Hepatitis A outbreak among men who have sex with men (MSM) in England, 2016–2018: The contribution of past and current vaccination policy and practice

Background Hepatitis A is a fecal-oral infection caused by hepatitis A virus (HAV). Men who have sex with men (MSM) and transgender women (TW) have been reported as target groups for HAV infection. This study aimed to determine the seroprevalence, risk factors, and circulating strains associated with HAV infection among MSM and TW in Central Brazil. Methods A cross-sectional study was conducted from November 2011 to September 2013. Serum samples were collected from 425 individuals for anti-HAV antibody testing and HAV molecular characterization. Of them, 149 (35.1%) participants were self-identified as transgender women. Statistical analysis was performed to evaluate the risk factors of HAV seropositivity. Results The seroprevalence of HAV exposure was 69.7% (95% Confidence Interval: 65.3–74.0%). Serological evidence of HAV was significantly higher in participants who self-identified as transgender women (83.2%) than MSM (62.3%). Increasing age, non-white race, and lower monthly household income were independently associated with HAV exposure among MSM. Only lower monthly household income was independently associated with HAV exposure among TW. One anti-HAV IgM positive sample, from a transgender woman (0.2%), was detected and classified as subgenotype IA. Conclusions High HAV prevalence was observed, markedly among TW. Considering the risky sexual behaviors this population is exposed to, HAV vaccination and prevention programs targeting this population should be considered to prevent outbreaks and the burden of the disease.

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Assessing countermeasures during a hepatitis A virus outbreak among men who have sex with men

Theoretical Biology and Medical Modelling ◽

10.1186/s12976-021-00150-1 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Ryohei Saito ◽

Akifumi Imamura ◽

Hiroshi Nishiura

Keyword(s):

Mathematical Model ◽

Situation Awareness ◽

Hepatitis A ◽

Hepatitis A Virus ◽

Reproduction Number ◽

Risky Behaviors ◽

Extrinsic Factors ◽

Environmental Transmission ◽

Sex With Men ◽

Epidemic Risk

Abstract Background A hepatitis A epidemic occurred among men who have sex with men (MSM) in Japan in 2017–2018. In this study, we employ a parsimonious mathematical model to epidemiologically investigate the dynamics of infection, aiming to evaluate the effectiveness of campaign-based interventions among MSM to raise awareness of the situation. Methods A mathematical model describing a mixture of human-to-human transmission and environmental transmission was fitted to surveillance data. Taking seasonally varying environmental transmission into account, we estimated the reproduction number of hepatitis A virus during the course of epidemic, and, especially, the abrupt decline in this reproduction number following campaign-based interventions. Results The reproduction number prior to the countermeasures ranged from 2.6 to 3.1 and then began to decrease following campaign-based interventions. After the first countermeasure, the reproduction number decreased, but the epidemic remained supercritical (i.e., Rt > 1). The value of Rt dropped well below one following the second countermeasure, which used web articles to widely disseminate information about the epidemic risk. Conclusions Although the effective reproduction number, Rt, changes because of both intrinsic and extrinsic factors, the timing of the examined countermeasures against hepatitis A in the MSM population was consistent with the abrupt declines observed in Rt. Even without vaccination, the epidemic was brought under control, and risky behaviors may have been changed by the increase in situation awareness reached through web articles.

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Outbreak of hepatitis A among men who have sex with men in Barcelona, Spain, September 2008 – March 2009

Eurosurveillance ◽

10.2807/ese.14.15.19175-en ◽

2009 ◽

Vol 14 (15) ◽

Author(s):

C Tortajada ◽

P G de Olalla ◽

R M Pinto ◽

A Bosch ◽

J Caylà

Keyword(s):

Hepatitis A ◽

Adult Men ◽

Threefold Increase ◽

Sex With Men

Between 1 September 2008 and 9 March 2009, 150 cases of hepatitis A were reported in Barcelona, representing a threefold increase compared with the same period in the previous two years. The majority of the cases occurred in adult men, including 87 who reported having sex with men. This indicated the possibility of an outbreak ongoing in the population of men who have sex with men (MSM) and emphasised the need to target this community with more effective vaccination programmes.

