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Fernandez-Fuertes M, Macias J, Corma-Gomez A, Salazar-Gonzalez A, Gonzalez-Serna A, Rincon P, Arriaza-Estevez MJ, Fuentes-Lopez A, Real LM, Pineda JA. Low rate of vaccination and risk of incident hepatitis A among HIV-infected men who have sex with men in Seville, Southern Spain. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:251-256. [PMID: 37230839 DOI: 10.1016/j.eimce.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/08/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Periodic outbreaks of hepatitis A (HAV) infection in men who have sex with men (MSM) have been reported. Low vaccination uptake in HIV-infected individuals could drive new outbreaks. We aimed at evaluating the incidence of and risk factors for HAV infection in people living with HIV (PLWH) in our area. We also assessed the rates of HAV vaccination. METHODS This was a prospective cohort study. 915 patients were included, 272 (30%) of them were anti-HAV seronegative at baseline. RESULTS Twenty-six (9.6%) susceptible individuals became infected. Incident cases peaked in 2009-2010 and 2017-2018. Incident HAV infection was independently associated with MSM [adjusted odds ratio (95% confidence ratio): 4.39 (1.35-14.27), p=0.014]. One hundred and five (38.6%) HAV seronegative patients were vaccinated, 21 (20%) of them did not respond, and one (1%) patient lost immunity against HAV. Four (29%) non-responders to vaccination showed incident HAV 5-9 years afterwards. CONCLUSIONS The incidence of HAV infection in a cohort of well-controlled PLWH remains low and stable, with intermittent outbreaks involving mainly non-immunized MSM. A significant proportion of PLWH remain susceptible to HAV infection due to insufficient vaccine uptake and limited response to vaccination. Importantly, patients not responding to HAV vaccination continue at risk of infection.
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Affiliation(s)
- Marta Fernandez-Fuertes
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Macias
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; Department of Medicine, University of Sevilla, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Anaïs Corma-Gomez
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Alejandro Gonzalez-Serna
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Rincon
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria J Arriaza-Estevez
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Fuentes-Lopez
- Microbiology Service, Hospital Universitario San Cecilio, Granada, Spain
| | - Luis M Real
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; Department of Surgery, Biochemistry and Immunology, School of Medicine, University of Malaga, Malaga, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan A Pineda
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; Department of Medicine, University of Sevilla, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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2
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Zufan SE, Mercoulia K, Kwong JC, Judd LM, Howden BP, Seemann T, Stinear TP. High-performance enrichment-based genome sequencing to support the investigation of hepatitis A virus outbreaks. Microbiol Spectr 2024; 12:e0283423. [PMID: 38018979 PMCID: PMC10783085 DOI: 10.1128/spectrum.02834-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/14/2023] [Indexed: 11/30/2023] Open
Abstract
IMPORTANCE This proof-of-concept study introduces a hybrid capture oligo panel for whole-genome sequencing of all six human pathogenic hepatitis A virus (HAV) subgenotypes, exhibiting a higher sensitivity than some conventional genotyping assays. The ability of hybrid capture to enrich multiple targets allows for a single, streamlined workflow, thus facilitating the potential harmonization of molecular surveillance of HAV with other enteric viruses. Even challenging sample matrices can be accommodated, making them suitable for broad implementation in clinical and public health laboratories. This innovative approach has significant implications for enhancing multijurisdictional outbreak investigations as well as our understanding of the global diversity and transmission dynamics of HAV.
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Affiliation(s)
- Sara E. Zufan
- The Center for Pathogen Genomics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Karolina Mercoulia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jason C. Kwong
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Louise M. Judd
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Doherty Applied Microbial Genomics, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Benjamin P. Howden
- The Center for Pathogen Genomics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Torsten Seemann
- The Center for Pathogen Genomics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Timothy P. Stinear
- The Center for Pathogen Genomics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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3
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Krumbholz A, Marcic A, Valentin M, Schemmerer M, Wenzel JJ. Hepatitis A outbreak in a refugee shelter in Kiel, northern Germany. J Med Virol 2023; 95:e29185. [PMID: 37916771 DOI: 10.1002/jmv.29185] [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] [Received: 07/27/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
In the spring of 2023, three Ukrainian war refugees from a municipal community shelter and a volunteer caregiver at an affiliated daycare center in Kiel, Germany, were diagnosed with infectious jaundice attributable to a single hepatitis A virus (HAV) subgenotype IA strain. Similar HAV sequences have been observed in Germany and other European countries for several years. One refugee and the volunteer required hospitalization. Four children were asymptomatically infected but excreted high levels of HAV ribonucleic acid in the stool. The infections were probably acquired in Germany, but a source could not be determined. The outbreak was contained through vaccination, increased hygiene, and education. The existing HAV vaccination recommendation for refugee shelter staff and volunteers should be consistently implemented.
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Affiliation(s)
- Andi Krumbholz
- Labor Dr. Krause und Kollegen MVZ GmbH, Kiel, Germany
- Institute for Infection Medicine, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anne Marcic
- Public Health Department of the State Capital Kiel, Kiel, Germany
| | - Malte Valentin
- Public Health Department of the State Capital Kiel, Kiel, Germany
| | - Mathias Schemmerer
- National Consultant Laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - Jürgen J Wenzel
- National Consultant Laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
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4
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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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5
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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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Chen GJ, Sun HY, Lin KY, Hsieh SM, Chuang YC, Liu WD, Huang YS, Pan SC, Wu UI, Cheng A, Huang YC, Wu CH, Su YC, Liu WC, Chang SY, Hung CC. A Randomized Clinical Trial of 1-Dose vs Accelerated 2-Dose Schedule for Hepatitis A Virus (HAV) Revaccination Among People With Human Immunodeficiency Virus Who Were Nonresponders or Had Seroreversion After Primary HAV Vaccination. Clin Infect Dis 2023; 77:529-536. [PMID: 37036404 DOI: 10.1093/cid/ciad206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND For people with human immunodeficiency virus (PWH) who have no serological responses to their primary hepatitis A virus (HAV) vaccination or have seroreversion after successful primary vaccination, the optimal revaccination strategy remains unclear. METHODS In this open-label, randomized clinical trial, PWH who tested negative for anti-HAV antibodies after receiving a standard 2-dose series of primary HAV vaccination were enrolled and assigned in a 1:1 ratio to receive either 1 dose (the 1-dose group) or 2 doses of HAV vaccine administered 4 weeks apart (the 2-dose group). Serological response rates and anti-HAV antibody titers were compared at weeks 24 and 48. RESULTS Of the 153 participants (77 in the 1-dose group and 76 in the 2-dose group), the overall serological response rates at week 48 after revaccination were similar between the 2 groups (2- vs 1-dose, 80.2% vs 71.4%, P = .20). However, anti-HAV antibody titers were consistently higher in the 2-dose group than in the 1-dose group. In subgroup analysis, PWH who were nonresponders to primary HAV vaccination were significantly more likely to mount a serological response after 2-dose HAV revaccination (68.4% vs 44.1%, P = .038). No severe adverse events were reported throughout the study. CONCLUSIONS Two-dose HAV revaccination administered 4 weeks apart yielded similar serological responses as 1-dose revaccination among PWH who were nonresponders or had seroreversion after primary HAV vaccination. The 2-dose revaccination schedule generated significantly higher anti-HAV antibody titers and was more likely to elicit serological responses at week 48 among PWH who were nonresponders to primary HAV vaccination. Clinical Trials Registration. NCT03855176.
