Recent outbreaks of severe hepatitis A virus infections in Vienna
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ORIGINAL ARTICLE
Recent outbreaks of severe hepatitis A virus infections in Vienna David Bauer 1,2 & Anna Farthofer 1 & David Chromy 1,2,3 & Benedikt Simbrunner 1,2 & Lisa Steininger 1,2 & Caroline Schmidbauer 1,2,4 & Teresa Binter 1,2 & Michael Trauner 1 & Mattias Mandorfer 1,2 & Ralf Schmidt 5 & Florian Mayer 5 & Heidemarie Holzmann 6 & Robert Strassl 5 & Thomas Reiberger 1,2,7 Received: 23 June 2020 / Accepted: 26 August 2020 # The Author(s) 2020
Abstract To explore the epidemiology and clinical course of hepatitis A virus (HAV) infections at the Vienna General Hospital. We retrospectively identified patients who were tested positive for HAV-IgM at the Vienna General Hospital form Q1/2008 to Q3/ 2018. Our definition of severe HAV infection was AST and/or ALT > 5 × above the upper limit of normal (ULN); and liver dysfunction as (i) hepatic encephalopathy or ammonia > 100 μmol/L, (ii) coagulopathy with INR > 1.5, or (iii) jaundice with bilirubin > 5 mg/dL. A total of 578 HAV-IgM (+) were identified, including 31 (5.4%) and 38 (6.6%) without and with liver dysfunction, respectively. A proportional increase in severe HAV cases with and without liver dysfunction occurred in 2016/ 2017 with (21.5% (vs. 8.0% in the years before; p < 0.001). Thirty-seven (53.6%) patients with severe HAV were hospitalized, 6 (9%) required ICU support, and one patient received liver transplantation within 30 days. Patients with severe HAV and liver dysfunction were more often male (60.5 vs. 43.1%, p = 0.055) and younger (31.5 vs. 63 years, p < 0.001) as compared with other HAV-IgM (+) cases. The observed increase of severe HAV infections in Vienna in 2017 among young males, coincided with a multinational HAV outbreak among MSM. Our data suggests a higher likelihood of severe courses of hepatitis A in MSM. Vaccination against HAV should be recommended for risk groups. Keywords Hepatitis A . Viral hepatitis A . Hepatitis A epidemiology . Austria
Introduction Hepatitis A virus (HAV) infection is usually a self-limiting viral disease with a reported case fatality of 0.1–0.3% [1, 2]. According to estimations by the WHO, HAV caused 16,900 and 11,200 deaths worldwide in 2005 and 2015, respectively [3]. Persons aged 40 years and older are more susceptible to HAV-associated complications and mortality than younger
persons [4]. Transmission usually occurs via the fecal-oral route as per contaminated food or water or person-to-person contact or smear transmission. While effective antiviral therapies are available for other types of viral infections, treatment options for acute HAV infection are limited to symptomatic measures [5, 6]. The HAV belongs to the family of Picornaviridae of the genus Hepatovirus and is a nonenveloped single-stranded RNA virus [7]. While only one
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-020-04028-x) contains supplementary material, which is available to authorized users. * Thomas Reiberger [email protected] 1
Division of Gastroenterology and He
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