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Doyle TJ, Gumke M, Stanek D, Moore J, Buck B, Locksmith T, Tomson K, Schmedes S, Churchwell G, Hubsmith SJ, Krishnamoorthy B, Poschman K, Danforth B, Chacreton D. Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021-2022. Emerg Infect Dis 2024; 30. [PMID: 38526187 PMCID: PMC10977815 DOI: 10.3201/eid3004.231392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
In 2022, concurrent outbreaks of hepatitis A, invasive meningococcal disease (IMD), and mpox were identified in Florida, USA, primarily among men who have sex with men. The hepatitis A outbreak (153 cases) was associated with hepatitis A virus genotype IA. The IMD outbreak (44 cases) was associated with Neisseria meningitidis serogroup C, sequence type 11, clonal complex 11. The mpox outbreak in Florida (2,845 cases) was part of a global epidemic. The hepatitis A and IMD outbreaks were concentrated in Central Florida and peaked during March--June, whereas mpox cases were more heavily concentrated in South Florida and had peak incidence in August. HIV infection was more common (52%) among mpox cases than among hepatitis A (21%) or IMD (34%) cases. Where feasible, vaccination against hepatitis A, meningococcal disease, and mpox should be encouraged among at-risk groups and offered along with program services that target those groups.
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Shamarina D, Sluga-O’Callaghan M, Kassianos G, Marijam A, Dave V, Davenport E, Andani A, Curran D, Dewda P, Steffen R. Knowledge, Attitudes, and Practices of European Healthcare Professionals towards Hepatitis A and Hepatitis B Vaccination in at-Risk Adults. Vaccines (Basel) 2023; 11:1645. [PMID: 38005977 PMCID: PMC10675089 DOI: 10.3390/vaccines11111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/15/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023] Open
Abstract
Despite the occurrence of several hepatitis A (hepA) and hepatitis B (hepB) outbreaks in Europe in the last few decades, not all European countries have implemented hepA and hepB vaccinations in their national immunization programs, especially for adults at risk for hepA and/or hepB infection, such as men who have sex with men or patients with chronic liver disease. Currently, little is known on the attitudes of European healthcare professionals (HCPs) towards hepA and hepB vaccinations for at-risk adults. We conducted an online survey among HCPs in Germany, Spain, and the United Kingdom to assess their awareness of and adherence to their national hepA and hepB vaccination guidelines for at-risk adults. Among the 698 HCPs who took the survey, most (91.1%) were familiar with their national vaccination recommendations and always followed them or followed them most of the time when advising or prescribing hepA or hepB vaccines. Major and moderate barriers for recommending or administering such vaccines were the non-disclosure of risk factors by the patient (53.0-57.6%) and the patient's lack of motivation or knowledge about the risk of the disease (50.3-52.9%). These results may help inform strategies to improve and accelerate hepA and hepB vaccination in European at-risk adults.
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Affiliation(s)
| | | | - George Kassianos
- Royal College of General Practitioners, London NW1 2FB, UK
- British Global & Travel Health Association, London BA1 2SA, UK
| | | | - Vaidehi Dave
- RTI Health Solutions, Research Triangle Park, Durham, NC 27709, USA
| | - Eric Davenport
- RTI Health Solutions, Research Triangle Park, Durham, NC 27709, USA
| | | | | | | | - Robert Steffen
- WHO Collaborating Centre for Travellers’ Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, CH-8001 Zurich, Switzerland
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas, Houston, TX 77030, USA
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Bardón De Tena P, Tapia Paniagua ST, Vico Sevilla JA, Clavijo E, Martínez Manzanares E, Gonzalez-Domenech CM. Unusual Surge of Acute Hepatitis A Cases in 2016 and 2017 in Malaga, Southern Spain: Characterization and Relationship with Other Concurrent European Outbreaks. J Clin Med 2023; 12:6613. [PMID: 37892751 PMCID: PMC10607832 DOI: 10.3390/jcm12206613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
We aimed to describe the Hepatitis A virus (HAV) cases that arose in Malaga (Spain) in 2016 and 2017 when the European Centre for Disease Prevention and Control (ECDC) reported several outbreaks among men who have sex with men (MSM). Therefore, we conducted a retrospective study gathering demographic, clinical, and immunological data from the acute HAV patients attending our hospital between March 2016 and December 2017. Additionally, VP1/P2A region was amplified from serum samples, sequenced, and genotyped. We finally performed a phylogenetic analysis, including the HAV strains from the other European outbreaks. A total of 184 HAV cases were reported, with the highest number in March 2017. The cohort mostly comprised Spaniards (81.0%), males (84.8%), and MSM (72.3%), with a median age of 33.0 years (interquartile range (IQR) = 25.0-43.0). Most patients exhibited symptoms. In addition, a successful amplification and sequencing of the VP1/P2A region was performed in 25 out of 106 serum samples (23.6%). All the sequences belonged to the genotype IA, and 20 were phylogenetically related to VRD_521_2016, first described in the United Kingdom (UK). In conclusion, HAV cases emerged in Malaga in 2016 and 2017, showing an epidemic character phylogenetically related to the predominant strain first detected in the UK. Characteristics of the cohort were similar to those from the European outbreaks.
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Affiliation(s)
| | - Silvana Teresa Tapia Paniagua
- Department of Microbiology, Faculty of Sciences, University of Malaga, Avenue Louis Pasteur w/n, 29010 Malaga, Spain; (S.T.T.P.); (E.C.); (E.M.M.)
| | | | - Encarnación Clavijo
- Department of Microbiology, Faculty of Sciences, University of Malaga, Avenue Louis Pasteur w/n, 29010 Malaga, Spain; (S.T.T.P.); (E.C.); (E.M.M.)
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria Hospital, 29010 Malaga, Spain
| | - Eduardo Martínez Manzanares
- Department of Microbiology, Faculty of Sciences, University of Malaga, Avenue Louis Pasteur w/n, 29010 Malaga, Spain; (S.T.T.P.); (E.C.); (E.M.M.)
| | - Carmen Maria Gonzalez-Domenech
- Department of Microbiology, Faculty of Sciences, University of Malaga, Avenue Louis Pasteur w/n, 29010 Malaga, Spain; (S.T.T.P.); (E.C.); (E.M.M.)
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Bogdanić N, Begovac J, Močibob L, Zekan Š, Grgić I, Ujević J, Đaković Rode O, Židovec-Lepej S. Hepatitis A Outbreak in Men Who Have Sex with Men Using Pre-Exposure Prophylaxis and People Living with HIV in Croatia, January to October 2022. Viruses 2022; 15:87. [PMID: 36680127 PMCID: PMC9861653 DOI: 10.3390/v15010087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Abstract
The hepatitis A virus (HAV) is a highly hepatotropic virus transmitted mainly via the fecal-oral route. The purpose of this study is to describe a prolonged HAV outbreak in HIV-infected men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users in Croatia in 2022. Croatia has a centralized system of HIV care and the PrEP service is only available at the University Hospital for Infectious Diseases (UHID), Zagreb. We reviewed all MSM living with HIV and MSM PrEP users at UHID and identified those diagnosed with HAV between January and October 2022. During this period, a total of 1036 MSM living with HIV and 361 PrEP users were followed, and 45 (4.4%) and 32 (8.9%) were diagnosed with HAV, respectively. Most cases were diagnosed in mid-February. A total of 70.1% (726/1036) MSM living with HIV and 82.3% (297/361) PrEP users were susceptible to HAV. Sequencing information was available for 34 persons; in all cases the HAV subtype IA was found. Our findings indicate that both MSM living with HIV and HIV-uninfected PrEP users are vulnerable to HAV infection and might be a potential source for a more widespread HAV epidemic.
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Affiliation(s)
| | - Josip Begovac
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Loris Močibob
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
| | - Šime Zekan
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Ivana Grgić
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
| | - Josip Ujević
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
| | - Oktavija Đaković Rode
- University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10 000 Zagreb, Croatia
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Selb R, Werber D, Falkenhorst G, Steffen G, Lachmann R, Ruscher C, McFarland S, Bartel A, Hemmers L, Koppe U, Stark K, Bremer V, Jansen K. A shift from travel-associated cases to autochthonous transmission with Berlin as epicentre of the monkeypox outbreak in Germany, May to June 2022. Euro Surveill 2022; 27:2200499. [PMID: 35801518 PMCID: PMC9264732 DOI: 10.2807/1560-7917.es.2022.27.27.2200499] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 11/20/2022] Open
Abstract
By 22 June 2022, 521 cases of monkeypox were notified in Germany. The median age was 38 years (IQR: 32-44); all cases were men. In Berlin, where 69% of all cases occurred, almost all were men who have sex with men. Monkeypox virus likely circulated unrecognised in Berlin before early May. Since mid-May, we observed a shift from travel-associated infections to mainly autochthonous transmission that predominantly took place in Berlin, often in association with visits to clubs and parties.
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Affiliation(s)
- Regina Selb
- Unit 'HIV/AIDS, STI and Blood-borne Infections', Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Dirk Werber
- State Office for Health and Social Affairs (SOHSA), Unit for Surveillance and Epidemiology of Infectious Diseases, Berlin, Germany
| | - Gerhard Falkenhorst
- Unit 'Gastrointestinal Infections, Zoonoses and Tropical Infections', Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Gyde Steffen
- Unit 'HIV/AIDS, STI and Blood-borne Infections', Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Raskit Lachmann
- Unit 'Gastrointestinal Infections, Zoonoses and Tropical Infections', Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Claudia Ruscher
- State Office for Health and Social Affairs (SOHSA), Unit for Surveillance and Epidemiology of Infectious Diseases, Berlin, Germany
| | - Sarah McFarland
- State Office for Health and Social Affairs (SOHSA), Unit for Surveillance and Epidemiology of Infectious Diseases, Berlin, Germany
| | - Alexander Bartel
- State Office for Health and Social Affairs (SOHSA), Unit for Surveillance and Epidemiology of Infectious Diseases, Berlin, Germany
| | - Lukas Hemmers
- State Office for Health and Social Affairs (SOHSA), Unit for Surveillance and Epidemiology of Infectious Diseases, Berlin, Germany
- Postgraduate Training in Applied Epidemiology (PAE) Unit 'Infectious Disease Epidemiology, Crisis Management, Outbreak Investigations and Training Programmes, Focal Point for the Public Health Service', Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Uwe Koppe
- Unit 'HIV/AIDS, STI and Blood-borne Infections', Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Klaus Stark
- Unit 'Gastrointestinal Infections, Zoonoses and Tropical Infections', Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Unit 'HIV/AIDS, STI and Blood-borne Infections', Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Klaus Jansen
- Unit 'HIV/AIDS, STI and Blood-borne Infections', Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Chuffi S, Gomes-Gouvêa MS, Casadio LVB, Nastri ACSS, Gonzalez MP, Cotia ALF, Aranda AGD, Tenore SB, Ono SK, Malta FM, Madalosso G, Ferreira PRA, Carrilho FJ, Pinho JRR. The Molecular Characterization of Hepatitis A Virus Strains Circulating during Hepatitis A Outbreaks in São Paulo, Brazil, from September 2017 to May 2019. Viruses 2021; 14:v14010073. [PMID: 35062277 PMCID: PMC8777592 DOI: 10.3390/v14010073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Outbreaks of hepatitis A may occur in countries of medium and high socioeconomic levels in which the population generally exhibits an increased susceptibility in young adults to this infection if they are not vaccinated against the hepatitis A virus (HAV). In Europe, an outbreak involved approximately 22 European countries with 4475 cases reported from 2016 to 2018; most of them were men who have sex with men (MSM). This outbreak expanded to North and South America, including Brazil, particularly in São Paulo city with 1547 reported cases from 2016 to 2019. In the present study, we characterized the HAV strains involved in the acute hepatitis A cases identified in the reference centers of São Paulo city during this outbreak. A total of 51 cases with positive anti-HAV IgM were included, 80.4% male, 68.6% of them between 20 and 40 years old and 41.7% MSM. HAV RNA was detected in 92% (47/51) of the cases. Subgenotype IA of HAV was identified and most of the strains were closely related to that isolated in outbreaks that occurred in different European countries in 2016. These results showed the epidemiological relation between these outbreaks and reinforce the need to implement vaccination against hepatitis A for the adult population, particularly for a population with a high-risk behavior.