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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
- Infection Control Room, Min-Sheng General Hospital, Taoyuan, 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 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
| | - Yu-Chung Chuang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Un-In Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medicine, National Taiwan University Cancer Center, Taipei, 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 Hsinchu Branch, Hsinchu, Taiwan
| | - Cheng-Hsin Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sui-Yuan Chang
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Laboratory 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 Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
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Lin KY, Sun HY, Huang YS, Liu WD, Hsieh SM, Huang SH, Chen GJ, Hung CC. Durability of serologic responses to inactivated hepatitis A virus vaccination among people living with HIV following acute hepatitis A outbreak: a 5-year follow-up study. Emerg Microbes Infect 2023:2239946. [PMID: 37470725 PMCID: PMC10392330 DOI: 10.1080/22221751.2023.2239946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Serologic responses to hepatitis A virus (HAV) vaccination may wane among immunocompromised populations. To evaluate the long-term seroresponses to 2-dose HAV vaccination, we retrospectively included people living with HIV (PLWH) who had achieved seroconversion within 12 months after vaccination at a university hospital during an outbreak of acute hepatitis A between 2015 and 2017. PLWH included in the study received either Havrix or Vaqta. The seroresponses were evaluated 60 months after the second dose of vaccination and estimated by the intention-to-treat (ITT) with last-observation-carried-forward (LOCF) and per-protocol (PP) analyses. Overall, 986 PLWH (median age, 34 years and CD4 count, 587 cells/µL) were included. The rates of PLWH with persistent seroprotection at month 60 of vaccination were 90.7% (894/986) and 97.4% (748/768) in the ITT with LOCF and PP analyses, respectively. PLWH with persistent seroprotection had achieved higher peak anti-HAV IgG titers after vaccination and had a slower decline in antibody levels compared with those with seroreversion. In the multivariable analysis, seroreversion at month 60 was associated with body-mass index (per 1-kg/m2 increase, AOR, 1.10; 95% CI, 1.04-1.17), lowest-ever CD4 count (per 10-cell/µL increase, AOR 0.98; 95% CI, 0.97-1.00), plasma HIV RNA <200 copies/ml at vaccination (AOR, 0.28; 95% CI, 0.14-0.59), and having received Vaqta as the first dose of HAV vaccination (AOR, 0.44; 95% CI, 0.27-0.70). The seroprotection against HAV remained high in the long-term follow-up among PLWH on antiretroviral therapy after 2-dose HAV vaccination. Regular monitoring of seroresponses and timely administration of HAV vaccines are warranted to maintain seroprotection.
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Affiliation(s)
- Kuan-Yin Lin
- 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
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Szu-Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
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8
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Colson P, Penant G, Delerce J, Boschi C, Wurtz N, Bedotto M, Branger S, Brouqui P, Parola P, Lagier JC, Cassir N, Tissot-Dupont H, Million M, Aherfi S, La Scola B. Sequencing of monkeypox virus from infected patients reveals viral genomes with APOBEC3-like editing, gene inactivation, and bacterial agents of skin superinfection. J Med Virol 2023; 95:e28799. [PMID: 37342884 DOI: 10.1002/jmv.28799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023]
Abstract
A large outbreak of Monkeypox virus (MPXV) infections has arisen in May 2022 in nonendemic countries. Here, we performed DNA metagenomics using next-generation sequencing with Illumina or Nanopore technologies for clinical samples from MPXV-infected patients diagnosed between June and July 2022. Classification of the MPXV genomes and determination of their mutational patterns were performed using Nextclade. Twenty-five samples from 25 patients were studied. A MPXV genome was obtained for 18 patients, essentially from skin lesions and rectal swabbing. All 18 genomes were classified in clade IIb, lineage B.1, and we identified four B.1 sublineages (B.1.1, B.1.10, B.1.12, B.1.14). We detected a high number of mutations (range, 64-73) relatively to a 2018 Nigerian genome (genome GenBank Accession no. NC_063383.1), which were harbored by a large part of a set of 3184 MPXV genomes of lineage B.1 recovered from GenBank and Nextstrain; and we detected 35 mutations relatively to genome ON563414.3 (a B.1 lineage reference genome). Nonsynonymous mutations occurred in genes encoding central proteins, among which transcription factors and core and envelope proteins, and included two mutations that would truncate a RNA polymerase subunit and a phospholipase d-like protein, suggesting an alternative start codon and gene inactivation, respectively. A large majority (94%) of nucleotide substitutions were G > A or C > U, suggesting the action of human APOBEC3 enzymes. Finally, >1000 reads were identified as from Staphylococcus aureus and Streptococcus pyogenes for 3 and 6 samples, respectively. These findings warrant a close genomic monitoring of MPXV to get a better picture of the genetic micro-evolution and mutational patterns of this virus, and a close clinical monitoring of skin bacterial superinfection in monkeypox patients.
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Affiliation(s)
- Philippe Colson
- IHU Méditerranée Infection, Marseille, France
- Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Univ., Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Gwilherm Penant
- IHU Méditerranée Infection, Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | | | - Céline Boschi
- IHU Méditerranée Infection, Marseille, France
- Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Univ., Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Nathalie Wurtz
- IHU Méditerranée Infection, Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Marielle Bedotto
- IHU Méditerranée Infection, Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Stéphanie Branger
- Service de Médecine Interne Infectiologie Aïgue Polyvalente, Centre hospitalier d'Avignon, Avignon, France
| | - Philippe Brouqui
- IHU Méditerranée Infection, Marseille, France
- Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Univ., Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Philippe Parola
- IHU Méditerranée Infection, Marseille, France
- Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Univ., Marseille, France
- Institut de Recherche pour le Développement (IRD), Vecteurs - Infections Tropicales et Méditerranéennes (VITROME), Aix-Marseille Univ., Marseille, France
| | - Jean-Christophe Lagier
- IHU Méditerranée Infection, Marseille, France
- Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Univ., Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Nadim Cassir
- IHU Méditerranée Infection, Marseille, France
- Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Univ., Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Hervé Tissot-Dupont
- IHU Méditerranée Infection, Marseille, France
- Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Univ., Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Matthieu Million
- IHU Méditerranée Infection, Marseille, France
- Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Univ., Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Sarah Aherfi
- IHU Méditerranée Infection, Marseille, France
- Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Univ., Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Bernard La Scola
- IHU Méditerranée Infection, Marseille, France
- Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Aix-Marseille Univ., Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
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9
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Richardson D, Pakianathan M, Ewens M, Mitchell H, Mohammed H, Wiseman E, Tweed M, Nichols K, Rawdah W, Cooper R, Macrowan R, Irish M, Evans A, Godbole G. British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023. Int J STD AIDS 2023:9564624231168217. [PMID: 37247427 DOI: 10.1177/09564624231168217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This is the first British Association of Sexual Health and HIV (BASHH) national guideline for the management of sexually transmitted enteric infections (STEI). This guideline is primarily aimed for level 3 sexual health clinics; however, it may also be applicable to other settings such as primary care or other hospital departments where individuals with STEI may present. This guideline makes recommendations on testing, management, partner notification and public health control of STEI.
