Quantitative approach of risk management strategies for hepatitis a virus-contaminated oyster production areas.

It is not yet known whether using the new molecular tools to monitor hepatitis A virus (HAV) in shellfish production areas could be useful for improving food safety. HAV contamination can be acute in coastal areas, such as Brittany, France, where outbreaks of hepatitis A have already occurred and have been linked to the consumption of raw shellfish. A quantitative probabilistic approach was carried out to estimate the mean annual risk of hepatitis A in an adult population of raw oyster consumers. Two hypothetical scenarios of contamination were considered, the first for a rare and brief event and the second for regular and prolonged episodes of contamination. Fourteen monitoring and management strategies were simulated. Their effects were assessed by the relative risk reduction in mean annual risk. The duration of closure after abnormal detection in the shellfish area was also considered. Among the strategies tested, results show that monthly molecular reverse transcription PCR monitoring of HAV is more useful than bacterial surveys. In terms of management measures, early closure of the shellfish area without waiting for confirmatory analysis was shown to be the most efficient strategy. When contamination is very short-lived and homogeneous in the shellfish production area, waiting for three negative results before reopening the area for harvest is time wasting. When contamination is not well identified or if contamination is heterogeneous, it can be harmful not to wait for three negative results. In addition, any preventive measures, such as improving sewage treatment or producing shellfish in safer areas, that can reduce contamination by at least 2 log units are more efficient and less costly. Finally we show that controlling and managing transferred shellfish are useful and can play an important role in preventing cases. Qualitative results from HAV monitoring can advantageously supplement other measures that improve the safety of shellfish products in exposed areas.