An Epidemic Outbreak of Hepatitis a Among Homosexual Men in Stockholm

Abstract

In 1979-1980, a distinct outbreak of hepatitis A occurred among homosexual men in Stockholm, Sweden, city and county area. The epidemic comprised 145 known cases. It began in December 1979 and progressed in waves during the following 10 months, with three distinct peaks separated by about six-week intervals. Actually, the incidence of hepatitis A in the Stockholm area showed a fivefold increase during 1980 as compared to the previous year. Clinical serologic, and social characteristics were studied more closely in 98 of the 145 homosexual men. Verification of hepatitis A was made by a solid-phase radioimmunoassay technique for detection of antibody to hepatitis A virus of the immunoglobulin M class. In addition, 64% of the men showed findings consistent with a prior hepatitis B (antibody to hepatitis B core antigen and/or antibody to hepatitis B surface antigen) and 34% were Treponema pallidum immobilization-positive from a prior or concomitant syphilis. Employment in risk professionals was common; thus, 19% worked in restaurants or otherwise handled food and 20% were engaged in medical care as compared to the 1% occupied in either branch of work among the general population in Sweden. Sexual habits with multiple partners and oral-anal sexual contacts were judged to be of major importance in the spread of this epidemic. Some spread of hepatitis A to the general population probably occurred due to the risk occupations of many homosexual men.

Hepatitis A virus infection and hepatitis A vaccination in human immunodeficiency virus-positive patients: A review

“…Numerous outbreaks of acute hepatitis A have been reported in the MSM population through sexual contacts, which are summarized in Table 2[43-70]. Since the early 1980s, outbreaks of acute hepatitis A among MSM have been described in Denmark[43], Sweden[44], the United Kingdom[45], and the United States[61,62]. The incidence of acute HAV infection among MSM peaked in the 1990s, and the affected countries included the United Kingdom[46,47,49,51], the Netherlands[48], Norway[50], the United States[63,65,66], Canada[64] and Australia[67-70].…”

Sexually transmitted hepatitis: a review.

“…Evidence for transmission of HAV among homosexual men has been reported from London,32 and an epidemic documented in Scandinavia. 33 Recently, an increasing number of cases of hepatitis A among homosexual men have been reported.34 Although the incidence in the general population is at a peak in a 10-year cycle this is not enough to explain the number of reports among homosexual men. The increase may be related to the increased prevalence of oroanal intercourse being adopted as a "safer" practice with respect to HIV transmission, but which still permits transmission of HAV.…”

Are homosexual males a risk group for hepatitis A infection in intermediate endemicity areas?

“…Transmission of hepatitis A virus (HAV) among homosexual males has been reported in different western countries since 1980, including outbreaks in several cities of Europe, North America and Australia [1][2][3][4][5][6][7]. Since the work performed by Corey and Holmes [1] it is well recognized that oral-anal sexual contact predisposes to HAV infection.…”