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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
- Patricia Ndumbi1,4 , Gudrun S Freidl1,5 , Christopher J Williams1,2 , Otilia Mårdh3 , Carmen Varela4 , Ana Avellón4 , Ingrid Friesema5 , Harry Vennema5 , Kazim Beebeejaun6 , Siew Lin Ngui6 , Michael Edelstein6 , Alison Smith-Palmer7 , Niamh Murphy8 , Jonathan Dean9 , Mirko Faber10 , Jürgen Wenzel11 , Mia Kontio12 , Luise Müller13 , Sofie Elisabeth Midgley13 , Lena Sundqvist14 , Josefine Lundberg Ederth14 , Anne-Marie Roque-Afonso15 , Elisabeth Couturier16 , Sofieke Klamer17 , Javiera Rebolledo17 , Vanessa Suin17 , Stephan W. Aberle18 , Daniela Schmid19 , Rita De Sousa20 , Gonçalo Figueiredo Augusto21 , Valeria Alfonsi22 , Martina Del Manso22 , Anna Rita Ciccaglione22 , Kassiani Mellou23 , Christos Hadjichristodoulou24 , Alastair Donachie1,25 , Maria-Louise Borg25 , Maja Sočan26 , Mario Poljak27 , Ettore Severi3 , Members of the European Hepatitis A Outbreak Investigation Team28
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View Affiliations Hide AffiliationsAffiliations: 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 articlePatricia Ndumbipatricia.ndumbi gmail.com
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Citation style for this article: Ndumbi Patricia, Freidl Gudrun S, Williams Christopher J, Mårdh Otilia, Varela Carmen, Avellón Ana, Friesema Ingrid, Vennema Harry, Beebeejaun Kazim, Ngui Siew Lin, Edelstein Michael, Smith-Palmer Alison, Murphy Niamh, Dean Jonathan, Faber Mirko, Wenzel Jürgen, Kontio Mia, Müller Luise, Midgley Sofie Elisabeth, Sundqvist Lena, Ederth Josefine Lundberg, Roque-Afonso Anne-Marie, Couturier Elisabeth, Klamer Sofieke, Rebolledo Javiera, Suin Vanessa, Aberle Stephan W., Schmid Daniela, De Sousa Rita, Augusto Gonçalo Figueiredo, Alfonsi Valeria, Del Manso Martina, Ciccaglione Anna Rita, Mellou Kassiani, Hadjichristodoulou Christos, Donachie Alastair, Borg Maria-Louise, Sočan Maja, Poljak Mario, Severi Ettore, Members of the European Hepatitis A Outbreak Investigation Team. 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. Euro Surveill. 2018;23(33):pii=1700641. https://doi.org/10.2807/1560-7917.ES.2018.23.33.1700641 Received: 17 Sep 2017; Accepted: 07 Mar 2018
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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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