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Affiliation(s)
- Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | | | | | | | | | | | | | | | - Waseem Rawdah
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Richard Cooper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Amy Evans
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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10
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Kiyohara T, Ishii K, Satake M, Matsubayashi K, Suzuki R, Sugiyama R, Sunagawa T, Muramatsu M. Seroepidemiology of hepatitis A virus infection in Japan: An area of very low endemicity. Microbiol Immunol 2023; 67:14-21. [PMID: 36333781 DOI: 10.1111/1348-0421.13035] [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: 06/23/2022] [Revised: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 11/08/2022]
Abstract
The incidence of hepatitis A virus (HAV) infection has declined significantly worldwide, including in Japan. A nationwide seroepidemiological study on hepatitis A in Japan has taken place almost every 10 years since 1973, and the last study was performed in 2003. In the present study, we describe the latest seroepidemiological pattern of hepatitis A in Japan using 7867 serum specimens obtained from healthy individuals collected between 2013 and 2017, approximately 10 years after the last study. Among them, 223 were anti-HAV positive. About 68% of individuals aged 60 years and older had anti-HAV antibodies, whereas only 1.1% of those aged below 60 years old had immunity; thus, almost all individuals younger than 60 years of age were HAV susceptible. In comparison with previous investigations, the susceptible population has increased and aged. According to data from the National Epidemiological Surveillance of Infectious Diseases (NESID) program, between 1989 and 2016, the proportion of patients with hepatitis A aged 60 years and older continuously increased with each year. The NESID data also suggested that recently, typical large foodborne outbreaks of hepatitis A have become rare, and cases tend to be reported among at-risk groups; overseas travelers contributed to 25% of hepatitis A cases, and in 2018, the first nationwide hepatitis A outbreak that affected mostly men who have sex with men was reported. The purpose of this study was to determine the current status of HAV infection in Japan, based on both seroepidemiology and the national surveillance data from the NESID.
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Affiliation(s)
- Tomoko Kiyohara
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Koji Ishii
- Department of Quality Assurance and Radiological Protection, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masahiro Satake
- Central Blood Institute, Japanese Red Cross Society, Tokyo, Japan
| | | | - Ryosuke Suzuki
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ryuichi Sugiyama
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomimasa Sunagawa
- Center for Field Epidemic Intelligence, Research and Professional Development, Tokyo, Japan
| | - Masamichi Muramatsu
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
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11
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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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12
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Guerrero-Vadillo M, Peñuelas M, Domínguez Á, Godoy P, Gómez-Barroso D, Soldevila N, Izquierdo C, Martínez A, Torner N, Avellón A, Rius C, Varela C. Epidemiological Characteristics and Spatio-Temporal Distribution of Hepatitis A in Spain in the Context of the 2016/2017 European Outbreak. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16775. [PMID: 36554666 PMCID: PMC9778781 DOI: 10.3390/ijerph192416775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
The aim of our study was to describe the results of the epidemiological surveillance of hepatitis A infections in Spain in the context of the 2016/2017 European outbreak, particularly of hepatitis A outbreaks reported in the MSM population, incorporating the results of a spatio-temporal analysis of cases. Hepatitis A cases and outbreaks reported in 2016-2017 to the National Epidemiological Surveillance Network were reviewed: outbreaks in which some of the cases belonged to the MSM group were described, and clusters of hepatitis A cases in men and women were analysed using a space-time scan statistic. Twenty-six outbreaks were identified, with a median size of two cases per outbreak, with most of the outbreak-related cases belonging to the 15-44 years-old group. Nearly 85% occurred in a household setting, and in all outbreaks, the mode of transmission was direct person-to-person contact. Regarding space-time analysis, twenty statistically significant clusters were identified in the male population and eight in the female population; clusters in men presented a higher number of observed cases and affected municipalities, as well as a higher percentage of municipalities classified as large urban areas. The elevated number of cases detected in clusters of men indicates that the number of MSM-related outbreaks may be higher than reported, showing that spatio-temporal analysis is a complementary, useful tool which may improve the detection of outbreaks in settings where epidemiological investigation may be more challenging.
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Affiliation(s)
- María Guerrero-Vadillo
- Doctorate Programme in Biomedical Sciences and Public Health, National University of Distance Education (UNED), 28015 Madrid, Spain
- National Centre for Epidemiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marina Peñuelas
- National Centre for Epidemiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ángela Domínguez
- Departament de Medicina, Universitat de Barcelona (UB), 08036 Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Pere Godoy
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Department of Medicine, Institut de Recerca Biomédica de Lleida (IRBLLeida)-Universidad de Lleida, 25008 Lleida, Spain
| | - Diana Gómez-Barroso
- National Centre for Epidemiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Nuria Soldevila
- Departament de Medicina, Universitat de Barcelona (UB), 08036 Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | | | - Ana Martínez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain
| | - Nuria Torner
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Ana Avellón
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Hepatitis Unit, National Centre of Microbiology, Instituto de Salud Carlos III, 28222 Majadahonda, Spain
| | - Cristina Rius
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - Carmen Varela
- National Centre for Epidemiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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13
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Mac Donald-Ottevanger MS, Prins M, van Dissel J, Rier N, Reimerink J, Zijlmans WCWR, Vreden SGS, Boyd A. Ethnic differences in hepatitis A and E virus seroprevalence in patients attending the Emergency Department, Paramaribo, Suriname. Trans R Soc Trop Med Hyg 2022; 117:197-204. [PMID: 36353973 PMCID: PMC9977238 DOI: 10.1093/trstmh/trac101] [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: 06/06/2022] [Revised: 09/16/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Hepatitis A virus (HAV) and hepatitis E virus (HEV) have enteric modes of transmission and are common causes of acute hepatitis in low- and middle-income countries. HEV is also characterised as a zoonotic infection and is prevalent in high-income countries. Data on HAV and HEV prevalence in Suriname, a middle-income country in South America, are scarce. METHODS Serum samples of 944 and 949 randomly selected patients attending the Emergency Department at the Academic Hospital of Paramaribo, the capital of Suriname, were analysed for anti-HAV antibodies (anti-HAV) and anti-HEV antibodies (anti-HEV), respectively. Determinants of anti-HAV and anti-HEV positive serology were evaluated using multivariable logistic regression. RESULTS Anti-HAV prevalence was 58.3% (95% CI 55.4 to 61.4%) and higher prevalence was independently associated with belonging to the Tribal or Indigenous population and older age. Anti-HEV prevalence was 3.7% (95% CI 2.6 to 5.0%) and higher prevalence was associated with Tribal and Creole ethnicity and older age. CONCLUSIONS In Suriname, exposure to HAV is consistent with a very low endemic country and exposure to HEV was rare. Both viruses were more prevalent in specific ethnic groups. As anti-HAVantibodies were less frequently found in younger individuals, they could be susceptible to potential HAV outbreaks and might require HAV vaccination.
