Year 2020 / Volume 112 / Number 6
Original
Sexual behaviour and poor hygiene are related to recent hepatitis a virus community outbreaks

448-455

DOI: 10.17235/reed.2020.6687/2019

Alberto Hernández Bustabad, Dalia Morales Arráez, Alejandra González, Antonia de Vera, Felicitas Díaz-Flores, María Lecuona Fernández, Juan Luís Gómez-Sirvent, Ana Avellón Calvo, Manuel Hernández-Guerra,

Abstract
Objectives: there has been a global increase in the incidence of hepatitis A infection. The aim of this study was to examine the characteristics of the increase in our region and the degree of adherence to the recommended hygienic measures after discharge from hospital. Methods: demographic, clinical and biochemical variables were collected from patients with acute hepatitis A in our health area. The patients were grouped as follows: January 2010 to December 2016 (historical cohort) and January 2017 to October 2017 (recent cohort). A phylogenetic analysis was also performed in the recent cohort. One month after discharge, bacterial growth was evaluated by a culture of the dominant hand imprint and were compared with a control group. Results: a total of 110 cases were registered with a median age of 36.3 years (range 3-89) and 77.3 % were male. The incidence was 0.82/100,000 inhabitants/year and 22.75/100,000 inhabitants/year in the historical and recent cohorts, respectively. Patients in the recent cohort were more frequently male (52.6 % vs. 82.4 %, p = 0.008) and younger (51.7 [3-89] vs. 33.4 [4-74] years, p < 0.001). In addition, 63.8 % of the recent cohort were men who had sex with other men and had unsafe sexual practices (37.5 %). Phylogenetic analysis showed a predominance of genotype A and a high frequency of the VRD 521-2016 sequence. A higher growth of enterobacteria was observed in patients with hepatitis A compared to the control group (7.3 % vs. 1.2 %, p = 0.005), despite specific hygienic measures given at discharge. Conclusions: a recent outbreak of hepatitis A in our area was related with gender, younger age and sexual practices. Hepatitis A infected subjects showed a poor adherence to hygienic measures. Our data suggests the need for policies that encourage preventive actions, particularly vaccination in this high-risk group.
Share Button
New comment
Comments
No comments for this article
References
1. European Centre for Disease Prevention and Control (ECDC). Annual epidemiological report on communicable diseases in Europe. Report on Status of communicable diseases in the EU and EEA/EFTA countries. 2007.
2. Centro Nacional de Epidemiología. Vigilancias, Alertas de Enfermedades. 2016.
3. WHO position paper on hepatitis A vaccines: June 2012-recommendations. Vaccine 2013 Jan 2;31(2):285-286.
4. Jacobsen KH, Wiersma ST. Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine 2010 Sep 24;28(41):6653-6657.
5. Perez-Sautu U, Costafreda MI, Lite J, Sala R, Barrabeig I, Bosch A, et al. Molecular epidemiology of hepatitis A virus infections in Catalonia, Spain, 2005-2009: circulation of newly emerging strains. J Clin Virol 2011 Oct;52(2):98-102.
6. Bordi L, Rozera G, Scognamiglio P, Minosse C, Loffredo M, Antinori A, et al. Monophyletic outbreak of Hepatitis A involving HIV-infected men who have sex with men, Rome, Italy 2008-2009. J Clin Virol 2012 May;54(1):26-29.
7. Ndumbi P, Freidl GS, Williams CJ, Mardh O, Varela C, Avellon A, 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 Aug;23(33).
8. Gozlan Y, Bar-Or I, Rakovsky A, Savion M, Amitai Z, Sheffer R, et al. Ongoing hepatitis A among men who have sex with men (MSM) linked to outbreaks in Europe in Tel Aviv area, Israel, December 2. Euro Surveill 2017 Jul 20;22(29).
9. Koenig KL, Shastry S, Burns MJ. Hepatitis A Virus: Essential Knowledge and a Novel Identify-Isolate-Inform Tool for Frontline Healthcare Providers. West J Emerg Med 2017 Oct;18(6):1000-1007.
10. Wendon Jea. EASL. Clinical Pratical Guidelines ib the management of acute (fulminant) liver failure. 66 ed. Journal of Hepatology, 2019. 1047-1081.
11. Garcia-Comas L, Ordobas M, Sanz JC, Ramos B, Arce A, Barranco D. [Population study of seroprevalence of antibodies against hepatitis A virus in the Community of Madrid, 2008-2009]. Enferm Infecc Microbiol Clin 2016 Jan;34(1):33-38.
12. ECDC. Annual Epidemiological Report 2016 - Hepatitis A. 2016.
13. Kroneman A, de SR, Verhoef L, Koopmans MPG, Vennema H, On Behalf Of The HAVNet Network. Usability of the international HAVNet hepatitis A virus database for geographical annotation, backtracing and outbreak detection. Euro Surveill 2018 Sep;23(37).
