Incidence of acute hepatitis A among HIV-positive patients during an outbreak among MSM in Taiwan: Impact of HAV vaccination
Incidence of acute hepatitis A among HIV-positive patients during an outbreak among MSM in Taiwan: Impact of HAV vaccination
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DOI：
10.1111/liv.13468
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发表时间：
2018-04-01
影响因子：
6.7
通讯作者：
Chang, Shan-Chwen
中科院分区：
文献类型：
--
作者：
Chen, Guan-Jhou;Lin, Kuan-Yin;Chang, Shan-Chwen
自2015年6月以来，台湾MSM中发生了前所未有的急性甲型肝炎疫情。我们的目的是描述甲肝感染的血清流行病学，并调查甲肝疫苗接种与疫情期间在最大的艾滋病毒护理指定医院的艾滋病毒阳性患者中急性甲型肝炎发病率之间的关系。方法回顾性分析2012 - 2016年艾滋病病毒阳性患者的甲肝血清状况、疫苗接种史及临床特点。为确定与急性甲型肝炎相关的因素，开展了病例对照研究。在疫情暴发期间，研究了甲肝疫苗接种率和甲肝血清阴性患者急性甲肝发病率的变化趋势。结果4.5年期间共纳入hiv阳性患者2088例，平均年龄37.7岁，其中男男性行为者占90.2%。总体HAV血清阳性率为34.3%，在老年和非msm患者中明显较高。在疫情爆发期间，急性甲型肝炎的估计发病率为每1000人-年随访52.6例。与获得急性甲型肝炎相关的因素是近期梅毒和未接种甲肝疫苗。疫情期间甲肝疫苗接种率从4.7%上升到70.6%，当高达65%的患者接种甲肝疫苗或甲肝病毒检测呈阳性时，急性甲肝发病率下降。结论青年hiv阳性人群血清HAV感染率较低。在持续暴发期间，通过甲型肝炎疫苗接种和提高群体免疫力，在艾滋病毒阳性和甲肝血清阴性患者中实现了急性甲型肝炎的预防。见581页社论
BackgroundAn unprecedented outbreak of acute hepatitis A has occurred among MSM in Taiwan since June 2015. We aimed to describe the seroepidemiology of HAV infection and to investigate the relationship between HAV vaccination and the incidence of acute hepatitis A among HIV-positive patients at the largest designated hospital for HIV care during the outbreak.MethodsBetween 2012 and 2016, the HAV serostatus, vaccination history and clinical characteristics of HIV-positive patients were retrospectively reviewed. A case-control study was performed to identify the factors associated with acute hepatitis A. The trends of HAV vaccination rate and incidence of acute hepatitis A among HAV-seronegative patients were examined during the outbreak.ResultsDuring the 4.5-year period, 2088 HIV-positive patients with a mean age of 37.7years and 90.2% being MSM were included. The overall HAV seroprevalence was 34.3%, which was significantly higher in older and non-MSM patients. The estimated incidence rate of acute hepatitis A was 52.6 cases per 1000 person-years of follow-up during the outbreak. The associated factors with acquiring acute hepatitis A were recent syphilis and having not received HAV vaccines. The HAV vaccination rate during the outbreak increased from 4.7% to 70.6% and the incidence rate of acute hepatitis A declined when up to 65% of the patients were immunized or tested positive for HAV.ConclusionsThe seroprevalence of HAV infection was low in the younger HIV-positive individuals. Prevention of acute hepatitis A was achieved among HIV-positive, HAV-seronegative patients through HAV vaccination and increased herd immunity during the ongoing outbreak.See Editorial on Page 581