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Affiliation(s)
- Samira Chuffi
- Laboratório de Gastroenterologia e Hepatologia Tropical—LIM/07, Departamento de Gastroenterologia, Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 500, São Paulo 05403-000, SP, Brazil; (S.C.); (J.R.R.P.)
| | - Michele S. Gomes-Gouvêa
- Laboratório de Gastroenterologia e Hepatologia Tropical—LIM/07, Departamento de Gastroenterologia, Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 500, São Paulo 05403-000, SP, Brazil; (S.C.); (J.R.R.P.)
- Correspondence:
| | - Luciana V. B. Casadio
- Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil; (L.V.B.C.); (A.C.S.S.N.)
| | - Ana Catharina S. S. Nastri
- Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil; (L.V.B.C.); (A.C.S.S.N.)
| | - Mario P. Gonzalez
- Instituto de Infectologia Emilio Ribas, São Paulo 05403-000, SP, Brazil; (M.P.G.); (A.L.F.C.); (A.G.D.A.)
| | - André L. F. Cotia
- Instituto de Infectologia Emilio Ribas, São Paulo 05403-000, SP, Brazil; (M.P.G.); (A.L.F.C.); (A.G.D.A.)
| | - Amanda G. D. Aranda
- Instituto de Infectologia Emilio Ribas, São Paulo 05403-000, SP, Brazil; (M.P.G.); (A.L.F.C.); (A.G.D.A.)
| | - Simone B. Tenore
- Centro de Referência e Treinamento—CRT DST-AIDS, São Paulo 05403-000, SP, Brazil;
- Hospital São Paulo, Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 05403-000, SP, Brazil;
| | - Suzane K. Ono
- Hospital das Clínicas, Departamento de Gastroenterologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil; (S.K.O.); (F.J.C.)
| | - Fernanda M. Malta
- Laboratório de Técnicas Especiais, Hospital Israelita Albert Einstein, Albert Einstein Medicina Diagnóstica, São Paulo 05403-000, SP, Brazil;
| | - Geraldine Madalosso
- Epidemiological Surveillance Center, Disease Control Coordination, State of São Paulo Department of Health, São Paulo 05403-000, SP, Brazil;
| | - Paulo R. A. Ferreira
- Hospital São Paulo, Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 05403-000, SP, Brazil;
| | - Flair J. Carrilho
- Hospital das Clínicas, Departamento de Gastroenterologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil; (S.K.O.); (F.J.C.)
| | - João R. R. Pinho
- Laboratório de Gastroenterologia e Hepatologia Tropical—LIM/07, Departamento de Gastroenterologia, Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 500, São Paulo 05403-000, SP, Brazil; (S.C.); (J.R.R.P.)
- Laboratório de Técnicas Especiais, Hospital Israelita Albert Einstein, Albert Einstein Medicina Diagnóstica, São Paulo 05403-000, SP, Brazil;
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Domínguez A, Varela C, Soldevila N, Izquierdo C, Guerrero M, Peñuelas M, Martínez A, Godoy P, Borràs E, Rius C, Torner N, Avellón AM, Castilla J. Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010-2018. Vaccines (Basel) 2021; 9:1214. [PMID: 34835145 PMCID: PMC8620672 DOI: 10.3390/vaccines9111214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 12/25/2022] Open
Abstract
We compared the cumulative incidence and characteristics of hepatitis A outbreaks in two groups of Spanish autonomous regions according to whether a universal or risk group vaccination strategy was followed. Outbreaks between 2010 and 2018 were analyzed. The cumulative incidence rate of outbreaks was estimated and compared by estimating the rate ratio (RR). The characteristics of the outbreaks and those of the first cases were compared. Adjusted OR (aOR) were calculated using a multivariate logistic regression model. Outbreak incidence was 16.04 per million persons in regions with universal vaccination and 20.76 in those with risk-group vaccination (RR 0.77; 95%CI 0.62-0.94). Imported outbreaks accounted for 65% in regions with universal vaccination and 28.7% in regions with risk-group vaccination (aOR 3.88; 95%CI 2.13-7.09). Adolescents and young adults aged 15-44 years and men who have sex with men were less frequently the first case of the outbreak in regions with a universal vaccination strategy (aOR 0.54; 95%CI 0.32-0.92 and 0.23; 95%CI 0.07-0.82, respectively). The cumulative incidence rate of outbreaks was lower in regions with universal vaccination. In all regions, independently of the vaccination strategy, activities to vaccinate persons belonging to high-risk groups for infection should be emphasized.
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Affiliation(s)
- Angela Domínguez
- Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
| | - Carmen Varela
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.G.); (M.P.)
| | - Núria Soldevila
- Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
| | | | - María Guerrero
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.G.); (M.P.)
| | - Marina Peñuelas
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.G.); (M.P.)
| | - Ana Martínez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain;
| | - Pere Godoy
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain;
| | - Eva Borràs
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain;
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - Núria Torner
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
| | - Ana María Avellón
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28222 Madrid, Spain
| | - Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Instituto Salud Pública de Navarra-IdiSNA, 31003 Pamplona, Spain
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Saito R, Imamura A, Nishiura H. Assessing countermeasures during a hepatitis A virus outbreak among men who have sex with men. Theor Biol Med Model 2021; 18:19. [PMID: 34635146 PMCID: PMC8507362 DOI: 10.1186/s12976-021-00150-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/04/2021] [Indexed: 12/04/2022] Open
Abstract
Background A hepatitis A epidemic occurred among men who have sex with men (MSM) in Japan in 2017–2018. In this study, we employ a parsimonious mathematical model to epidemiologically investigate the dynamics of infection, aiming to evaluate the effectiveness of campaign-based interventions among MSM to raise awareness of the situation. Methods A mathematical model describing a mixture of human-to-human transmission and environmental transmission was fitted to surveillance data. Taking seasonally varying environmental transmission into account, we estimated the reproduction number of hepatitis A virus during the course of epidemic, and, especially, the abrupt decline in this reproduction number following campaign-based interventions. Results The reproduction number prior to the countermeasures ranged from 2.6 to 3.1 and then began to decrease following campaign-based interventions. After the first countermeasure, the reproduction number decreased, but the epidemic remained supercritical (i.e., Rt > 1). The value of Rt dropped well below one following the second countermeasure, which used web articles to widely disseminate information about the epidemic risk. Conclusions Although the effective reproduction number, Rt, changes because of both intrinsic and extrinsic factors, the timing of the examined countermeasures against hepatitis A in the MSM population was consistent with the abrupt declines observed in Rt. Even without vaccination, the epidemic was brought under control, and risky behaviors may have been changed by the increase in situation awareness reached through web articles. Supplementary Information The online version contains supplementary material available at 10.1186/s12976-021-00150-1.
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Affiliation(s)
- Ryohei Saito
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido, 060-8638, Japan
| | - Akifumi Imamura
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido, 060-8638, Japan. .,Kyoto University School of Public Health, Yoshidakonoecho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8503, Japan.
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9
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Herzog C, Van Herck K, Van Damme P. Hepatitis A vaccination and its immunological and epidemiological long-term effects - a review of the evidence. Hum Vaccin Immunother 2021; 17:1496-1519. [PMID: 33325760 PMCID: PMC8078665 DOI: 10.1080/21645515.2020.1819742] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023] Open
Abstract
Hepatitis A virus (HAV) infections continue to represent a significant disease burden causing approximately 200 million infections, 30 million symptomatic illnesses and 30,000 deaths each year. Effective and safe hepatitis A vaccines have been available since the early 1990s. Initially developed for individual prophylaxis, HAV vaccines are now increasingly used to control hepatitis A in endemic areas. The human enteral HAV is eradicable in principle, however, HAV eradication is currently not being pursued. Inactivated HAV vaccines are safe and, after two doses, elicit seroprotection in healthy children, adolescents, and young adults for an estimated 30-40 years, if not lifelong, with no need for a later second booster. The long-term effects of the single-dose live-attenuated HAV vaccines are less well documented but available data suggest they are safe and provide long-lasting immunity and protection. A universal mass vaccination strategy (UMV) based on two doses of inactivated vaccine is commonly implemented in endemic countries and eliminates clinical hepatitis A disease in toddlers within a few years. Consequently, older age groups also benefit due to the herd protection effects. Single-dose UMV programs have shown promising outcomes but need to be monitored for many more years in order to document an effective immune memory persistence. In non-endemic countries, prevention efforts need to focus on 'new' risk groups, such as men having sex with men, prisoners, the homeless, and families visiting friends and relatives in endemic countries. This narrative review presents the current evidence regarding the immunological and epidemiological long-term effects of the hepatitis A vaccination and finally discusses emerging issues and areas for research.
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Affiliation(s)
- Christian Herzog
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Koen Van Herck
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Chavarria-Miró G, de Castellarnau M, Fuentes C, D'Andrea L, Pérez-Rodríguez FJ, Beguiristain N, Bosch A, Guix S, Pintó RM. Advances for the Hepatitis A Virus Antigen Production Using a Virus Strain With Codon Frequency Optimization Adjustments in Specific Locations. Front Microbiol 2021; 12:642267. [PMID: 33679679 PMCID: PMC7935560 DOI: 10.3389/fmicb.2021.642267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/26/2021] [Indexed: 12/13/2022] Open
Abstract
The available cell-adapted hepatitis A virus (HAV) strains show a very slow replication phenotype hampering the affordable production of antigen. A fast-growing strain characterized by the occurrence of mutations in the internal ribosome entry site (IRES), combined with changes in the codon composition has been selected in our laboratory. A characterization of the IRES activity of this fast-growing strain (HM175-HP; HP) vs. its parental strain (HM175; L0) was assessed in two cell substrates used in vaccine production (MRC-5 and Vero cells) compared with the FRhK-4 cell line in which its selection was performed. The HP-derived IRES was significantly more active than the L0-derived IRES in all cells tested and both IRES were more active in the FRhK-4 cells. The translation efficiency of the HP-derived IRES was also much higher than the L0-derived IRES, particularly, in genes with a HP codon usage background. These results correlated with a higher virus production in a shorter time for the HP strain compared to the L0 strain in any of the three cell lines tested, and of both strains in the FRhK-4 cells compared to Vero and MRC-5 cells. The addition of wortmannin resulted in the increase of infectious viruses and antigen in the supernatant of FRhK-4 infected cells, independently of the strain. Finally, the replication of both strains in a clone of FRhK-4 cells adapted to grow with synthetic sera was optimal and again the HP strain showed higher yields.
