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Successful Attempt to Counter Hep A Outbreak in Paris MSM With HAV Vaccine
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16th European AIDS Conference, October 25-27, 2017. Milan
Mark Mascolini
Rates of hepatitis A virus (HAV) vaccination of Paris men who have sex with men (MSM) jumped sharply in response to a targeted program at a suburban Paris hospital [1]. The vaccine program aimed to slow an HAV epidemic that began in March 2017 in Paris MSM.
The Regional Health Agency (ARS) for Paris received more than 300 reports of acute HAV infection in MSM since March 2017. Similar outbreaks are occurring in other parts of Europe and Asia. The Paris epidemic has developed during an HAV vaccine shortage. Although most acute HAV infections involve men 15 to 49 years old, men 50 or older and boys younger than 15 have been affected.
In response, the ARS made more vaccines available in hospitals and sexual health clinics starting on March 25, 2017. This study aimed to track uptake of HAV immunization among MSM at Foch Hospital in Suresnes between March 2017 and August 2017. The hospital has had 4 acute HAV infections in HIV-positive MSM during the current outbreak. Hospital researchers recorded HAV immunizations in March 2017 among HIV-positive MSM and HIV-negative MSM using preexposure prophylaxis (PrEP) to prevent HIV infection. They reanalyzed HAV immunizations in this population at the end of July 2017.
The March 2017 study population included 257 HIV-positive MSM (median age 48.9) and 31 MSM using PrEP (median age 33.7). The investigators detected HAV antibodies in 195 men with HIV (76%) and calculated a vaccination rate of 53%. Only 20% of 31 HIV-negative PrEP users had received the HAV vaccine.
The hospital contacted 51 HAV-negative men between March 23 and July 31 and invited them to get the HAV vaccine at the hospital pharmacy. All but 1 agreed. The 50 vaccinated men included 32 with HIV and 18 on PrEP. Among these vaccinated men, 85% had anti-HAV antibodies after the first vaccine dose. HAV vaccine coverage rose from 53% to 84% among MSM with HIV and from 20% to 89% among men on PrEP.
The researchers concluded that baseline HAV vaccine rates were high in their HIV-positive MSM population but low in MSM using PrEP. The targeted immunization intervention greatly expanded HAV vaccination coverage in both groups of MSM. The hospital has recorded no new cases of HAV since May 1, 2017, although the HAV outbreak continues in the overall Paris area. The Foch team concluded that "improved access to the HAV vaccine and monitoring of the implementation of HAV vaccination are urgently needed to control the outbreak."
US health authorities advise HAV vaccination for everyone at 1 year of age [2]. For adults, HAV vaccination is recommended for MSM, street drug users, people who live in a community with a high HAV rate or who travel to countries with a high rate, people with long-term liver disease, blood-clotting factor recipients, and people working with HAV-infected animals or doing HAV research [2].
References
1. Zucman D, Chan Hew Wai A, Lesprit P, et al. Acute hepatitis A outbreak in men who have sex with men (MSM) in Paris area: implementation of targeted HAV vaccine in a context of vaccine shortage. 16th European AIDS Conference. October 25-27, 2017. Milan. Abstract PS12/2.
2. Centers for Disease Control and Prevention. Vaccines and preventable diseases. Hepatitis A in-short. https://www.cdc.gov/vaccines/vpd/hepa/public/in-short-adult.html#who
1/ECDC A outbreaks in the EU/EEA mostly affecting men who have sex with men - second update, 19 May 2017. Stockholm:
ECDC; 2017.
2/Freidl GS et al Euro Surveill 2017; 22. doi:10.2807/1560-7917.
3/Beebeejaun K et al. Outbreak of hepatitis A associated with men who have sex with men (MSM), England, July 2016 to January 2017. Euro
Surveill 2017; 22.
4Chen GJ, Lin KY, Hung CC, Chang SC. Hepatitis A outbreak among men who have sex with men in a country of low endemicity of hepatitis A
infection. J Infect Dis 2017
1/Agence Nationale de Securite du Medicament et des Produits de Sante (ANSM). Ruptures de stock des medicaments. Available at:
http://ansm.sante.fr/S-informer/Informations-de-securiteRupturesde-stock-des-medicaments. Accessed 22 April 2017.
2/Zucman D et al. How to Face the Outbreak of Viral Hepatitis A in Men Who Have Sex With Men in France Without Vaccines? CID 2017;65(6):
1053-4
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