Why the study?
Unprecedented large outbreaks of acute hepatitis A predominantly affecting men who have sex with men (MSM) reemerged, prompting an assessment of an early vaccination campaign targeting MSM living with HIV in Taiwan.
Does an early initiated HAV vaccination campaign reduce acute hepatitis A cases in MSM living with HIV?
Does an early initiated HAV vaccination campaign reduce acute hepatitis A cases in MSM living with HIV?
An early initiated HAV vaccination campaign targeting MSM living with HIV effectively curtailed a large hepatitis A outbreak.
May support targeted HAV vaccination campaigns in MSM with HIV during outbreaks; extends observational data but leaves open need for confirmatory trials.
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.
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Lin et al. (2019) studied this question.
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