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Affiliation(s)
- Gemma Chavarria-Miró
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Montserrat de Castellarnau
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Cristina Fuentes
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Lucía D'Andrea
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Francisco-Javier Pérez-Rodríguez
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Nerea Beguiristain
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Albert Bosch
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Susana Guix
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Rosa M Pintó
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
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Riess M, Enkirch T, Sundqvist L, Lundberg Ederth J. High impact of molecular surveillance on hepatitis A outbreak case detection in Sweden: a retrospective study, 2009 to 2018. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2021; 26. [PMID: 33663645 PMCID: PMC7934221 DOI: 10.2807/1560-7917.es.2021.26.9.1900763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundSwedish hepatitis A surveillance includes sequence-based typing, but its contribution to outbreak detection in relation to epidemiological investigations has not been fully evaluated.AimTo evaluate the role of sequence-based typing in hepatitis A outbreak detection and to describe the hepatitis A epidemiology in Sweden to improve surveillance.MethodsWe retrospectively investigated hepatitis A virus sequences of 447 cases notified in Sweden 2009-18. We performed a phylogenetic analysis of evolutionary distances to identify cases with similar virus sequences (≥ 459/460 identical nt in the VP1/P2A junction). Unique sequences, dyads and sequence-based clusters (SBCs) were identified. We linked non-sequenced cases by epidemiological information and retrospectively assessed the value of typing for outbreak identification.ResultsFifty-five percent (n = 542/990) of the notified hepatitis A cases were referred to the Public Health Agency of Sweden for typing and 447 (45%) were sequenced successfully. Subgenotypes included IA (42.5%, n = 190), IB (42.7%, n = 191) and IIIA (14.8%, n = 66). Phylogenetic analysis identified 154 unique sequences, 33 dyads (66 cases) and 34 SBCs (227 cases). The combination of molecular and epidemiological data revealed 23 potential outbreaks comprising 201 cases. Cases were linked by sequence (59%, n = 118), epidemiological data (11%, n = 23) or both (30%, n = 60). Typing was needed to identify 15 of 23 potential outbreak signals.ConclusionSequence-based typing contributed substantially to detecting clustering cases and identifying outbreaks in Sweden. The results show routine sequence-based typing detects outbreaks, promotes timely outbreak investigations and facilitates international collaboration.
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Affiliation(s)
- Maximilian Riess
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden.,Public Health Agency of Sweden, Department of Microbiology, Solna, Sweden
| | - Theresa Enkirch
- Public Health Agency of Sweden, Department of Microbiology, Solna, Sweden
| | - Lena Sundqvist
- Public Health Agency of Sweden, Department of Communicable Disease Control and Health Protection, Solna, Sweden
| | - Josefine Lundberg Ederth
- Public Health Agency of Sweden, Department of Public Health Analysis and Data Management, Solna, Sweden
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12
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Ruscher C, Faber M, Werber D, Stark K, Bitzegeio J, Michaelis K, Sagebiel D, Wenzel JJ, Enkelmann J. Resurgence of an international hepatitis A outbreak linked to imported frozen strawberries, Germany, 2018 to 2020. ACTA ACUST UNITED AC 2021; 25. [PMID: 32945256 PMCID: PMC7502883 DOI: 10.2807/1560-7917.es.2020.25.37.1900670] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Following outbreaks linked to frozen strawberries in Sweden and Austria in 2018, 65 cases linked to the same hepatitis A virus strain were detected in Germany between October 2018 and January 2020, presenting in two waves. Two case–control studies and a comparison of cases’ consumption frequencies with purchase data from a large consumer panel provided strong evidence for frozen strawberry cake as the main vehicle of transmission. Of 46 cases interviewed, 27 reported consuming frozen strawberry cake and 25 of these identified cake(s) from brand A spontaneously or in product picture-assisted recall. Trace back investigations revealed that the Polish producer involved in the previous outbreaks in Sweden and Austria had received frozen strawberries from Egypt via a wholesaler that also delivered frozen strawberries to manufacturer of brand A. Phylogenetic analyses linked the outbreak strain to similar strains formerly isolated from sewage, stool and strawberries in Egypt. Complete trace back and timely recall of products with strong evidence of contamination is important to control an outbreak and prevent later resurgence, particularly for food items with a long shelf life. Continued molecular surveillance of hepatitis A is needed to identify outbreaks and monitor the success of food safety interventions.
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Affiliation(s)
- Claudia Ruscher
- State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
| | - Mirko Faber
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - Dirk Werber
- State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
| | - Klaus Stark
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - Julia Bitzegeio
- State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
| | - Kai Michaelis
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - Daniel Sagebiel
- State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
| | - Jürgen J Wenzel
- National Consultant Laboratory for Hepatitis A Virus and Hepatitis E Virus, Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - Julia Enkelmann
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
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Dimitriou P, Nikolopoulos GK, Koliou M, Constantinou E, Azina C, Panayiotou M, Christaki E. An Outbreak of Hepatitis A among Young Adult Men in Cyprus. Pathogens 2020; 9:pathogens9110979. [PMID: 33238551 PMCID: PMC7700564 DOI: 10.3390/pathogens9110979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Outbreaks of acute hepatitis A (AHA) have recently been reported in Europe among men who have sex with men (MSM). The aim of this work was to evaluate, for the first time, trends in the reported cases of AHA in Cyprus over the last seven years. Methods: We retrospectively studied all people reported with AHA in Cyprus between January 2013 and December 2019. Demographic data, type of transmission, vaccination status for HAV, laboratory and clinical data were analyzed. Results: The asnalysis involved 33 AHA cases (age 32.7 ± 17.4 years, 78.8% males). An increase in AHA reports was observed between July 2017 and June 2018 when more than a third (n = 13) of the cases of the period 2013–2019 were reported. The reporting rate of AHA doubled from 0.52 cases per 100,000 population (before July 2017) to 1.12 cases per 100,000 population (July 2017–June 2018). The male/female (M/F) ratio increased from one in 2013 to eight in 2018. Conclusion: An increase in AHA reports occurred in Cyprus between July 2017 and June 2018. Many cases with AHA in that period were MSM. Enhanced surveillance and timely public health interventions, like vaccination and awareness promotion, are important for preventing future outbreaks.
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Affiliation(s)
- Panagiotis Dimitriou
- Department of Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.A.); (E.C.)
| | - Georgios K. Nikolopoulos
- Medical School, University of Cyprus, 2029 Nicosia, Cyprus;
- Correspondence: ; Tel.: +357-22-895223
| | - Maria Koliou
- Unit for Surveillance and Control of Communicable Diseases, Medical and Public Health Services, Ministry of Health, 1448 Nicosia, Cyprus; (M.K.); (E.C.)
| | - Elisavet Constantinou
- Unit for Surveillance and Control of Communicable Diseases, Medical and Public Health Services, Ministry of Health, 1448 Nicosia, Cyprus; (M.K.); (E.C.)
| | - Chara Azina
- Department of Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.A.); (E.C.)
| | | | - Eirini Christaki
- Department of Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.A.); (E.C.)
- Medical School, University of Cyprus, 2029 Nicosia, Cyprus;
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Zimmermann R, Faber M, Dudareva S, Ingiliz P, Jessen H, Koch J, Marcus U, Michaelis K, Rieck T, Ruscher C, Schilling B, Schumacher J, Sissolak D, Thoulass J, Wenzel JJ, Werber D, Sagebiel D. Hepatitis A outbreak among MSM in Berlin due to low vaccination coverage: Epidemiology, management, and successful interventions. Int J Infect Dis 2020; 103:146-153. [PMID: 33207272 DOI: 10.1016/j.ijid.2020.11.133] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To describe the characteristics of a large hepatitis A virus (HAV) outbreak among men who have sex with men (MSM) in Berlin and to assess the impact of measures implemented. METHODS Cases of laboratory-confirmed, symptomatic HAV infection notified in Berlin, Germany between August 2016 and February 2018 were analysed using routine and enhanced surveillance data including genotyping results. Several studies involving different groups of participants were conducted to further investigate the outbreak, including surveys on knowledge and practices of HAV vaccination among physicians and vaccination coverage and determinants of vaccination status among MSM. The measures implemented were categorized by target group in a Gantt chart. To assess their impact, health insurance data on HAV vaccination uptake were analysed, comparing Berlin and other federal states. RESULTS During the outbreak period, a total of 222 cases were reported (of which 91 were sequence-confirmed), with a peak in case numbers in January 2017. Physicians were aware of the existing vaccination recommendations, but vaccination coverage among 756 MSM was low, with 32.7% being completely vaccinated and 17.3% being incompletely vaccinated before 2017. HAV vaccination before 2017 was associated with being born in Germany (odds ratio 2.36) and HIV-positive (odds ratio 1.80). HAV monovalent vaccination uptake increased by 164% from 2016 to 2017 among males in Berlin, compared to 7% in other federal states. CONCLUSIONS Multiple measures targeting the MSM community, physicians, and public health to increase HAV vaccination uptake were successfully implemented. To prevent future HAV outbreaks, we recommend monitoring vaccination coverage among MSM, promoting awareness of existing recommendations among physicians, and ensuring access for foreign-born and young MSM.
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Affiliation(s)
- Ruth Zimmermann
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Mirko Faber
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany.
| | - Sandra Dudareva
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | | | | | - Judith Koch
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Ulrich Marcus
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Kai Michaelis
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Thorsten Rieck
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Claudia Ruscher
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany; Postgraduate Training in Applied Epidemiology (PAE), Affiliated with the European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; State Office for Health and Social Affairs (LaGeSo), Berlin, Germany
| | - Birte Schilling
- Local Public Health Authority, Berlin Tempelhof-Schöneberg, Germany
| | | | | | - Janine Thoulass
- Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany; Postgraduate Training in Applied Epidemiology (PAE), Affiliated with the European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jürgen J Wenzel
- National Consultant Laboratory for Hepatitis A and Hepatitis E, Institute of Clinical Microbiology and Hygiene, University Medical Centre Regensburg, Regensburg, Germany
| | - Dirk Werber
- State Office for Health and Social Affairs (LaGeSo), Berlin, Germany
| | - Daniel Sagebiel
- State Office for Health and Social Affairs (LaGeSo), Berlin, Germany
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Syphilis and HIV infection in patients with hepatitis A: a preliminary study from one centre in Poland. Postepy Dermatol Alergol 2020; 37:810-811. [PMID: 33240025 PMCID: PMC7675093 DOI: 10.5114/ada.2020.100493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/10/2019] [Indexed: 12/03/2022] Open
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16
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Epidemiology and clinical course of hepatitis A in Cantabria before and after the epidemic outbreak of June 2016. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Fortea J, Fernandez González M, Samaniego Vega L, Puente Á, Cuadrado A, Cabezas J, Llerena S, Sáez López A, Crespo J, Fábrega E. Epidemiología y curso clínico de la hepatitis A en Cantabria antes y después del brote epidémico de junio 2016. Rev Clin Esp 2020; 220:400-408. [DOI: 10.1016/j.rce.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/12/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
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Nicolay N, Le Bourhis-Zaimi M, Lesourd A, Martel M, Roque-Afonso AM, Erouart S, Etienne M, Ndeikoundam Ngangro N. A description of a hepatitis A outbreak in men who have sex with men and public health measures implemented in Seine-Maritime department, Normandy, France, 2017. BMC Public Health 2020; 20:1441. [PMID: 32962667 PMCID: PMC7510153 DOI: 10.1186/s12889-020-09499-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In 2016-2017, a European-wide circulation of genotype IA hepatitis A virus was responsible for hepatitis A outbreaks in men who have sex with men (MSM). This study aimed to describe the outbreak investigation in Seine-Maritime department (France) and the control measures implemented accordingly. METHODS Outbreak description used data from mandatory reporting and enhanced surveillance of male cases. Confirmed case was genotype IA isolated, possible cases had no reported genotype information. Targeted control measures included communication on sexual practices at risk of hepatitis A transmission and two vaccination campaigns in April 2017 and January 2018. Characteristics of cases and vaccinees were described. We reported the best communication channel for relaying outbreak information and control measures based on the monitoring of social network activities and feedback from vaccinees. RESULTS During the outbreak period (December 2016 to December 2017), a total of 48 confirmed outbreak cases and 30 possible outbreak cases were notified. Among them, 69 were male (88%). Two epidemic waves were observed. Cases encountered their partners through gay-dating apps (54%) and in one specific sauna (62%). In response to the outbreak, two vaccination campaigns were deployed. A total of 156 MSM were vaccinated, of whom 56 in a truck parked beside the sauna. Most of the vaccinees had been informed about the campaign through dating apps (44%). Community-based organizations involved in sexual health promotion and other gay social media were very proactive in sharing information about the outbreak and promoting the vaccination campaign through their social media account and also on site (gay venues). Vaccinees reported the same sexual practices at risk of hepatitis A transmission as cases. CONCLUSIONS In response to this massive hepatitis A outbreak that affected mostly MSM in Seine-Maritime department, vaccination campaign remained the cornerstone of prevention. Prevention officers from the community-based organization played a key role in vaccination promotion. Gay-dating apps and outdoor sessions of vaccination allowed to effectively reach MSM. Cost-effectiveness studies might analyze the interest of a continuous sexual health promotion including vaccination against hepatitis A in MSM through dating apps and social networks.
