Recent outbreaks of severe hepatitis A virus infections in Vienna

Bauer, David JM; Farthofer, Anna; Chromy, David; Simbrunner, Benedikt; Steininger, Lisa; Schmidbauer, Caroline; Binter, Teresa; Trauner, Michael; Mandorfer, Mattias; Schmidt, Ralf; Mayer, Florian; Holzmann, Heidemarie; Straßl, Robert; Reiberger, Thomas

doi:10.1007/s10096-020-04028-x

Cited by 14 publications

(9 citation statements)

References 22 publications

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“…Overall, we observed stable numbers of HEV infections—despite increasing numbers of HEV-IgM and IgG tests—and stable numbers of severe disease courses without and with liver dysfunction during the study period. This increase in HEV-IgM and IgG tested individuals is comparable to the increase in testing for other hepatotropic viruses at our center (e.g., HAV) [ 25 ]. The sensitivity and specificity especially of the serological HEV tests used increased over the observation period.…”

Section: Discussionsupporting

confidence: 70%

Low mortality despite temporary liver dysfunction in severe courses of acute hepatitis E

Bauer

Aberle

Farthofer

et al. 2022

Wien Klin Wochenschr

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Summary Background Hepatitis E virus (HEV) infection can cause severe viral hepatitis and eventually liver failure. We aim to provide novel data on the epidemiology and the course of HEV infections from Q1/2008 to Q3/2018 at the Vienna General Hospital. Methods Of the 88,945 people tested, we identified HEV-IgM positive (+) or HEV-PCR (+) patients and retrospectively collated information on the course of infection from patient records. Results Among 151 HEV-IgM or PCR (+) (median age 51 years, 45.8% female), 7 (4.6%) had non-severe acute HEV infection (ALT ≥ 2–5-fold upper limit of normal, ULN), 11 (7.3%) had severe HEV infection without liver dysfunction (LD) (ALT > 5-fold ULN), and 9 (6.0%) with LD (ikterus or bilirubin > 5 mg/dL, OR coagulopathy or INR > 1.5, OR encephalopathy or ammonia > 100 µmol/L). HEV-RNA-PCR was performed in 58/190 (30.5%) HEV-IgM (+) patients and was positive in 19 (30.6%). Rates of HEV IgM/PCR positivity remained stable over the observation period. The HEV genotype (GT) was GT‑1 in 71.4% (n = 5) and GT‑3 in 28.6% (n = 2). Travel history was recorded for 9/20 (45.0%) of severe HEV and 12/20 (60.0%) patients with severe HEV infection were hospitalized. One patient with pre-existing liver disease and concomitant EBV infection required intensive care. No patient required transplantation and the 30-day mortality was 3/151 (1.9%). Despite the increased testing rates, the absolute number of diagnosed HEV infections at Vienna General Hospital remained constant between 2008 to 2018. Conclusion Although approximately half of the patients with severe acute HEV infection required hospitalization, admissions to the intensive care unit (ICU) and short-term mortality were low.

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Section: Discussionsupporting

confidence: 70%

Low mortality despite temporary liver dysfunction in severe courses of acute hepatitis E

Bauer

Aberle

Farthofer

et al. 2022

Wien Klin Wochenschr

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“…During November 2016 to December 2017 in Asturias, Spain, the HAV outbreak was associated with more severe hepatitis and more cases with positive syphilis serology compared to the period from January 2004 to September 2016 [ 22 ]. In Vienna, there was an increase of severe HAV infections among young males in 2016/2017: 21.5% vs. 8.0% in 2008–2016 with liver dysfunction, p < 0.001 [ 36 ]. Between January and June 2017, 44 HAV cases were registered at the hospital in Barcelona; the vast majority (96%) were male, 67% were MSM, and 39% required hospitalization [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Hepatitis A Outbreak in Men Who Have Sex with Men Using Pre-Exposure Prophylaxis and People Living with HIV in Croatia, January to October 2022

Bogdanić

Begovać

Močibob

et al. 2022

Viruses

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The hepatitis A virus (HAV) is a highly hepatotropic virus transmitted mainly via the fecal–oral route. The purpose of this study is to describe a prolonged HAV outbreak in HIV-infected men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users in Croatia in 2022. Croatia has a centralized system of HIV care and the PrEP service is only available at the University Hospital for Infectious Diseases (UHID), Zagreb. We reviewed all MSM living with HIV and MSM PrEP users at UHID and identified those diagnosed with HAV between January and October 2022. During this period, a total of 1036 MSM living with HIV and 361 PrEP users were followed, and 45 (4.4%) and 32 (8.9%) were diagnosed with HAV, respectively. Most cases were diagnosed in mid-February. A total of 70.1% (726/1036) MSM living with HIV and 82.3% (297/361) PrEP users were susceptible to HAV. Sequencing information was available for 34 persons; in all cases the HAV subtype IA was found. Our findings indicate that both MSM living with HIV and HIV-uninfected PrEP users are vulnerable to HAV infection and might be a potential source for a more widespread HAV epidemic.

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“…Studies have reported a major outbreak of hepatitis A that swept through European and American countries between mid-2016 and 2017, mainly within the MSM community [25][26][27][28]. Bauer et al [6], in a study carried out in Vienna coinciding with a multinational hepatitis A outbreak in MSM, reported 53.6% of patients were hospitalized with severe disease, 9% required ICU support, and one patient received a liver transplant within 30 days. Spanish studies have found that recent hepatitis A outbreaks were closely related to a younger age and sexual practices [29,30].…”

Section: Discussionmentioning

confidence: 99%

“…Although unusual in low endemic countries, hepatic failure requiring transplantation and death from hepatitis A may also occur [6].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010–2018

et al. 2021

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We compared the cumulative incidence and characteristics of hepatitis A outbreaks in two groups of Spanish autonomous regions according to whether a universal or risk group vaccination strategy was followed. Outbreaks between 2010 and 2018 were analyzed. The cumulative incidence rate of outbreaks was estimated and compared by estimating the rate ratio (RR). The characteristics of the outbreaks and those of the first cases were compared. Adjusted OR (aOR) were calculated using a multivariate logistic regression model. Outbreak incidence was 16.04 per million persons in regions with universal vaccination and 20.76 in those with risk-group vaccination (RR 0.77; 95%CI 0.62–0.94). Imported outbreaks accounted for 65% in regions with universal vaccination and 28.7% in regions with risk-group vaccination (aOR 3.88; 95%CI 2.13–7.09). Adolescents and young adults aged 15–44 years and men who have sex with men were less frequently the first case of the outbreak in regions with a universal vaccination strategy (aOR 0.54; 95%CI 0.32–0.92 and 0.23; 95%CI 0.07–0.82, respectively). The cumulative incidence rate of outbreaks was lower in regions with universal vaccination. In all regions, independently of the vaccination strategy, activities to vaccinate persons belonging to high-risk groups for infection should be emphasized.

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Recent outbreaks of severe hepatitis A virus infections in Vienna

Cited by 14 publications

References 22 publications

Low mortality despite temporary liver dysfunction in severe courses of acute hepatitis E

Low mortality despite temporary liver dysfunction in severe courses of acute hepatitis E

Hepatitis A Outbreak in Men Who Have Sex with Men Using Pre-Exposure Prophylaxis and People Living with HIV in Croatia, January to October 2022

Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010–2018

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