Acute Hepatitis A Outbreak Among Men Who Have Sex With Men in Krakow, Poland; February 2017–February 2018

Abstract

Since February 2017 in Poland, an increasing number of acute hepatitis A (AHA) cases have been reported; a noteworthy increase to 3,072 cases of AHA in 2017 compared to 35 cases in 2016 was reported by the National Institute of Public Health (NIPH). The aim of this study was to evaluate the demographic features, clinical manifestations, laboratory results, and sexually transmitted coinfections. All cases of AHA diagnosed between February 2017 and February 2018 at the University Hospital in Krakow were analyzed. A total of 119 cases of hepatitis A virus (HAV) were reported; 105 (88%) were males and 14 (12%) were females, with a mean age 31 years (range 19–62). In 84 patients (71%), the HAV was transmitted by oral–anal sexual contact between men. Six women were infected by close house contact with men infected with HAV. The route of transmission was not identified for 29 cases, and 88 patients (74%) required hospitalization. Among the cases, the following coinfections were already diagnosed: HIV 36 patients (30%), chronic hepatitis C virus (HCV) 4 patients (3%), and chronic hepatitis B virus (HBV) 2 patients (1.5%). During AHA diagnosis, some new sexually transmitted infections (STIs) were detected; syphilis eight patients (6.7%), HIV/syphilis seven patients (6%), HIV//HCV/syphilis one patient, and acute retroviral syndrome/ Shigella flexneri one patient. Overall, AHA outbreak in Poland in 2017 affected primarily men who have sex with men (MSM) and was connected with oral–anal sexual contacts, and the majority of patients did not have HAV vaccination. These results show a clear need for routinely offering HAV vaccination to at-risk populations and that awareness among health-care workers about HAV sexual transmission may help introduce prevention methods.

Behavioral Intentions to Use Patient Portals to Disclose HIV and Other Sexually Transmitted Infection Testing Histories with Sexual Partners Among U.S. Sexual Minority Men

“…Finally, our analysis does not consider how patient portals may also be used to convey information effectively for public health control of Hepatitis A outbreaks occurring globally among SMM and its connection to fecal-oral transmission. Conversations disclosing testing could easily translate to disclosing Hepatitis A and B (HAV, HBV) vaccinations [54][55][56][57]. SMM are recommended to be vaccinated for HAV and HBV [58,59].…”

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

“…It showed how useful were the different innovative ways in promoting the vaccine in MSM, notably the use of pop-up messages through gay-dating apps in addition to the invaluable role of the community-based organizations [ 26 , 27 ]. While many authors recommended to improve communication toward MSM and to expand access to vaccine during the outbreak [ 18 – 20 , 24 – 28 ], vaccine offer during outreach campaigns e.g. at sexual venues or in mobile clinics, has been rarely documented [ 17 ].…”

“…In 2017, an outbreak extensively affected MSM throughout Europe [ 18 – 24 ]. Early publications reported that three HAV strains of genotype IA (genotype sequences VRD_521_2016, RIVM-HAV16–090 or V16–25801) circulated in several European Union/ European Economic Area (EU/EEA) member States since June 2016 [ 25 – 28 ].…”

Epidemiological investigation on hepatitis A virus infection outbreak in the area of Rzeszow city during the years 2017/18

“…The last outbreak of HAV infection in Europe and North America among MSM and HIV infected individuals should increase awareness among health care professional that infections can be spread by sexual contacts as well [ 22 ]. The vaccination against HAV should be routinely offered among MSM, bisexual, transgender as well as heterosexual with risky sexual behaviors [ 12 , 23 , 24 ].…”