Abstract
STUDY OBJECTIVE—To evaluate an intervention designed to curtail an outbreak of hepatitis A among gay men, especially the young and sexually active, by promoting their free vaccination. DESIGN—The study analysed routine passive surveillance data, carried out questionnaire and serological surveys of vaccinees, and surveys among the target population in non-clinical venues. SETTING AND INTERVENTION—15 000 free doses of hepatitis A vaccine were made available through clinics with large gay clienteles, or at gay events, and advertised by various means, in Montréal, Canada, from August 1996 to November 1997. Simultaneous vaccination against hepatitis B (always free for gay men) was also encouraged. PARTICIPANTS—Information was obtained from persons with the disease during the epidemic period, a sample of men requesting vaccination, and five community samples of gay men. MAIN RESULTS—The outbreak involved 376 gay men and the vaccine was distributed to approximately 10 000. Vaccinees were older than cases, but had many sex partners and comprised more food handlers. Special vaccination clinics at gay events were well attended but did not reach more high risk men than regular medical venues. A self reported vaccine coverage of 49% was achieved, but 26% of vaccinees already had anti-HAV antibodies. Disease incidence declined rapidly during the campaign. CONCLUSIONS—The intervention nearly tripled self reported hepatitis A vaccine coverage but its late start precludes proving that it caused the subsequent drop in incidence. However, it also increased hepatitis B vaccination and it is believed it improved links between gay men, public health, clinicians and community groups. Keywords: hepatitis A; immunisation; homosexuality
Full Text
The Full Text of this article is available as a PDF (141.1 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Allard R., Durand L., Guy M., Deshaies D., Robert J. Hepatitis A in downtown Montreal, Quebec, 1990-1992. Can Commun Dis Rep. 1995 Apr 30;21(8):71–76. [PubMed] [Google Scholar]
- Bryan J. P., Nelson M. Testing for antibody to hepatitis A to decrease the cost of hepatitis A prophylaxis with immune globulin or hepatitis A vaccines. Arch Intern Med. 1994 Mar 28;154(6):663–668. [PubMed] [Google Scholar]
- Centers for Disease Control and Prevention (CDC) Hepatitis A vaccination of men who have sex with men--Atlanta, Georgia, 1996-1997. MMWR Morb Mortal Wkly Rep. 1998 Sep 4;47(34):708–711. [PubMed] [Google Scholar]
- Christenson B., Broström C., Böttiger M., Hermanson J., Weiland O., Ryd G., Berg J. V., Sjöblom R. An epidemic outbreak of hepatitis A among homosexual men in Stockholm. Hepatitis A, a special hazard for the male homosexual subpopulation in Sweden. Am J Epidemiol. 1982 Oct;116(4):599–607. doi: 10.1093/oxfordjournals.aje.a113442. [DOI] [PubMed] [Google Scholar]
- Corey L., Holmes K. K. Sexual transmission of hepatitis A in homosexual men: incidence and mechanism. N Engl J Med. 1980 Feb 21;302(8):435–438. doi: 10.1056/NEJM198002213020804. [DOI] [PubMed] [Google Scholar]
- Desenclos J. C., MacLafferty L. Community wide outbreak of hepatitis A linked to children in day care centres and with increased transmission in young adult men in Florida 1988-9. J Epidemiol Community Health. 1993 Aug;47(4):269–273. doi: 10.1136/jech.47.4.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Henning K. J., Bell E., Braun J., Barker N. D. A community-wide outbreak of hepatitis A: risk factors for infection among homosexual and bisexual men. Am J Med. 1995 Aug;99(2):132–136. doi: 10.1016/s0002-9343(99)80132-6. [DOI] [PubMed] [Google Scholar]
- Høybye G., Skinhøj P., Hentzer B., Faber V., Mathiesen L. An epidemic of acute viral hepatitis in male homosexuals. Etiology and clinical characteristics. Scand J Infect Dis. 1980;12(4):241–244. doi: 10.3109/inf.1980.12.issue-4.01. [DOI] [PubMed] [Google Scholar]
- Ishida T., Nakamura T., Ajisawa A., Negishi M., Kashiyama T., Takechi A., Iwamoto A. Outbreak of hepatitis A virus infection among HIV-1 seropositive men who had sex with men. Jpn J Infect Dis. 1999 Jun;52(3):131–132. [PubMed] [Google Scholar]
- Katz M. H., Hsu L., Wong E., Liska S., Anderson L., Janssen R. S. Seroprevalence of and risk factors for hepatitis A infection among young homosexual and bisexual men. J Infect Dis. 1997 May;175(5):1225–1229. doi: 10.1086/593675. [DOI] [PubMed] [Google Scholar]
- Leentvaar-Kuijpers A., Kool J. L., Veugelers P. J., Coutinho R. A., van Griensven G. J. An outbreak of hepatitis A among homosexual men in Amsterdam, 1991-1993. Int J Epidemiol. 1995 Feb;24(1):218–222. doi: 10.1093/ije/24.1.218. [DOI] [PubMed] [Google Scholar]
- McMahon B. J., Beller M., Williams J., Schloss M., Tanttila H., Bulkow L. A program to control an outbreak of hepatitis A in Alaska by using an inactivated hepatitis A vaccine. Arch Pediatr Adolesc Med. 1996 Jul;150(7):733–739. doi: 10.1001/archpedi.1996.02170320079014. [DOI] [PubMed] [Google Scholar]
- Newell A., Asboe D., Azadian B. Outbreak of hepatitis A in homosexual men in Riverside. Sex Transm Infect. 1998 Aug;74(4):304–305. [PubMed] [Google Scholar]
- Príkazský V., Oleár V., Cernoch A., Safary A., André F. E. Interruption of an outbreak of hepatitis A in two villages by vaccination. J Med Virol. 1994 Dec;44(4):457–459. doi: 10.1002/jmv.1890440427. [DOI] [PubMed] [Google Scholar]
- Stewart T., Crofts N. An outbreak of hepatitis A among homosexual men in Melbourne. Med J Aust. 1993 Apr 19;158(8):519–521. doi: 10.5694/j.1326-5377.1993.tb121865.x. [DOI] [PubMed] [Google Scholar]
- Stokes M. L., Ferson M. J., Young L. C. Outbreak of hepatitis A among homosexual men in Sydney. Am J Public Health. 1997 Dec;87(12):2039–2041. doi: 10.2105/ajph.87.12.2039. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sundkvist T., Aitken C., Duckworth G., Jeffries D. Outbreak of acute hepatitis A among homosexual men in East London. Scand J Infect Dis. 1997;29(3):211–212. doi: 10.3109/00365549709019028. [DOI] [PubMed] [Google Scholar]
- Walsh B., Sundkvist T., Maguire H., Young Y., Heathcock R., Iverson A. Rise in hepatitis A among gay men in the Thames regions 1995 and 1996. Genitourin Med. 1996 Dec;72(6):449–450. doi: 10.1136/sti.72.6.449. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Werzberger A., Mensch B., Kuter B., Brown L., Lewis J., Sitrin R., Miller W., Shouval D., Wiens B., Calandra G. A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children. N Engl J Med. 1992 Aug 13;327(7):453–457. doi: 10.1056/NEJM199208133270702. [DOI] [PubMed] [Google Scholar]