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Affiliation(s)
| | - Maria Prins
- Public Health Service of Amsterdam, Department of Infectious Diseases, Amsterdam 1018 WT, The Netherlands,Amsterdam UMC, Department of Infectious Diseases, Amsterdam Infection and Immunity (AII), University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Jaap van Dissel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven 3720 BA, The Netherlands
| | - Neela Rier
- Department of Medical Microbiology, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Johan Reimerink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven 3720 BA, The Netherlands
| | - Wilco C W R Zijlmans
- Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Stephen G S Vreden
- Foundation for Scientific Research Suriname (SWOS), Paramaribo, Suriname
| | - Anders Boyd
- Public Health Service of Amsterdam, Department of Infectious Diseases, Amsterdam 1018 WT, The Netherlands,Amsterdam UMC, Department of Infectious Diseases, Amsterdam Infection and Immunity (AII), University of Amsterdam, Amsterdam 1105 AZ, The Netherlands,Stichting HIV monitoring, Amsterdam 1105 BD, The Netherlands
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14
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Ferri LP, Junqueira PDS, de Almeida MMS, Oliveira MG, de Oliveira BR, Diniz e Silva BV, Magalhães LS, Villar LM, Caetano KAA, Souza MM, Carneiro MADS, Martins RMB, Teles SA. Viral Hepatitis A, B and C in a Group of Transgender Women in Central Brazil. Trop Med Infect Dis 2022; 7:269. [PMID: 36288010 PMCID: PMC9610098 DOI: 10.3390/tropicalmed7100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Transgender women (TGW) have limited access to affordable viral hepatitis testing, hepatitis B vaccination, and treatment. We aimed to estimate the prevalence of viral hepatitis A, B, and C, as well as to compare the adherence and immunogenicity of two hepatitis B vaccine schedules among TGW in Central Brazil. A total of 440 TGW were interviewed and tested for hepatitis A, B, and C serological markers from 2017 to 2018. The hepatitis B vaccine was offered to 230 eligible TGW: 112 received a super accelerated hepatitis B vaccine schedule (G1) and 118 a standard schedule (G2). The antibody against the hepatitis A virus (HAV) was detected in 75.63% of the participants, and 12.3% of the TGW were exposed to the hepatitis B virus (HBV). Two (0.46%) participants were HBV carriers. Only 41.5% of the participants showed a serological profile of hepatitis B vaccination. The antibody against the hepatitis C virus (anti-HCV) was found in six participants (1.37%). Of the TGW who received the first vaccine dose, 62 (55.36%) and 49 (41.52%) in G1 and G2, respectively, received three doses (p = 0.036). The vaccine response was evaluated in 28 G1 and 22 G2 TGW; of these, 89.3% and 100% developed protective anti-hepatitis B surface-antigen titers, respectively (p = 0.113). Since one-third of younger transgender women are susceptible to HAV, hepatitis B immunization is low, and the anti-HCV rate is higher in this group than in the general population in Central Brazil, public-health attention is warranted. The super-accelerated scheme demonstrated better adhesion and good immunogenicity, suggesting that it would be a more cost-effective solution.
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Affiliation(s)
| | | | | | | | | | | | | | - Lívia Melo Villar
- Laboratory of Viral Hepatitis, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro 21040-900, Brazil
| | | | - Márcia Maria Souza
- Faculty of Nursing, Federal University of Goiás, Goiânia 74690-900, Brazil
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15
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Gouda M, Fitzpatrick C, Williams D, Richardson D. Hepatitis A testing and susceptibility in men who have sex with men: an unintended benefit of PrEP. Sex Health 2022; 19:228-229. [PMID: 35705517 DOI: 10.1071/sh22061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
Hepatitis A is a sexually transmitted enteric infection in men who have sex with men (MSM). HIV pre-exposure prophylaxis (PrEP) has increased opportunities for sexual health interventions in MSM. 588 (372 in 2019, 216 in 2021) MSM attended for the first time in the study periods. MSM were significantly more likely to be screened for Hepatitis A susceptibility in 2021 than 2019 (93% vs 56%, P =0.0001). Susceptibility (Hepatitis A IgG negative) to Hepatitis A did not change between in 2021 and 2019 (48% vs 47%, P =0.921). De-medicalising PrEP is important as it will increase overall uptake. However, coupling PrEP with other sexual health interventions must not be lost.
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Affiliation(s)
- Mahmoud Gouda
- Department of Sexual Health & HIV Medicine, University Hospitals Sussex NHS Foundation Trust, University Hospitals Sussex, Brighton BN2 5BE, UK
| | - Colin Fitzpatrick
- Department of Sexual Health & HIV Medicine, University Hospitals Sussex NHS Foundation Trust, University Hospitals Sussex, Brighton BN2 5BE, UK
| | - Deborah Williams
- Department of Sexual Health & HIV Medicine, University Hospitals Sussex NHS Foundation Trust, University Hospitals Sussex, Brighton BN2 5BE, UK
| | - Daniel Richardson
- Department of Sexual Health & HIV Medicine, University Hospitals Sussex NHS Foundation Trust, University Hospitals Sussex, Brighton BN2 5BE, UK; and Brighton & Sussex Medical School, Brighton, UK
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16
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Martín-Carbonero L, de Miguel R, Serrano L, Bernardino JI, Valencia E, Busca C, Micán R, Montejano R, Moreno V, Pérez-Valero I, Arribas JR, González-García J, Montes M. Acute hepatitis B among HIV positive persons: A two-decade review of cases from a Spanish cohort. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:121-124. [PMID: 35249671 DOI: 10.1016/j.eimce.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/09/2020] [Indexed: 06/14/2023]
Abstract
PURPOSE To review the incidence and characteristics of acute hepatitis B (AHB) in a large cohort of HIV infected persons from a low prevalence region during the last two decades. METHODS Retrospective review of an HIV Cohort from a single reference centre in Madrid, Spain, between 2000 and 2018. AHB was diagnosed in persons with newly acquired HBAgS and acute hepatitis with positive IgM anti-HBc. RESULTS Out of 5443 HIV+ patients in our cohort (3098 anti-HBc negative), 18 developed AHB from 2000 to 2018. The global incidence was 0.02 (0.01-0.04) per 100 patient-year in the entire population and 0.06 (0.01-0.1) per 100 patient-year in the anti-HBc negative population. A statistically significant decrease in AHB incidence was observed during these years (β=-0.006; p=0.047). All 18 patients diagnosed with AHB were men, the majority (16) occurred in men who have sex with men. AHB was observed in 4 persons previously unresponsive to vaccination. Regarding antiretroviral treatment (ART), 15 were not receiving ART, two persons were on ART with any HBV active drugs and one person had lamivudine in the regimen. Two persons (11%) developed chronic hepatitis B. There were no cases of fulminant hepatitis. CONCLUSION The incidence of AHB in HIV positive persons in our cohort was low and shows a progressive decline in the last 20 years. Cases occurred in persons not protected against VHB: not vaccinated or non-responders to vaccine that were not receiving tenofovir.