14. Freidl GS, Sonder GJ, Bovee LP, Friesema IH, van Rijckevorsel GG, Ruijs WL, et al. Hepatitis A outbreak among men who have sex with men (MSM) predominantly linked with the EuroPride, the Netherlands, July 2016 to February 2017. Euro Surveill 2017 Feb 23;22(8).
15. Epidemiological characteristics and associated factors of acute hepatitis A outbreak among HIV-coinfected men who have sex with men in Taiwan, June 2015-December 2016. Journal of Viral Hepatitis, 2018. 1208-1215.
16. Beebeejaun K, Degala S, Balogun K, Simms I, Woodhall SC, Heinsbroek E, et al. Outbreak of hepatitis A associated with men who have sex with men (MSM), England, July 2016 to January 2017. Euro Surveill 2017 Feb 2;22(5).
17. Lanini S, Minosse C, Vairo F, Garbuglia A, Di B, V, Agresta A, et al. A large ongoing outbreak of hepatitis A predominantly affecting young males in Lazio, Italy; August 2. PLoS One 2017;12(11):e0185428.
18. Weerakoon AP, Chen MY, Read TR, Bradshaw C, Fairley CK. Immunity to hepatitis A when outbreaks of infection in men who have sex with men (MSM) are rare. Vaccine 2012 May 14;30(23):3430-3434.
19. Chlibek R, Cecetkova B, Smetana J, Prymula R, Kohl I. [Seroprevalence of antibodies against hepatitis A virus and hepatitis B virus in nonvaccinated adult population over 40 years of age]. Epidemiol Mikrobiol Imunol 2006 Aug;55(3):99-104.
20. GlaxoSmithKline Biologicals. HAVRIX: Full Prescription Information (Package Insert).
21. MERCK&Co. VAQTA: Full Prescription Information (Package Insert). 2017.
22. WHO position paper on hepatitis A vaccines. 28-29 ed. Weekly epidemiological record, 2012. 87, 261-276.
23. Papaevangelou V, Alexopoulou Z, Hadjichristodoulou C, Kourlamba G, Katsioulis A, Theodoridou K, et al. Time trends in pediatric hospitalizations for hepatitis A in Greece (1999-2013): Assessment of the impact of universal infant immunization in 2008. Hum Vaccin Immunother 2016 Jul 2;12(7):1852-1856.
24. Dominguez A, Oviedo M, Carmona G, Jansa JM, Borras E, Salleras L, et al. Epidemiology of hepatitis A before and after the introduction of a universal vaccination programme in Catalonia, Spain. J Viral Hepat 2008 Oct;15 Suppl 2:51-56.
25. Arnal JM, Frisas O, Garuz R, Antonanzas F. Cost effectiveness of hepatitis A virus immunisation in Spain. Pharmacoeconomics 1997 Sep;12(3):361-373.
26. Lin KY, Hsieh SM, Sun HY, Lo YC, Sheng WH, Chuang YC, et al. Serologic responses and effectiveness of hepatitis A vaccination among human immunodeficiency virus-positive individuals during the outbreak of acute hepatitis A. Hepatology 2018 Jul;68(1):22-31.
27. Martinelli D, Bitetto I, Tafuri S, Lopalco PL, Mininni RM, Prato R. Control of hepatitis A by universal vaccination of children and adolescents: an achieved goal or a deferred appointment? Vaccine 2010 Sep 24;28(41):6783-6788.
28. Dhankhar P, Nwankwo C, Pillsbury M, Lauschke A, Goveia MG, Acosta CJ, et al. Public Health Impact and Cost-Effectiveness of Hepatitis A Vaccination in the United States: A Disease Transmission Dynamic Modeling Approach. Value Health 2015 Jun;18(4):358-367.
29. Martinez A, Broner S, Sala MR, Manzanares-Laya S, Godoy P, Planas C, et al. Changes in the epidemiology of hepatitis A outbreaks 13 years after the introduction of a mass vaccination program. Hum Vaccin Immunother 2015;11(1):192-197.
30. Werber D, Michaelis K, Hausner M, Sissolak D, Wenzel J, Bitzegeio J, et al. Ongoing outbreaks of hepatitis A among men who have sex with men (MSM), Berlin, November 2016 to January 2. Euro Surveill 2017 Feb 2;22(5).
31. Lavarone M, et al. Outbreak of acute hepatitis A involving young men in Lombardy Region, Italy: risk factors, clinical and virological characteristics. Journal of Hepatology, 2019.
32. Boucher A, et al. Clinical and virological features of acute hepatitis A during and ongoing outbreak among men who have sex with men in the North of France. Sex Transm Infect, 2018. 1-3.
33. Rodriguez-Tajes S, Perpinan E, Caballol B, Lens S, Marino Z, Costa J, et al. Hepatitis A outbreak in Barcelona among men who have sex with men (MSM), January-June 2017: A hospital perspective. Liver Int 2018 Apr;38(4):588-593.
34. Garcia Ferreira AJ, Ortega AA, Cobos RJ, Bardon de TP, Calderon CM, Garcia Garcia AM, et al. Outbreak of acute hepatitis A in the health area served by the Hospital Universitario Virgen de la Victoria (HUVV): a change in epidemiology. Rev Esp Enferm Dig 2018 Jun;110(6):380-385.
35. Fraile M ea, et al. Hepatitis aguda por virus de la hepatitis A durante la expansión epidémica de 2017 en Asturias. Med Clin (Barc), 2018.
36. Fortea JI, et al. Epidemiología y curso clínico de la hepatitis A en Cantabria antes y después del brote epidémico de junio 2016. Rev Clin Esp. 2019.
Related articles