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Affiliation(s)
- Nathalie Nicolay
- Santé publique France, French national public health agency, Normandy regional office, 76100, Rouen, France.
- European Centre for Disease Prevention and Control (ECDC), Gustav III:s boulevard 40, 16973, Solna, Sweden.
| | - Maggie Le Bourhis-Zaimi
- Santé publique France, French national public health agency, Normandy regional office, 76100, Rouen, France
| | - Anais Lesourd
- Infectious and Tropical Diseases Department, Rouen University Hospital, 76000, Rouen, France
| | - Mélanie Martel
- Santé publique France, French national public health agency, Normandy regional office, 76100, Rouen, France
| | | | | | - Manuel Etienne
- Infectious and Tropical Diseases Department, Rouen University Hospital, 76000, Rouen, France
- Normandie Univ, UNIROUEN, UNICAEN, GRAM 2.0, 76000, Rouen, France
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Ruscher C, Werber D, Thoulass J, Zimmermann R, Eckardt M, Winter C, Sagebiel D. Dating apps and websites as tools to reach anonymous sexual contacts during an outbreak of hepatitis A among men who have sex with men, Berlin, 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 31138363 PMCID: PMC6540642 DOI: 10.2807/1560-7917.es.2019.24.21.1800460] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background In an outbreak of hepatitis A among men who have sex with men (MSM) in Berlin (2016 and 2017), patients frequently reported anonymous sex and use of dating applications to meet sexual contacts, hampering tracing and vaccination of contacts. Aim Our objective was to evaluate dating apps and websites as a means of spreading prevention messages among MSM during the ongoing outbreak. Methods Advertisements in different formats were placed on three MSM dating apps and eight websites for anonymous dating during three weeks in March and April 2017. We calculated frequency of ads shown and click-through rates (CTR) and investigated the independent effect of format and platform on the number of clicks using a negative binomial regression model. We evaluated the campaign’s impact using a survey among visitors of a large gay-lesbian street-festival in Berlin. Results Overall, 1,920,180 ads were shown and clicked on 8,831 times (CTR = 0.46%). The multivariable model showed significantly more clicks on one dating app (incidence rate ratio (IRR) = 9.5; 95% confidence interval (CI): 7.7–12.2) than on websites and on full-screen ads (IRR = 3.1; 95% CI: 2.5–3.8) than on banner ads. Of 266 MSM who participated in the survey, 190 (71%) knew about the outbreak and 39 (15%) declared to have been vaccinated recently because of the campaign. Conclusions Dating apps provided a means to rapidly reach and influence a substantial number of MSM in Berlin and should complement case-based contact tracing among MSM in outbreak settings. Clicking on ads depended on platform and format used.
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Affiliation(s)
- Claudia Ruscher
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.,State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
| | - Dirk Werber
- State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
| | - Janine Thoulass
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Ruth Zimmermann
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Matthias Eckardt
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
| | - Christian Winter
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
| | - Daniel Sagebiel
- State Office for Health and Social Affairs (LAGeSo), Berlin, Germany
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Brito WID, Souto FJD. Universal hepatitis A vaccination in Brazil: analysis of vaccination coverage and incidence five years after program implementation. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200073. [PMID: 32638856 DOI: 10.1590/1980-549720200073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In 2014, Brazil introduced a universal immunization program against the hepatitis A virus (HAV) for children in the second year of life, using a single dose of inactivated virus vaccine. The objective of this study was to evaluate the vaccination coverage (VC) against HAV in Brazil, against the incidence of cases reported five years after the implementation of the program. METHODOLOGY Secondary data were obtained by searching free access electronic sites of the Ministry of Health, Department of Informatics of the Unified Health System (Departamento de Informática do Sistema Único de Saúde - DATASUS), for incidence analysis and VC from 2014 to 2018. RESULTS VC ranged from 60.13 to 97.07%. The homogeneity of VC against hepatitis A did not reach the established goal throughout all states but for a few exceptions. After 2015, CV decreased in all regions of the country. Despite insufficient coverage, a concomitant reduction in the incidence of Hepatitis A took place throughout the country. The incidence rate fell from 3.29 to 0.80/100,000 between 2014 and 2018. However, there was an interruption in the pace of incidence fall between 2017 and 2018, which may be a consequence of insufficient VC. This phenomenon seems to be part of a widespread downward trend in vaccination effort across the country, also verified for other vaccines, such as poliomyelitis and measles, mumps and rubella vaccine. CONCLUSION These figures suggest the need for implementing efforts to improve hepatitis A VC rates in the country.
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Affiliation(s)
- Wagner Izidoro de Brito
- Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil
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Origin of HAV strains responsible for 2016-2017 outbreak among MSM: Viral phylodynamics in Lazio region. PLoS One 2020; 15:e0234010. [PMID: 32470049 PMCID: PMC7259881 DOI: 10.1371/journal.pone.0234010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/15/2020] [Indexed: 12/31/2022] Open
Abstract
In Europe HAV infection occurs mainly among specific risk groups, such as consumers of specific food. Sexual transmission of HAV has been demonstrated, particularly among Men-Who-Have-Sex-With-Men (MSM), causing MSM-specific outbreaksin Europe. Here we report a molecular epidemiologic and phylodynamic analysis on HAV sequences in Lazio (central Italy)to identify genetic background and the phylogenetic relations, and test the HAV infection dynamics during a large outbreak through phylodynamic model.Among all HAV sequences found during 2013-2018 in Lazio, low genetic diversity was observed in HAV population in 2016 and 2017, along with high frequenciesVRD_521_2016and RIVM-HAV16-090, suggesting a large expansion event of viral population. The initial expansion of both VRD_521_2016 and RIVM-HAV16-090 clusters dated back to 2012 (95% HPD:2006-2015). During the2016-2017outbreak in Lazio region, the Re peaked around mid-2016, with a value of 1.73 (95% HPD: 1.03-2.37), consistent with incidence trend of AHA cases in Lazio between 2016 and mid-2017. This study showed the magnitude of HAV outbreak in Lazio during 2016-2017, demonstrating the epidemic continuity to MSM-specific outbreak in Europe. The HAV dataset is available on interactive phylodynamic platform https://nextstrain.org to real-time update of future outbreaks.
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22
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Hernández Bustabad A, Morales Arráez D, González A, de Vera A, Díaz-Flores F, Lecuona Fernández M, Gómez-Sirvent JL, Avellón Calvo A, Hernández-Guerra M. Sexual behaviour and poor hygiene are related to recent hepatitis a virus community outbreaks. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:448-455. [PMID: 32450702 DOI: 10.17235/reed.2020.6687/2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES there has been a global increase in the incidence of hepatitis A infection. The aim of this study was to examine the characteristics of the increase in our region and the degree of adherence to the recommended hygienic measures after discharge from hospital. METHODS demographic, clinical and biochemical variables were collected from patients with acute hepatitis A in our health area. The patients were grouped as follows: January 2010 to December 2016 (historical cohort) and January 2017 to October 2017 (recent cohort). A phylogenetic analysis was also performed in the recent cohort. One month after discharge, bacterial growth was evaluated by a culture of the dominant hand imprint and were compared with a control group. RESULTS a total of 110 cases were registered with a median age of 36.3 years (range 3-89) and 77.3 % were male. The incidence was 0.82/100,000 inhabitants/year and 22.75/100,000 inhabitants/year in the historical and recent cohorts, respectively. Patients in the recent cohort were more frequently male (52.6 % vs. 82.4 %, p = 0.008) and younger (51.7 [3-89] vs. 33.4 [4-74] years, p < 0.001). In addition, 63.8 % of the recent cohort were men who had sex with other men and had unsafe sexual practices (37.5 %). Phylogenetic analysis showed a predominance of genotype A and a high frequency of the VRD 521-2016 sequence. A higher growth of enterobacteria was observed in patients with hepatitis A compared to the control group (7.3 % vs. 1.2 %, p = 0.005), despite specific hygienic measures given at discharge. CONCLUSIONS a recent outbreak of hepatitis A in our area was related with gender, younger age and sexual practices. Hepatitis A infected subjects showed a poor adherence to hygienic measures. Our data suggests the need for policies that encourage preventive actions, particularly vaccination in this high-risk group.
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Affiliation(s)
| | | | | | - Antonia de Vera
- Central Laboratory, Hospital Universitario de Canarias, España
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23
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Martínez Lozano H, Conthe Alonso A, Bañares R. A new pattern in hepatitis A virus infection in an urban population. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:178-182. [PMID: 32081016 DOI: 10.17235/reed.2020.6526/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION hepatitis A virus (HAV) infection is a common cause of acute hepatitis worldwide. Since the generalization of vaccination, its incidence had markedly declined. Nevertheless, several HAV-outbreaks have been described in the last decade, mainly related to contaminated alimentary products. In recent years, a new pattern of acute HAV infection has been described with changes in the demographic profile of the infected population, which is more common in healthy young men. PATIENTS AND METHODS a retrospective case series study was performed to evaluate this possible change in the pattern of HAV infection. The case series included all patients with a diagnosis of HAV acute infection in our hospital between January 2005 and May 2017. RESULTS a total of 196 cases were diagnosed which were comprised of two probable outbreaks: one starting in November 2008 of 26 cases and one starting in 2016 with 69 cases at the time of data collection. The two outbreak populations were comparable. While the sporadic cases group was predominantly formed by pediatric and third-age patients with a slight male tendency, the outbreak related cases showed a clear predominance for young males (proportion of males: 63.2% vs 85.3%, p < 0.001). A possible chronological relationship with the national gay festivity celebrated in Madrid was observed. Outbreak related cases had higher bilirubin, alanine aminotransferase and longer APPT at diagnosis as well as a lower albumin concentration. The clinical relevance was minimal with a similar hospitalization rate and clinical outcome in both groups. There were no related deaths, acute liver failure or need for liver transplantation in our cohort. CONCLUSION these epidemiological findings emphasize the importance of implementing preventive measures as well as social awareness campaigns.
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Affiliation(s)
| | | | - Rafael Bañares
- Aparato Digestivo, Hospital General Universitario Gregorio Marañón
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24
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Epidemiology of hepatitis A in Greece in the last decade: management of reported cases and outbreaks and lessons learned. Epidemiol Infect 2020; 148:e58. [PMID: 32052723 PMCID: PMC7078582 DOI: 10.1017/s0950268820000382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hepatitis A is a mandatory notifiable disease in Greece. Here, we present the epidemiological data for 2009-2018 and the results of outbreak investigations performed, and discuss future public health priorities.Overall, 1193 cases were reported; 320 migrants/refugees, 240 Roma, 112 travellers and 521 from the general population. The median age of the affected general population (37 years) had an increasing trend (from 30.8 years in 2009 to 40.5 in 2018, P < 0.001) and was significantly higher than that among Roma and migrants (7 and 8 years, respectively, P < 0.001). Twenty-two cases (2.2%) were unvaccinated patients with a chronic liver disease. Fifty clusters with 2-12 cases each were recorded; 44 were attributed to person-to-person transmission and six to food consumption. Three outbreaks accounting for 32.3% of the total number of recorded cases were identified; in 2013 among Roma (112 cases), in 2016 among refugees (188 cases) and in 2017 among men having sex with men (96 cases; 33 of them (34.4%) HIV-positive). The epidemiological data depict that improving living conditions and vaccination coverage of deprived populations, and informing adults on the disease focusing at faecal-oral transmission during sexual intercourse and travel should be the future public health priorities.
