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. 2021 Feb;40(2):335-344.
doi: 10.1007/s10096-020-04028-x. Epub 2020 Sep 17.

Recent outbreaks of severe hepatitis A virus infections in Vienna

David Bauer  1   2 , Anna Farthofer  1 , David Chromy  1   2   3 , Benedikt Simbrunner  1   2 , Lisa Steininger  1   2 , Caroline Schmidbauer  1   2   4 , Teresa Binter  1   2 , Michael Trauner  1 , Mattias Mandorfer  1   2 , Ralf Schmidt  5 , Florian Mayer  5 , Heidemarie Holzmann  6 , Robert Strassl  5 , Thomas Reiberger  7   8   9
Affiliations

Recent outbreaks of severe hepatitis A virus infections in Vienna

David Bauer et al. Eur J Clin Microbiol Infect Dis. 2021 Feb.

Abstract

To explore the epidemiology and clinical course of hepatitis A virus (HAV) infections at the Vienna General Hospital. We retrospectively identified patients who were tested positive for HAV-IgM at the Vienna General Hospital form Q1/2008 to Q3/2018. Our definition of severe HAV infection was AST and/or ALT > 5 × above the upper limit of normal (ULN); and liver dysfunction as (i) hepatic encephalopathy or ammonia > 100 μmol/L, (ii) coagulopathy with INR > 1.5, or (iii) jaundice with bilirubin > 5 mg/dL. A total of 578 HAV-IgM (+) were identified, including 31 (5.4%) and 38 (6.6%) without and with liver dysfunction, respectively. A proportional increase in severe HAV cases with and without liver dysfunction occurred in 2016/2017 with (21.5% (vs. 8.0% in the years before; p < 0.001). Thirty-seven (53.6%) patients with severe HAV were hospitalized, 6 (9%) required ICU support, and one patient received liver transplantation within 30 days. Patients with severe HAV and liver dysfunction were more often male (60.5 vs. 43.1%, p = 0.055) and younger (31.5 vs. 63 years, p < 0.001) as compared with other HAV-IgM (+) cases. The observed increase of severe HAV infections in Vienna in 2017 among young males, coincided with a multinational HAV outbreak among MSM. Our data suggests a higher likelihood of severe courses of hepatitis A in MSM. Vaccination against HAV should be recommended for risk groups.

Keywords: Austria; Hepatitis A; Hepatitis A epidemiology; Viral hepatitis A.

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Conflict of interest statement

D.B. received travel support from AbbVie and Gilead.

F.A. none declared.

C.D. served as a speaker and/or consultant and/or advisory board member for AbbVie, Gilead, and MSD, and received travel support from AbbVie, MSD, ViiV Healthcare, and Gilead.

S.B. received travel support by AbbVie and Gilead.

S.L. none declared.

S.C. received travel support from AbbVie, Gilead, and Gebro.

M.M. served as a speaker and/or consultant and/or advisory board member for AbbVie, Bristol-Myers Squibb, Collective Acumen, Gilead, and W. L. Gore & Associates and received travel support from AbbVie, Bristol-Myers Squibb, and Gilead.

S.R. none decleared.

T.M. received speaker fees from BMS, Falk, Gilead, Intercept and MSD; advisory board fees from Albireo, BiomX, Boehringer Ingelheim, Falk, Genfit, Gilead, Intercept, MSD, Novartis, Phenex, Regulus, and Shire. He further received travel grants from Abbvie, Falk, Gilead, Intercept and Jansen and unrestricted research grants from Albireo, Cymabay, Falk, Gilead, Intercept, MSD, and Takeda.

ST.R. none declared.

M.F. none declared.

H.H. none declared.

T.R. received grant support from Abbvie, Boehringer Ingelheim, Gilead, MSD, Philips Healthcare, and Gore; speaking honoraria from Abbvie, Gilead, Gore, Intercept, Roche, and MSD; consulting/advisory board fee from Abbvie, Bayer, Boehringer Ingelheim, Gilead, Intercept, MSD, and Siemens; and travel support from Boehringer Ingelheim, Gilead, and Roche.

Figures

Fig. 1
Fig. 1
Study flow chart (| - or, HAV - hepatitis A virus, HA - hepatitis A, (+) - positive, n - number, IgM - immunoglobulin M, w/o - without, TA - transaminases, ULN - upper limit of normal, INR - international normalized ratio, Bili - bilirubin)
Fig. 2
Fig. 2
a Number of HAV-IgM (+) patients tested per year. b Yearly incidence of HAV-IgM/RNA (+) with disease course shown as IgM (+) non-severe (blue), severe w/o liver dysfunction (black), and severe with liver dysfunction (red), the black line and right axis showing the course of male to female ratio over the years in the observation period. (HAV - hepatitis A virus, HA - hepatitis A, w/o without, M.F-Ratio - male-to-female ratio; + - positive)
Fig. 3
Fig. 3
a Course of ALT serum levels in severe HA hepatitis with liver dysfunction. b Course of AST serum levels in severe HA hepatitis with liver dysfunction. c Course of bilirubin serum levels in severe HA hepatitis with liver dysfunction. d Course of INR serum levels in severe HA hepatitis with liver dysfunction. (ALT alanine transaminase, AST aspartate transaminase, d day)
See this image and copyright information in PMC

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