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SDG 3: Hepatitis

Abstract

Background

Hepatitis A and B vaccinations are recommended for men who have sex with men (MSM), given their increased risk of infection. However, data on vaccination programmes are scarce.

Aim

To use information on vaccination recommendations and vaccine uptake among MSM in the WHO European Region to guide prevention.

Methods

From a large pan-European MSM Internet Survey (EMIS-2017), we analysed data on self-reported hepatitis A and B vaccination status by age, education, financial coping, settlement size, outness (disclosure of sexual behaviour), migration history and diagnosis with hepatitis C or HIV, using multivariable logistic regression. Additionally, we collected information on national hepatitis A and B vaccination recommendations.

Results

We present data of 113,884 MSM, median age 36 years (IQR: 27–47). Vaccination for hepatitis A and B was recommended and free for MSM in 7 and 18 of 43 countries, respectively. Of all respondents, 48% (n = 50,966) reported ever being vaccinated against hepatitis A, and 53% (n = 56,889) against hepatitis B. Odds for being vaccinated against hepatitis A increased with outness (‘out to (almost) all’ aOR: 1.78, 95% CI: 1.72–1.85 vs ‘out to none’) and were higher in countries where vaccination was recommended and free for MSM (aOR: 2.22, 95% CI: 1.29–3.82 vs ‘no recommendation’). Results for hepatitis B were similar (outness: aOR: 1.81, 95% CI: 1.75–1.88 and MSM-specific vaccination recommendation: aOR: 2.44, 95% CI: 1.54–3.85).

Conclusion

Large proportions of MSM in Europe remain vulnerable to hepatitis A and B, despite available vaccination. Implementation of MSM-specific vaccination recommendations and greater efforts to improve the societal climate for MSM are needed to address gaps in vaccine coverage.

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2024-11-07
2024-12-12
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.45.2400100
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References

