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Outbreak of Hepatitis a in Men Who Have Sex with Men in 2017 December 2017 . Europe’s journal on infectious disease epidemiology, prevention and control Special edition: Outbreak of hepatitis A in men who have sex with men in 2017 December 2017 Featuring • Outbreak reports from England, France, Germany, Israel and the Netherlands • and more... www.eurosurveillance.org Editorial team Editorial advisors Based at the European Centre for Albania: Alban Ylli, Tirana Disease Prevention and Control (ECDC), Austria: Maria Paulke-Korinek, Vienna 171 65 Stockholm, Sweden Belgium: Koen de Schrijver; Tinne Lernout, Antwerp Telephone number Bosnia and Herzegovina: Sanjin Musa, Sarajevo +46 (0)8 58 60 11 38 Bulgaria: Iva Christova, Sofia E-mail Croatia: Sanja Music Milanovic, Zagreb [email protected] Cyprus: Maria Koliou, Nicosia Czech Republic: Jan Kynčl, Prague Editor-in-chief Denmark: Peter Henrik Andersen, Copenhagen Dr Ines Steffens Estonia: Kuulo Kutsar, Tallinn Senior editor Finland: Outi Lyytikäinen, Helsinki Kathrin Hagmaier France: Judith Benrekassa, Paris Germany: Jamela Seedat, Berlin Scientific editors Greece: Rengina Vorou, Athens Karen Wilson Hungary: Ágnes Hajdu, Budapest Janelle Sandberg Iceland: Gudrun Sigmundsdottir, Reykjavík Assistant editors Ireland: Lelia Thornton, Dublin Alina Buzdugan Italy: Paola De Castro, Rome Vilasini Roy Latvia: Dzintars Mozgis, Riga Ingela Rumenius Lithuania: Saulius Caplinskas, Vilnius Associate editors Luxembourg: Thérèse Staub, Luxembourg Andrea Ammon, European Centre for Disease Prevention The former Yugoslav Republic of Macedonia: Aziz Pollozhani, and Control (ECDC), Stockholm, Sweden (resting associate Skopje editorship during tenure as acting Director of ECDC) Malta: Tanya Melillo Fenech, Msida Tommi Asikainen, Brussels, Belgium Montenegro: Senad BegiĆ, Podgorica Magnus Boman, Stockholm, Sweden Netherlands: Danielle Nijsten, Bilthoven Mike Catchpole, Stockholm, Sweden Norway: to be confirmed Denis Coulombier, Stockholm, Sweden Poland: Malgorzata Sadkowska-Todys, Warsaw Natasha Crowcroft, Toronto, Canada Portugal: Paulo Jorge Nogueira, Lisbon Christian Drosten, Bonn, Germany Romania: Daniela Pitigoi, Bucharest Karl Ekdahl, Stockholm, Sweden Serbia: Mijomir Pelemis, Belgrade Johan Giesecke, Stockholm, Sweden Slovakia: Lukáš Murajda, Bratislava David Heymann, London, United Kingdom Slovenia: Maja Sočan, Ljubljana Heath Kelly, Canberra, Australia Spain: Rosa Cano Portero, Madrid Irena Klavs, Ljubljana, Slovenia Sweden: Anders Wallensten, Stockholm Karl Kristinsson, Reykjavik, Iceland Turkey: Fehminaz Temel, Ankara Daniel Lévy-Bruhl, Paris, France United Kingdom: Nick Phin, London Jacob Moran-Gilad, Beer-Sheva, Israel World Health Organization Regional Office for Europe: Robb Panayotis T. Tassios, Athens, Greece Butler, Copenhagen Hélène Therre, Paris, France Henriette de Valk, Paris, France Sylvie van der Werf, Paris, France Design / Layout Fabrice Donguy / Dragos Platon Online submission system http://www.editorialmanager.com/eurosurveillance/ www.eurosurveillance.org © Eurosurveillance, 2017 Contents Special edition: Outbreak of hepatitis A in men who have sex with men in 2017 Rapid Communications Hepatitis A outbreak in HIV-infected MSM and in PrEP-using MSM despite a high level of immunity, Lyon, France, January to June 2017 2 Charre C et al. Ongoing hepatitis A among men who have sex with men (MSM) linked to outbreaks in Europe in Tel Aviv area, Israel, December 2016 – June 2017 6 Mor O 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 10 Freidl G et al. Ongoing outbreaks of hepatitis A among men who have sex with men (MSM), Berlin, November 2016 to January 2017 – linked to other German cities and European countries 15 Werber D et al. Outbreak of hepatitis A associated with men who have sex with men (MSM), England, July 2016 to January 2017 20 Beebeejaun K et al. © Eurosurveillance www.eurosurveillance.org 1 Rapid communications Hepatitis A outbreak in HIV-infected MSM and in PrEP-using MSM despite a high level of immunity, Lyon, France, January to June 2017 Caroline Charre1,2, Christophe Ramière1,2,3, Anne-Marie Roque-Afonso⁴, Christian Chidiac2,5, Fabien Zoulim2,6,7, Matthieu Godinot⁸, Joseph Koffi5,6, Caroline Scholtès1,2,7, Jean-Michel Livrozet⁸, HAV Lyon Study Group⁹, Laurent Cotte⁵ 1. Laboratoire de Virologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France 2. Université de Lyon, Lyon, France 3. CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France 4. National reference centre for hepatitis A virus (Centre national de référence du virus de l’hépatite A), Virologie, Hôpital Paul Brousse, AP-HP, Villejuif, France 5. Service de maladie infectieuse et tropicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France 6. Service d’Hépatologie et de gastroentérologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France 7. INSERM, U871, Lyon, France 8. Service de maladie infectieuse et tropicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France 9. The members of the HAV Lyon Study Group are listed at the end of the article Correspondence: Caroline Charre ([email protected]) Citation style for this article: Charre Caroline, Ramière Christophe, Roque-Afonso Anne-Marie, Chidiac Christian, Zoulim Fabien, Godinot Matthieu, Koffi Joseph, Scholtès Caroline, Livrozet Jean-Michel, HAV Lyon Study Group, Cotte Laurent. Hepatitis A outbreak in HIV-infected MSM and in PrEP-using MSM despite a high level of immunity, Lyon, France, January to June 2017. Euro Surveill. 