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Affiliation(s)
- Luz Martín-Carbonero
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain.
| | - Rosa de Miguel
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Lucía Serrano
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Jose I Bernardino
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Eulalia Valencia
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Carmen Busca
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Rafael Micán
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Rocío Montejano
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Victoria Moreno
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Ignacio Pérez-Valero
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Jose Ramón Arribas
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Juan González-García
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Marisa Montes
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
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17
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Genotyping and Molecular Diagnosis of Hepatitis A Virus in Human Clinical Samples Using Multiplex PCR-Based Next-Generation Sequencing. Microorganisms 2022; 10:microorganisms10010100. [PMID: 35056549 PMCID: PMC8779169 DOI: 10.3390/microorganisms10010100] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 02/04/2023] Open
Abstract
Hepatitis A virus (HAV) is a serious threat to public health worldwide. We used multiplex polymerase chain reaction (PCR)-based next-generation sequencing (NGS) to derive information on viral genetic diversity and conduct precise phylogenetic analysis. Four HAV genome sequences were obtained using multiplex PCR-based NGS. HAV whole-genome sequence of one sample was obtained by conventional Sanger sequencing. The HAV strains demonstrated a geographic cluster with sub-genotype IA strains in the Republic of Korea. The phylogenetic pattern of HAV viral protein (VP) 3 region showed no phylogenetic conflict between the whole-genome and partial-genome sequences. The VP3 region in serum and stool samples showed sensitive detection of HAV with differences of quantification that did not exceed <10 copies/μL than the consensus VP4 region using quantitative PCR (qPCR). In conclusion, multiplex PCR-based NGS was implemented to define HAV genotypes using nearly whole-genome sequences obtained directly from hepatitis A patients. The VP3 region might be a potential candidate for tracking the genotypic origin of emerging HAV outbreaks. VP3-specific qPCR was developed for the molecular diagnosis of HAV infection. This study may be useful to predict for the disease management and subsequent development of hepatitis A infection at high risk of severe illness.
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18
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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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19
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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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20
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Migueres M, Lhomme S, Izopet J. Hepatitis A: Epidemiology, High-Risk Groups, Prevention and Research on Antiviral Treatment. Viruses 2021; 13:1900. [PMID: 34696330 PMCID: PMC8540458 DOI: 10.3390/v13101900] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/17/2022] Open
Abstract
The hepatitis A virus (HAV) is a leading cause of acute viral hepatitis worldwide. It is transmitted mainly by direct contact with patients who have been infected or by ingesting contaminated water or food. The virus is endemic in low-income countries where sanitary and sociodemographic conditions are poor. Paradoxically, improving sanitary conditions in these countries, which reduces the incidence of HAV infections, can lead to more severe disease in susceptible adults. The populations of developed countries are highly susceptible to HAV, and large outbreaks can occur when the virus is spread by globalization and by increased travel and movement of foodstuffs. Most of these outbreaks occur among high-risk groups: travellers, men who have sex with men, people who use substances, and people facing homelessness. Hepatitis A infections can be prevented by vaccination; safe and effective vaccines have been available for decades. Several countries have successfully introduced universal mass vaccination for children, but high-risk groups in high-income countries remain insufficiently protected. The development of HAV antivirals may be important to control HAV outbreaks in developed countries where a universal vaccination programme is not recommended.
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Affiliation(s)
- Marion Migueres
- Virology Laboratory, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France; (S.L.); (J.I.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, 31300 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Sébastien Lhomme
- Virology Laboratory, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France; (S.L.); (J.I.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, 31300 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Jacques Izopet
- Virology Laboratory, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France; (S.L.); (J.I.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, 31300 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
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21
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Duarte G, Pezzuto P, Barros TD, Mosimann G, Martinez-Espinosa FE. Brazilian Protocol for Sexually Transmitted Infections 2020: viral hepatitis. Rev Soc Bras Med Trop 2021; 54:e2020834. [PMID: 34008732 PMCID: PMC8210490 DOI: 10.1590/0037-8682-834-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 12/09/2022] Open
Abstract
This article discusses viral hepatitis, a theme addressed by the Clinical Protocol and Therapeutic Guidelines to Comprehensive Care for People with Sexually Transmitted Infections and, more precisely, by the Clinical Protocols and Therapeutic Guidelines for Hepatitis B and Hepatitis C and Coinfections, published by the Brazilian Ministry of Health. Besides the broad spectrum of health impairment, hepatitis A, B, and C viruses also present different transmission forms, whether parenteral, sexual, vertical, or fecal-oral. Among the strategies suggested for the control of viral hepatitis, in addition to behavioral measures, are expanded diagnosis, early vaccination against hepatitis A and hepatitis B viruses, and access to available therapeutic resources. Considering vertical transmission of the hepatitis B and hepatitis C viruses, screening for pregnant women with chronic hepatitis B and C is an essential perinatal health strategy, indicating with precision those who can benefit from the prophylactic interventions. Viral hepatitis A, B, and C are responsible for more than 1.34 million deaths worldwide every year, from which 66% are the result of hepatitis B, 30% of hepatitis C, and 4% of hepatitis A.
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Affiliation(s)
- Geraldo Duarte
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Paula Pezzuto
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | - Tiago Dahrug Barros
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | - Gláucio Mosimann
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
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22
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Duarte G, Pezzuto P, Barros TD, Mosimann Junior G, Martínez-Espinosa FE. [Brazilian Protocol for Sexually Transmitted Infections 2020: viral hepatitis]. ACTA ACUST UNITED AC 2021; 30:e2020834. [PMID: 33729415 DOI: 10.1590/s1679-4974202100016.esp1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/03/2020] [Indexed: 01/01/2023]
Abstract
This article discusses viral hepatitis, a theme addressed by the Clinical Protocol and Therapeutic Guidelines to Comprehensive Care for People with Sexually Transmitted Infections and, more precisely, by the Clinical Protocols and Therapeutic Guidelines for Hepatitis B and Hepatitis C and Coinfections, published by the Brazilian Ministry of Health. Besides the broad spectrum of health impairment, hepatitis A, B and C viruses also present different forms of transmission, whether parenteral, sexual, vertical or oral. Among the strategies suggested for the control of viral hepatitis, in addition to behavioral measures, are expanded diagnosis, early vaccination against hepatitis A and hepatitis B viruses, and access to available therapeutic resources. Considering vertical transmission of the hepatitis B and hepatitis C viruses, screening for pregnant women with chronic hepatitis B and C is an important perinatal health strategy, indicating with precision those who can benefit from the prophylactic interventions.
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Affiliation(s)
- Geraldo Duarte
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Paula Pezzuto
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | - Tiago Dahrug Barros
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
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23
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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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24
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Bauer D, Farthofer A, Chromy D, Simbrunner B, Steininger L, Schmidbauer C, Binter T, Trauner M, Mandorfer M, Schmidt R, Mayer F, Holzmann H, Strassl R, Reiberger T. Recent outbreaks of severe hepatitis A virus infections in Vienna. Eur J Clin Microbiol Infect Dis 2021; 40:335-344. [PMID: 32940811 PMCID: PMC7817601 DOI: 10.1007/s10096-020-04028-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
To explore the epidemiology and clinical course of hepatitis A virus (HAV) infections at the Vienna General Hospital. We retrospectively identified patients who were tested positive for HAV-IgM at the Vienna General Hospital form Q1/2008 to Q3/2018. Our definition of severe HAV infection was AST and/or ALT > 5 × above the upper limit of normal (ULN); and liver dysfunction as (i) hepatic encephalopathy or ammonia > 100 μmol/L, (ii) coagulopathy with INR > 1.5, or (iii) jaundice with bilirubin > 5 mg/dL. A total of 578 HAV-IgM (+) were identified, including 31 (5.4%) and 38 (6.6%) without and with liver dysfunction, respectively. A proportional increase in severe HAV cases with and without liver dysfunction occurred in 2016/2017 with (21.5% (vs. 8.0% in the years before; p < 0.001). Thirty-seven (53.6%) patients with severe HAV were hospitalized, 6 (9%) required ICU support, and one patient received liver transplantation within 30 days. Patients with severe HAV and liver dysfunction were more often male (60.5 vs. 43.1%, p = 0.055) and younger (31.5 vs. 63 years, p < 0.001) as compared with other HAV-IgM (+) cases. The observed increase of severe HAV infections in Vienna in 2017 among young males, coincided with a multinational HAV outbreak among MSM. Our data suggests a higher likelihood of severe courses of hepatitis A in MSM. Vaccination against HAV should be recommended for risk groups.
