Hepatitis A outbreaks in Europe mostly affects men who have sex with men

The European Center for Disease Prevention and Control advised that hepatitis A outbreaks have been spreading across Europe, with most cases reported among unvaccinated men who have sex with men. The ECDC provided recommendations for awareness and prevention, as reported in a rapid risk assessment published Feb. 23, 2017.

“As suggested in our latest rapid risk assessment, further transmission may be prevented by vaccination of men who have sex with men and post-exposure prophylaxis among contacts of those infected,” Andrea Ammon, ECDC acting director, said in a press release. “Limited vaccine availability in some countries may however have an impact on the implementation of such control measures.”

According to the report, outbreaks of hepatitis A in the MSM population is particularly related to direct oral–anal contact during sex, anonymous sex, multiple sex partners and sex-on-premises venues. The ECDC recommends a combination vaccine for both hepatitis A and hepatitis B, which has been shown to be safe with high efficacy.

Since February 2016, the ECDC has confirmed 287 hepatitis A cases with three distinct strains of sub-genotype IA among the following countries: Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden, and the United Kingdom.

Notably, a high number of reported hepatitis A cases were travel-associated, especially with travel to Spain.

The ECDC recommends that in locations where hepatitis A vaccination is not universally offered to MSM or the uptake is low, priority should be focused on MSM who are travelling to destinations reporting outbreaks, living in areas of ongoing outbreaks and those who are at risk for severe outcomes from hepatitis A, such as those with HBV or HCV and those who inject drugs.

The rapid risk assessment provides the following advice on prevention:

Provide primary prevention advice and promote vaccination through health programs, consultation and social media;

Increase awareness about ongoing outbreaks and outbreak locations.

Emphasize the importance of partner notification;

Provide post-exposure prophylaxis to identified sexual, household and other close contacts of those infected;

Raise awareness regarding the risk of contracting hepatitis A through risky sexual behavior, including the importance of personal hygiene and sexual protection such as dental dams and condoms;

Refer all cases of hepatitis A among men who have sex with men to sexual health services for further STI/HIV testing; and

Report cases of hepatitis A to public health authorities where required.

“Most cases are reported among HAV-unvaccinated adult MSM, with only a few women affected. No cases of infected food handlers have been reported associated to these events, nor has there been any indication of associated foodborne transmission. Thus, these clusters are considered mainly propagated by person-to-person sexual transmission,” the researchers conclude in their report. “The multinational dimension of these clusters may be explained by the highly interconnected sexual networks among MSM in Europe. In at least two EU Member States, the United Kingdom and Germany, secondary cases have been linked to travel-associated index cases. The circulation of three different HAV genotype IA strains in the MSM population is likely to be the result of several introductions into these networks.”

Reference: European Centre for Disease Prevention and Control. Hepatitis A outbreaks in the EU/EEA mostly affecting men who have sex with men. http://ecdc.europa.eu/en/publications/Publications/hiv-sti-prevention-among-men-who-have-sex-with-men-guidance.pdf. Published February 23, 2017. Accessed June 16, 2017.