Editorial

Orthohepevirus C as causal agent of acute hepatitis in Spain

DOI: 10.17235/reed.2022.8993/2022

Letter

SARS-CoV-2 vaccine, a new autoimmune hepatitis trigger?

DOI: 10.17235/reed.2022.8820/2022

Letter

A case of COVID-19 with concomitant infection with hepatitis A

DOI: 10.17235/reed.2021.8372/2021

Letter

Autoimmune hepatitis triggered by COVID-19

DOI: 10.17235/reed.2021.8045/2021

Letter

Acute hepatitis due to olmesartan: an uncommon entity

DOI: 10.17235/reed.2020.7236/2020

Original

A new pattern in hepatitis A virus infection in an urban population

DOI: 10.17235/reed.2020.6526/2019

Letter

Acute seronegative hepatitis C: two case reports

DOI: 10.17235/reed.2019.5921/2018

Letter to the Editor

Autoimmune hepatitis as a complication of common variable immunodeficiency

DOI: 10.17235/reed.2018.5280/2017

Citation tools
Hernández Bustabad A, Morales Arráez D, González A, de Vera A, Díaz-Flores F, Lecuona Fernández M, et all. Sexual behaviour and poor hygiene are related to recent hepatitis a virus community outbreaks. 6687/2019


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 723 visits.
This article has been downloaded 140 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 16/10/2019

Accepted: 18/12/2019

Online First: 26/05/2020

Published: 08/06/2020

Article revision time: 58 days

Article Online First time: 223 days

Article editing time: 236 days


Share
This article has been rated by 3 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology