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. 2018 Aug;23(33):1700641.
doi: 10.2807/1560-7917.ES.2018.23.33.1700641.

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

Patricia Ndumbi  1   2 , Gudrun S Freidl  1   3 , Christopher J Williams  1   4 , Otilia Mårdh  5 , Carmen Varela  2 , Ana Avellón  2 , Ingrid Friesema  3 , Harry Vennema  3 , Kazim Beebeejaun  6 , Siew Lin Ngui  6 , Michael Edelstein  6 , Alison Smith-Palmer  7 , Niamh Murphy  8 , Jonathan Dean  9 , Mirko Faber  10 , Jürgen Wenzel  11 , Mia Kontio  12 , Luise Müller  13 , Sofie Elisabeth Midgley  13 , Lena Sundqvist  14 , Josefine Lundberg Ederth  14 , Anne-Marie Roque-Afonso  15 , Elisabeth Couturier  16 , Sofieke Klamer  17 , Javiera Rebolledo  17 , Vanessa Suin  17 , Stephan W Aberle  18 , Daniela Schmid  19 , Rita De Sousa  20 , Gonçalo Figueiredo Augusto  21 , Valeria Alfonsi  22 , Martina Del Manso  22 , Anna Rita Ciccaglione  22 , Kassiani Mellou  23 , Christos Hadjichristodoulou  24 , Alastair Donachie  1   25 , Maria-Louise Borg  25 , Maja Sočan  26 , Mario Poljak  27 , Ettore Severi  28   5 ; Members of the European Hepatitis A Outbreak Investigation Team  29
Collaborators, Affiliations

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

Patricia Ndumbi et al. Euro Surveill. 2018 Aug.

Erratum in

  • Authors' correction for Euro Surveill. 2018;23(33).
    Eurosurveillance editorial team. Eurosurveillance editorial team. Euro Surveill. 2021 Sep;26(36):210909c. doi: 10.2807/1560-7917.ES.2021.26.36.210909c. Euro Surveill. 2021. PMID: 34505570 Free PMC article. No abstract available.

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.

Keywords: hepatitis A; hepatitis A virus; men who have sex with men - MSM; sexually transmitted infections; vaccine-preventable diseases; vaccines and immunisation.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Confirmed hepatitis A cases by strain and date of reporting in multi-strain outbreak affecting predominantly MSM, 1 June 2016–31 May 2017, participating European Union/European Economic Area countries, (n = 1,386 cases)
Figure 2
Figure 2
Confirmed hepatitis A cases by strain and geographical distribution in multi-strain outbreak affecting predominantly MSM, 1 June 2016–31 May 2017, participating European Union/European Economic Area countries (n = 1,400 cases)
See this image and copyright information in PMC

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