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25
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De Oliveira TM, Vieira NSG, Sepp TDS, Souto FJD. Recent trends in hepatitis A incidence in Brazil. J Med Virol 2020; 92:1343-1349. [DOI: 10.1002/jmv.25694] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/31/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Talita M. De Oliveira
- Facimed Medicine CourseCollege of Biomedical Sciences of CacoalCacoal Rondônia Brazil
| | - Nádia S. G. Vieira
- Facimed Medicine CourseCollege of Biomedical Sciences of CacoalCacoal Rondônia Brazil
| | - Thaís D. S. Sepp
- Facimed Medicine CourseCollege of Biomedical Sciences of CacoalCacoal Rondônia Brazil
| | - Francisco J. D. Souto
- Facimed Medicine CourseCollege of Biomedical Sciences of CacoalCacoal Rondônia Brazil
- Internal Medicine DepartmentFederal University of Mato GrossoCuiabá Mato Grosso Brazil
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26
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Hernández E, de Castro V, Avellón A, González I, Muniozguren N, Vázquez S, Muñoz-Chimeno M. Brote de hepatitis A asociado a un manipulador de alimentos en Bizkaia, 2017. Enferm Infecc Microbiol Clin 2019; 37:569-573. [DOI: 10.1016/j.eimc.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/09/2019] [Accepted: 01/27/2019] [Indexed: 02/08/2023]
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27
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Enkirch T, Eriksson R, Persson S, Schmid D, Aberle SW, Löf E, Wittesjö B, Holmgren B, Johnzon C, Gustafsson EX, Svensson LM, Sandelin LL, Richter L, Lindblad M, Brytting M, Maritschnik S, Tallo T, Malm T, Sundqvist L, Ederth JL. Hepatitis A outbreak linked to imported frozen strawberries by sequencing, Sweden and Austria, June to September 2018. ACTA ACUST UNITED AC 2019; 23. [PMID: 30326994 PMCID: PMC6194910 DOI: 10.2807/1560-7917.es.2018.23.41.1800528] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Between June–September 2018, 20 hepatitis A cases were notified in six counties in Sweden. Combined epidemiological and microbiological investigations identified imported frozen strawberries produced in Poland as the source of the outbreak. Sequence analysis confirmed the outbreak strain IB in the strawberries with 100 % identity and the respective batch was withdrawn. Sharing the sequence information internationally led to the identification of 14 additional cases in Austria, linked to strawberries from the same producer.
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Affiliation(s)
- Theresa Enkirch
- European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Public Health Agency of Sweden, Solna, Sweden
| | | | | | - Daniela Schmid
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Stephan W Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Emma Löf
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden.,Public Health Agency of Sweden, Solna, Sweden
| | - Bengt Wittesjö
- Department of Communicable Disease Control and Prevention, Blekinge County, Sweden
| | - Birgitta Holmgren
- Department of Communicable Disease Control and Prevention, Skåne County, Sweden
| | - Charlotte Johnzon
- The Environment and Health Administration of Stockholm Municipality, Stockholm, Sweden
| | - Eva X Gustafsson
- Department of Communicable Disease Control and Prevention, Skåne County, Sweden
| | - Lena M Svensson
- Department of Communicable Disease Control and Prevention, Östergötland County, Sweden
| | - Lisa Labbé Sandelin
- Department of Communicable Disease Control and Prevention, Kalmar County, Sweden
| | - Lukas Richter
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | | | | | | | | | - Therese Malm
- Department of Communicable Disease Control and Prevention, Gävleborg County, Sweden
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28
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Friesema IH, Sonder GJ, Petrignani MW, Meiberg AE, van Rijckevorsel GG, Ruijs WL, Vennema H. Spillover of a hepatitis A outbreak among men who have sex with men (MSM) to the general population, the Netherlands, 2017. ACTA ACUST UNITED AC 2019; 23. [PMID: 29897040 PMCID: PMC6152169 DOI: 10.2807/1560-7917.es.2018.23.23.1800265] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Since 2015, outbreaks of hepatitis A among men who have sex with men (MSM) have been reported worldwide. To examine the impact of these MSM outbreaks in the Netherlands, we combined notification and epidemiological data with sequence analysis. Our results show the hazards of outbreaks within risk-groups spilling over into the largely susceptible general population. One third of the outbreak-related hepatitis A virus genotypes were detected in non-MSM cases.
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Affiliation(s)
- Ingrid Hm Friesema
- Centre for Infectious Diseases, Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Gerard Jb Sonder
- Department of Infectious Disease Control, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands
| | - Mariska Wf Petrignani
- National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Annemarie E Meiberg
- National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Gini Gc van Rijckevorsel
- National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Wilhelmina Lm Ruijs
- National Coordination Centre for Communicable Disease Control, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Harry Vennema
- Centre for Infectious Diseases Research, Diagnostics and Screening, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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29
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Gallian P, Barlet V, Mouna L, Gross S, Lecam S, Ricard C, Wind F, Pouchol E, Fabra C, Flan B, Visse C, Djoudi R, Couturier E, de Valk H, Tiberghien P, Roque-Afonso AM. Hepatitis A: an epidemiological survey in blood donors, France 2015 to 2017. ACTA ACUST UNITED AC 2019; 23. [PMID: 29845926 PMCID: PMC6152213 DOI: 10.2807/1560-7917.es.2018.23.21.1800237] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since mid-2016, hepatitis A virus (HAV) outbreaks, involving predominantly men who have sex with men (MSM), have affected countries in Europe and overseas. In France, HAV screening of blood donations in 2017 revealed a HAV-RNA prevalence ca fivefold higher than during 2015-16 (4.42/106 vs 0.86/106; p = 0.0005). In 2017, despite a higher male-to-female ratio (5.5 vs 0.7) and the identification of MSM-associated outbreak strains, only one of 11 infected male donors self-reported being a MSM.
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Affiliation(s)
- Pierre Gallian
- Unité des Virus Emergents (UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection), Marseille, France.,Etablissement Français du Sang Provence Alpes Côte d'Azur et Corse, Marseille, France
| | - Valérie Barlet
- Etablissement Français du Sang Auvergne Rhône Alpes, Beynost, France
| | - Lina Mouna
- AP-HP, Hôpital Paul Brousse, Virologie, CNR des Virus des hépatites à transmission entérique, INSERM U1993, Villejuif, France
| | - Sylvie Gross
- Etablissement Français du Sang, Saint Denis-La Plaine Stade de France, France
| | - Sophie Lecam
- Etablissement Français du Sang Centre Pays de Loire, Nantes, France
| | - Céline Ricard
- Etablissement Français du Sang Haut de France, Lille, France
| | - Françoise Wind
- Etablissement Français du Sang Occitanie, Toulouse, France
| | - Elodie Pouchol
- Etablissement Français du Sang, Saint Denis-La Plaine Stade de France, France
| | - Cécile Fabra
- Etablissement Français du Sang Provence Alpes Côte d'Azur et Corse, Marseille, France
| | | | | | - Rachid Djoudi
- Etablissement Français du Sang, Saint Denis-La Plaine Stade de France, France
| | - Elisabeth Couturier
- Santé Publique France, French national public health agency, Saint-Maurice, France
| | - Henriette de Valk
- Santé Publique France, French national public health agency, Saint-Maurice, France
| | - Pierre Tiberghien
- Université de Franche-Comté, Inserm, Etablissement Français du Sang, UMR 1098, Besançon, France.,Etablissement Français du Sang, Saint Denis-La Plaine Stade de France, France
| | - Anne-Marie Roque-Afonso
- AP-HP, Hôpital Paul Brousse, Virologie, CNR des Virus des hépatites à transmission entérique, INSERM U1993, Villejuif, France
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30
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Ribeiro S, de Sousa D, Medina D, Castro R, Lopes Â, Rocha M. Prevalence of gonorrhea and chlamydia in a community clinic for men who have sex with men in Lisbon, Portugal. Int J STD AIDS 2019; 30:951-959. [PMID: 31284840 PMCID: PMC6732818 DOI: 10.1177/0956462419855484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Men who have sex with men (MSM) are at greater risk for sexually transmitted
infections (STIs). Data on MSM chlamydia and gonorrhea prevalence estimates and
associated risk factors are scarce. To our knowledge, this is the first study to
describe the prevalence and the determinants of both chlamydia and gonorrhea
infections in MSM in Portugal. We conducted a cross-sectional study using data
from 1832 visits to CheckpointLX, a community-based center for screening
blood-borne viruses and other STIs in MSM. Overall prevalence of chlamydia or
gonorrhea in our sample was 16.05%, with 14.23% coinfection and 40.73%
asymptomatic presentation among those testing positive. Anorectal infection was
most common for chlamydia (67.26%), followed by urethral (24.78%) and oral
(19.47%) infection. Oral infection was most common for gonorrhea (55.63%),
followed by anal (51.25%) and urethral (17.50%) infection. In multivariate
analyses, young age (U = 94684, p = 0.014),
being foreign-born (χ2 = 11.724, p = 0.003),
reporting STI symptoms (χ2 = 5.316, p = 0.021),
inhaled drug use (χ2 = 4.278, p = 0.039) and having
a higher number of concurrent (χ2 = 18.769,
p < 0.001) or total (χ2 = 5.988,
p = 0.050) sexual partners were each associated with higher
rates of chlamydia or gonorrhea infection. Young and migrant MSM are a
vulnerable population to STIs, as are those who use inhaled drugs and those with
a higher number of concurrent or total sexual partners. Although Portugal has no
guidelines on chlamydia and gonorrhea screening, our results point toward a need
for greater awareness about the importance of high-frequency screening for those
at increased risk (i.e., every three to six months).