  1. Linder KA, Malani PN. Hepatitis A. JAMA. 2017;318(23):2393.  https://doi.org/10.1001/jama.2017.17244  PMID: 29094153 
  2. Jacobsen KH. Globalization and the changing epidemiology of hepatitis A virus. Cold Spring Harb Perspect Med. 2018;8(10):a031716.  https://doi.org/10.1101/cshperspect.a031716  PMID: 29500305 
  3. World Health Organization. WHO position paper on hepatitis A vaccines - October 2022. Wkly Epidemiol Rec. 2022;97(40):493-512. Available from: https://www.who.int/publications/i/item/who-wer9740-493-512
  4. Ndumbi P, Freidl GS, Williams CJ, Mårdh O, Varela C, Avellón A, et al. 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):1700641.  https://doi.org/10.2807/1560-7917.ES.2018.23.33.1700641  PMID: 30131095 
  5. Seto W-K, Lo Y-R, Pawlotsky J-M, Yuen M-F. Chronic hepatitis B virus infection. Lancet. 2018;392(10161):2313-24.  https://doi.org/10.1016/S0140-6736(18)31865-8  PMID: 30496122 
  6. World Health Organization (WHO). Hepatitis B Fact Sheet. Geneva: WHO. [Accessed: 18 Jul 2023]. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
  7. European Centre for Disease Prevention and Control (ECDC). Hepatitis B - Annual Epidemiological Report for 2022. Stockholm: ECDC; 2024. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/AER%20HEPB%202022_0.pdf
  8. World Health Organization (WHO). Hepatitis B in the WHO European Region. Fact Sheet July 2022. Geneva: WHO; 2022. Available from: https://www.who.int/docs/librariesprovider2/default-document-library/hepatitis-b-in-the-who-european-region-factsheet-july-2022.pdf?sfvrsn=f8eb7bbb_2&download=true
  9. Miglietta A, Quinten C, Lopalco PL, Duffell E. Impact of hepatitis B vaccination on acute hepatitis B epidemiology in European Union/European Economic Area countries, 2006 to 2014. Euro Surveill. 2018;23(6):17-00278.  https://doi.org/10.2807/1560-7917.ES.2018.23.6.17-00278  PMID: 29439751 
  10. Pattyn J, Hendrickx G, Vorsters A, Van Damme P. Hepatitis B vaccines. J Infect Dis. 2021;224(12) Suppl 2;S343-51.  https://doi.org/10.1093/infdis/jiaa668  PMID: 34590138 
  11. Shouval D. Immunization against Hepatitis A. Cold Spring Harb Perspect Med. 2019;9(2):a031682.  https://doi.org/10.1101/cshperspect.a031682  PMID: 29661808 
  12. World Health Organization (WHO). Action plan for the health sector response to viral hepatitis in the WHO European Region. Geneva: WHO; 2017. Available from: www.euro.who.int/en/health-topics/communicable-diseases/hepatitis/publications/2017/action-plan-for-the-health-sector-response-to-viral-hepatitis-in-the-who-european-region-2017
  13. Brandl M, Schmidt AJ, Marcus U, An der Heiden M, Dudareva S. Are men who have sex with men in Europe protected from hepatitis B? Epidemiol Infect. 2020;148:e27.  https://doi.org/10.1017/S0950268820000163  PMID: 32052715 
  14. Vet R, de Wit JB, Das E. Factors associated with hepatitis B vaccination among men who have sex with men: a systematic review of published research. Int J STD AIDS. 2017;28(6):534-42.  https://doi.org/10.1177/0956462415613726  PMID: 26503555 
  15. Pachankis JE, Hatzenbuehler ML, Hickson F, Weatherburn P, Berg RC, Marcus U, et al. Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey. AIDS. 2015;29(10):1239-46.  https://doi.org/10.1097/QAD.0000000000000724  PMID: 26035323 
  16. World Health Organization (WHO). Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations. Report No.: 9240052399. Geneva: WHO; 2022. Available from: https://www.who.int/publications/i/item/9789240052390
  17. European Commission. Council Recommendation of 21 June 2024 on vaccine-preventable cancers (C/2024/4259). Luxembourg: Publications Office of the European Union. 28.6.2024. Available from: http://data.europa.eu/eli/C/2024/4259/oj
  18. The EMIS Network. EMIS-2017 – The European Men-Who-Have-Sex-With-Men Internet Survey. Key findings from 50 countries. Report No.: 978-92-9498-341-1. Stockholm: European Centre for Disease Prevention and Control; 2019. Available from: https://www.emis-project.eu/european-report-2017
  19. Weatherburn P, Hickson F, Reid DS, Marcus U, Schmidt AJ. European men-who-have-sex-with-men internet survey (EMIS-2017): design and methods. Sex Res Soc Policy. 2020;17(4):543-57.  https://doi.org/10.1007/s13178-019-00413-0 
  20. European Centre for Disease Prevention and Control (ECDC). Vaccine Scheduler. Stockholm: ECDC. [Accessed: 15 Aug 2023]. Available from: https://vaccine-schedule.ecdc.europa.eu
  21. World Health Organization (WHO). Immunization data. Geneva: WHO. [Accessed: 15 Aug 2023]. Available from: https://immunizationdata.who.int/listing.html?topic=&location=
  22. Burdi S, Brandl M, Marcus U, Duffell E, Severi E, Mozalevskis A, et al. Viral hepatitis knowledge and vaccination awareness among men who have sex with men (MSM) in 43 countries of the WHO European Region: results from the European MSM Internet Survey (EMIS-2017). Euro Surveill. 2024; (Forthcoming).
  23. European Centre for Disease Prevention and Control (ECDC). Hepatitis A virus in the EU/EEA, 1975-2014. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/en/publications-data/hepatitis-virus-eueea-1975-2014
