2017年1月至2018年11月,加拿大多伦多甲型肝炎社区爆发对男男性行为者的影响不成比例。

H. Sachdeva, M. Benusic, S. Ota, R. Stuart, J. Maclachlan, V. Dubey, A. Andonov
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引用次数: 18

摘要

2016年底和2017年初,一些国家开始报告甲型肝炎病毒(HAV)暴发,涉及男男性行为者(MSM)、非法吸毒者和无家可归者或住房不足者之间的人际传播。目的描述2017年1月至2018年11月加拿大多伦多甲型肝炎暴发的流行病学和公共卫生应对情况。方法随着其他国家报告的MSM中HAV病例数量的增加,对2017年6月1日至2018年11月1日报告的所有非旅行相关HAV病例进行了加强监测,包括对2017年1月至2017年6月报告的病例进行回顾性分析。进行描述性分析和病毒测序以描述人与人之间的传播模式和目标干预措施。控制战略包括采取干预措施,促进接触前甲肝疫苗接种,包括针对男男性行为者的社交媒体运动,向卫生保健提供者和疫苗诊所发送信息。结果根据暴发病例定义,共发现52例甲肝确诊和疑似病例。80%以上的暴发病例为男性(n=43/52),在可获得数据的病例中,64% (n=25/39)报告曾接触过男男性接触者。有51个病例的住院数据;56%的确诊病例(n=23/41)和40%的可能病例(n=4/10)需要住院治疗。在血清样本进行甲肝病毒测序的病例中,83% (n=30/36)携带国际上在男男性行为者中暴发流行的三种毒株之一;72% (n=26/36)为VRD_521_2016,该病毒已在最近报告的欧洲MSM暴发中检测到。利用受男男性行为者欢迎的社交媒体平台和有针对性的疫苗诊所,有针对性地促进公共资助的疫苗接种,以提高男男性行为者对甲肝病毒的认识和疫苗接种。结论加拿大现已发生甲型肝炎疫情,原因是甲型肝炎毒株的人际传播,对男同性恋者的影响不成比例,可能是从国际男同性恋者疫情输入的。甲肝病毒的基因测序、病例的风险因素分析、监测高危人群疫苗覆盖率的趋势以及开展疫苗接种运动,以解决男男男性行为人群中甲肝病毒暴露前疫苗覆盖率的障碍,这些都可能预防未来的疫情。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Community outbreak of hepatitis A disproportionately affecting men who have sex with men in Toronto, Canada, January 2017-November 2018.
Background In late 2016 and early 2017, a number of countries began reporting hepatitis A virus (HAV) outbreaks involving person-to-person transmission among men who have sex with men (MSM), people using illicit drugs and homeless or underhoused persons. Objective To describe the epidemiology and public health response to an outbreak of HAV disproportionately affecting MSM in Toronto, Canada from January 2017 to November 2018. Methods Following an increase in the number of cases of HAV in MSM being reported in other countries, enhanced surveillance was performed for all non-travel-related cases of HAV reported from June 1, 2017 to November 1, 2018, including a retrospective analysis of cases reported from January 2017 to June 2017. Descriptive analysis and viral sequencing were performed to describe person-to-person transmission patterns and target interventions. Control strategies included interventions to promote the uptake of preexposure HAV vaccination, including social media campaigns geared to MSM, messaging to healthcare providers and vaccine clinics. Results Based on the outbreak case definitions, 52 confirmed and probable cases of HAV were identified. Over 80% of outbreak cases were male (n=43/52) and, among those for whom data were available, 64% (n=25/39) reported an MSM exposure. Data on hospitalization was available for 51 cases; 56% of confirmed cases (n=23/41) and 40% of probable cases (n=4/10) required hospitalization. Of the cases with serum samples that had HAV sequencing, 83% (n=30/36) had one of the three strains seen circulating in outbreaks among MSM internationally; 72% (n=26/36) were VRD_521_2016, which had been detected in recently reported European outbreaks among MSM. Targeted promotion of publicly-funded vaccination using social media platforms popular with MSM and targeted vaccine clinics were developed to promote HAV awareness and vaccine uptake among MSM. Conclusion Outbreaks of HAV, attributed to person-to-person transmission of strains of HAV that disproportionately affected MSM and were likely to have been imported from international MSM outbreaks, have now occurred in Canada. Genetic sequencing of HAV, risk factor analysis of cases, monitoring trends of vaccine coverage in high-risk groups and initiation of vaccination campaigns that address barriers to HAV preexposure vaccine coverage in the MSM population may prevent future outbreaks.
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