Changing hepatitis A epidemiology in the European Union: new challenges and opportunities.

This perspective on hepatitis A in the European Union and European Economic Area (EU/EEA) presents epidemiological data on new cases and outbreaks and vaccination policies. Hepatitis A endemicity in the EU/EEA ranges from very low to intermediate with a decline in notification rates in recent decades. Vaccination uptake has been insufficient to compensate for the increasing number of susceptible individuals. Large outbreaks occur. Travel increases the probability of introducing the virus into susceptible populations and secondary transmission. Travel medicine services and healthcare providers should be more effective in educating travellers and travel agents regarding the risk of travel-associated hepatitis A. The European Centre for Disease Prevention and Control (ECDC) endorses the World Health Organization's recommendations on vaccination of high-risk groups in countries with low and very low endemicity and on universal vaccination in countries with intermediate endemicity. Those recommendations do not cover the use of hepatitis A vaccine to control outbreaks. ECDC together with EU/EEA countries should produce evidence-based recommendations on hepatitis A immunisation to control outbreaks. Data about risk behaviours, exposure and mortality are scarce at the EU/EEA level. EU/EEA countries should report to ECDC comprehensive epidemiological and microbiological data to identify opportunities for prevention.