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Surveillance and outbreak report Open Access
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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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/content/10.2807/1560-7917.ES.2018.23.33.1700641
2018-08-16
2019-03-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.33.1700641
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References

  1. Wang X, Ren J, Gao Q, Hu Z, Sun Y, Li X, et al. Hepatitis A virus and the origins of picornaviruses. Nature. 2015;517(7532):85-8.  https://doi.org/10.1038/nature13806  PMID: 25327248 
  2. Nainan OV, Xia G, Vaughan G, Margolis HS. Diagnosis of hepatitis a virus infection: a molecular approach. Clin Microbiol Rev. 2006;19(1):63-79.  https://doi.org/10.1128/CMR.19.1.63-79.2006  PMID: 16418523 
  3. Keeffe EB. Hepatitis A and B superimposed on chronic liver disease: vaccine-preventable diseases. Trans Am Clin Climatol Assoc. 2006;117:227-37, discussion 237-8. PMID: 18528476 
  4. Sfetcu O, Irvine N, Ngui SL, Emerson C, McCaughey C, Donaghy P. Hepatitis A outbreak predominantly affecting men who have sex with men in Northern Ireland, October 2008 to July 2009. Euro Surveill. 2011;16(9):19808. Available from: https://doi.org/10.2807/ese.16.09.19808-en PMID: 21392487 
  5. Centers for Disease Control and Prevention (CDC). Hepatitis A among homosexual men--United States, Canada, and Australia. MMWR Morb Mortal Wkly Rep. 1992;41(9):155,61-4. PMID:1741008
  6. Tortajada C, de Olalla PG, Diez E, Pinto RM, Bosch A, Perez U, et al. Saunas Working Group. Hepatitis A among men who have sex with men in Barcelona, 1989-2010: insufficient control and need for new approaches. BMC Infect Dis. 2012;12(1):11.  https://doi.org/10.1186/1471-2334-12-11  PMID: 22264382 
  7. Bordi L, Rozera G, Scognamiglio P, Minosse C, Loffredo M, Antinori A, et al. GEAS Group. Monophyletic outbreak of Hepatitis A involving HIV-infected men who have sex with men, Rome, Italy 2008-2009. J Clin Virol. 2012;54(1):26-9.  https://doi.org/10.1016/j.jcv.2012.01.009  PMID: 22341552 
  8. Dabrowska MM, Nazzal K, Wiercinska-Drapalo A. Hepatitis A and hepatitis A virus/HIV coinfection in men who have sex with men, Warsaw, Poland, September 2008 to September 2009. Euro Surveill. 2011;16(34):19950. Available from: https://doi.org/10.2807/ese.16.34.19950-en PMID: 21903035 
  9. Charre C, Ramière C, Roque-Afonso A-M, Chidiac C, Zoulim F, Godinot M, et al. Hav Lyon Study Group. Hepatitis A outbreak in HIV-infected MSM and in PrEP-using MSM despite a high level of immunity, Lyon, France, January to June 2017. Euro Surveill. 2017;22(48):17-00742.  https://doi.org/10.2807/1560-7917.ES.2017.22.48.17-00742  PMID: 29208161 
  10. Laurence JC. Hepatitis A and B immunizations of individuals infected with human immunodeficiency virus. Am J Med. 2005;118(10) Suppl 10A;75S-83S.  https://doi.org/10.1016/j.amjmed.2005.07.024  PMID: 16271546 
  11. Centers for Disease Control and Prevention (CDC). Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1999;48(RR-12):1-37. PMID: 10543657 
  12. World Health Organization (WHO). WHO position paper on hepatitis A vaccines – June 2012. Wkly Epidemiol Rec. 2012;87(28/29):261-76. PMID: 22905367 
  13. Beltrami JF, Shouse RL, Blake PA. Trends in infectious diseases and the male to female ratio: possible clues to changes in behavior among men who have sex with men. AIDS Educ Prev. 2005;17(6) Suppl B;49-59. PMID: 16401182 
  14. Public Health England (PHE). Hepatitis A: case questionnaire. London: PHE; 2016. Available from: https://www.gov.uk/government/publications/hepatitis-a-case-questionnaire
  15. Beebeejaun K, Degala S, Balogun K, Simms I, Woodhall SC, Heinsbroek E, et al. Outbreak of hepatitis A associated with men who have sex with men (MSM), England, July 2016 to January 2017. Euro Surveill. 2017;22(5):30454.  https://doi.org/10.2807/1560-7917.ES.2017.22.5.30454  PMID: 28183392 
  16. Freidl GS, Sonder GJB, Bovée LPMJ, Friesema IHM, van Rijckevorsel GGC, Ruijs WLM, et al. Hepatitis A outbreak among men who have sex with men (MSM) predominantly linked with the EuroPride, the Netherlands, July 2016 to February 2017. Euro Surveill. 2017;22(8):30468.  https://doi.org/10.2807/1560-7917.ES.2017.22.8.30468  PMID: 28251892 
  17. Werber D, Michaelis K, Hausner M, Sissolak D, Wenzel J, Bitzegeio J, et al. Ongoing outbreaks of hepatitis A among men who have sex with men (MSM), Berlin, November 2016 to January 2017 - linked to other German cities and European countries. Euro Surveill. 2017;22(5):30457.  https://doi.org/10.2807/1560-7917.ES.2017.22.5.30457  PMID: 28183391 