2017;22(48):pii=17-00742. https://doi.org/10.2807/1560-7917.ES.2017.22.48.17-00742 Article submitted on 07 Nov 2017 / accepted on 27 Nov 2017 / published on 30 Nov 2017 Since 2016, an increase in the number of hepatitis A January and 30 June 2017 were included. Diagnosis was cases affecting mainly men who have sex with men based on the detection of serum HAV-specific IgM anti- (MSM) has been reported in low endemic countries in bodies (ADVIA Centaur HAV assays, Siemens, Canada) Europe. We calculated the attack rate in Lyon, France, along with elevated liver enzymes. HAV sequencing in populations considered at high-risk: HIV-infected from IgM-positive samples was performed by the HAV MSM and HIV-negative MSM receiving HIV pre-expo- national reference centre in Villejuif, France, as previ- sure prophylaxis (PrEP). In these populations, high ously reported [6]. level of immunity did not prevent the outbreak, indi- cating that vaccination should be reinforced, particu- All 2,023 HIV-infected MSM and 415 PrEP users fol- larly in younger individuals. lowed during the period were enrolled. Demographics (age, HIV status, PrEP use), HAV and hepatitis B virus Several outbreaks of acute hepatitis A among men (HBV) serological status, previous history of HAV infec- who have sex with men (MSM) have been recently tion and HAV vaccination history were retrieved from reported in different European countries [1-4]. Since the clinical database and are compiled in the Table. the end of 2016, an important increase in the number The proportion of HAV-susceptible patients was deter- of acute hepatitis A cases in MSM has been also noti- mined based on medical, serological and vaccination fied in France through the national mandatory report- history. Criteria for HAV immunity were: (i) past docu- ing system [5]. The aim of this study was to evaluate mented acute hepatitis A or (ii) past positive test for the proportion of hepatitis A virus (HAV)-susceptible HAV total antibodies or (iii) administration of at least individuals and the attack rate of acute hepatitis A in one dose of hepatitis A vaccine before January 2017. HIV-infected MSM and in HIV-negative MSM receiving Evaluation of the attack rate in HIV-infected suscepti- HIV pre-exposure prophylaxis (PrEP). ble patients was determined by category of age. To take into account the patients with unknown HAV immune Case definition and cohort description status, sensitivity analyses were performed assuming The infectious diseases department of the Hospices that patients with unknown HAV immune status were Civils de Lyon follows ca 3,800 HIV-infected patients considered as susceptible (best case scenario), and per year, representing 94% of HIV-infected patients fol- that patients with unknown HAV immune status were lowed in the Rhône department. Additionally, 415 MSM considered as immune (worst case scenario). The hep- who used PrEP in the Rhône department were followed atitis A attack rate was not determined by category of in the infectious diseases department during the study age in PrEP users due to the limited number of cases. period. All cases of acute hepatitis A diagnosed in the HAV cases in HIV-negative MSM not enrolled in the PrEP Hospices Civils de Lyon virology laboratory between 1 programme were not considered for the determination 2 www.eurosurveillance.org Figure 1 Table Epidemic curve of total hepatitis A cases, January–June Characteristics of HIV-infected MSM (n = 2,023) and 2017, Lyon, France (n = 46) MSM PrEP users (n = 415), January–June 2017, Lyon, France 9 MSM HIV+ (n = 16) MSM PrEP 8 HIV-infected MSM users MSM HIV- PreP (n = 3) Characteristic 7 (n = 2,023) MSM HIV- (n = 14) (n = 415) Othersa (n = 13) 6 Age 49 36 5 median (IQR) (40–57) (29–44) 4 CD4 cells count / mm3 676 NA 3 median (IQR) (515–857) 2 n % Antiretroviral treatment a 1 2,006/2,022 99.2 Number of cases acute hepatitis A NA n % 0 HIV viral load < 40 copies/ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 mL 815/1,963a 92.5 Week of disease onset (2017) HBV status n % n % Chronic hepatitis B 67 3.3 1 0.2 HIV +: HIV infected; HIV-: HIV negative; MSM: men who have sex Cured hepatitis 693 34.3 18 4.3 with men; PrEP: pre-exposure prophylaxis Vaccinated 1,041 51.5 349 84.1 a The category ‘Others’ includes women, children and heterosexual Non immune 175 8.6 31 7.5 men. Unknown 47 2.3 16 3.9 HAV status n % n % Immune 1,219 60.3 305 73.5 of the attack rate, since the denominator for this popu- • Vaccinated 417 20.6 158 38.1 • Previous history of lation is unknown.
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