Tanaka Satoshi, Kishi Tomomi, Ishihara Akio, Watanabe Dai, Uehira Tomoko, Ishida Hisashi, Shirasaka Takuma, Mita Eiji
Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Hepatol Res. 2019 Jun;49(6):705-710. doi: 10.1111/hepr.13314. Epub 2019 Mar 1.
Ongoing hepatitis A outbreaks among men who have sex with men (MSM) have been reported worldwide, mainly in Europe, since 2016. In Japan, there has been an increase in the number of notified hepatitis A cases since January 2018, most of which were suspected to have been transmitted through homosexual contact. In this paper, we describe the current outbreak situation of hepatitis A among MSM.
Between March and July 2018, 13 cases of hepatitis A were identified in our hospital. All cases were identified as MSM. Data on clinical and laboratory findings and therapies were collected from medical records. Serum or stool samples were obtained from 13 patients and subjected to sequence analysis.
Of all patients, 12 reported to have male-to-male homosexual contact within 7 weeks prior to symptom onset, and 6 visited sex-on-premises venues in the same area. Furthermore, 12 patients were infected with HIV and consequently received antiretroviral therapy with sustained viral suppression. Ten patients received pulsed methylprednisolone therapy. Plasma exchange was additionally carried out in one patient. All patients received inpatient hospital care and were discharged alive. Sequence information, which was available in all cases, showed that the hepatitis A virus strain was identical to the EuroPride strain (RIVM-HAV16-090).
Results of sequence analysis suggest that the ongoing hepatitis A outbreak among MSM in Japan is linked to the 2016 European outbreaks. A vaccination program is urgently required for high-risk populations to control this ongoing outbreak.
自2016年以来，全球范围内均有关于男男性行为者（MSM）中甲型肝炎持续暴发的报道，主要发生在欧洲。在日本，自2018年1月以来，甲型肝炎报告病例数有所增加，其中大多数疑似通过同性恋接触传播。在本文中，我们描述了MSM中甲型肝炎的当前暴发情况。
2018年3月至7月期间，我院确诊了13例甲型肝炎病例。所有病例均为MSM。从病历中收集临床、实验室检查结果及治疗数据。从13例患者中采集血清或粪便样本并进行序列分析。
所有患者中，12例报告在症状出现前7周内有男男性接触，6例去过同一地区的经营性性场所。此外，12例患者感染了HIV，因此接受了抗逆转录病毒治疗且病毒得到持续抑制。10例患者接受了脉冲式甲泼尼龙治疗。1例患者还进行了血浆置换。所有患者均接受住院治疗且均康复出院。所有病例均获得的序列信息显示，甲型肝炎病毒株与欧洲骄傲株（RIVM-HAV16-090）相同。
序列分析结果表明，日本MSM中正在发生的甲型肝炎暴发与2016年欧洲的暴发有关。迫切需要为高危人群制定疫苗接种计划以控制此次持续的暴发。
