International Liver Congress

International Liver Congress

April 12, 2018
2 min read

Italian hepatitis A outbreak among MSM linked to two European strains

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PARIS — New data linked hepatitis A cases from an ongoing outbreak among men who have sex with men in the Lombardy region of Italy to strains found in two other recent European outbreaks, according to a presentation at the International Liver Congress 2018.

“We wanted to understand the ongoing HAV outbreak within a large group of patients including MSM from seven hospitals in the Lombardy region,” Massimo Iavarone, MD, from the Fondazione IRCCS Cà Granda Ospedale Maggiore Hospital in Milan, Italy, said in a press release. “We used viral phylogenetic analysis to see if this outbreak was linked to other recent European outbreaks.”

The European Center for Disease Prevention and Control announced in 2017 that hepatitis A outbreaks have been spreading across Europe, with most cases reported among unvaccinated men who have sex with men.

Iavarone and colleagues prospectively analyzed 244 patients diagnosed with acute HAV between January 2017 and May 2017, most of whom were men (94%), 55% were MSM, 17% had chronic liver disease, 19% had HIV. Regarding route of transmission, 63% referred to possible sexual contact in the prior 3 months and 18% reported an HAV-positive partner.

Over a median hospital stay of 7 days (range, 2-44 days), 181 patients required hospitalization. Median alanine aminotransferase peak level was 2,368 IU/mL and median bilirubin peak level was 6.6 mg/dL. Most patients had HAV genotype IA (93%), while the remaining patients had genotype IB.

All cases of genotype IA belonged to one of three separate clusters recently reported in a multi-country European outbreak: 59% of cases were infected with the U.K. strain, 40% with the Netherlands strain, and 1% with the Germany strain. Cases infected with the Netherlands strain were prevalent at the beginning of the outbreak in January, whereas the U.K. strain increased near the end of the study.

Iavarone noted that the linked HAV outbreaks involved young active workers with a high rate of hospitalizations, which may impact admissions to liver and infectious disease units and have significant direct and indirect economic consequences.

“This study emphasizes the risk of acute HAV infection via sexual transmission in risk groups such as MSM,” Markus Cornberg, MD, from the Hannover Medical School in Germany and EASL Governing Board Member, said in the press release. “Awareness campaigns for the prevention of sexually transmitted infections are important, and in this case of HAV, vaccination can prevent infections.” – by Talitha Bennett

For more information:

Iavarone M, et al. PS-059. Presented at: International Liver Congress; Apr. 11-15, 2018; Paris, France.

Disclosure: Iavarone reports having a financial relationship relative to his presentations. Healio Gastroenterology and Liver Disease could not confirm that relationship at the time of publication.