Hepatitis A cases on the rise among adult males, 25-40 years old

Hepatitis A, cases increasing among adult males, 25-40 years old

Sharp increase in cases of hepatitis A, particularly in the metropolitan areas of Rome, Naples, and Milan. These are a few dozen cases that in the majority affect adults and particularly men between 25 and 40 years of age, to suggest a prevalent mode of spread by sexual contact. Infection can also occur through consumption of water and food, such as raw or undercooked shellfish contaminated with the virus.

SYMPTOMS AND CAUSES– Hepatitis A (formerly known as infectious hepatitis) is an acute infectious disease of the liver caused by a virus. The time between infection and the onset of symptoms is between two and six weeks: among the most common are nausea, vomiting, diarrhea, jaundice (eyes and skin take on a yellowish color), dark urine, light stools, fever and abdominal pain. Acute liver failure may rarely occur, an event more common in the elderly. Although hepatitis A presents a generally benign course and severe cases are rare and predominantly affect people with other concomitant diseases, its course in adults is often prolonged, even for months and debilitating.

After a single infection the individual acquires immunity for the rest of his or her life.

L’HEPATITIS A IN MSM SUBJECTS – With regard to males practicing male-to-male (MSM) sex, small local epidemics of hepatitis A among have been reported in the 2000s in Europe and the United States. In Italy we currently have reports of cases mainly in Milan, Rome, Padua and Naples. However, these are only a few dozen cases, which have limited bearing on the spread of the disease in the general population, which remains extremely low (around 0.6 cases per 100,000 population, SEIEVA data).

“In the case of hepatitis A, protection with condoms – states the Prof. John Baptist Gaeta, Full Professor of `Infectious Diseases` at the Second University of Naples – does not prevent fecal-oral transmission following oral-anal sexual contacts. In practice, the hepatitis A vaccine has good efficacy in preventing cases of infection and therefore should be recommended immediately to contacts of affected cases (including cohabiting family members) and more generally to all individuals exposed to risk because of their sexual habits.

To achieve the latter goal, an information campaign&#8221is indispensable;.

THE’EFFICACY OF THE VACCINE– Hepatitis A virus vaccination is expressly recommended in the National Vaccine Prevention Plan for MSM individuals. The efficacy of vaccination in reducing the risk of infection even during an epidemic has recently been demonstrated in Taiwan, where more than 750 cases of hepatitis A have been reported among MSM since 2015.

“In a study involving more than 1,500 MSM with HIV infection implemented during a hepatitis A epidemic that caused more than 750 cases among MSM, those who did not agree to undergo vaccination – states the Prof. Massimo Galli, Professor of Infectious Diseases University of Milan, as well as vice president of the SIMIT, Italian Society of Infectious and Tropical Diseases – experienced hepatitis 16.5 times more frequently than those who received even a single dose of vaccine. This has made it possible to determine in this case 93.6 percent effectiveness of vaccination, despite the fact that its administration could be considered late in the development of the epidemic.

The results of this study, which was presented last week at the Conference on Retroviruses and Opportunistic Infections (CROI), the most important scientific conference on HIV/AIDS held in Seattle this year, further confirm, therefore, the indication of hepatitis A vaccination for MSM”.

– ADMINISTRATIONS; Given the situation in our cities, it is appropriate for people who believe they may have been exposed to the infection or who believe they are at risk to get vaccinated. Once a case of hepatitis is detected, immediate vaccination of cohabiting family members and contacts should be recommended, valid for prophylaxis of secondary cases.

Vaccination is implemented – declares the Prof. Massimo Puoti, Director of Complex Structure of Infectious Diseases Grande Ospedale Metropolitano Niguarda di Milano – by two intramuscular administrations 6 months apart. Since it is a vaccine containing killed virus, there are no contraindications in its use in people with diseases that cause immunodepression.

Vaccination has also been shown to be effective in the majority of people who carry HIV infection and is especially recommended in people with chronic hepatopathy (as a result of the increased likelihood of developing severe forms), people with coagulopathies such that they require long-term therapy with blood derivatives, and people who use intravenous drugs”.