Rapid risk assessment: Hepatitis A outbreak in the EU/EEA mostly affecting men who have sex with men, 3rd update, 28 June 2017

Risk assessment

European Centre for Disease Prevention and Control. Hepatitis A outbreaks in the EU/EEA mostly affecting men who have sex with men – third update, 28 June 2017. Stockholm: ECDC; 2017.

Third update of a previous assessment on the ongoing transmission of hepatitis A virus infection mainly affecting men who have sex with men in EU/EEA countries.

Executive summary

Since June 2016, 1 500 confirmed hepatitis A (HAV) cases and 2 660 probable or suspected cases have been reported in the EU, predominantly among adult men who have sex with men (MSM).

Responding to the outbreaks, EU/EEA countries should consider enhancing national hepatitis A surveillance in order to ensure timely monitoring of this outbreak and rapid detection of critical developments, such as the extension of the outbreak into other population groups at increased risk of infection or the introduction into the food chain.

Sharing of anonymised microbiological and epidemiological details of new cases and questionnaires used during outbreak investigations through the Epidemic Intelligence Information System for Food- and Waterborne Diseases and Zoonoses (EPIS-FWD) is encouraged in order to monitor the epidemiological situation.

The main prevention measure in the context of the current outbreaks is hepatitis A vaccination of MSM. ECDC guidance for HIV and sexually transmitted infection prevention among MSM encourages Member States to offer and promote vaccination of MSM against hepatitis A. Information on vaccine availability should be included in health promotion programmes targeting MSM, particularly at sex venues.

Where hepatitis A vaccination is not universally offered to MSM, the following groups could be prioritised for vaccination, in line with the national vaccine recommendations:

  • MSM living in areas where there are ongoing outbreaks;
  • MSM travelling to destinations reporting outbreaks of hepatitis A among MSM;
  • MSM attending Pride festivals this summer, where the likelihood of contact with HAV-infected individuals could be elevated (provision of vaccination at Pride festival venues could be considered);
  • MSM at risk of severe outcome as a result of hepatitis A, for example those with chronic liver disease, hepatitis B and/or hepatitis C and those who inject drugs.

In this context, promoting and offering HAV vaccination to MSM attending Pride festivals this summer is suggested, as the likelihood of sexual contact with HAV-infected individuals could be higher. However, limited HAV vaccine availability in some countries may have an impact on this.

Vaccine procurement and licensing agreements for the various hepatitis A vaccines differ between countries. It is therefore suggested that countries interact directly with marketing authorisation holders to enquire about supplies at the national level as early as possible (i.e. create forecasts of the number of doses required and make procurement arrangements.) It is advisable that any changes in current hepatitis A vaccination policies and supplementary immunisation activities be planned as early as possible. At the national level, where marketing of hepatitis A vaccines is authorised in accordance with national legislation, regulatory authorities should be informed of supply shortages.

In addition to vaccination, additional options are considered for preventing transmission among MSM in the rapid risk assessment.