Hepatitis A susceptibility in newly attending men who have sex with men to an urban sexual health centre

Abstract

Within the UK, the majority of hepatitis A occurs in high risk groups such as men who have sex with men (MSM). It has been estimated that 70% of MSM need immunity to provide adequate herd immunity. We aimed to estimate the proportion of hepatitis A susceptibility in MSM throughout a 10-year period (2010–2019), and explore associated demographic factors. Using our Electronic Patient Record system, we extracted anonymous clinical data between for MSM at their first attendance; including hepatitis A IgG result, age, country of birth and diagnosis of an STI. Overall, 1401/6884(20%) were tested for hepatitis A IgG at their first attendance, with 626/1401 (45%, 95% CI = 42%–47%) showing susceptibility. Testing rates increased between 2010–2019 (OR = 67.79, 95%CI = 39.09–117.60, p = <0.0001); however, susceptibility remained similar (OR = 0.98, 95%CI = 0.33–2.89, p = 0.98). MSM aged 35 and under had significantly higher susceptibility vs MSM aged over 35 (OR 3.4176, 95%CI = 2.71–4.31, p = <0.0001). UK-born had significantly higher susceptibility vs non-UK born (OR 1.5, 95%CI = 1.2147–1.8618, p = 0.0002). Susceptibility of hepatitis A in MSM may be higher than necessary to control future outbreaks. It is important that effective targeting of MSM, particularly young MSM, occur at all levels of healthcare and not solely rely on opportunistic presentation at a sexual health clinic.

Factors associated with hepatitis A susceptibility among men who have sex with men using HIV pre-exposure prophylaxis in Northeastern Brazil: A cross-sectional study

“…Young age and having health insurance, as a proxy for better socioeconomic status, were significantly associated with HAV susceptibility in this study, consistent with results reported by other authors [ 18 , 19 , 26 , 27 , 29 , 30 ]. Fecal-oral transmission of HAV is associated with lack of access to safe water and sanitation facilities and poor hygiene [ 3 , 36 ].…”

“…Data on status of immunity to HAV in MSM are scarce in Brazil, hindering the development of public policies focused on prevention. The observed frequency of HAV susceptibility (37.6%; 95% IC: 32.1-43.3) in study participants was lower than that detected among MSM population samples from the Netherlands (63.0%; 95% IC: 60.0-65.0) [18], Estonia (68.0%), [25], France (50.4%), [26] and Italy (57.2%), [27] but similar to rates found in USA (42.0%), [28] Australia (32.0%; 95% CI 29.0-35.0), [29] and United Kingdom (45%; 95% CI: 42.0-47.0) [30] and very similar to that found in a study with MSM from Central Brazil (37.7%) [19]. These regional differences may be explained mainly by distinct socioeconomic patterns among the countries, that are inversely correlated with HAV endemicity levels, but also may result from varying degrees of HAV exposure through sexual behaviors [2,4].…”

Transmission dynamics of the 2016-18 outbreak of hepatitis A among men who have sex with men in England and cost-effectiveness analysis of vaccination strategies to prevent future outbreaks

“…This included data from 725 male outbreak cases between 17 July 2016 to 30 May 2018, which were all assumed to be MSM despite fewer reported as such (n=507). For seroprevalence, pooled data from seven surveys estimated 65·8% (SD=15·0%) of MSM being antibody positive in England in 2018 (Table S3)( 19 , 20 and PHE unpublished data). The calibration (see SI.1.4) involved varying four parameters which were estimated with uncertainty: (1) transmission coefficient; (2) proportion of MSM initially susceptible to infection; (3) reduction in contact rate during the HAV outbreak; and (4) time at which this reduction occurs.…”

British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023

“…Mpox. 6,18,35–37 Patients who are having issues with chemsex use including dependence should be supported using local guidelines.…”