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Considerations on the Current Universal Vaccination Policy against Hepatitis A in Greece after Recent Outbreaks

PLoS ONE ◽

10.1371/journal.pone.0116939 ◽

2015 ◽

Vol 10 (1) ◽

pp. e0116939 ◽

Cited By ~ 18

Author(s):

Kassiani Mellou ◽

Theologia Sideroglou ◽

Vassiliki Papaevangelou ◽

Anna Katsiaflaka ◽

Nikolaos Bitsolas ◽

...

Keyword(s):

Hepatitis A ◽

Universal Vaccination ◽

Vaccination Policy

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Clinical and virological features of acute hepatitis A during an ongoing outbreak among men who have sex with men in the North of France

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053395 ◽

2018 ◽

Vol 95 (1) ◽

pp. 75-77 ◽

Cited By ~ 13

Author(s):

Anne Boucher ◽

Agnes Meybeck ◽

Kazali Alidjinou ◽

Thomas Huleux ◽

Nathalie Viget ◽

...

Keyword(s):

Acute Hepatitis ◽

Hepatitis A ◽

Hepatitis A Virus ◽

Healthcare Providers ◽

High Rate ◽

Missed Opportunities ◽

The North ◽

Acute Hepatitis A ◽

History Of ◽

Sex With Men

ObjectivesSince February 2017, an increase of acute hepatitis A (AHA) cases has been notified in North of France. We aimed to report clinical and virological features of 49 cases treated in three hospitals in Lille European Metropolis (LEM).MethodsAll adult patients treated for AHA in 3 LEM hospitals between 20 February and 5 July 2017 were included. Demographic characteristics, exposure risk factors to hepatitis A virus (HAV), AHA manifestations and concomitant sexually transmitted infections (STI) were retrospectively recorded.ResultsForty-nine cases of AHA were diagnosed among which 34 (69%) were hospitalised. Severe AHA occurred in 7 (14%) patients. The median age of cases was 36 years. All cases except 1 were men and 32 (65%) were identified as men having sex with men (MSM). Eleven (23%) patients were HIV-infected, 5 were under HIV pre-exposure prophylaxis (PrEP), 6 had a history of HIV postexposure prophylaxis and 19 had a history of at least one STI. Only three patients had received HAV vaccine. Proportion of patients tested for syphilis, chlamydial and gonococcal infections was 75% (18/24) in those seen by sexual health specialists and 21% (6/29) in those seen by other specialists. At least one concomitant STI was diagnosed in 13 out of 24 tested patients (54%). RT-PCR sequencing was available for 38 cases and confirmed co-circulation of 3 different strains of subgenotype IA (VRD 521 2016: n=24, RIVM-HAV16-090: n=13, V16-25801: n=1), already identified in several European countries.ConclusionsWe are facing an outbreak of AHA among MSM in the North of France with a high rate of hospitalisation. Analysis of cases highlighted missed opportunities of vaccination and lack of concomitant STI screening. Awareness among healthcare providers and MSM should be increased and HAV vaccination promoted.

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Acute Hepatitis A Outbreak Among Men Who Have Sex With Men in Krakow, Poland; February 2017–February 2018

American Journal of Men s Health ◽

10.1177/1557988319895141 ◽

2019 ◽

Vol 13 (6) ◽

pp. 155798831989514 ◽

Cited By ~ 4

Author(s):

Aleksandra Raczyńska ◽

Nimmi Nimesha Wickramasuriya ◽

Anna Kalinowska-Nowak ◽

Aleksander Garlicki ◽

Monika Bociąga-Jasik

Keyword(s):

