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Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017.
Euro Surveill. 2018 08; 23(33)ES

Abstract

Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16-25801 and RIVM-HAV16-090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16-090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour.

Authors+Show Affiliations

Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain. European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden.National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden.Public Health Wales, Cardiff, United Kingdom. European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden.European Centre for Disease Prevention and Control, Solna, Sweden.Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain.Instituto de Salud Carlos III, CIBER Epidemiología y Salud Pública, Madrid, Spain.National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.Public Health England Colindale, London, United Kingdom.Public Health England Colindale, London, United Kingdom.Public Health England Colindale, London, United Kingdom.Health Protection Scotland, Glasgow, Scotland, United Kingdom.Health Protection Surveillance Centre, Dublin, Ireland.National Virus Reference Laboratory, Dublin, Ireland.Robert Koch Institute, Berlin, Germany.University Hospital Regensburg, Regensburg, Germany.National Institute for Health and Welfare (THL), Helsinki, Finland.Statens Serum Institut, Copenhagen, Denmark.Statens Serum Institut, Copenhagen, Denmark.The Public Health Agency of Sweden, Stockholm, Sweden.The Public Health Agency of Sweden, Stockholm, Sweden.Centre National de Référence Virus des hépatites à transmission entérique, Villejuif, France.Sante publique France, Saint-Maurice, France.Sciensano, Brussels, Belgium.Sciensano, Brussels, Belgium.Sciensano, Brussels, Belgium.Medical University of Vienna, Vienna, Austria.Austrian Agency of Health and Food Safety, Vienna, Austria.National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal.Directorate-General of Health, Lisbon, Portugal.Instituto Superiore Di Sanita, Rome, Italy.Instituto Superiore Di Sanita, Rome, Italy.Instituto Superiore Di Sanita, Rome, Italy.Hellenic Centre for Disease Control, Athens, Greece.University of Thessaly, Larissa, Greece.Health Promotion and Disease Prevention Directorate, Msida, Malta. European Programme for Intervention Epidemiology Training (EPIET)| European Centre for Disease Prevention and Control, Solna, Sweden.Health Promotion and Disease Prevention Directorate, Msida, Malta.National Institute of Public Health, Ljubljana, Slovenia.University of Ljubljana, Ljubljana, Slovenia.European Centre for Disease Prevention and Control, Solna, Sweden.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30131095

Citation

Ndumbi, Patricia, et al. "Hepatitis a Outbreak Disproportionately Affecting Men Who Have Sex With Men (MSM) in the European Union and European Economic Area, June 2016 to May 2017." Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, vol. 23, no. 33, 2018.
Ndumbi P, Freidl GS, Williams CJ, et al. Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017. Euro Surveill. 2018;23(33).
Ndumbi, P., Freidl, G. S., Williams, C. J., Mårdh, O., Varela, C., Avellón, A., Friesema, I., Vennema, H., Beebeejaun, K., Ngui, S. L., Edelstein, M., Smith-Palmer, A., Murphy, N., Dean, J., Faber, M., Wenzel, J., Kontio, M., Müller, L., Midgley, S. E., ... Severi, E. (2018). Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017. Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, 23(33). https://doi.org/10.2807/1560-7917.ES.2018.23.33.1700641
Ndumbi P, et al. Hepatitis a Outbreak Disproportionately Affecting Men Who Have Sex With Men (MSM) in the European Union and European Economic Area, June 2016 to May 2017. Euro Surveill. 2018;23(33) PubMed PMID: 30131095.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hepatitis A outbreak disproportionately affecting men who have sex with men (MSM) in the European Union and European Economic Area, June 2016 to May 2017. AU - Ndumbi,Patricia, AU - Freidl,Gudrun S, AU - Williams,Christopher J, AU - Mårdh,Otilia, AU - Varela,Carmen, AU - Avellón,Ana, AU - Friesema,Ingrid, AU - Vennema,Harry, AU - Beebeejaun,Kazim, AU - Ngui,Siew Lin, AU - Edelstein,Michael, AU - Smith-Palmer,Alison, AU - Murphy,Niamh, AU - Dean,Jonathan, AU - Faber,Mirko, AU - Wenzel,Jürgen, AU - Kontio,Mia, AU - Müller,Luise, AU - Midgley,Sofie Elisabeth, AU - Sundqvist,Lena, AU - Ederth,Josefine Lundberg, AU - Roque-Afonso,Anne-Marie, AU - Couturier,Elisabeth, AU - Klamer,Sofieke, AU - Rebolledo,Javiera, AU - Suin,Vanessa, AU - Aberle,Stephan W, AU - Schmid,Daniela, AU - De Sousa,Rita, AU - Augusto,Gonçalo Figueiredo, AU - Alfonsi,Valeria, AU - Del Manso,Martina, AU - Ciccaglione,Anna Rita, AU - Mellou,Kassiani, AU - Hadjichristodoulou,Christos, AU - Donachie,Alastair, AU - Borg,Maria-Louise, AU - Sočan,Maja, AU - Poljak,Mario, AU - Severi,Ettore, AU - ,, PY - 2018/8/23/entrez PY - 2018/8/23/pubmed PY - 2019/10/2/medline KW - hepatitis A KW - hepatitis A virus KW - men who have sex with men - MSM KW - sexually transmitted infections KW - vaccine-preventable diseases KW - vaccines and immunisation JF - Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin JO - Euro Surveill. VL - 23 IS - 33 N2 - Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16-25801 and RIVM-HAV16-090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16-090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour. SN - 1560-7917 UR - https://www.unboundmedicine.com/medline/citation/30131095/Hepatitis_A_outbreak_disproportionately_affecting_men_who_have_sex_with_men__MSM__in_the_European_Union_and_European_Economic_Area_June_2016_to_May_2017_ L2 - http://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.33.1700641 DB - PRIME DP - Unbound Medicine ER -