Abstract
Hepatitis A virus (HAV) is the major cause of enterically transmitted infectious hepatitis. Between 2016 and 2017, the number of confirmed cases of hepatitis A virus (HAV) increased from 64 to 786 in São Paulo affecting mainly adults aged between 18 and 39 years (80%) and males (88%). To support epidemiological surveillance, the present study monitored the presence of HAV in urban sewage samples collected bimonthly for 1 year (November 2017–November 2018) in the central region of the city, where most of cases were detected. Sewage samples were concentrated by polyethylene glycol precipitation and HAV RNA was quantified by RT-qPCR. Nucleotide sequencing targeting the VP1/2A junction region was carried out to genotype the HAV strains. HAV was detected in 76.9% (40/52) of the samples, with a geometric mean viral load of 5.09 × 104 (± SD 4.51 × 105) genome copies (GC/L) (Mauá Street) and 5.27 × 104 (± SD 1.26 × 106) GC/L (Prestes Maia Avenue). Of the 40 positive samples, 8 were typed as HAV subgenotype IA [100% nucleotide (nt) identity with HAV strain VRD_521_2016]. Highest homology was obtained with sequences from European countries (Italy, Spain) and Israel, all of which had reported recent HAV outbreaks associated with men who have sex with men. Our results highlight that wastewater surveillance is a useful tool to support investigating HAV outbreaks in the community, including circulating genotypes.
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Acknowledgements
We want to acknowledge Maria Bernadete de Paula Eduardo and Maria Carla da Silva, from the Epidemiological Surveillance Center (São Paulo State Department of Health), for providing information on hepatitis A cases. The authors also thank Flávio Silva Machado, from Basic Sanitation Company of the State of São Paulo (SABESP), for contributing additional information about the study area.
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MIZS and MRFB contributed to the study conception and design. Material preparation, sampling collection, and virus detection were performed by MRFB, RSA, SCG, AJM, ATG, CJB, and RLOS. Bioinformatics analysis and interpretation of results were performed by TP. The manuscript was written by TP. All authors read, revised, and approved the final manuscript.
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Prado, T., Barbosa, M.R.F., Araújo, R.S. et al. Hepatitis A Outbreaks and Environmental Circulation of Genotype IA Strains in the São Paulo City, 2017–2018. Food Environ Virol 13, 520–527 (2021). https://doi.org/10.1007/s12560-021-09497-7
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DOI: https://doi.org/10.1007/s12560-021-09497-7