Chronic Hepatitis ◽

Acute Hepatitis ◽

Hepatitis A ◽

Clinical Manifestations ◽

Sexually Transmitted ◽

Acute Retroviral Syndrome ◽

Chronic Hepatitis B Virus ◽

Route Of Transmission ◽

Acute Hepatitis A ◽

Sex With Men

Since February 2017 in Poland, an increasing number of acute hepatitis A (AHA) cases have been reported; a noteworthy increase to 3,072 cases of AHA in 2017 compared to 35 cases in 2016 was reported by the National Institute of Public Health (NIPH). The aim of this study was to evaluate the demographic features, clinical manifestations, laboratory results, and sexually transmitted coinfections. All cases of AHA diagnosed between February 2017 and February 2018 at the University Hospital in Krakow were analyzed. A total of 119 cases of hepatitis A virus (HAV) were reported; 105 (88%) were males and 14 (12%) were females, with a mean age 31 years (range 19–62). In 84 patients (71%), the HAV was transmitted by oral–anal sexual contact between men. Six women were infected by close house contact with men infected with HAV. The route of transmission was not identified for 29 cases, and 88 patients (74%) required hospitalization. Among the cases, the following coinfections were already diagnosed: HIV 36 patients (30%), chronic hepatitis C virus (HCV) 4 patients (3%), and chronic hepatitis B virus (HBV) 2 patients (1.5%). During AHA diagnosis, some new sexually transmitted infections (STIs) were detected; syphilis eight patients (6.7%), HIV/syphilis seven patients (6%), HIV//HCV/syphilis one patient, and acute retroviral syndrome/ Shigella flexneri one patient. Overall, AHA outbreak in Poland in 2017 affected primarily men who have sex with men (MSM) and was connected with oral–anal sexual contacts, and the majority of patients did not have HAV vaccination. These results show a clear need for routinely offering HAV vaccination to at-risk populations and that awareness among health-care workers about HAV sexual transmission may help introduce prevention methods.

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Epidemiology of hepatitis A in Greece in the last decade: management of reported cases and outbreaks and lessons learned

Epidemiology and Infection ◽

10.1017/s0950268820000382 ◽

2020 ◽

Vol 148 ◽

Author(s):

K. Mellou ◽

A. Chrysostomou ◽

T. Sideroglou ◽

M. Kyritsi ◽

T. Georgakopoulou ◽

...

Keyword(s):

Public Health ◽

General Population ◽

Hepatitis A ◽

Epidemiological Data ◽

Lessons Learned ◽

Health Priorities ◽

Oral Transmission ◽

Increasing Trend ◽

Outbreak Investigations ◽

Sex With Men

Abstract Hepatitis A is a mandatory notifiable disease in Greece. Here, we present the epidemiological data for 2009–2018 and the results of outbreak investigations performed, and discuss future public health priorities. Overall, 1193 cases were reported; 320 migrants/refugees, 240 Roma, 112 travellers and 521 from the general population. The median age of the affected general population (37 years) had an increasing trend (from 30.8 years in 2009 to 40.5 in 2018, P < 0.001) and was significantly higher than that among Roma and migrants (7 and 8 years, respectively, P < 0.001). Twenty-two cases (2.2%) were unvaccinated patients with a chronic liver disease. Fifty clusters with 2–12 cases each were recorded; 44 were attributed to person-to-person transmission and six to food consumption. Three outbreaks accounting for 32.3% of the total number of recorded cases were identified; in 2013 among Roma (112 cases), in 2016 among refugees (188 cases) and in 2017 among men having sex with men (96 cases; 33 of them (34.4%) HIV-positive). The epidemiological data depict that improving living conditions and vaccination coverage of deprived populations, and informing adults on the disease focusing at faecal–oral transmission during sexual intercourse and travel should be the future public health priorities.

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P516 Low immunity to hepatitis a amongst men who have sex with men attending a large sexual health clinic in melbourne, australia

10.1136/sextrans-2019-sti.594 ◽

2019 ◽

Author(s):

Lenka Vodstrcil ◽

Christopher Fairley ◽

Catriona Bradshaw ◽

Marcus Chen ◽

Eric Chow

Keyword(s):

Sexual Health ◽

Hepatitis A ◽

Health Clinic ◽

Sex With Men

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