Clinical characteristics of acute hepatitis A outbreak in Taiwan, 2015–2016: observations from a tertiary medical center

Abstract

BackgroundAcute hepatitis A is a fecal-oral transmitted disease related to inadequate sanitary conditions. In addition to its traditional classification, several outbreaks in the men who have sex with men (MSM) population have resulted in acute hepatitis A being recognized as a sexually transmitted disease. However, few studies have clarified the clinical manifestations in these outbreaks involving the MSM population.MethodsBeginning in June 2015, there was an outbreak of acute hepatitis A involving the MSM population in Northern Taiwan. We conducted a 15-year retrospective study by recruiting 207 patients with the diagnosis of acute hepatitis A that included the pre-outbreak (January 2001 to May 2015) and outbreak (June 2015 to August 2016) periods in a tertiary medical center in Northern Taiwan. Using risk factors, comorbidities, presenting symptoms, laboratory test results and imaging data, we aimed to evaluate the clinical significance of acute hepatitis A in the MSM population, where human immunodeficiency virus (HIV) coinfection is common.ResultsThere was a higher prevalence of reported MSM (p < 0.001), HIV (p < 0.001) and recent syphilis (p < 0.05) coinfection with acute hepatitis A during the outbreak period. The outbreak population had more prominent systemic symptoms, was more icteric with a higher total bilirubin level (p < 0.05) and had a 7-times higher tendency (p < 0.05) to have a hepatitis A relapse.ConclusionsThe clinical course of acute hepatitis A during an outbreak involving the MSM and HIV-positive population is more symptomatic and protracted than in the general population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2555-x) contains supplementary material, which is available to authorized users.

The impact of HIV infection and men who have sex with men status on hepatitis A infection: The experience of two tertiary centres in Northern Italy during the 2017 outbreak and in the 2009‐2016 period

“…Some publications suggest different clinical course and disease severity when hepatitis A occurs in MSM or HIV‐infected patients . The aim of this study was to analyse the demographics, risk factors, comorbidities and laboratory results of hospitalized cases of acute hepatitis A in two tertiary level hospitals in Northern Italy (Fondazione IRCCS Policlinico San Matteo Pavia and Milan Niguarda Hospital) in 2017 and in the 2009‐2016 period, to evaluate whether HIV infection or MSM status can affect the clinical course of the disease.…”

Serologic responses and effectiveness of hepatitis A vaccination among human immunodeficiency virus–positive individuals during the outbreak of acute hepatitis A

“…Outbreaks of acute hepatitis A among those at‐risk populations have been described since the 1980s and have reemerged across the Asia‐Pacific region, the United States, and several European countries since 2015 . In Taiwan, an unprecedented outbreak with more than 1,000 indigenous cases of acute hepatitis A occurred in 2015‐2016, which was characterized by a high proportion of MSM and human immunodeficiency virus (HIV)–positive individuals . Furthermore, phylogenetic analysis demonstrated that the outbreak strains in Taiwan and The Netherlands were identical, suggesting that HAV might have been transmitted through sexual networks and international travel …”

An outbreak of acute hepatitis A among young adult men: clinical features and HIV coinfection rate from a large teaching hospital in Rome, Italy

“…In high‐income countries, the transmission route through sexual contacts is the one mainly linked to outbreaks, and thus MSM and HIV‐positive patients represent the most important target groups for vaccination campaigns. Although no death was registered in our centre, recent studies report fatal courses during this outbreak . Fulminant hepatitis A is, in fact, a deadly disease, with pre‐existing liver disease and a history of alcohol or drug abuse being risk factors for a fatal outcome.…”