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Affiliation(s)
- Sofia Ribeiro
- 1 Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands; Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Diogo de Sousa
- 2 Faculty of Medicine, University of Porto, Oporto, Portugal
| | - Diogo Medina
- 3 CheckpointLX, Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Rita Castro
- 4 UEI de Microbiologia Médica, Grupo DST, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa
| | - Ângela Lopes
- 5 Grupo DST e Virologia, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa
| | - Miguel Rocha
- 6 Scientific Coordinator of CheckpointLX, Grupo de Ativistas em Tratamentos, Lisbon, Portugal
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31
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Enkirch T, Severi E, Vennema H, Thornton L, Dean J, Borg ML, Ciccaglione AR, Bruni R, Christova I, Ngui SL, Balogun K, Němeček V, Kontio M, Takács M, Hettmann A, Korotinska R, Löve A, Avellón A, Muñoz-Chimeno M, de Sousa R, Janta D, Epštein J, Klamer S, Suin V, Aberle SW, Holzmann H, Mellou K, Ederth JL, Sundqvist L, Roque-Afonso AM, Filipović SK, Poljak M, Vold L, Stene-Johansen K, Midgley S, Fischer TK, Faber M, Wenzel JJ, Takkinen J, Leitmeyer K. Improving preparedness to respond to cross-border hepatitis A outbreaks in the European Union/European Economic Area: towards comparable sequencing of hepatitis A virus. Euro Surveill 2019; 24:1800397. [PMID: 31311618 PMCID: PMC6636214 DOI: 10.2807/1560-7917.es.2019.24.28.1800397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/18/2019] [Indexed: 12/13/2022] Open
Abstract
IntroductionSequence-based typing of hepatitis A virus (HAV) is important for outbreak detection, investigation and surveillance. In 2013, sequencing was central to resolving a large European Union (EU)-wide outbreak related to frozen berries. However, as the sequenced HAV genome regions were only partly comparable between countries, results were not always conclusive.AimThe objective was to gather information on HAV surveillance and sequencing in EU/European Economic Area (EEA) countries to find ways to harmonise their procedures, for improvement of cross-border outbreak responses.MethodsIn 2014, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on HAV surveillance practices in EU/EEA countries. The survey enquired whether a referral system for confirming primary diagnostics of hepatitis A existed as well as a central collection/storage of hepatitis A cases' samples for typing. Questions on HAV sequencing procedures were also asked. Based on the results, an expert consultation proposed harmonised procedures for cross-border outbreak response, in particular regarding sequencing. In 2016, a follow-up survey assessed uptake of suggested methods.ResultsOf 31 EU/EEA countries, 23 (2014) and 27 (2016) participated. Numbers of countries with central collection and storage of HAV positive samples and of those performing sequencing increased from 12 to 15 and 12 to 14 respectively in 2016, with all countries typing an overlapping fragment of 218 nt. However, variation existed in the sequenced genomic regions and their lengths.ConclusionsWhile HAV sequences in EU/EEA countries are comparable for surveillance, collaboration in sharing and comparing these can be further strengthened.
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Affiliation(s)
- Theresa Enkirch
- Public Health Agency of Sweden, Solna, Sweden
- European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Ettore Severi
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | - Harry Vennema
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Lelia Thornton
- HSE - Health Protection Surveillance Centre, Dublin, Ireland
| | - Jonathan Dean
- National Virus Reference Laboratory, Dublin, Ireland
| | | | | | | | - Iva Christova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Koye Balogun
- Public Health England (PHE), London, United Kingdom
| | | | - Mia Kontio
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mária Takács
- National Public Health Institute, Budapest, Hungary
| | | | | | - Arthur Löve
- Landspitali- National University Hospital, Reykjavik, Iceland
| | - Ana Avellón
- Carlos III Institute of Health, Madrid, Spain
| | | | - Rita de Sousa
- National Institute of Health Dr. Ricardo Jorge (INSA), Lisbon, Portugal
| | - Denisa Janta
- National Institute of Public Health, Bucharest, Romania
| | | | - Sofieke Klamer
- Scientific Institute of Public Health, Brussels, Belgium
| | - Vanessa Suin
- Sciensano, Directorate Infectious diseases in humans, Brussels, Belgium
| | - Stephan W Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | | | - Kassiani Mellou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | | | | | | | | | - Mario Poljak
- Institute of Microbiology and Immunology, Ljubljana, Slovenia
| | - Line Vold
- Norwegian institute of Public Health, Oslo, Norway
| | | | | | - Thea Kølsen Fischer
- Statens Serum Institut (SSI), Copenhagen, Denmark
- Department of Infectious Diseases and Global Health, University of Southern Denmark, Odense, Denmark
| | - Mirko Faber
- Robert Koch Institute (RKI), Berlin, Germany
| | - Jürgen J Wenzel
- National Reference Laboratory for HAV, Regensburg University Medical Center, Regensburg, Germany
| | - Johanna Takkinen
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Katrin Leitmeyer
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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32
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Tanaka S, Kishi T, Ishihara A, Watanabe D, Uehira T, Ishida H, Shirasaka T, Mita E. Outbreak of hepatitis A linked to European outbreaks among men who have sex with men in Osaka, Japan, from March to July 2018. Hepatol Res 2019; 49:705-710. [PMID: 30656793 DOI: 10.1111/hepr.13314] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/19/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022]
Abstract
AIM Ongoing hepatitis A outbreaks among men who have sex with men (MSM) have been reported worldwide, mainly in Europe, since 2016. In Japan, there has been an increase in the number of notified hepatitis A cases since January 2018, most of which were suspected to have been transmitted through homosexual contact. In this paper, we describe the current outbreak situation of hepatitis A among MSM. METHODS Between March and July 2018, 13 cases of hepatitis A were identified in our hospital. All cases were identified as MSM. Data on clinical and laboratory findings and therapies were collected from medical records. Serum or stool samples were obtained from 13 patients and subjected to sequence analysis. RESULTS Of all patients, 12 reported to have male-to-male homosexual contact within 7 weeks prior to symptom onset, and 6 visited sex-on-premises venues in the same area. Furthermore, 12 patients were infected with HIV and consequently received antiretroviral therapy with sustained viral suppression. Ten patients received pulsed methylprednisolone therapy. Plasma exchange was additionally carried out in one patient. All patients received inpatient hospital care and were discharged alive. Sequence information, which was available in all cases, showed that the hepatitis A virus strain was identical to the EuroPride strain (RIVM-HAV16-090). CONCLUSIONS Results of sequence analysis suggest that the ongoing hepatitis A outbreak among MSM in Japan is linked to the 2016 European outbreaks. A vaccination program is urgently required for high-risk populations to control this ongoing outbreak.
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Affiliation(s)
- Satoshi Tanaka
- Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tomomi Kishi
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Akio Ishihara
- Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Dai Watanabe
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tomoko Uehira
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hisashi Ishida
- Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takuma Shirasaka
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Eiji Mita
- Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan
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Oikonomou KG, Tsai E, Sarpel D, Dieterich DT. Liver Disease in Human Immunodeficiency Virus Infection. Clin Liver Dis 2019; 23:309-329. [PMID: 30947879 DOI: 10.1016/j.cld.2018.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Liver disease in human immunodeficiency virus (HIV) remains a main cause of morbidity and mortality. Liver-related morbidity and mortality can be caused by multiple etiologic factors, including opportunistic infections, direct and indirect effects of antiretrovirals, direct and indirect effects of HIV, and viral hepatitides. These factors present with varied liver pathophysiologic mechanisms that lead to abnormalities in liver enzymes and synthetic function test, followed by distinct clinical presentations. This article elucidates the direct effects on HIV in the liver and explores the diagnostic and management challenges in patients with HIV in the era of highly active antiretroviral treatment.
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Affiliation(s)
- Katerina G Oikonomou
- Icahn School of Medicine at Mount Sinai, 1 Gustav L. Levy Place, New York, NY 10029-6574, USA.
| | - Eugenia Tsai
- Icahn School of Medicine at Mount Sinai, 1 Gustav L. Levy Place, New York, NY 10029-6574, USA
| | - Dost Sarpel
- Icahn School of Medicine at Mount Sinai, 1 Gustav L. Levy Place, New York, NY 10029-6574, USA
| | - Douglas T Dieterich
- Icahn School of Medicine at Mount Sinai, 1 Gustav L. Levy Place, New York, NY 10029-6574, USA
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Watanabe S, Morimoto N, Miura K, Takaoka Y, Nomoto H, Tsukui M, Isoda N, Ohnishi H, Nagashima S, Takahashi M, Okamoto H, Yamamoto H. Full-genome characterization of the RIVM-HAV16-090-like hepatitis A virus strains recovered from Japanese men who have sex with men, with sporadic acute hepatitis A. Hepatol Res 2019; 49:521-530. [PMID: 30645783 DOI: 10.1111/hepr.13313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/29/2018] [Accepted: 01/08/2019] [Indexed: 02/08/2023]
Abstract
AIM The major transmission mode of hepatitis A virus (HAV) in Japan is the fecal-oral route by contaminated foods. In contrast, HAV infection is well documented as a sexually transmitted disease in Europe and North America. The present study was undertaken to determine the full-genome sequence of HAV and trace the transmission route of HAV in Japanese men who have sex with men (MSM). METHODS In 2018, we encountered three Japanese MSM with acute hepatitis A co-infected with HIV for 4-12 years. Serum samples obtained from these patients were used for HAV full-genome analyses. RESULTS Isolated HAV strains were segregated into subgenotype IA. The three HAV strains shared 100% identity within the 481-nucleotide partial sequence. The entire nucleotide sequence showed that the three strains were 99.97% similar to each other with only two nucleotide substitutions. At the amino acid level, the three strains differed from each other by only one or two amino acids. All three strains obtained in the present study were >99.6% identical to the 66 reported strains isolated from Taiwan and European countries during 2015-2017. In addition, these 66 strains include the RIVM-HAV16-090 (EuroPride) strain, which has been involved in HAV outbreaks among MSM worldwide. CONCLUSIONS We determined for the first time the full-genome sequence of HAV isolated from Japanese MSM with acute hepatitis A and found that the strains were identical to those from MSM worldwide. Thus, these HAV strains were imported to Japan from foreign countries through MSM.
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Affiliation(s)
- Shunji Watanabe
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Naoki Morimoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Kouichi Miura
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yoshinari Takaoka
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Hiroaki Nomoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Mamiko Tsukui
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Norio Isoda
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Hiroshi Ohnishi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Shigeo Nagashima
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Masaharu Takahashi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
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Alberts CJ, Boyd A, Bruisten SM, Heijman T, Hogewoning A, Rooijen MV, Siedenburg E, Sonder GJB. Hepatitis A incidence, seroprevalence, and vaccination decision among MSM in Amsterdam, the Netherlands. Vaccine 2019; 37:2849-2856. [PMID: 30992222 DOI: 10.1016/j.vaccine.2019.03.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several outbreaks of Hepatitis A virus (HAV) were recently documented among men who have sex with men (MSM) in Europe. We investigated the HAV incidence among MSM in Amsterdam, the Netherlands; and HAV seroprevalence and HAV vaccination decision among MSM visiting the Sexually Transmitted Infection (STI) clinic in Amsterdam. METHODS Using surveillance data from 1992 to 2017 of MSM with acute HAV in Amsterdam, we estimated the incidence by calendar year and age. We explored HAV seroprevalence by calendar year and age, determinants for HAV seropositivity, and opting-in/out for HAV vaccination using data collected among MSM that visited the STI clinic between 2006 and 2017 and were included in a nationwide Hepatitis B virus (HBV) vaccination programme. Offering HAV vaccination at the STI clinic differed over three consecutive periods: not offered, offered for free, or offered for 75 euros. Logistic regression analyses were used to explore determinants. RESULTS HAV incidence increased in 2016/17 after 4 years of absence and peaked in MSM around 35 years of age. Among MSM visiting the STI clinic, HAV seroprevalence was 37% (95%CI = 35-40%), which was constant over the period 2006-2017, and increased with age (p < 0.001). Determinants for HAV seropositivity in multivariable analysis were: older age (p < 0.001), originating from an HAV endemic country (p < 0.001), and being HBV seropositive (p = 0.001). MSM opted-in more frequently when HAV vaccination was offered for free versus paid (89% versus 11%, respectively; p < 0.001). Younger MSM were less inclined to vaccinate when payment was required (p = 0.010). Post-hoc analyses showed that 98% versus 46% of MSM visiting the Amsterdam STI clinic would be protected against HAV infection if HAV vaccination was offered for free or for 75 euros, respectively. CONCLUSIONS The MSM population of Amsterdam is vulnerable to a new HAV outbreak. We strongly recommend that MSM have access to free hepatitis A vaccination.
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Affiliation(s)
- Catharina J Alberts
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands; INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
| | - Sylvia M Bruisten
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands; Amsterdam Infection & Immunity Institute (AI&II), Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.
| | - Titia Heijman
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands.
| | - Arjan Hogewoning
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands; Amsterdam Infection & Immunity Institute (AI&II), Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.
| | - Martijn van Rooijen
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands.
| | - Evelien Siedenburg
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands.
| | - Gerard J B Sonder
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands; Amsterdam Infection & Immunity Institute (AI&II), Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.
