 3: 371–374.
Shoesmith WD , Oo Tha N , Naing KS , Abbas RB , Abdullah AF , 2016. Unrecorded alcohol and alcohol-related harm in rural Sabah, Malaysia: a socio-economically deprived region with expensive beer and cheap local spirits. Alcohol Alcohol 51: 741–746.
Lewallen S , Courtright P , 1998. Epidemiology in practice: case-control studies. Community Eye Health 11: 57–58.
Mbithi JN , Springthorpe VS , Sattar SA , 1990. Chemical disinfection of hepatitis A virus on environmental surfaces. Appl Environ Microbiol 56: 3601–3604.
Nasheri N , Vester A , Petronella N , 2019. Foodborne viral outbreaks associated with frozen produce. Epidemiol Infect 147: e291.
Setyowati D , Mubawadi T , Mirasa YA , Purwanto D , Amin M , Utsumi T , Soetjipto S , Juniastuti J , Lusida MI , 2020. Molecular epidemiology of hepatitis A outbreaks in two districts in Indonesia in 2018: same subtype, but different strains. Biomed Rep 12: 51–58.
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Foodborne outbreaks of hepatitis A virus (HAV) are most commonly associated with fresh and frozen produce and with various types of shellfish. Alcoholic beverage-borne outbreaks of hepatitis A are extremely rare. Here, we report an outbreak of hepatitis A associated with the consumption of a traditional wine at a funeral ceremony in the Sabah state of Malaysian Borneo. Confirmed cases were determined by serum anti-HAV immunoglobulin M and/or for fecal HAV by reverse transcription polymerase chain reaction (RT-PCR). The amplicons of RT-PCR were subjected to nucleotide sequencing followed by phylogenetic analysis. We conducted a 1:2 case–control study to identify the possible exposure that led to the outbreak. Sixteen patients met the case definition, they were 18 to 58 years old and 90% of them were males. The case–control study showed that the consumption of nipa palm wine during the ceremony was significantly associated (P = 0.0017) with hepatitis A infection (odds ratio, 5.44; 95% CI, 1.80–16.43). Untreated river water was used to dilute the traditional wine, which was assumed to be the source of the infection. Phylogenetically, these viruses belonged to genotype IA and formed an independent cluster with strains from Taiwan, Japan, and the Philippines. This strain might be an emerging HAV in Asian countries. Environmental assessments were performed and environmental samples were negative for HAV. The incidence of hepatitis A in Sabah was also determined and it was 0.795/100,000 population. Strict monitoring of traditional wine production should be implemented by the local authority to prevent future outbreaks.
Financial support: The investigation was undertaken within the Ministry of Health activities and supported by Launching Grant for Centre of Excellence from Universiti Malaysia Sabah (Grant Number: AM 18006).
Authors’ addresses: Muhammad Jikal, M. Hafiz Mukhsam, Ismail Ali, and Esther Bernad, Sabah State Health Department, Ministry of Health, Kota Kinabalu, Sabah, Malaysia, E-mails: email@example.com, firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Daisuke Mori and Kamruddin Ahmed, Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia, E-mails: email@example.com and firstname.lastname@example.org. Ahmad Faudzi Yusoff, Institute of Medical Research, Ministry of Health, Jalan Pahang, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia, E-mail: email@example.com. Sarawasthi Bina Rai, Aimst University, Bedong, Kedah, Malaysia, E-mail: firstname.lastname@example.org. Liza Abd Latif, Cynthia C. E. Bailon, and Lim Guan Lee, Beaufort Health Office, Ministry of Health, Pekan Beaufort, Beaufort, Sabah, Malaysia, E-mails: email@example.com, firstname.lastname@example.org, and email@example.com. Alfred A. S. Perianayagam and Vielerian Fredolin, Papar Health Office, Ministry of Health, Bandar Papar, Papar, Sabah, Malaysia, E-mails: firstname.lastname@example.org and email@example.com.