Hepatitis A epidemic in men who have sex with men (MSM) in Milan, Italy Hepatitis A epidemic in MSM in Milan

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Gianuario Aulicino
Marino Faccini
Anna Lamberti
Sabrina Senatori
Giorgio Ciconali
Cecilia Gandolfi
Cristina Galli
Catia Tagliacarne
Silvana Castaldi http://orcid.org/0000-0003-1716-6624
Luisa Romanò

Keywords

Hepatitis A epidemic MSM

Abstract

Background and aim of the work: Hepatitis A is an infectious disease characterized by fecal-oral transmission; however, a rise in sexually-transmitted cases has been observed, particularly among “men who have sex with men”. In Europe, a Hepatitis A epidemic occurred among men who have sex with men between 2016 and 2018. The aim of this study is to describe this Hepatitis A epidemic in the city of Milan and to analyze the incidence of Sexually Transmitted Diseases co-infection among Hepatitis A cases. Methods: Hepatitis A cases were traced and identified. Epidemiological data were collected and Hepatitis A vaccination was investigated. Cases were georeferenced, calculating incidence rates for each Milan Municipality. Viral genotypic analysis was carried out. Results:  353 cases were reported in Milan. Incidence rates resulted significantly higher in males (RR 18.1 CI9 5% 11.5 – 28.4). 70 cases reported foreign travel. 172 cases reported “Men  who have Sex with Men” behaviour. Genotypic analysis revealed correlation with strains of the European “Men who have Sex with Men” epidemic. Georeferencing showed asymmetric case distribution. Only 12 cases reported Hepatitis A vaccination. The Relative Risk for syphilis infection among Hepatitis A cases was 133.9 (95% CI 81.7 – 219.7) and 29.7 (95%CI 9.5 – 92.7) for gonorrhea. Conclusions:  Most genotyped cases (93.7%) correlated to the European Hepatitis A epidemic among Men who have Sex with Men. Georeferencing showed a greater incidence of Hepatitis A cases in areas characterized by the homosexual community. The higher incidence of Sexually Transmitted Diseases co-infection in Hepatitis A cases correlated to clusters responsible for the European Hepatitis A epidemic, suggests increased sexual promiscuity among Men who have Sex with Men. These data support the need for Hepatitis A vaccination programs and sensitization of Men who have Sex with Men to the adoption of safe sexual practices.

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References

BIBLIOGRAPHY
1. WHO. Hepatitis A. factsheet 2019 Available at: https://www.who.int/news-room/fact- sheets/detail/hepatitis-a
2. Gervasi G, Biticchi M, Zaratti L, Franco E. Epidemics of Hepatitis A and opportunities for vaccination: a focus on the category of men who practice sex with men (MSM). Ig Sanita Pubbl. 2018;74(3):295–304.
3. Ndumbi P, Freidl GS, Williams CJ, 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;23(33).
4. European Centre for Disease Prevention and Control (ECDC). Epidemiological update: hepatitis A outbreak in the EU/EEA mostly affecting men who have sex with men. [Internet]. 2018. Available from: https://ecdc.europa.eu/en/newsevents/%0Aepidemiological-update-hepatitis-outbreak-eueeamostly-%0Aaffecting-men-who-have-sex-men-1
5. Istituto Superiore di Sanità. Bollettino SEIEVA Epidemiologia delle epatiti virali acute in Italia Numero 2 - Aggiornamento 2017 [Internet]. Available from: https://www.epicentro.iss.it/epatite/bollettino/Bollettino-n.2-2017.pdf
6. European Commission. Commission Implementing Decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions [Internet]. 2018. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX%3A32018D0945&from=EN%29
7. Bruni R, Taffon S, Equestre M, et al. Key Role of Sequencing to Trace Hepatitis A Viruses Circulating in Italy During a Large Multi-Country European Foodborne Outbreak in 2013. 2016;11(2):e0149642.
8. Caso D, Faccini M, Formenti C, Lamberti A, Rossetti E, Senatore S. Report malattie infettive ATS Milano [Internet]. 2017. Available from: https://www.ats-milano.it/portale/Pubblicazione-documenti/Report-sulla-prevenzione
9. European Centre for Disease Prevention and Control (ECDC). EMIS-2010 The European Men-Who-HaveSex-With-Men Internet Survey [Internet]. 2010. Available from: https://www.ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/EMIS-2010-european-men-who-have-sex-with-men-survey.pdf
10. Cotter SM, Sansom S, Long T, et al. Outbreak of Hepatitis A among Men Who Have Sex with Men : Implications for Hepatitis A Vaccination Strategies. J Infect Dis. 2003;187(8):1235–40.
11. Friesema IHM, Sonder GJB, Petrignani MWF, et al. Spillover of a hepatitis A outbreak among men who have sex with men ( MSM ) to the general population , the Netherlands, 2017. Euro Surveill. 2018;23(23).
12. Hess KL, Crepaz N, Rose C, Purcell D, Paz-bailey G. Trends in Sexual Behavior Among Men Who have Sex with Men (MSM) in High-Income Countries, 1990-2013: A Systematic Review. AIDS Behav. 2017;21(10):2811–34.

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