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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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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] [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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Ndumbi P, Freidl GS, Williams CJ, Mårdh O, Varela C, Avellón A, Friesema I, Vennema H, Beebeejaun K, Ngui SL, Edelstein M, Smith-Palmer A, Murphy N, Dean J, Faber M, Wenzel J, Kontio M, Müller L, Midgley SE, Sundqvist L, Ederth JL, Roque-Afonso AM, Couturier E, Klamer S, Rebolledo J, Suin V, Aberle SW, Schmid D, De Sousa R, Augusto GF, Alfonsi V, Del Manso M, Ciccaglione AR, Mellou K, Hadjichristodoulou C, Donachie A, Borg ML, Sočan M, Poljak M, Severi E. Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017. Euro Surveill 2018; 23:1700641. [PMID: 30131095 PMCID: PMC6205254 DOI: 10.2807/1560-7917.es.2018.23.33.1700641] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 03/07/2018] [Indexed: 01/30/2023] Open
Abstract
Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16-25801 and RIVM-HAV16-090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16-090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour.
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Affiliation(s)
- Patricia Ndumbi
- European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden
- Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Gudrun S Freidl
- European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Christopher J Williams
- European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden
- Public Health Wales, Cardiff, United Kingdom
| | - Otilia Mårdh
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Carmen Varela
- Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Ana Avellón
- Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Ingrid Friesema
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Harry Vennema
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Siew Lin Ngui
- Public Health England Colindale, London, United Kingdom
| | | | | | - Niamh Murphy
- Health Protection Surveillance Centre, Dublin, Ireland
| | - Jonathan Dean
- National Virus Reference Laboratory, Dublin, Ireland
| | | | | | - Mia Kontio
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | | | | | | | | | - Anne-Marie Roque-Afonso
- Centre National de Référence Virus des hépatites à transmission entérique, Villejuif, France
| | | | | | | | | | | | - Daniela Schmid
- Austrian Agency of Health and Food Safety, Vienna, Austria
| | - Rita De Sousa
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | | | | | | | | | - Alastair Donachie
- European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden
- Health Promotion and Disease Prevention Directorate, Msida, Malta
| | | | - Maja Sočan
- National Institute of Public Health, Ljubljana, Slovenia
| | | | - Ettore Severi
- Karolinska Institutet, Stockholm, Sweden
- European Centre for Disease Prevention and Control, Solna, Sweden
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Epidemiology of sexually transmitted viral hepatitis in human immunodeficiency virus-positive men who have sex with men in Asia. J Formos Med Assoc 2015; 114:1154-61. [PMID: 26375778 DOI: 10.1016/j.jfma.2015.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/02/2015] [Accepted: 08/11/2015] [Indexed: 01/10/2023] Open
Abstract
Both human immunodeficiency virus (HIV) and viral hepatitis constitute major disease burden globally. As with other parts of the world, the HIV epidemic in Asia impacts mainly on men who have sex with men, one of the at-risk populations for sexually transmitted viral hepatitis. With the increasing availability of effective antiretroviral therapy, HIV-related mortality of people living with HIV has markedly reduced. Liver disease has become an important cause of mortality and morbidity in the HIV-infected population. With the improvement of socioeconomic conditions and availability of healthcare in Asian countries in recent years, the epidemiology of sexually transmitted viral hepatitis among HIV-positive men who have sex with men has also evolved. This review updates the epidemiology of different types of sexually transmitted viral hepatitis in this defined population in Asia.
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Baek JH, Kim CO, Park JY, Jeong SJ, Koo NS, Kim HW, Han SH, Choi JY, Song YG, Kim JM. Clinical factors associated with hepatitis A virus seropositivity in HIV-infected adults living in a country with an epidemiologic shift for hepatitis A virus infection. J Korean Med Sci 2012; 27:969-71. [PMID: 22876069 PMCID: PMC3410250 DOI: 10.3346/jkms.2012.27.8.969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/20/2012] [Indexed: 01/13/2023] Open
Abstract
The number of HIV-infected individuals susceptible to Hepatitis A virus (HAV) infection is increasing in Korea; however, it has proven difficult to devise a vaccination policy therefore because limited seroepidemiologic data exists for them. Accordingly, anti-HAV IgG was measured in 188 HIV-infected adults between July 2008 and July 2010. The nadir CD4+ T lymphocyte counts were not different between the HAV-positive and -negative groups (197 ± 138 vs 202 ± 129, P = 0.821). The only factor independently associated with seropositive status was age under 40 yr old (OR 0.017, P < 0.001). Our findings suggest that HAV vaccination in HIV-infected adults should be targeted at persons under the age of 40 yr.
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Affiliation(s)
- Ji Hyeon Baek
- Department of Infectious Disease, Inha University Hospital, Incheon, Korea
| | - Chang Oh Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine and Liver Cirrhosis Clinical Research Centre, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Soo Koo
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Won Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Han
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Song
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
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