Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017

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Abstract

Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16–25801 and RIVM-HAV16–090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16–090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour.

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Most cited references 12

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WHO position paper on hepatitis A vaccines – June 2012.

(2012)

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Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP).

(1999)

Routine vaccination of children is the most effective way to reduce hepatitis A incidence nationwide over time. Since licensure of hepatitis A vaccine in 1995, this strategy has been implemented incrementally, starting with the recommendation of the Advisory Committee on Immunization Practices (ACIP) in 1996 to vaccinate children living in communities with the highest rates of infection and disease. These updated recommendations represent the next phase of this hepatitis A immunization strategy. Vaccination of children living in states and communities with consistently elevated rates of hepatitis A will provide protection from disease and is expected to reduce the overall incidence of hepatitis A. This report updates the ACIP's 1996 recommendations on the prevention of hepatitis A through immunization (MMWR 1996;45:[No. RR-151) and includes a) new data about the epidemiology of hepatitis A; b) recent findings about the effectiveness of community-based hepatitis A vaccination programs; and c) recommendations for the routine vaccination of children in states, counties, and communities with rates that are twice the 1987-1997 national average or greater (i.e., > or = 20 cases per 100,000 population) and consideration of routine vaccination of children in states, counties, and communities with rates exceeding the 1987-1997 national average (i.e., > or = 10 but <20 cases per 100,000 population). Unchanged in this report are previous recommendations regarding the vaccination of persons in groups at increased risk for hepatitis A or its adverse consequences and recommendations regarding the use of immune globulin for protection against hepatitis A.

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Molecular epidemiological studies show that hepatitis A virus is endemic among active homosexual men in Europe.

S Corbet, Sylvia M. Bruisten, Siew Ngui … (2007)

Large outbreaks of hepatitis A have occurred in Denmark, Germany, the Netherlands, Norway, Spain, Sweden, and the United Kingdom during the period 1997-2005 affecting homosexual men. A collaborative study was undertaken between these countries to determine if the strains involved in these hepatitis A outbreaks were related genetically. The N-terminal region of VP1 and the VP1/P2A region of the strains were sequenced and compared. The majority of the strains found among homosexual men from the different European countries formed a closely related cluster, named MSM1, belonging to genotype IA. Different HAV strains circulated among other risk groups in these countries during the same period, indicating that specific strains were circulating among homosexual men exclusively. Similar strains found among homosexual men from 1997 to 2005 indicate that these HAV strains have been circulating among homosexual men for a long time. The homosexual communities are probably too small within the individual countries to maintain HAV in their population over time, whereas the homosexual communities across Europe are probably sufficiently large to sustain continued circulation of homologous HAV strains for years resulting in an endemic situation among homosexual men. (c) 2007 Wiley-Liss, Inc.

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Author and article information

Journal

Journal ID (nlm-ta): Euro Surveill

Journal ID (iso-abbrev): Euro Surveill

Journal ID (publisher-id): ES

Title: Eurosurveillance

Publisher: European Centre for Disease Prevention and Control (ECDC)

ISSN (Print): 1025-496X

ISSN (Electronic): 1560-7917

Publication date (Print): 16 August 2018

Volume: 23

Issue: 33

Electronic Location Identifier: 1700641

Affiliations

[1 ]European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden

[2 ]Public Health Wales, Cardiff, United Kingdom

[3 ]European Centre for Disease Prevention and Control, Solna, Sweden

[4 ]Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain

[5 ]National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

[6 ]Public Health England Colindale, London, United Kingdom.

[7 ]Health Protection Scotland, Glasgow, Scotland, United Kingdom

[8 ]Health Protection Surveillance Centre, Dublin, Ireland

[9 ]National Virus Reference Laboratory, Dublin, Ireland

[10 ]Robert Koch Institute, Berlin, Germany

[11 ]University Hospital Regensburg, Regensburg, Germany

[12 ]National Institute for Health and Welfare (THL), Helsinki, Finland

[13 ]Statens Serum Institut, Copenhagen, Denmark

[14 ]The Public Health Agency of Sweden, Stockholm, Sweden

[15 ]Centre National de Référence Virus des hépatites à transmission entérique, Villejuif, France

[16 ]Sante publique France, Saint-Maurice, France

[17 ]Sciensano, Brussels, Belgium

[18 ]Medical University of Vienna, Vienna, Austria

[19 ]Austrian Agency of Health and Food Safety, Vienna, Austria

[20 ]National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal

[21 ]Directorate-General of Health, Lisbon, Portugal

[22 ]Instituto Superiore Di Sanita, Rome, Italy

[23 ]Hellenic Centre for Disease Control, Athens, Greece

[24 ]University of Thessaly, Larissa, Greece

[25 ]Health Promotion and Disease Prevention Directorate, Msida, Malta

[26 ]National Institute of Public Health, Ljubljana, Slovenia

[27 ]University of Ljubljana, Ljubljana, Slovenia

[28 ]The Members of the European Hepatitis A Outbreak Investigation Team have been listed at the end of this article

Author notes

Correspondence: Patricia Ndumbi ( patricia.ndumbi@ 123456gmail.com )

Article

Publisher ID: 1700641 Publisher ID: 1700641 Other ID: 1700641

DOI: 10.2807/1560-7917.ES.2018.23.33.1700641

PMC ID: 6205254

PubMed ID: 30131095

SO-VID: 8ca09210-23e8-490f-99f9-22ee4e927473

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This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made.

History

Date received : 17 September 2017

Date accepted : 07 March 2018

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Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017

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Abstract

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Point-Of-Care Testing for Hepatitis

Most cited references 12

WHO position paper on hepatitis A vaccines – June 2012.

Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP).

Molecular epidemiological studies show that hepatitis A virus is endemic among active homosexual men in Europe.

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Cited by 47

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