荷兰阿姆斯特丹男男性行为者中的甲型肝炎发病率、血清流行率和疫苗接种决策。
Hepatitis A incidence, seroprevalence, and vaccination decision among MSM in Amsterdam, the Netherlands.
机构信息
Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands.
Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, the Netherlands; INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
出版信息
Vaccine. 2019 May 9;37(21):2849-2856. doi: 10.1016/j.vaccine.2019.03.048. Epub 2019 Apr 13.
BACKGROUND
Several outbreaks of Hepatitis A virus (HAV) were recently documented among men who have sex with men (MSM) in Europe. We investigated the HAV incidence among MSM in Amsterdam, the Netherlands; and HAV seroprevalence and HAV vaccination decision among MSM visiting the Sexually Transmitted Infection (STI) clinic in Amsterdam.
METHODS
Using surveillance data from 1992 to 2017 of MSM with acute HAV in Amsterdam, we estimated the incidence by calendar year and age. We explored HAV seroprevalence by calendar year and age, determinants for HAV seropositivity, and opting-in/out for HAV vaccination using data collected among MSM that visited the STI clinic between 2006 and 2017 and were included in a nationwide Hepatitis B virus (HBV) vaccination programme. Offering HAV vaccination at the STI clinic differed over three consecutive periods: not offered, offered for free, or offered for 75 euros. Logistic regression analyses were used to explore determinants.
RESULTS
HAV incidence increased in 2016/17 after 4 years of absence and peaked in MSM around 35 years of age. Among MSM visiting the STI clinic, HAV seroprevalence was 37% (95%CI = 35-40%), which was constant over the period 2006-2017, and increased with age (p < 0.001). Determinants for HAV seropositivity in multivariable analysis were: older age (p < 0.001), originating from an HAV endemic country (p < 0.001), and being HBV seropositive (p = 0.001). MSM opted-in more frequently when HAV vaccination was offered for free versus paid (89% versus 11%, respectively; p < 0.001). Younger MSM were less inclined to vaccinate when payment was required (p = 0.010). Post-hoc analyses showed that 98% versus 46% of MSM visiting the Amsterdam STI clinic would be protected against HAV infection if HAV vaccination was offered for free or for 75 euros, respectively.
CONCLUSIONS
The MSM population of Amsterdam is vulnerable to a new HAV outbreak. We strongly recommend that MSM have access to free hepatitis A vaccination.
背景
最近在欧洲，男男性行为者（MSM）中爆发了几起甲型肝炎病毒（HAV）疫情。我们调查了荷兰阿姆斯特丹 MSM 中的 HAV 发病率；并调查了在阿姆斯特丹性传播感染（STI）诊所就诊的 MSM 中的 HAV 血清流行率和 HAV 疫苗接种决策。
方法
使用 1992 年至 2017 年阿姆斯特丹急性 HAV 中 MSM 的监测数据，我们按日历年度和年龄估算发病率。我们按日历年度和年龄探索 HAV 血清流行率，探讨 HAV 血清阳性的决定因素，以及在 2006 年至 2017 年期间访问 STI 诊所并被纳入全国乙型肝炎病毒（HBV）疫苗接种计划的 MSM 中选择/不选择 HAV 疫苗接种的情况。在 STI 诊所提供 HAV 疫苗接种在三个连续时期有所不同：不提供、免费提供或 75 欧元提供。使用逻辑回归分析探讨决定因素。
结果
在 4 年没有 HAV 疫情后，2016/17 年 HAV 发病率上升，在 35 岁左右的 MSM 中达到高峰。在访问 STI 诊所的 MSM 中，HAV 血清流行率为 37%（95%CI=35-40%），在 2006-2017 年期间保持不变，并随年龄增长而增加（p<0.001）。多变量分析中 HAV 血清阳性的决定因素是：年龄较大（p<0.001）、来自 HAV 流行国家（p<0.001）和 HBV 血清阳性（p=0.001）。当 HAV 疫苗接种免费提供时，MSM 选择接种的频率更高（分别为 89%和 11%；p<0.001）。当需要支付费用时，年轻的 MSM 不太倾向于接种疫苗（p=0.010）。事后分析显示，如果 HAV 疫苗接种免费或 75 欧元提供，访问阿姆斯特丹 STI 诊所的 MSM 中有 98%和 46%分别会免受 HAV 感染。
结论
阿姆斯特丹的 MSM 人群容易受到新的 HAV 爆发的影响。我们强烈建议 MSM 能够获得免费的甲型肝炎疫苗接种。
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