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Souto FJD, de Brito WI, Fontes CJF. Impact of the single-dose universal mass vaccination strategy against hepatitis A in Brazil. Vaccine 2019; 37:771-775. [DOI: 10.1016/j.vaccine.2018.12.054] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 11/15/2022]
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Jayasundara D, Hui BB, Regan DG, Heywood AE, MacIntyre CR, Wood JG. Modelling the decline and future of hepatitis A transmission in Australia. J Viral Hepat 2019; 26:199-207. [PMID: 30315680 DOI: 10.1111/jvh.13018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/23/2018] [Accepted: 09/17/2018] [Indexed: 12/13/2022]
Abstract
Hepatitis A incidence has declined in most countries through a combination of prevention measures, augmented through the use of a highly effective vaccine. In Australia, the proportion of the population susceptible to hepatitis A infection has declined over time due to high rates of opportunistic vaccination as well as the sustained inflow of seropositive immigrants from high-endemicity countries. These factors have contributed to a rapid decline in incidence. An age-structured hepatitis A transmission model incorporating demographic changes was fitted to seroprevalence and disease notification data and used to project incidence trends and transmission potential for hepatitis A in the general population. Robustness of findings was assessed through worst-case scenarios regarding vaccine uptake, migration and the duration of immunity. The decline in age-specific seroprevalence until the introduction of hepatitis A vaccine in 1994 was well explained through a declining basic reproduction number (R0 ) that remained >1. Accounting for existing immunity, we estimated that the effective reproduction number (Reff ) <1 in the general population of Australia since the early 1990s, declining more rapidly after the introduction of the hepatitis A vaccine. Future projections under a variety of scenarios support Reff remaining <1 with continued low incidence in the general population. In conclusion, our results suggest that sustained endemic transmission in the general Australian population is no longer possible although risks of sporadic outbreaks remain. This suggests potential for local elimination of hepatitis A infection in Australia, provided that elimination criteria can be defined and satisfied in risk groups. The methodology used here to investigate elimination potential can easily be replicated in settings such as in the USA where sequential seroprevalence studies are supported by routine notification data.
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Affiliation(s)
- Duleepa Jayasundara
- Faculty of Medicine, School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ben B Hui
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - David G Regan
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Anita E Heywood
- Faculty of Medicine, School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- Faculty of Medicine, School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - James G Wood
- Faculty of Medicine, School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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Acute hepatitis A virus infection in patients hospitalized at the Department of Infectious Diseases, Medical University of Lublin (Eastern Poland) in 2017 - a hospital-based retrospective study. Clin Exp Hepatol 2018; 4:271-274. [PMID: 30603676 PMCID: PMC6311741 DOI: 10.5114/ceh.2018.80131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/11/2018] [Indexed: 11/17/2022] Open
Abstract
The aim of our study was to analyze medical records of all adult patients with acute hepatitis A virus (HAV) infection who were hospitalized at the Department of Infectious Diseases, Medical University of Lublin, Poland in 2017. During the studied period acute HAV infection was confirmed in 33 patients. In the study group there were 30 men and 3 women. The mean time of hospitalization was 12 days. All patients recovered with no clinical sequelae.
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Werner RN, Gaskins M, Nast A, Dressler C. Incidence of sexually transmitted infections in men who have sex with men and who are at substantial risk of HIV infection - A meta-analysis of data from trials and observational studies of HIV pre-exposure prophylaxis. PLoS One 2018; 13:e0208107. [PMID: 30507962 PMCID: PMC6277101 DOI: 10.1371/journal.pone.0208107] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/12/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) and who engage in condomless anal intercourse with casual partners are at high risk of acquiring sexually transmitted infections (STIs), but reliable epidemiological data are scarce. Studies on HIV pre-exposure prophylaxis (PrEP) enrol MSM who indicate that they engage in behaviour that puts them at high risk of acquiring HIV. Because they also screen for STIs at regular intervals, these studies may serve as a valuable source to estimate incidence rates of STIs in this subpopulation of MSM. METHODS We systematically searched for trials and observational studies of PrEP in MSM that reported data on the incidence of STIs during the study period. Incidence rates were calculated as events per 100 person-years (py) with 95% confidence intervals (CI). Data from individual studies were pooled building subgroups along study types and geography. We performed sensitivity analyses, including data only from studies that met pre-defined quality criteria. RESULTS Twenty-four publications on 20 studies were included. The majority of studies reported that sexual behaviour and/or STI incidence remained stable or decreased during the study period. For syphilis, incidence rates ranged from 1.8/100py to 14.9/100py, the pooled estimate was 9.1/100py (95%-CI: 7.7-10.9). Incidence rates for gonorrhoea and chlamydia of any site ranged from 13.3/100py to 43.0/100py and 15.1/100py to 48.5/100py, respectively. Considering only studies that met the criteria for sensitivity analysis yielded pooled estimates of 39.6/100py (95%-CI: 32.9-47.6) and 41.8/100py (95%-CI: 33.9-51.5), respectively. The overall estimate for hepatitis C incidence was 1.3/100py (95%-CI: 1.0-1.8). CONCLUSIONS Despite partly heterogeneous results, the data depict high incidence rates of STIs among MSM who engage in higher-risk sexual behaviours such as condomless sex with casual partners. This subpopulation of MSM requires access to STI screening at close intervals. By offering access to structures that provide regular STI monitoring and prompt treatment, PrEP may not only decrease HIV incidence but also have beneficial effects in decreasing the burden of STIs.
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Affiliation(s)
- Ricardo Niklas Werner
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venerology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | - Matthew Gaskins
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venerology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | - Alexander Nast
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venerology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | - Corinna Dressler
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venerology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
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Sabrià A, Gregori J, Garcia-Cehic D, Guix S, Pumarola T, Manzanares-Laya S, Caylà JA, Bosch A, Quer J, Pintó RM. Evidence for positive selection of hepatitis A virus antigenic variants in vaccinated men-having-sex-with men patients: Implications for immunization policies. EBioMedicine 2018; 39:348-357. [PMID: 30472089 PMCID: PMC6354442 DOI: 10.1016/j.ebiom.2018.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 01/23/2023] Open
Abstract
Background A huge outbreak in the men-having-sex-with-men (MSM) has hit Europe during the years 2016–2018. Outbreak control has been hampered by vaccine shortages in many countries, and to minimize their impact, reduction of antigen doses has been implemented. However, these measures may have consequences on the evolution of hepatitis A virus (HAV), leading to the emergence of antigenic variants. Cases in vaccinated MSM patients have been detected in Barcelona, opening the possibility to study HAV evolution under immune pressure. Methods We performed deep-sequencing analysis of ten overlapping fragments covering the complete capsid coding region of HAV. A total of 14578255 reads were obtained and used for the analysis of virus evolution in vaccinated versus non-vaccinated patients. We estimated maximum and minimum mutation frequencies, and Shannon entropy in the quasispecies of each patient. Non-synonymous (NSyn) mutations affecting residues exposed in the capsid surface were located, with respect to epitopes, using the recently described crystal structure of HAV, as an indication of its potential role in escaping to the effect of vaccines. Findings HAV evolution at the quasispecies level, in non-vaccinated and vaccinated patients, revealed higher diversity in epitope-coding regions of the vaccinated group. Although amino acid replacements occurring in and around the epitopes were observed in both groups, their abundance was significantly higher in the quasispecies of vaccinated patients, indicating ongoing processes of fixation. Interpretation Our data suggest positive selection of antigenic variants in some vaccinated patients, raising concerns for new vaccination polices directed to the MSM group.
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Affiliation(s)
- Aurora Sabrià
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Josep Gregori
- Liver Unit, Internal Medicine Hospital Vall d'Hebron, Autonomous University of Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Roche Diagnostics, S.L., Sant Cugat del Vallés, Barcelona, Spain
| | - Damir Garcia-Cehic
- Liver Unit, Internal Medicine Hospital Vall d'Hebron, Autonomous University of Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Guix
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Virology Unit, Microbiology Department, Hospital Vall d'Hebron, Autonomous University of Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Sandra Manzanares-Laya
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp) del Instituto de Salud Carlos III, Madrid, Spain
| | - Joan A Caylà
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp) del Instituto de Salud Carlos III, Madrid, Spain
| | - Albert Bosch
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Josep Quer
- Liver Unit, Internal Medicine Hospital Vall d'Hebron, Autonomous University of Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain.
| | - Rosa M Pintó
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain.
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Agüero F, Masuet-Aumatell C, Morchon S, Ramon-Torrell JM. Men who have sex with men: A group of travellers with special needs. Travel Med Infect Dis 2018; 28:74-80. [PMID: 30399444 DOI: 10.1016/j.tmaid.2018.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/08/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Fernando Agüero
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Medical Sciences Department, School of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Masuet-Aumatell
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Medical Sciences Department, School of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Morchon
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Medical Sciences Department, School of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Ramon-Torrell
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain; Medical Sciences Department, School of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain.
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Ndumbi P, Freidl GS, Williams CJ, Mårdh O, Varela C, Avellón A, Friesema I, Vennema H, Beebeejaun K, Ngui SL, Edelstein M, Smith-Palmer A, Murphy N, Dean J, Faber M, Wenzel J, Kontio M, Müller L, Midgley SE, Sundqvist L, Ederth JL, Roque-Afonso AM, Couturier E, Klamer S, Rebolledo J, Suin V, Aberle SW, Schmid D, De Sousa R, Augusto GF, Alfonsi V, Del Manso M, Ciccaglione AR, Mellou K, Hadjichristodoulou C, Donachie A, Borg ML, Sočan M, Poljak M, Severi E. 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; 23:1700641. [PMID: 30131095 PMCID: PMC6205254 DOI: 10.2807/1560-7917.es.2018.23.33.1700641] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 03/07/2018] [Indexed: 01/30/2023] Open
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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Affiliation(s)
- Patricia Ndumbi
- European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden
- Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Gudrun S Freidl
- European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Christopher J Williams
- European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden
- Public Health Wales, Cardiff, United Kingdom
| | - Otilia Mårdh
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Carmen Varela
- Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Ana Avellón
- Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Ingrid Friesema
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Harry Vennema
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Siew Lin Ngui
- Public Health England Colindale, London, United Kingdom
| | | | | | - Niamh Murphy
- Health Protection Surveillance Centre, Dublin, Ireland
| | - Jonathan Dean
- National Virus Reference Laboratory, Dublin, Ireland
| | | | | | - Mia Kontio
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | | | | | | | | | - Anne-Marie Roque-Afonso
- Centre National de Référence Virus des hépatites à transmission entérique, Villejuif, France
| | | | | | | | | | | | - Daniela Schmid
- Austrian Agency of Health and Food Safety, Vienna, Austria
| | - Rita De Sousa
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | | | | | | | | | - Alastair Donachie
- European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden
- Health Promotion and Disease Prevention Directorate, Msida, Malta
| | | | - Maja Sočan
- National Institute of Public Health, Ljubljana, Slovenia
| | | | - Ettore Severi
- Karolinska Institutet, Stockholm, Sweden
- European Centre for Disease Prevention and Control, Solna, Sweden
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Thienkrua W, van Griensven F, Mock PA, Dunne EF, Raengsakulrach B, Wimonsate W, Howteerakul N, Ungsedhapand C, Chiwarakorn A, Holtz TH. Young Men Who Have Sex with Men at High Risk for HIV, Bangkok MSM Cohort Study, Thailand 2006-2014. AIDS Behav 2018; 22:2137-2146. [PMID: 29138981 DOI: 10.1007/s10461-017-1963-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
High HIV incidence has been reported in young men who have sex with men (YMSM) in North America and Western Europe, but there are limited data from Southeast Asia suggesting MSM may be the driver of the HIV epidemic in this region. We described HIV incidence and risk factors among 494 YMSM enrolled in a cohort study in Bangkok, Thailand. The HIV incidence was 7.4 per 100 person-years. In multivariable analysis, reporting use of an erectile dysfunction drug in combination with club drugs, having receptive or both insertive and receptive anal intercourse with men, having hepatitis A infection, having rectal Chlamydia trachomatis, having hepatitis B infection prior to HIV seroconversion, and reporting not always using condoms with male steady partners were significantly associated with HIV incidence in YMSM. Reduction in new HIV infections in YMSM are critical to reach targets set by Thailand and the region.
