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. 2012 Jan 20:12:11.
doi: 10.1186/1471-2334-12-11.

Hepatitis A among men who have sex with men in Barcelona, 1989-2010: insufficient control and need for new approaches

Cecilia Tortajada  1 , Patricia G de Olalla, Elia Diez, Rosa M Pinto, Albert Bosch, Unai Perez, Milagros Sanz, Joan A Caylà; Saunas Working Group
Affiliations

Hepatitis A among men who have sex with men in Barcelona, 1989-2010: insufficient control and need for new approaches

Cecilia Tortajada et al. BMC Infect Dis. .

Abstract

Background: Men who have sex with men (MSM) are a known group at risk for hepatitis A and outbreaks among this group are frequent. In Barcelona, vaccination for MSM has been recommended since 1994. In 1998 a vaccination campaign among preadolescents was implemented and an immunization program in gay bathhouses began in 2004.

Objective: to asses the incidence of hepatitis A in adults in Barcelona from 1989 to 2010 and to evaluate the outbreaks among MSM including all genotypes involved.

Methods: All cases of acute hepatitis A among young adults notified to the Public Health Agency of Barcelona from 1989 to 2010 were included for analyses. We calculated the annual incidence rate and the incidence ratio male-to-female (M:F) as a marker for MSM. Spearman's coefficient was used to evaluate trends. We also evaluated the outbreaks among MSM and compared their characteristics using Chi-squared and ANOVA test. Fragment amplification of the VP1/P2A region was used for genetic analysis.

Results: The median annual incidence for the period of study was 4.7/100000 among females and 11.7/100000 among males. The rate of hepatitis A for adult woman decreased over time (Spearman' coefficient = -0.63, p = 0.002), whereas there was no decrease for adult men (Spearman' coefficient = 0.097, p = 0.67). During the study period the M:F ratio increased (Spearman' coefficient = 0.73, p < 0.001).Three large outbreaks among MSM were detected. When comparing outbreaks, there was a decrease in the percentage of bathhouse users (from 47% to 19%, p = 0.0001) and sex workers (from 6.5% to 0%) while the percentage of HIV infected individuals did not change significantly (range: 21%-28%, p = 0.36). The isolated strains were closely related to those circulating in Europe.

Conclusions: Annual incidences remain high among MSM without tendency to decrease. More strategies which effectively reach the whole MSM community are needed.

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Figures

Figure 1
Figure 1
Annual incidence of hepatitis A per 100000 inhabitants for males and females between 20 and 44 year old, and male-to-female ratio by years of symptom onset. Barcelona, 1989-2010.
See this image and copyright information in PMC

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