Between 25 July to 22 December 2017, 37 cases of hepatitis A were reported in adults in NSW with one of three strains of the virus linked to national outbreaks. The majority of these infections are thought to have been acquired through male to male sexual transmission.
Thirty-five (95%) of the 37 cases are male, with 20 reporting being men who have sex with men (MSM). Thirty-one cases (84%) live in the metropolitan Sydney region, and three of the six cases who live outside Sydney reported travel to Sydney during their exposure period. Five of the 37 cases travelled outside Australia during their exposure period.
Other Australian states and territories are also reporting outbreaks of hepatitis A among men who have sex with men (MSM), with three strains being reported. All viruses detected as part of locally acquired outbreaks in Australia are related to strains currently circulating in Europe associated with a large, multi-country outbreak. Since the start of the outbreak, four times the usual number of hepatitis A cases have been reported across Europe, with 2,873 cases confirmed as outbreak-related by sequencing, predominantly among MSM (see the ECDC report).
As of 8 April 2018, 100 days (two incubation periods) have passed since the last NSW case was infectious. The NSW outbreak investigation is now closed, however the risk of hepatitis A among MSM remains high, especially those travelling interstate and internationally.
Hepatitis A vaccination recommended for men who have sex with men
Hepatitis A vaccination is strongly recommended for men who have sex with men, as anal sex and oral-anal sex have been identified as risk factors for infection. The two dose vaccination course is safe and provides high levels of protection. Men who engage in sexual activity with other men are strongly encouraged to speak to their GP or local sexual health clinic about vaccination against hepatitis A. Follow this link for a list of sexual health clinics.
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. 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.
NSW Health media release [15 September 2017]
Information for health professionals
Information for GPs [5 September 2017]
Information for Sexual Health Clinics and other clinicians [15 September 2017]
For further information please see hepatitis A disease information.