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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
2019-12-06
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.33.1700641
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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
<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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    • 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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