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44
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Chen GJ, Sun HY, Lin KY, Cheng A, Huang YC, Hsieh SM, Sheng WH, Liu WC, Hung CC, Chang SC. Serological responses to revaccination with hepatitis A virus (HAV) vaccines among HIV-positive individuals whose anti-HAV antibody waned after primary vaccination. Liver Int 2018; 38:1198-1205. [PMID: 29240985 DOI: 10.1111/liv.13665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/05/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Among HIV-positive individuals, seroprotection for hepatitis A virus (HAV) following primary vaccination may wane with time. However, seroresponses to HAV revaccination are rarely investigated among HIV-positive patients who have lost protective antibodies after primary vaccination. METHODS During the outbreak of acute hepatitis A in Taiwan after June 2015, HAV-seronegative, HIV-positive individuals were advised to receive two doses of HAV vaccines at 24 weeks apart. A retrospective 1:2 matched case-control study was conducted to compare the seroresponses at weeks 4, 24, 28 and 48 of HAV vaccination between those who underwent revaccination after having lost protective antibodies (case patients) and those who underwent primary vaccination (controls). RESULTS Seventy-five case patients and 150 matched controls were included. The serological response rates were consistently higher among the case patients than controls: 88.1% vs 10.5% at week 4 following the first dose of HAV vaccination (P < .001); 93.3% vs 46.0% at week 24 (immediately before the second dose; P < .001); 98.7% vs 62.7% at week 28 (4 weeks after the second dose; P < .001) and 98.7% vs 92.7% at week 48 (P = .06). The anti-HAV antibody titres as reflected by the semi-quantitative assay for the case patients were also significantly higher than the controls at weeks 24, 28 and 48 following HAV vaccination. CONCLUSIONS We demonstrated faster and better serological responses to HAV revaccination among the HIV-positive individuals who had lost their anti-HAV antibodies after primary vaccination. Single dose of HAV revaccination may provide rapid and sufficient seroresponses for HAV during the outbreak of acute hepatitis A.
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Affiliation(s)
- Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yin Lin
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Chia Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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45
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Greco L, Uceda Renteria SC, Guarneri D, Orlandi A, Zoccoli A, Benardon S, Cusini M, Lunghi G. HEV and HAV seroprevalence in men that have sex with men (MSM): An update from Milan, Italy. J Med Virol 2018; 90:1323-1327. [PMID: 29446470 DOI: 10.1002/jmv.25052] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 02/06/2018] [Indexed: 12/28/2022]
Abstract
Hepatitis E virus (HEV) is a feco-orally transmitted pathogen and one of the most common cause of acute hepatitis worldwide. Recent studies in developed countries suggested that a direct human-to-human contact such as for sexually transmitted diseases may play a significant role in the HEV spread. The aim of this study was to investigate the seroprevalence of HEV and HAV in a group of MSM, including subjects HIV, and Treponema infected, in Milan, Italy. The overall anti HEV IgG seroprevalence in MSM was 10.2% (65/636), instead in the control group the detection rate was 5.2% (15/288) (P < 0.05); the anti HAV seroprevalence was 42.8% in MSM, when in the control group the positivity rate was 29.2% (P < 0.05). The rate of coinfection HEV/HAV was 14.6% in MSM and 1% in control group (P < 0.05). In the future, sexual history, HIV status, and STI risk might address specific investigations to prevent spread of pathogens such HEV in MSM, before becoming a substantial public health problem like for HAV outbreaks.
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Affiliation(s)
- Letizia Greco
- Virology Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara C Uceda Renteria
- Virology Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Guarneri
- Virology Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Orlandi
- Virology Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Zoccoli
- Virology Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Susanna Benardon
- Department of Dermatology, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Cusini
- Department of Dermatology, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Lunghi
- Virology Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
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46
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Colby DJ, Posuwan N, Kroon E, Phanuphak N, Ananworanich J, Robb ML, Phanuphak P, Poovorawan Y. Reply to Chen et al. J Infect Dis 2018; 218:505-507. [DOI: 10.1093/infdis/jiy161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Donn J Colby
- SEARCH, Thai Red Cross AIDS Research Centre, Chulalongkorn University, Bangkok, Thailand
| | - Nawarat Posuwan
- Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok, Thailand
| | - Eugene Kroon
- SEARCH, Thai Red Cross AIDS Research Centre, Chulalongkorn University, Bangkok, Thailand
| | - Nittaya Phanuphak
- SEARCH, Thai Red Cross AIDS Research Centre, Chulalongkorn University, Bangkok, Thailand
| | - Jintanat Ananworanich
- SEARCH, Thai Red Cross AIDS Research Centre, Chulalongkorn University, Bangkok, Thailand
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Merlin L Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | | | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok, Thailand
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47
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Charre C, Ramière C, Roque-Afonso AM, Chidiac C, Zoulim F, Godinot M, Koffi J, Scholtès C, Livrozet JM, Hav Lyon Study Group, Cotte L. Hepatitis A outbreak in HIV-infected MSM and in PrEP-using MSM despite a high level of immunity, Lyon, France, January to June 2017. ACTA ACUST UNITED AC 2018; 22. [PMID: 29208161 PMCID: PMC5725789 DOI: 10.2807/1560-7917.es.2017.22.48.17-00742] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Since 2016, an increase in the number of hepatitis A cases affecting mainly men who have sex with men (MSM) has been reported in low endemic countries in Europe. We calculated the attack rate in Lyon, France, in populations considered at high-risk: HIV-infected MSM and HIV-negative MSM receiving HIV pre-exposure prophylaxis (PrEP). In these populations, high level of immunity did not prevent the outbreak, indicating that vaccination should be reinforced, particularly in younger individuals.
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Affiliation(s)
- Caroline Charre
- Université de Lyon, Lyon, France.,Laboratoire de Virologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Christophe Ramière
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Université de Lyon, Lyon, France.,Laboratoire de Virologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Anne-Marie Roque-Afonso
- National reference centre for hepatitis A virus (Centre national de référence du virus de l'hépatite A), Virologie, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - Christian Chidiac
- Service de maladie infectieuse et tropicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Lyon, France
| | - Fabien Zoulim
- INSERM, U871, Lyon, France.,Service d'Hépatologie et de gastroentérologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Lyon, France
| | - Matthieu Godinot
- Service de maladie infectieuse et tropicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Joseph Koffi
- Service d'Hépatologie et de gastroentérologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Service de maladie infectieuse et tropicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Caroline Scholtès
- INSERM, U871, Lyon, France.,Université de Lyon, Lyon, France.,Laboratoire de Virologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Livrozet
- Service de maladie infectieuse et tropicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Laurent Cotte
- Service de maladie infectieuse et tropicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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48
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Puoti M, Rossotti R, Merli M. Hepatitis A Virus in men who have sex with men: Need for awareness and vaccination. Liver Int 2018; 38:581-584. [PMID: 29575768 DOI: 10.1111/liv.13702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Massimo Puoti
- SC Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Rossotti
- SC Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Merli
- SC Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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49
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Rodríguez-Tajes S, Perpiñán E, Caballol B, Lens S, Mariño Z, Costa J, Vilella A, Pérez-Del-Pulgar S, Forns X, Koutsoudakis G. Hepatitis A outbreak in Barcelona among men who have sex with men (MSM), January-June 2017: A hospital perspective. Liver Int 2018; 38:588-593. [PMID: 28980376 DOI: 10.1111/liv.13606] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/25/2017] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Acute hepatitis A is transmitted mainly via the faecal-oral route and/or contaminated aliment. Furthermore, several outbreaks in the men who have sex with men (MSM) population classified hepatitis A as a sexually transmitted disease (STD). We aimed to clarify an ongoing hepatitis A outbreak in Barcelona with respect to patients' characteristics and viral phylogenetic analysis. METHODS We prospectively analyzed 46 cases of hepatitis A infection that were registered in our hospital between January and June 2017. We evaluated demographics data, risk factors, presenting symptoms, sexual orientation, comorbidities and further STD infections. The phylogenetic correlation of the current circulating viruses among them and other hepatitis A strains was assessed by sequencing of the VP1/P2A region. RESULTS Most patients were male (44, 96%) with median age 33.5 years (range 28-50). Thirty-one (67%) were MSM and 18 (39%) required hospitalization. Molecular phylogenetic analyses revealed that all patients were infected by hepatitis A subgenotype IA strains. Moreover, current strains comprised 3 distinct clusters, previously reported in ongoing outbreaks in the United Kingdom, Berlin and the Netherlands. However, these strains were phylogenetically diverse to those previously reported in Barcelona metropolitan region. CONCLUSIONS Ongoing hepatitis A outbreak in Barcelona affects primarily the MSM community and is phylogenetically linked to current hepatitis A outbreaks described in other European countries. As a result of the high admission rate, these outbreaks may impact the admission pattern of referral liver units. Control measures, for example vaccinations programs tailored to the MSM community, must be taken to control further spreading.
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Affiliation(s)
| | - Elena Perpiñán
- Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | | | - Sabela Lens
- Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Zoe Mariño
- Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Josep Costa
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | - Anna Vilella
- Preventive Medicine and Epidemiology Department, Hospital Clínic, Barcelona, Spain.,Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain.,Public Health Department, University of Barcelona, Barcelona, Spain
| | - Sofía Pérez-Del-Pulgar
- Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - George Koutsoudakis
- Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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50
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Gozlan Y, Bar-Or I, Rakovsky A, Savion M, Amitai Z, Sheffer R, Ceder N, Anis E, Grotto I, Mendelson E, Mor O. 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. ACTA ACUST UNITED AC 2018; 22:30575. [PMID: 28749336 PMCID: PMC5532962 DOI: 10.2807/1560-7917.es.2017.22.29.30575] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/20/2017] [Indexed: 11/25/2022]
Abstract
Between December 2016 and June 2017, 19 Hepatitis A virus (HAV)-positive cases, 17 of which were among men who have sex with men (MSM) were identified in the Tel Aviv area. Seven of the 15 sewage samples collected between January and June 2017 were also HAV-positive. All sequences clustered with two of the three strains identified in the current European HAV outbreak. We demonstrate that despite an efficient vaccination programme, HAV can still be transmitted to an unvaccinated high-risk population.
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Affiliation(s)
- Yael Gozlan
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan
| | - Itay Bar-Or
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan
| | - Aviya Rakovsky
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan
| | - Michal Savion
- Tel-Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Ziva Amitai
- Tel-Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Rivka Sheffer
- Tel-Aviv District Health Office, Ministry of Health, Tel Aviv, Israel
| | - Noa Ceder
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Emilia Anis
- Public Health Services, Ministry of Health, Jerusalem, Israel.,Hebrew University Hadassah Braun School of Public Health and Community Medicine, Jerusalem
| | - Itamar Grotto
- Public Health Services, Ministry of Health, Jerusalem, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan.,School of Public Health, Tel Aviv University, Tel Aviv
| | - Orna Mor
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan
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