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Hepatitis A incidence,seroprevalence, and vaccination decision among MSM in Amsterdam,the Netherlands
Institution:1. Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands;2. INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France;3. Amsterdam Infection & Immunity Institute (AI&II), Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands
Abstract:BackgroundSeveral outbreaks of Hepatitis A virus (HAV) were recently documented among men who have sex with men (MSM) in Europe. We investigated the HAV incidence among MSM in Amsterdam, the Netherlands; and HAV seroprevalence and HAV vaccination decision among MSM visiting the Sexually Transmitted Infection (STI) clinic in Amsterdam.MethodsUsing surveillance data from 1992 to 2017 of MSM with acute HAV in Amsterdam, we estimated the incidence by calendar year and age. We explored HAV seroprevalence by calendar year and age, determinants for HAV seropositivity, and opting-in/out for HAV vaccination using data collected among MSM that visited the STI clinic between 2006 and 2017 and were included in a nationwide Hepatitis B virus (HBV) vaccination programme. Offering HAV vaccination at the STI clinic differed over three consecutive periods: not offered, offered for free, or offered for 75 euros. Logistic regression analyses were used to explore determinants.ResultsHAV incidence increased in 2016/17 after 4 years of absence and peaked in MSM around 35 years of age. Among MSM visiting the STI clinic, HAV seroprevalence was 37% (95%CI = 35–40%), which was constant over the period 2006–2017, and increased with age (p < 0.001). Determinants for HAV seropositivity in multivariable analysis were: older age (p < 0.001), originating from an HAV endemic country (p < 0.001), and being HBV seropositive (p = 0.001). MSM opted-in more frequently when HAV vaccination was offered for free versus paid (89% versus 11%, respectively; p < 0.001). Younger MSM were less inclined to vaccinate when payment was required (p = 0.010). Post-hoc analyses showed that 98% versus 46% of MSM visiting the Amsterdam STI clinic would be protected against HAV infection if HAV vaccination was offered for free or for 75 euros, respectively.ConclusionsThe MSM population of Amsterdam is vulnerable to a new HAV outbreak. We strongly recommend that MSM have access to free hepatitis A vaccination.
Keywords:Hepatitis A virus  the Netherlands  Men who have sex with men  Sexual transmission  Epidemiology  HAV IgG seroprevalence  MSM"}  {"#name":"keyword"  "$":{"id":"k0040"}  "$$":[{"#name":"text"  "_":"Men who have sex with men  HAV"}  {"#name":"keyword"  "$":{"id":"k0050"}  "$$":[{"#name":"text"  "_":"Hepatitis A virus  HBV"}  {"#name":"keyword"  "$":{"id":"k0060"}  "$$":[{"#name":"text"  "_":"Hepatitis B virus  HCV"}  {"#name":"keyword"  "$":{"id":"k0070"}  "$$":[{"#name":"text"  "_":"Hepatitis C virus  HEV"}  {"#name":"keyword"  "$":{"id":"k0080"}  "$$":[{"#name":"text"  "_":"Hepatitis E virus  HIV"}  {"#name":"keyword"  "$":{"id":"k0090"}  "$$":[{"#name":"text"  "_":"Human immunodeficiency virus  IgG"}  {"#name":"keyword"  "$":{"id":"k0100"}  "$$":[{"#name":"text"  "_":"Immunoglobulin G  IgM"}  {"#name":"keyword"  "$":{"id":"k0110"}  "$$":[{"#name":"text"  "_":"Immunoglobulin M  IQR"}  {"#name":"keyword"  "$":{"id":"k0120"}  "$$":[{"#name":"text"  "_":"Interquartile range  aRR"}  {"#name":"keyword"  "$":{"id":"k0130"}  "$$":[{"#name":"text"  "_":"Adjusted relative risk  95% CI"}  {"#name":"keyword"  "$":{"id":"k0140"}  "$$":[{"#name":"text"  "_":"95% confidence interval
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