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Gonçalo Padeira1, Maria João Martins2, Maria João Brito1

1 - Unidade de Infecciologia Pediátrica, Hospital Dona Estefânia. CHLC-EPE. Lisboa
2 - Unidade de Saúde Publica

- 10th World Congress of theWorld Society for Pediatric Infectious Diseases, China

Introduction: Transmission of hepatitis A virus (HAV) is predominately by the faecal-oral route. Sexual transmission has been associated in men who have sex with men (MSM). Between February 2016 and 2017, 13 EU countries have reported clusters associated with different HAV sequences of genotype IA. In May of 2017 Portugal notified 242 cases since December 2016 of which 57% were MSM.
Case Report: A 15 year-old boy with irrelevant past history was hospitalized for diarrhea, abdominal pain and jaundice. The investigation revealed hepatitis A. We found no epidemiological context. One week later a 14 year-old boy was admitted with the same symptoms, same absence of a clear epidemiological link and serological evaluation with hepatitis A. Although they lived in the same borough the two patients did not attend the same school, or had extracurricular activities together. In this context genotyping of the virus isolated was requested with determination of the HAV strain VRD_521_2016 of sub-genotype IA (identical viral RNA sequence of 505 nucleotides from the VP1/2A region). At the same time a third case, a 12 year-old boy, with the same symptoms and the same virus was found. The investigation identified a 40 year-old male subject who sold cookies in the borough and had sexual relations with the three patients.
Comments: Most cases of HAV are reported in adult MSM. These clusters are considered mainly propagated by person-to-person sexual transmission. As such in children diagnose it is very important to find a clear epidemiological link as it can be a first sign of sexual assault.