Assessment of the national response to acute viral hepatitis A in Tunisia, 2016–2017

Introduction In Tunisia, the epidemiology of hepatitis A has considerably changed in recent years, and the country has moved from high endemicity level to a low endemicity level with an overall national prevalence of IgG anti HAV antibodies estimated at 79% and a low level of immunity in young people. During 2016 year, the national notifiable diseases surveillance system detected the occurrence of a national outbreak of HVA affecting more than 12 governorates. In this context, we have strengthened the national response to the VHA outbreak by establishment of new guidelines. Our aim was to establish a summary report of the national response to HAV epidemic from 2016 to 2017. Methods The national response is based on: early notification of any probable or confirmed HAV case from the regional level to the national level, the immediate epidemiological investigation around cases and active case finding (school or community-based survey), school eviction or work stoppage of any probable or confirmed case for a period of 14 days from the date of onset of symptoms and post-exposure emergency vaccination. Results Until October 2017, 2046 confirmed cases of HVA were recorded, including 1555 in schools and 491 in community settings. The most affected governorate was Gabes (831cases). The number of schools affected was about 458, mostly in rural areas, with poor hygienic conditions and drinking water supply problems. The average age was 10.15 ± 8 years, and 82% of the subjects were enrolled in school. The icteric form was the most common in 68% of cases. Eleven cases of death were noted. Conclusion The epidemic is still expanding in the country, especially schools in rural areas, which requires strengthening the response, awareness and involvement of the various structures concerned like the Ministry of Education, environment and civil society.