  18. Eurostat. Luxembourg: Eurostat; May 2017. Available from: http://ec.europa.eu/eurostat/web/population-demography-migration-projections/population-data/database
  19. European Centre for Disease Prevention and Control (ECDC). Epidemiological update: hepatitis A outbreak in the EU/EEA mostly affecting men who have sex with men. Stockholm: ECDC; 2018. Available from: https://ecdc.europa.eu/en/news-events/epidemiological-update-hepatitis-outbreak-eueea-mostly-affecting-men-who-have-sex-men-1
  20. World Health Organization (WHO). Hepatitis A outbreaks mostly affecting men who have sex with men – European Region and the Americas. Geneva: WHO; 2017. Available from: http://www.who.int/csr/don/07-june-2017-hepatitis-a/en/
  21. Gozlan Y, Bar-Or I, Rakovsky A, Savion M, Amitai Z, Sheffer R, et al. Ongoing hepatitis A among men who have sex with men (MSM) linked to outbreaks in Europe in Tel Aviv area, Israel, December 2016 - June 2017. Euro Surveill. 2017;22(29):30575.  https://doi.org/10.2807/1560-7917.ES.2017.22.29.30575  PMID: 28749336 
  22. Latash J, Dorsinville M, Rosso PD, Antwi M, Reddy V, Waechter H, et al. Increase in Reported Hepatitis A Among Men Who Have Sex with Men — New York City, January–March, 2017. 2017 CSTE annual conference. 2017.
  23. Stene-Johansen K, Tjon G, Schreier E, Bremer V, Bruisten S, Ngui SL, et al. Molecular epidemiological studies show that hepatitis A virus is endemic among active homosexual men in Europe. J Med Virol. 2007;79(4):356-65.  https://doi.org/10.1002/jmv.20781  PMID: 17311331 
  24. European Centre for Disease Prevention and Control (ECDC). EMIS 2010: The European Men-Who-Have-Sex-With-Men Internet Survey. Stockholm: ECDC; 2010. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/EMIS-2010-european-men-who-have-sex-with-men-survey.pdf
  25. National Institute for Public Health and the Environment (RIVM). Sexually transmitted infections including HIV, in the Netherlands in 2016. Bilthoven: RIVM; 2017. Available from: http://www.rivm.nl/en/Documents_and_publications/Scientific/Reports/2017/June/Sexually_transmitted_infections_including_HIV_in_the_Netherlands_in_2016
  26. Mohan K, Hibbert M, Rooney G, Canvin M, Childs T, Jenkins C, et al. What is the overlap between HIV and shigellosis epidemics in England: further evidence of MSM transmission? Sex Transm Infect. 2018;94(1):67-71.  https://doi.org/10.1136/sextrans-2016-052962  PMID: 28490580 
  27. Carrillo-Santisteve P, Tavoschi L, Severi E, Bonfigli S, Edelstein M, Byström E, et al. ECDC HAV Expert Panel. Seroprevalence and susceptibility to hepatitis A in the European Union and European Economic Area: a systematic review. Lancet Infect Dis. 2017;17(10):e306-19.  https://doi.org/10.1016/S1473-3099(17)30392-4  PMID: 28645862 
  28. European Centre for Disease Prevention and Control (ECDC). HIV and STI prevention among men who have sex with men. Stockholm: ECDC; 2015. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/hiv-sti-prevention-among-men-who-have-sex-with-men-guidance.pdf
  29. Chen NY, Liu ZH, Shie SS, Chen TH, Wu TS. Clinical characteristics of acute hepatitis A outbreak in Taiwan, 2015-2016: observations from a tertiary medical center. BMC Infect Dis. 2017;17(1):441.  https://doi.org/10.1186/s12879-017-2555-x  PMID: 28633630 
  30. Public Health England (PHE). Hepatitis A infection: prevention and control guidance. London: PHE; 2017. Available from: https://www.gov.uk/government/publications/hepatitis-a-infection-prevention-and-control-guidance
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
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Patricia+Ndumbi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ndumbi Patricia</a>, <a href="/search?value1=Gudrun+S+Freidl&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Freidl Gudrun S</a>, <a href="/search?value1=Christopher+J+Williams&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Williams Christopher J</a>, <a href="/search?value1=Otilia+M%C3%A5rdh&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mårdh Otilia</a>, <a href="/search?value1=Carmen+Varela&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Varela Carmen</a>, <a href="/search?value1=Ana+Avell%C3%B3n&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Avellón Ana</a>, <a href="/search?value1=Ingrid+Friesema&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Friesema Ingrid</a>, <a href="/search?value1=Harry+Vennema&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vennema Harry</a>, <a href="/search?value1=Kazim+Beebeejaun&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Beebeejaun Kazim</a>, <a href="/search?value1=Siew+Lin+Ngui&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ngui