Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany.
Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany.
Int J Infect Dis. 2021 Feb;103:146-153. doi: 10.1016/j.ijid.2020.11.133. Epub 2020 Nov 15.
To describe the characteristics of a large hepatitis A virus (HAV) outbreak among men who have sex with men (MSM) in Berlin and to assess the impact of measures implemented.
Cases of laboratory-confirmed, symptomatic HAV infection notified in Berlin, Germany between August 2016 and February 2018 were analysed using routine and enhanced surveillance data including genotyping results. Several studies involving different groups of participants were conducted to further investigate the outbreak, including surveys on knowledge and practices of HAV vaccination among physicians and vaccination coverage and determinants of vaccination status among MSM. The measures implemented were categorized by target group in a Gantt chart. To assess their impact, health insurance data on HAV vaccination uptake were analysed, comparing Berlin and other federal states.
During the outbreak period, a total of 222 cases were reported (of which 91 were sequence-confirmed), with a peak in case numbers in January 2017. Physicians were aware of the existing vaccination recommendations, but vaccination coverage among 756 MSM was low, with 32.7% being completely vaccinated and 17.3% being incompletely vaccinated before 2017. HAV vaccination before 2017 was associated with being born in Germany (odds ratio 2.36) and HIV-positive (odds ratio 1.80). HAV monovalent vaccination uptake increased by 164% from 2016 to 2017 among males in Berlin, compared to 7% in other federal states.
Multiple measures targeting the MSM community, physicians, and public health to increase HAV vaccination uptake were successfully implemented. To prevent future HAV outbreaks, we recommend monitoring vaccination coverage among MSM, promoting awareness of existing recommendations among physicians, and ensuring access for foreign-born and young MSM.
描述柏林男男性行为者（MSM）中大规模甲型肝炎病毒（HAV）爆发的特征，并评估所采取措施的影响。
对 2016 年 8 月至 2018 年 2 月期间德国柏林通过实验室确诊、有症状的 HAV 感染病例进行了分析，采用常规和强化监测数据，包括基因分型结果。开展了几项涉及不同参与者群体的研究，以进一步调查疫情，包括对医生中 HAV 疫苗接种知识和实践以及 MSM 疫苗接种覆盖率和疫苗接种状况决定因素的调查。以目标人群为分类，在甘特图中列出了所采取的措施。为了评估其影响，分析了 HAV 疫苗接种覆盖率的健康保险数据，比较了柏林和其他联邦州的数据。
在疫情期间，共报告了 222 例病例（其中 91 例经序列确认），2017 年 1 月达到病例数高峰。医生了解现有的疫苗接种建议，但 756 名 MSM 的疫苗接种覆盖率较低，其中完全接种疫苗的比例为 32.7%，在 2017 年之前未完全接种疫苗的比例为 17.3%。2017 年之前，HAV 疫苗接种与在德国出生（比值比 2.36）和 HIV 阳性（比值比 1.80）相关。与其他联邦州相比，2017 年柏林男性 HAV 单价疫苗接种量增加了 164%，而其他联邦州仅增加了 7%。
针对 MSM 群体、医生和公共卫生部门采取了多项措施，以提高 HAV 疫苗接种率。为了预防未来的 HAV 爆发，我们建议监测 MSM 中的疫苗接种覆盖率，提高医生对现有建议的认识，并确保为外国出生和年轻的 MSM 提供疫苗接种机会。