  24. European Centre for Disease Prevention and Control (ECDC). Surveillance and prevention of hepatitis B and C in Europe. Stockholm: ECDC; 2010. Available from: www.ecdc.europa.eu/en/publications-data/surveillance-and-prevention-hepatitis-b-and-c-europe
  25. European Liver Patients Association. The 2016 Hep-CORE Report. Brussels: ELPA; 2017. Available from: https://elpa.eu/wp-content/uploads/2019/09/Hep-CORE-2016-full-report.pdf
  26. Mereckiene J, Cotter S, Lopalco P, D’Ancona F, Levy-Bruhl D, Giambi C, et al. Hepatitis B immunisation programmes in European Union, Norway and Iceland: where we were in 2009? Vaccine. 2010;28(28):4470-7.  https://doi.org/10.1016/j.vaccine.2010.04.037  PMID: 20451643 
  27. Khetsuriani N, Mosina L, Van Damme P, Mozalevskis A, Datta S, Tohme RA. Progress toward Hepatitis B control - World Health Organization European Region, 2016-2019. MMWR Morb Mortal Wkly Rep. 2021;70(30):1029-35.  https://doi.org/10.15585/mmwr.mm7030a1  PMID: 34324482 
  28. Lernout T, Hendrickx G, Vorsters A, Mosina L, Emiroglu N, Van Damme P. A cohesive European policy for hepatitis B vaccination, are we there yet? Clin Microbiol Infect. 2014;20(Suppl 5):19-24.  https://doi.org/10.1111/1469-0691.12535 
  29. Xiridou M, Adam P, Meiberg A, Visser M, Matser A, de Wit J, et al. The impact of the COVID-19 pandemic on hepatitis B virus vaccination and transmission among men who have sex with men: A mathematical modelling study. Vaccine. 2022;40(33):4889-96.  https://doi.org/10.1016/j.vaccine.2022.06.075  PMID: 35810058 
  30. European Centre for Disease Prevention and Control (ECDC). STI cases on the rise across Europe Stockholm: ECDC; 2024. Available from: https://www.ecdc.europa.eu/en/news-events/sti-cases-rise-across-europe
  31. Friesema IH, Sonder GJ, Petrignani MW, Meiberg AE, van Rijckevorsel GG, Ruijs WL, et al. Spillover of a hepatitis A outbreak among men who have sex with men (MSM) to the general population, the Netherlands, 2017. Euro Surveill. 2018;23(23):1800265.  https://doi.org/10.2807/1560-7917.ES.2018.23.23.1800265  PMID: 29897040 
  32. Zhang X-S, Ong JJ, Macgregor L, Vilaplana TG, Heathcock ST, Mindlin M, et al. Transmission dynamics of the 2016-18 outbreak of hepatitis A among men who have sex with men in England and cost-effectiveness analysis of vaccination strategies to prevent future outbreaks. Lancet Reg Health Eur. 2022;19:100426.  https://doi.org/10.1016/j.lanepe.2022.100426  PMID: 36039276 
  33. World Health Organization (WHO). Global hepatitis report 2017. Report No.: 9241565454. Geneva: WHO; 2017. Available from: https://www.who.int/publications/i/item/9789241565455
  34. Xiridou M, Visser M, Urbanus A, Matser A, van Benthem B, Veldhuijzen I. Ending risk-group HBV vaccination for MSM after the introduction of universal infant HBV vaccination: A mathematical modelling study. Vaccine. 2021;39(21):2867-75.  https://doi.org/10.1016/j.vaccine.2021.04.008  PMID: 33896665 
  35. Rolnick SJ, Parker ED, Nordin JD, Hedblom BD, Wei F, Kerby T, et al. Self-report compared to electronic medical record across eight adult vaccines: do results vary by demographic factors? Vaccine. 2013;31(37):3928-35.  https://doi.org/10.1016/j.vaccine.2013.06.041  PMID: 23806243 
  36. Velan B, Yadgar Y. On the implications of desexualizing vaccines against sexually transmitted diseases: health policy challenges in a multicultural society. Isr J Health Policy Res. 2017;6(1):30.  https://doi.org/10.1186/s13584-017-0153-4  PMID: 28666469 
  37. Rezayatmand R, Pavlova M, Groot W. The impact of out-of-pocket payments on prevention and health-related lifestyle: a systematic literature review. Eur J Public Health. 2013;23(1):74-9.  https://doi.org/10.1093/eurpub/cks034  PMID: 22544911 
  38. The European Region of the International Lesbian, Gay, Bisexual, Trans and Intersex Association -Europe. Rainbow Map 2023. Geneva: ILGA; 2023. Available from: https://www.ilga-europe.org/files/uploads/2023/05/rainbow-map-2023.pdf
  39. Pachankis JE, Hatzenbuehler ML, Berg RC, Fernández-Dávila P, Mirandola M, Marcus U, et al. Anti-LGBT and anti-immigrant structural stigma: an intersectional analysis of sexual minority men’s HIV risk when migrating to or within Europe. J Acquir Immune Defic Syndr. 2017;76(4):356-66.  https://doi.org/10.1097/QAI.0000000000001519 
  40. Maqsood Q, Sumrin A, Iqbal M, Younas S, Hussain N, Mahnoor M, et al. Hepatitis C virus/hepatitis B virus coinfection: Current prospectives. Antivir Ther. 2023;28(4):13596535231189643.  https://doi.org/10.1177/13596535231189643  PMID: 37489502 
  41. Hu J, Liu K, Luo J. HIV-HBV and HIV-HCV coinfection and liver cancer development. Cancer Treat Res. 2019;177:231-50.  https://doi.org/10.1007/978-3-030-03502-0_9  PMID: 30523627 
  42. Schmidt AJ, Rasi M, Esson C, Christinet V, Ritzler M, Lung T, et al. The Swiss STAR trial - an evaluation of target groups for sexually transmitted infection screening in the sub-sample of men. Swiss Med Wkly. 2020;150(5153):w20392.  https://doi.org/10.4414/smw.2020.20392  PMID: 33382077 
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