Siew Lin</a>, <a href="/search?value1=Michael+Edelstein&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Edelstein Michael</a>, <a href="/search?value1=Alison+Smith-Palmer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Smith-Palmer Alison</a>, <a href="/search?value1=Niamh+Murphy&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Murphy Niamh</a>, <a href="/search?value1=Jonathan+Dean&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dean Jonathan</a>, <a href="/search?value1=Mirko+Faber&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Faber Mirko</a>, <a href="/search?value1=J%C3%BCrgen+Wenzel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wenzel Jürgen</a>, <a href="/search?value1=Mia+Kontio&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kontio Mia</a>, <a href="/search?value1=Luise+M%C3%BCller&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Müller Luise</a>, <a href="/search?value1=Sofie+Elisabeth+Midgley&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Midgley Sofie Elisabeth</a>, <a href="/search?value1=Lena+Sundqvist&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sundqvist Lena</a>, <a href="/search?value1=Josefine+Lundberg+Ederth&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ederth Josefine Lundberg</a>, <a href="/search?value1=Anne-Marie+Roque-Afonso&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Roque-Afonso Anne-Marie</a>, <a href="/search?value1=Elisabeth+Couturier&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Couturier Elisabeth</a>, <a href="/search?value1=Sofieke+Klamer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Klamer Sofieke</a>, <a href="/search?value1=Javiera+Rebolledo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rebolledo Javiera</a>, <a href="/search?value1=Vanessa+Suin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Suin Vanessa</a>, <a href="/search?value1=Stephan+W.+Aberle&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Aberle Stephan W.</a>, <a href="/search?value1=Daniela+Schmid&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schmid Daniela</a>, <a href="/search?value1=Rita+De+Sousa&option1=author&noRedirect=true" class="nonDisambigAuthorLink">De Sousa Rita</a>, <a href="/search?value1=Gon%C3%A7alo+Figueiredo+Augusto&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Augusto Gonçalo Figueiredo</a>, <a href="/search?value1=Valeria+Alfonsi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Alfonsi Valeria</a>, <a href="/search?value1=Martina+Del+Manso&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Del Manso Martina</a>, <a href="/search?value1=Anna+Rita+Ciccaglione&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ciccaglione Anna Rita</a>, <a href="/search?value1=Kassiani+Mellou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mellou Kassiani</a>, <a href="/search?value1=Christos+Hadjichristodoulou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hadjichristodoulou Christos</a>, <a href="/search?value1=Alastair+Donachie&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Donachie Alastair</a>, <a href="/search?value1=Maria-Louise+Borg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Borg Maria-Louise</a>, <a href="/search?value1=Maja+So%C4%8Dan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sočan Maja</a>, <a href="/search?value1=Mario+Poljak&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Poljak Mario</a>, <a href="/search?value1=Ettore+Severi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Severi Ettore</a>, <a href="/search?value1=Members+of+the+European+Hepatitis+A+Outbreak+Investigation+Team&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Members of the European Hepatitis A Outbreak Investigation Team</a></span>. 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. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(33):pii=1700641. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.33.1700641" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.33.1700641</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 17 Sep 2017;&nbsp;&nbsp; <span class="generated">Accepted</span>: 07 Mar 2018 </span> </p>
/content/10.2807/1560-7917.ES.2018.23.33.1700641
/content/10.2807/1560-7917.ES.2018.23.33.1700641
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Supplementary data

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    • Supplement 2. Supplementary Table. Hepatitis A vaccine recommendations and cost for MSM and HIV-positive patients.

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    • Supplement 1. European outbreak case definition

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