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Affiliation(s)
- David Bauer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - Anna Farthofer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - David Chromy
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Simbrunner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - Lisa Steininger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - Caroline Schmidbauer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Medicine II, Wilhelminenspital, Vienna, Austria
| | - Teresa Binter
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria
| | - Ralf Schmidt
- Institute of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Mayer
- Institute of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Robert Strassl
- Institute of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
- Vienna HIV & Liver Study Group, Medical University of Vienna, Vienna, Austria.
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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25
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Honda M, Asakura H, Kanda T, Somura Y, Ishii T, Yamana Y, Kaneko T, Mizutani T, Takahashi H, Kumagawa M, Sasaki R, Masuzaki R, Kanezawa S, Nirei K, Yamagami H, Matsumoto N, Nagashima M, Chiba T, Moriyama M. Male-Dominant Hepatitis A Outbreak Observed among Non-HIV-Infected Persons in the Northern Part of Tokyo, Japan. Viruses 2021; 13:v13020207. [PMID: 33573054 PMCID: PMC7910831 DOI: 10.3390/v13020207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
Recently, we experienced an outbreak of acute hepatitis A virus (HAV) infection between 2018 and 2020. Herein, we describe this male-dominant HAV infection outbreak observed among non-human immunodeficiency virus (HIV)-infected persons in the northern part of Tokyo, Japan. Clinical information was collected from patient interviews and from medical record descriptions. In the present study, 21 patients were retrospectively analyzed. A total of 90.4 and 33.3% of patients were males, and men who have sex with men (MSM), respectively. The total bilirubin levels and platelet counts tended to be lower in the MSM group than in the non-MSM group. C-reactive protein (CRP) levels tended to be higher in acute liver failure (ALF) patients than in non-ALF patients. Prolonged cholestasis was observed in one patient (4.8%). We also found that 18 HAV isolates belonged to HAV subgenotype IA/subgroup 13 (S13), which clustered with the HAV isolate (KX151459) that was derived from an outbreak of HAV infection among MSM in Taiwan in 2015. Our results suggest that the application of antivirals against HAV, as well as HAV vaccines, would be useful for the treatment and prevention of severe HAV infection.
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Affiliation(s)
- Masayuki Honda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Hiroyuki Asakura
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Shinjuku, Tokyo 169-0073, Japan; (H.A.); (Y.S.); (M.N.); (T.C.)
| | - Tatsuo Kanda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
- Correspondence: ; Tel.: +81-3-3972-8111; Fax: +81-3-3956-8496
| | - Yoshiko Somura
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Shinjuku, Tokyo 169-0073, Japan; (H.A.); (Y.S.); (M.N.); (T.C.)
| | - Tomotaka Ishii
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Yoichiro Yamana
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Tomohiro Kaneko
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Taku Mizutani
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Hiroshi Takahashi
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Mariko Kumagawa
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Reina Sasaki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Ryota Masuzaki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Shini Kanezawa
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Kazushige Nirei
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Hiroaki Yamagami
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Naoki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
| | - Mami Nagashima
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Shinjuku, Tokyo 169-0073, Japan; (H.A.); (Y.S.); (M.N.); (T.C.)
| | - Takashi Chiba
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Shinjuku, Tokyo 169-0073, Japan; (H.A.); (Y.S.); (M.N.); (T.C.)
| | - Mitsuhiko Moriyama
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi, Tokyo 173-8610, Japan; (M.H.); (T.I.); (Y.Y.); (T.K.); (T.M.); (H.T.); (M.K.); (R.S.); (R.M.); (S.K.); (K.N.); (H.Y.); (N.M.); (M.M.)
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Impact of a Gender-Neutral HPV Vaccination Program in Men Who Have Sex with Men (MSM). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030963. [PMID: 33499347 PMCID: PMC7908442 DOI: 10.3390/ijerph18030963] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/23/2022]
Abstract
A major challenge in human papillomavirus (HPV) vaccine programs is the universal gender-neutral recommendation, as well as estimation of its long-term effect. The objective of this study is to predict the added benefit of male vaccination, especially in men who have sex with men (MSM), and to analyze the impact of the program on society. We propose a mathematical model of the HPV infection based on a network paradigm. Data from Spain allowed constructing the sexual network. HPV force of infection was taken from literature. Different scenarios using variable vaccine coverage in both males and females were studied. Strong herd immunity is shown in the heterosexual population, with an important decrease of HPV 6/11 infections both in men and in unvaccinated women with an only-women vaccination at 14 years of age. No impact of this program occurred in the infection incidence in MSM. This group would only benefit from a vaccination program that includes males. However, the impact at short term would be lower than in heterosexual men. The protection of MSM can only be achieved by direct vaccination of males. This may have important consequences for public health.
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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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Martín-Carbonero L, de Miguel R, Serrano L, Bernardino JI, Valencia E, Busca C, Micán R, Montejano R, Moreno V, Pérez-Valero I, Arribas JR, González-García J, Montes M. Acute hepatitis B among HIV positive persons: A two-decade review of cases from a Spanish cohort. Enferm Infecc Microbiol Clin 2020; 40:S0213-005X(20)30302-5. [PMID: 33268188 DOI: 10.1016/j.eimc.2020.09.012] [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: 07/15/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To review the incidence and characteristics of acute hepatitis B (AHB) in a large cohort of HIV infected persons from a low prevalence region during the last two decades. METHODS Retrospective review of an HIV Cohort from a single reference centre in Madrid, Spain, between 2000 and 2018. AHB was diagnosed in persons with newly acquired HBAgS and acute hepatitis with positive IgM anti-HBc. RESULTS Out of 5443 HIV+ patients in our cohort (3098 anti-HBc negative), 18 developed AHB from 2000 to 2018. The global incidence was 0.02 (0.01-0.04) per 100 patient-year in the entire population and 0.06 (0.01-0.1) per 100 patient-year in the anti-HBc negative population. A statistically significant decrease in AHB incidence was observed during these years (β=-0.006; p=0.047). All 18 patients diagnosed with AHB were men, the majority (16) occurred in men who have sex with men. AHB was observed in 4 persons previously unresponsive to vaccination. Regarding antiretroviral treatment (ART), 15 were not receiving ART, two persons were on ART with any HBV active drugs and one person had lamivudine in the regimen. Two persons (11%) developed chronic hepatitis B. There were no cases of fulminant hepatitis. CONCLUSION The incidence of AHB in HIV positive persons in our cohort was low and shows a progressive decline in the last 20 years. Cases occurred in persons not protected against VHB: not vaccinated or non-responders to vaccine that were not receiving tenofovir.
