Liver Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
Liver Int. 2018 Apr;38(4):588-593. doi: 10.1111/liv.13606. Epub 2017 Nov 10.
BACKGROUND & AIMS: Acute hepatitis A is transmitted mainly via the faecal-oral route and/or contaminated aliment. Furthermore, several outbreaks in the men who have sex with men (MSM) population classified hepatitis A as a sexually transmitted disease (STD). We aimed to clarify an ongoing hepatitis A outbreak in Barcelona with respect to patients' characteristics and viral phylogenetic analysis.
We prospectively analyzed 46 cases of hepatitis A infection that were registered in our hospital between January and June 2017. We evaluated demographics data, risk factors, presenting symptoms, sexual orientation, comorbidities and further STD infections. The phylogenetic correlation of the current circulating viruses among them and other hepatitis A strains was assessed by sequencing of the VP1/P2A region.
Most patients were male (44, 96%) with median age 33.5 years (range 28-50). Thirty-one (67%) were MSM and 18 (39%) required hospitalization. Molecular phylogenetic analyses revealed that all patients were infected by hepatitis A subgenotype IA strains. Moreover, current strains comprised 3 distinct clusters, previously reported in ongoing outbreaks in the United Kingdom, Berlin and the Netherlands. However, these strains were phylogenetically diverse to those previously reported in Barcelona metropolitan region.
Ongoing hepatitis A outbreak in Barcelona affects primarily the MSM community and is phylogenetically linked to current hepatitis A outbreaks described in other European countries. As a result of the high admission rate, these outbreaks may impact the admission pattern of referral liver units. Control measures, for example vaccinations programs tailored to the MSM community, must be taken to control further spreading.
甲型肝炎主要通过粪-口途径和/或受污染的食物传播。此外，一些男男性接触者（MSM）人群中的暴发事件将甲型肝炎归类为性传播疾病（STD）。我们旨在阐明巴塞罗那正在发生的甲型肝炎暴发事件，包括患者特征和病毒系统发育分析。
我们前瞻性分析了 2017 年 1 月至 6 月期间在我院登记的 46 例甲型肝炎感染病例。我们评估了人口统计学数据、危险因素、临床表现、性取向、合并症和其他性传播疾病感染。通过对 VP1/P2A 区域进行测序，评估了当前流行病毒与其他甲型肝炎毒株之间的系统发育相关性。
大多数患者为男性（44 例，96%），中位年龄 33.5 岁（范围 28-50 岁）。31 例（67%）为 MSM，18 例（39%）需要住院治疗。分子系统发育分析显示，所有患者均感染了甲型肝炎亚基因型 IA 株。此外，当前毒株包括 3 个不同的聚类，这些聚类先前在英国、柏林和荷兰的正在进行的暴发中被报道过。然而，这些毒株与以前在巴塞罗那大都市区报告的毒株在系统发育上存在差异。
巴塞罗那正在发生的甲型肝炎暴发主要影响 MSM 人群，与其他欧洲国家描述的当前甲型肝炎暴发在系统发育上有关。由于高住院率，这些暴发可能会影响转诊肝脏单位的入院模式。必须采取控制措施，例如针对 MSM 人群的疫苗接种计划，以控制进一步传播。
