Comelli Agnese, Izzo Ilaria, Casari Salvatore, Spinetti Angiola, Bergamasco Alberto, Castelli Francesco
University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy.
Infez Med. 2018 Mar 1;26(1):46-51.
Since June 2016, an outbreak of hepatitis A has been reported in Europe. Here we report the HAV outbreak in Brescia (Northern Italy) from July 2016 to July 2017. We actively recorded all HAV cases defined by detection of HAV IgM antibodies in serum. Data on sexual behaviour, travel attitudes, concomitant sexually transmitted diseases (STDs), clinical presentation and laboratory results were collected. Forty-two confirmed cases were recorded: 25 (60%) were MSM and reported sexual contact at risk of STDs. Compared to 2015 and the first half of 2016, when only three hepatitis A cases were recorded, in the 12 months in question the number of cases rose 14-fold. Among 25 MSM, 14 were HIV-infected. Hepatitis A is usually a self-limiting disease, but it could be more serious in the case of HIV co-infection, immunosuppression and chronic hepatitis. HAV infection has a high outbreak potential in MSM because of more common oro-anal practices compared to HS, a high interconnectedness global network, chemsex practices and a new tendency to travel abroad to attend group sex events. In our experience, most cases occurred in MSM and 56% of them were HIV-infected, suggesting the need to promote active screening, immunization and education in this population.
自2016年6月以来，欧洲报告了甲型肝炎疫情。在此，我们报告2016年7月至2017年7月意大利北部布雷西亚的甲型肝炎疫情。我们积极记录所有通过血清中甲型肝炎IgM抗体检测确诊的病例。收集了性行为、旅行态度、合并性传播疾病（STD）、临床表现和实验室检查结果等数据。共记录了42例确诊病例：25例（60%）为男男性行为者（MSM），且报告有感染STD风险的性接触。与2015年及2016年上半年仅记录到3例甲型肝炎病例相比，在上述12个月期间病例数增长了14倍。在25例MSM中，14例感染了艾滋病毒。甲型肝炎通常是一种自限性疾病，但在合并艾滋病毒感染、免疫抑制和慢性肝炎的情况下可能更为严重。由于与异性性行为相比，男男性行为中口交更为常见，全球网络高度互联，存在使用新型毒品后的性行为（chemsex）以及前往国外参加群交活动的新趋势，甲型肝炎病毒感染在男男性行为者中具有很高的暴发潜力。根据我们的经验，大多数病例发生在男男性行为者中，其中56%感染了艾滋病毒，这表明有必要在该人群中推广主动筛查、免疫接种和教育。
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