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Affiliation(s)
- Luz Martín-Carbonero
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain.
| | - Rosa de Miguel
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Lucía Serrano
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Jose I Bernardino
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Eulalia Valencia
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Carmen Busca
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Rafael Micán
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Rocío Montejano
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Victoria Moreno
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Ignacio Pérez-Valero
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Jose Ramón Arribas
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Juan González-García
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
| | - Marisa Montes
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Idipaz, Madrid, Spain
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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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Bien-Gund CH, Zhao P, Cao B, Tang W, Ong JJ, Baral SD, Bauermeister JA, Yang LG, Luo Z, Tucker JD. Providing competent, comprehensive and inclusive sexual health services for men who have sex with men in low- and middle-income countries: a scoping review. Sex Health 2020; 16:320-331. [PMID: 31213225 DOI: 10.1071/sh18191] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
Although men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmissible infections, sexual health services for MSM in low- and middle-income countries (LMIC) remain under-resourced and are poorly understood. A scoping review of literature on MSM sexual health in LMIC was conducted in order to identify key clinical services and gaps in knowledge. Three databases were searched, in addition to hand-reviewing key journals and bulletins, to identify literature with a focus on MSM sexual health. Key services related to providing care to MSM in LMIC that emerged from our review are described. These services include creation of safe and confidential clinic environments, HIV testing services, behavioural interventions, HIV pre-exposure prophylaxis (PrEP), rapid antiretroviral therapy (ART) initiation and STI services. Compared with high-income settings, major differences in LMIC include lack of diagnostic technology, unfavourable legal environments and lack of funding for MSM health. Innovative approaches to healthcare delivery, such as harnessing mobile technology, self-testing and crowdsourcing interventions, can improve health services among MSM in LMIC. There are gaps in the evidence about how best to provide sexual health services for MSM in LMIC settings. Implementation research and scale-up of existing biomedical and behavioural interventions, such as HIV/STI testing services, PrEP and early antiretroviral initiation are urgently needed in LMIC.
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Affiliation(s)
- Cedric H Bien-Gund
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Peipei Zhao
- Shenzhen Nanshan Center for Chronic Disease Control, No. 8 Longyuan Road, Shenzhen 510855, China
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, 3688 Nanhai Avenue, Shenzhen 518060, China
| | - Weiming Tang
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Social Entrepreneurship to Spur Health, No. 2 Lujing Road, Guangzhou 510095, China; and School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC 27516, USA
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Stefan D Baral
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - José A Bauermeister
- Department of Family and Community Health, School of Nursing, 418 Curie Boulevard, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Li-Gang Yang
- Guangdong Provincial STD Control Center, No. 2 Lujing Road, Guangzhou 510095, China
| | - Zhenzhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, No. 8 Longyuan Road, Shenzhen 510855, China
| | - Joseph D Tucker
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Social Entrepreneurship to Spur Health, No. 2 Lujing Road, Guangzhou 510095, China; and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; and Institute of Global Health and Infectious Diseases, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC 27599, USA; and Corresponding author.
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Co-Occurrence of Hepatitis A Infection and Chronic Liver Disease. Int J Mol Sci 2020; 21:ijms21176384. [PMID: 32887515 PMCID: PMC7504211 DOI: 10.3390/ijms21176384] [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] [Received: 08/10/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatitis A virus (HAV) infection occasionally leads to a critical condition in patients with or without chronic liver diseases. Acute-on-chronic liver disease includes acute-on-chronic liver failure (ACLF) and non-ACLF. In this review, we searched the literature concerning the association between HAV infection and chronic liver diseases in PubMed. Chronic liver diseases, such as metabolic associated fatty liver disease and alcoholic liver disease, coinfection with other viruses, and host genetic factors may be associated with severe hepatitis A. It is important to understand these conditions and mechanisms. There may be no etiological correlation between liver failure and HAV infection, but there is an association between the level of chronic liver damage and the severity of acute-on-chronic liver disease. While the application of an HAV vaccination is important for preventing HAV infection, the development of antivirals against HAV may be important for preventing the development of ACLF with HAV infection as an acute insult. The latter is all the more urgent given that the lives of patients with HAV infection and a chronic liver disease of another etiology may be at immediate risk.
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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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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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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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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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Hepatitis A virus infection in an HIV-positive man with previously confirmed immunity against hepatitis A virus. Clin J Gastroenterol 2020; 13:844-846. [PMID: 32036552 DOI: 10.1007/s12328-020-01102-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
A Japanese man with human immunodeficiency virus (HIV) was detected 9 years ago to have a positive titer for hepatitis A virus (HAV) immunoglobulin (Ig) G, without a history of HAV infection or vaccination. His plasma HIV RNA was well-controlled on antiretroviral therapy for more than 6 years. He developed HAV infection with subsequent reduction of the HAV IgG titer. A decreasing HAV IgG in persons living with HIV might indicate the possibility of HAV reinfection and should prompt the consideration for additional vaccination.
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Rossotti R, Puoti M. Sexually Transmitted Hepatitis. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Probert WS, Gonzalez C, Espinosa A, Hacker JK. Molecular Genotyping of Hepatitis A Virus, California, USA, 2017-2018. Emerg Infect Dis 2019; 25:1594-1596. [PMID: 31310213 PMCID: PMC6649344 DOI: 10.3201/eid2508.181489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We implemented subgenomic and whole-genome sequencing to support the investigation of a large hepatitis A virus outbreak among persons experiencing homelessness, users of illicit drugs, or both in California, USA, during 2017-2018. Genotyping data helped confirm case-patients, track chains of transmission, and monitor the effectiveness of public health control measures.
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Díaz NA, Ambrosioni J. HIV-1 primary infection and acute hepatitis A: Beware of co-infection! Enferm Infecc Microbiol Clin 2019; 38:345-347. [PMID: 31862116 DOI: 10.1016/j.eimc.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Natalia Anahí Díaz
- Infectious Diseases Service, Hospital Cesar Milstein, Buenos Aires, Argentina; Infectious Diseases Service, Hospital Clinic-IDIPABS, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIPABS, Barcelona, Spain.
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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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42
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Guillaume M, Mouna L, Coustillères F, Lemée V, Roque-Afonso AM, Mourez T, Lefaucheur R. Invasive meningoencephalitis as the first manifestation of hepatitis A. J Viral Hepat 2019; 26:1330-1333. [PMID: 31319008 DOI: 10.1111/jvh.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/27/2019] [Accepted: 06/13/2019] [Indexed: 12/09/2022]
Abstract
Since mid-2016, Europe has been facing a major hepatitis A epidemic, with more than 25 000 cases reported to the European CDC, in 2018. We describe herein a rare case of invasive HAV meningoencephalitis as a prodrome of the classic hepatitis, which largely explains a delay in diagnosis.
