Authorities are tracking two outbreaks of hepatitis A in Australia, one in the Sydney area of New South Wales and one in Victoria. Gay and bisexual men are particularly at risk, as are those who inject drugs. Medical advice recommends that all men who have sex with men are vaccinated against hepatitis A as soon as possible.
The Travel Health Pro website reports that –
As of 12 January 2018, two outbreaks of hepatitis A have been reported. In New South Wales, 29 of the 30 cases are male, with 16 reporting being men who have sex with men (MSM). In Victoria, 27 confirmed cases are reported and the outbreak is affecting gay, bisexual and other MSM, and people who inject drugs.
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The New South Wales Government’s Communicable Diseases Weekly Report offers more detail on the NSW outbreak –
Two new cases of hepatitis A infection were reported this week (Table 1). Both of these cases are thought to have been acquired their infections while overseas. On average, there are three cases reported in NSW per month, and usually most cases have acquired their infection overseas.
From 25 July to 6 January 2018, there have been a total of 35 cases of hepatitis A reported in adults in NSW under investigation as part of a locally transmitted outbreak. This includes one new case identified in the previous reporting week.
Molecular typing of the viruses isolated from 31 of these cases has shown that they share an identical partial genome sequence, meaning that the cases are all part of the same outbreak. The median age of the 31 cases is 41 years (range 21 to 69 years). Twenty-nine of the 30 cases are male, with 16 reporting being men who have sex with men (MSM). Four of the 31 cases travelled outside Australia during their exposure period. These 31 cases are residents of South Eastern Sydney Local Health District (LHD) (10), Sydney LHD (8), Northern Sydney LHD (3), Central Coast LHD (3), Western Sydney LHD (2), South Western Sydney LHD (2), Hunter New England LHD (2) and Illawarra Shoalhaven LHD (1). Three of the six cases who live outside Sydney reported travel to Sydney during their exposure period.
The four remaining cases have molecular typing results pending; three are male, and two identify as MSM. The molecular typing of hepatitis A viruses in this cluster shows they are very similar to a strain currently circulating in Europe associated with a large, multi-country outbreak. Since June 2016, 1,500 confirmed hepatitis A cases and 2,660 probable or suspected cases have been reported in Europe, predominantly among MSM (see the ECDC report).
It is suspected that the earlier outbreak cases and some of the later cases have been exposed to a common source as they share overlapping exposure periods. Secondary cases have also been identified, with evidence that some infections have been transmitted from person to person. Men who engage in sexual activity with other men (MSM) are being reminded to get vaccinated, as anal sex and oral-anal sex have been identified as risk factors for infection (see media release). Despite extensive investigation, to date no food item or other possible exposure has been found in common with all the cases. NSW public health units are continuing to investigate possible sources of infection in conjunction with the NSW Food Authority (see the related media release).
Hepatitis A is a viral infection of the liver. Symptoms include feeling unwell, lack of appetite, aches and pains, fever, nausea, and abdominal discomfort, followed by dark urine, pale stools and jaundice (yellowing of the skin and eyes). The illness usually lasts from one to three weeks. People who experience these symptoms are advised to see their GP.
Infected people can transmit the virus to others from two weeks before the development of symptoms until one week after the appearance of jaundice. The virus is spread by the faecal-oral route, including through the consumption of contaminated food or water or by direct contact with an infected person. While infectious, people diagnosed with hepatitis A should avoid preparing food or drink for other people, sharing utensils or towels, or having sex for at least one week after onset of jaundice. There is no specific treatment for hepatitis A and people sometimes require hospitalisation for supportive care. A safe and effective vaccine is available, with two doses spaced at least six months apart shown to provide high levels of protection against infection for many years. Hepatitis A vaccination is routinely recommended for people at higher risk of infection and those who are at increased risk of severe liver disease. These include travellers to countries where hepatitis A is common (most developing countries), some occupational groups, men who have sex with men, people with developmental disabilities and people with chronic liver disease.
People exposed to hepatitis A can be protected from developing the disease if they receive the vaccine or protective antibodies within two weeks of exposure.
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