Kuan-Yin Lin1,2, Hsin-Yun Sun2,3, Yi-Hsuan Chen2, Yi-Chun Lo4, Szu-Min Hsieh3, Wang-Huei Sheng3, Yu-Chung Chuang3, Sung-Ching Pan3, Aristine Cheng3, Chien-Ching Hung3,5,6,7, Chi-Tai Fang2,3, Shan-Chwen Chang3. 1. Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City. 2. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei. 3. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei. 4. Centers for Disease Control, National Taiwan University College of Medicine, Taipei. 5. Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei. 6. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. 7. China Medical University, Taichung, Taiwan.
Abstract
BACKGROUND: Beginning from 2015-2016, unprecedented large outbreaks of acute hepatitis A that predominantly affected men who have sex with men (MSM) reemerged across the continents. We assessed the impact of an early initiated hepatitis A virus (HAV) vaccination campaign that targeted MSM living with human immunodeficiency virus (HIV) during the 2015-2017 hepatitis A outbreak in Taiwan. METHODS: First, we ascertained the effectiveness of HAV vaccination for MSM living with HIV using a nested case-control study of 1470 persons living with HIV who were initially HAV-seronegative. We then fitted a model of HAV transmission among MSM, risk-structured by HIV status, to the actual epidemic curve of reported acute hepatitis A cases in Taiwan during 2015-2017. RESULTS: Fifty-five cases of acute hepatitis A were matched to 220 controls. Single-dose and 2-dose HAV vaccination provided protection rates of 96.1% and 97.8% among recipient MSM living with HIV, respectively. Model fitting yielded basic reproductive number estimates of 7.26 (MSM living with HIV) and 3.04 (MSM not living with HIV). In a counterfactual scenario without an HAV vaccination campaign, the outbreak would have involved 7153 hepatitis A cases during 2015-2017 in contrast to the 1352 that were observed. We therefore estimated that the HAV vaccination campaign averted 80.7% (sensitivity analysis, 48.8%-92.7%) of acute hepatitis A cases that would otherwise have occurred by the end of 2017. CONCLUSIONS: The early initiated HAV vaccination campaign, which targeted MSM living with HIV, very effectively curtailed the 2015-2017 hepatitis A outbreak in Taiwan.
BACKGROUND: Beginning from 2015-2016, unprecedented large outbreaks of acute hepatitis A that predominantly affected men who have sex with men (MSM) reemerged across the continents. We assessed the impact of an early initiated hepatitis A virus (HAV) vaccination campaign that targeted MSM living with human immunodeficiency virus (HIV) during the 2015-2017 hepatitis A outbreak in Taiwan. METHODS: First, we ascertained the effectiveness of HAV vaccination for MSM living with HIV using a nested case-control study of 1470 persons living with HIV who were initially HAV-seronegative. We then fitted a model of HAV transmission among MSM, risk-structured by HIV status, to the actual epidemic curve of reported acute hepatitis A cases in Taiwan during 2015-2017. RESULTS: Fifty-five cases of acute hepatitis A were matched to 220 controls. Single-dose and 2-dose HAV vaccination provided protection rates of 96.1% and 97.8% among recipient MSM living with HIV, respectively. Model fitting yielded basic reproductive number estimates of 7.26 (MSM living with HIV) and 3.04 (MSM not living with HIV). In a counterfactual scenario without an HAV vaccination campaign, the outbreak would have involved 7153 hepatitis A cases during 2015-2017 in contrast to the 1352 that were observed. We therefore estimated that the HAV vaccination campaign averted 80.7% (sensitivity analysis, 48.8%-92.7%) of acute hepatitis A cases that would otherwise have occurred by the end of 2017. CONCLUSIONS: The early initiated HAV vaccination campaign, which targeted MSM living with HIV, very effectively curtailed the 2015-2017 hepatitis A outbreak in Taiwan.
Authors: Andrew F Brouwer; Jonathan L Zelner; Marisa C Eisenberg; Lynsey Kimmins; Macey Ladisky; Jim Collins; Joseph N S Eisenberg Journal: Epidemiology Date: 2020-09 Impact factor: 4.860