Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan.
Liver Int. 2018 Apr;38(4):594-601. doi: 10.1111/liv.13468. Epub 2017 Jun 1.
An unprecedented outbreak of acute hepatitis A has occurred among MSM in Taiwan since June 2015. We aimed to describe the seroepidemiology of HAV infection and to investigate the relationship between HAV vaccination and the incidence of acute hepatitis A among HIV-positive patients at the largest designated hospital for HIV care during the outbreak.
Between 2012 and 2016, the HAV serostatus, vaccination history and clinical characteristics of HIV-positive patients were retrospectively reviewed. A case-control study was performed to identify the factors associated with acute hepatitis A. The trends of HAV vaccination rate and incidence of acute hepatitis A among HAV-seronegative patients were examined during the outbreak.
During the 4.5-year period, 2088 HIV-positive patients with a mean age of 37.7 years and 90.2% being MSM were included. The overall HAV seroprevalence was 34.3%, which was significantly higher in older and non-MSM patients. The estimated incidence rate of acute hepatitis A was 52.6 cases per 1000 person-years of follow-up during the outbreak. The associated factors with acquiring acute hepatitis A were recent syphilis and having not received HAV vaccines. The HAV vaccination rate during the outbreak increased from 4.7% to 70.6% and the incidence rate of acute hepatitis A declined when up to 65% of the patients were immunized or tested positive for HAV.
The seroprevalence of HAV infection was low in the younger HIV-positive individuals. Prevention of acute hepatitis A was achieved among HIV-positive, HAV-seronegative patients through HAV vaccination and increased herd immunity during the ongoing outbreak.
自 2015 年 6 月以来，台湾男男性行为者（MSM）中爆发了一场前所未有的甲型肝炎急性疫情。我们旨在描述甲型肝炎病毒（HAV）感染的血清流行病学，并在疫情期间，调查最大的艾滋病毒定点医院中 HIV 阳性患者中 HAV 疫苗接种与甲型肝炎急性发病率之间的关系。
在 2012 年至 2016 年期间，回顾了 HIV 阳性患者的 HAV 血清状态、疫苗接种史和临床特征。进行病例对照研究，以确定与甲型肝炎急性有关的因素。在疫情期间，检查了 HAV 阴性患者的 HAV 疫苗接种率和急性肝炎发病率的趋势。
在 4.5 年期间，纳入了 2088 名平均年龄为 37.7 岁且 90.2%为 MSM 的 HIV 阳性患者。总体 HAV 血清阳性率为 34.3%，在年龄较大和非 MSM 患者中明显更高。在疫情期间，急性肝炎 A 的估计发病率为每 1000 人年 52.6 例。获得急性肝炎 A 的相关因素是近期梅毒和未接种 HAV 疫苗。疫情期间，HAV 疫苗接种率从 4.7%增加到 70.6%，当有多达 65%的患者接受 HAV 疫苗接种或检测呈 HAV 阳性时，急性肝炎 A 的发病率下降。
年轻的 HIV 阳性个体的 HAV 感染血清阳性率较低。通过 HAV 疫苗接种和在疫情期间增加群体免疫力，在 HIV 阳性、HAV 阴性患者中实现了急性肝炎 A 的预防。