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Affiliation(s)
- Maxime Guillaume
- Rouen University Hospital, Department of Neurology, Rouen, France
| | - Lina Mouna
- AP-HP, Paul Brousse Hospital, Virology, National Reference Center for HAV, Université Paris Sud, INSERM 1193, Villejuif, France
| | | | - Véronique Lemée
- UNIROUEN, EA2656, GRAM, Rouen University Hospital, Normandie Univ, Rouen, France
| | - Anne-Marie Roque-Afonso
- AP-HP, Paul Brousse Hospital, Virology, National Reference Center for HAV, Université Paris Sud, INSERM 1193, Villejuif, France
| | - Thomas Mourez
- UNIROUEN, EA2656, GRAM, Rouen University Hospital, Normandie Univ, Rouen, France
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43
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Lee YL, Chen GJ, Chen NY, Liou BH, Wang NC, Lee YT, Yang CJ, Huang YS, Tang HJ, Huang SS, Lin YC, Cheng CY, Lee CH, Chen TC, Wu TS, Liu CE, Lu PL, Hung CC. Less Severe but Prolonged Course of Acute Hepatitis A in Human Immunodeficiency Virus (HIV)-Infected Patients Compared With HIV-Uninfected Patients During an Outbreak: A Multicenter Observational Study. Clin Infect Dis 2019; 67:1595-1602. [PMID: 29672699 DOI: 10.1093/cid/ciy328] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/13/2018] [Indexed: 01/22/2023] Open
Abstract
Background This multicenter retrospective cohort study aimed to compare the clinical presentations and evolution of acute hepatitis A (AHA) between human immunodeficiency virus (HIV)-infected patients and HIV-uninfected counterparts during the AHA outbreak. Methods Clinical and laboratory data were collected from the medical records of the patients with AHA at the 14 hospitals around Taiwan between May 2015 and May 2017. Results A total of 297 adult patients with AHA were included during the study period. Their mean age was 31.4 years (range, 19.0-76.1 years); 93.4% were men and 58.6% were men who have sex with men. Of 265 patients with known HIV serostatus, 166 (62.6%) were HIV infected. Compared with HIV-uninfected patients, HIV-infected patients had a lower peak alanine aminotransferase (ALT) level (median, 1312 vs 2014 IU/L, P = .003), less coagulopathy (6.0% vs 16.2%, P = .007), and less hepatomegaly or splenomegaly on imaging studies, but a higher rate of delayed resolution of hepatitis (38.8% vs 21.3%, P = .009). HIV-infected patients with plasma RNA load <1000 copies/mL while receiving combination antiretroviral therapy (cART) had a higher peak ALT level (median, 1420 vs 978 IU/L, P = .006) and less delay in resolution of hepatitis (30.6% vs 48.8%, P = .047) than patients without cART or with plasma RNA load ≥1000 copies/mL. Conclusions During an AHA outbreak, HIV-infected patients had a lower severity, but delayed resolution, of AHA than HIV-uninfected patients. Better viral suppression by cART alleviated the impact of HIV infection on the disease course of AHA in HIV-infected patients.
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Affiliation(s)
- Yu-Lin Lee
- Department of Internal Medicine, Changhua Christian Hospital, Taipei
| | - Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Nan-Yu Chen
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Bo-Huang Liou
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, National Defense Medical Center, Taipei
| | - Ning-Chi Wang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Yuan-Ti Lee
- School of Medicine, Chung Shan Medical University, Taichung.,Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung
| | - Chia-Jui Yang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City.,School of Medicine, National Yang-Ming University, Taipei
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan
| | - Shie-Shian Huang
- Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Taipei
| | - Yi-Chun Lin
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taipei
| | - Chien-Yu Cheng
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taipei.,School of Public Health, National Yang-Ming University, Taipei
| | - Chen-Hsiang Lee
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taipei.,Chang Gung University College of Medicine, Taipei
| | - Tun-Chieh Chen
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Taipei.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Taipei
| | - Ting-Shu Wu
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Chun-Eng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Taipei
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Taipei.,College of Medicine, Kaohsiung Medical University, Taipei
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.,Department of Parasitology, National Taiwan University College of Medicine, Taipei
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44
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Kroneman A, de Sousa R, Verhoef L, Koopmans MPG, Vennema H, On Behalf Of The HAVNet Network. Usability of the international HAVNet hepatitis A virus database for geographical annotation, backtracing and outbreak detection. ACTA ACUST UNITED AC 2019; 23. [PMID: 30229723 PMCID: PMC6144472 DOI: 10.2807/1560-7917.es.2018.23.37.1700802] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
HAVNet is an international laboratory network sharing sequences and corresponding metadata on hepatitis A virus in an online database. Aim: We give an overview of the epidemiological and genetic data and assess the usability of the present dataset for geographical annotation, backtracing and outbreak detection. Methods: A descriptive analysis was performed on the timeliness, completeness, epidemiological data and geographic coverage of the dataset. Length and genomic region of the sequences were reviewed as well as the numerical and geographical distribution of the genotypes. The geographical signal in the sequences was assessed based on a short common nt stretch using a 100% identity analysis. Results: The 9,211 reports were heterogeneous for completeness and timeliness, and for length and genomic region of the sequences. Some parts of the world were not represented by the sequences. Geographical differences in prevalence of HAV genotypes described previously could be confirmed with this dataset and for a third (1,075/3,124) of the included sequences, 100% identity of the short common sequence coincided with an identical country of origin. Conclusion: Analysis of a subset of short, shared sequences indicates that a geographical annotation on the level of individual countries is possible with the HAVNet data. If the current incompleteness and heterogeneity of the data can be improved on, HAVNet could become very useful as a worldwide reference set for geographical annotation and for backtracing and outbreak detection.
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Affiliation(s)
- Annelies Kroneman
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Rita de Sousa
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Linda Verhoef
- Office for Risk Assessment and Research, Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht, the Netherlands (current affiliation).,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
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45
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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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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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47
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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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48
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Recent epidemiology of sexually transmissible enteric infections in men who have sex with men. Curr Opin Infect Dis 2019; 31:50-56. [PMID: 29251673 DOI: 10.1097/qco.0000000000000423] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Sexual transmission of enteric pathogens in men who have sex with men (MSM) has been described since the 1970s. Recently, an increasing number of enteric infection outbreaks have been reported in MSM. This article summarizes recent outbreaks and discusses the key issues for prevention and control. RECENT FINDINGS Sexually transmissible enteric infections (STEIs) can spread rapidly and internationally within highly connected MSM populations and are often associated with antimicrobial resistance (AMR). The infections often cluster in high-risk groups of HIV-positive MSM who are more likely to engage in diverse sexual practices and chemsex, and to have multiple other sexually transmitted infections (STIs). SUMMARY The roles of asymptomatic and/or persistent infection and other contextual factors in STEI transmission are not well described. STEI-associated AMR is increasing and has potential to spread rapidly in MSM, warranting further public health attention. A better understanding of the factors associated with sexual transmission will enable the development of more effective control measures. A holistic approach that promotes health and wellbeing as well as infection prevention and management is needed.
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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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50
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Heendeniya A, Bogoch II. Antiretroviral Medications for the Prevention of HIV Infection: A Clinical Approach to Preexposure Prophylaxis, Postexposure Prophylaxis, and Treatment as Prevention. Infect Dis Clin North Am 2019; 33:629-646. [PMID: 31239092 DOI: 10.1016/j.idc.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preventing new human immunodeficiency virus (HIV) infections is essential to halting the global pandemic. HIV prevention strategies include integrating both nonpharmacologic (eg, safe sexual counseling, circumcision) and pharmacologic approaches. Several pharmacologic HIV prevention strategies are increasingly used globally and include postexposure prophylaxis, preexposure prophylaxis, and treatment as prevention. These prevention modalities have enormous clinical and public health appeal, as they effectively reduce HIV acquisition in individuals and also may lower HIV incidence in communities when integrated and implemented broadly. Efforts are now underway to scale HIV prevention programs using these techniques in both high- and low-resource settings.
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Affiliation(s)
- Amila Heendeniya
- Division of Infectious Diseases, Toronto General Hospital, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Isaac I Bogoch
- Division of Infectious Diseases, Toronto General Hospital, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, Ontario M5G 2C4, Canada; Division of General Internal Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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