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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "434" "paginaFinal" => "436" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Domínguez, X. Forns" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Domínguez" "email" => array:1 [ 0 => "angela.dominguez@ub.edu" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "X." "apellidos" => "Forns" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Departament de Medicina, Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CIBER de Epidemiología y Salud Pública (CIBEResp), Instituto de salud Carlos III, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Hepatología, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es posible el control de los brotes de hepatitis A en hombres que tienen sexo con hombres?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hepatitis A is a transmittable disease that results in a high disease burden worldwide and is estimated to cause more than a million cases and more than 10,000 deaths worldwide annually. Although most of the disease’s morbidity and mortality occur in low-income countries, cases and outbreaks also occur in high-income countries and particularly affect individuals who travel to endemic countries or who have greater exposure to the virus due to lifestyle-related or job-related practices.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Hepatitis A can be prevented through vaccination, and a number of countries recommend vaccination universally for the entire pediatric population, as well as for certain risk groups of any age. The United States recommends the vaccine for children in the second year of life and individuals of any age who present chronic liver disease, bleeding disorders, men who have sex with men (MSM), injecting and noninjecting drug users, homeless people, laboratory workers exposed to the hepatitis A virus, travelers to endemic countries and cohabitants and others in close contact with children adopted from these countries. Although the recommendations for hepatitis A vaccination in Europe are not homogeneous, most countries (including Spain)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> recommend vaccination for individuals from the risk groups defined by medical and lifestyle conditions, which include MSM, a group that represents 1.86–3.4 % of the Spanish male population aged 18–59 years.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The article by Fortea et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> published in this issue analyzeas the characteristics of patients with hepatitis reported in Cantabria during 2 periods: January 2013 to May 2016 and June 2016 to September 2018. The article highlights that there was a greater proportion of men with a predominance of the homosexual orientation during the second period.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Several hepatitis A outbreaks have occurred in Europe, and the MSM group was the most affected in the outbreak recorded between 2016 and 2018. Between June 2016 and May 2017, 84 % of the men were identified as MSM, and 43 % of the cases had traveled to Spain, which was the most affected country.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It is worth noting that there have been other outbreaks due to the same viral strain outside Europe, which significantly affected the MSM group, as was the case in Chile<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and Argentina.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The impact of these outbreaks in Germany,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> England,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The Netherlands<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and Spain<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> has not been limited to MSM.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Various authors who have studied hepatitis A outbreaks in MSM<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,10,11</span></a> agree that the practices of anonymous sex in saunas or in other public locations hinders the identification of the sources of infection in these cases and the identification of their contacts who could benefit from preventive actions. These practices increase the resources needed and the difficulty in controlling the outbreak. It has been estimated that the healthcare costs of the outbreak in England was over 1.5 million pounds (mostly due to hospitalization costs), indicating the significant financial cost resulting from the patient load generated by hepatitis A, which could have been avoided with vaccination.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Administering the hepatitis A vaccine is the most useful preventive measure for the disease, given that the vaccine is safe and highly effective. In Catalonia, where the combined vaccine against hepatitis A and B was introduced for preadolescents at the end of 1998 and achieved a vaccination coverage of 91 %, the estimated effectiveness was 99 % (95 % CI 93.1–99.8).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The benefit of the vaccine was not limited to the vaccinated cohorts but extended to other age groups who had not be administered the vaccine. However, universal vaccination in childhood or in adolescence does not prevent the short-term emergence of outbreaks in MSM, as shown by a study that compared the outbreaks that occurred before and after the introduction of the vaccine for preadolescents in Catalonia.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The impact of hepatitis A on the MSM group is difficult to estimate because the information on sexual preferences is not always available; however, monitoring changes in the incidence rates in men and women is useful for identifying outbreaks and the presence of a higher incidence.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> In Catalonia, it was observed that during 2005–2015, the incidence rate decreased in women but not in men. Although the males in all age groups showed higher incidence rates for the disease than the females, the maximum differences corresponded to the 20–34-year-old (8.8 and 2.8 per 100,000 for men and women, respectively) and 35–49-year-old groups (5.7 and 2.0 per 100,000).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Despite the recommendation by public health authorities (both at the national and international level) to vaccinate MSM against hepatitis A, the vaccination coverage is very low. In fact, 41 % of MSM who responded to a survey conducted by the European Centre for Disease Prevention and Control were unaware of the recommendation for vaccination against hepatitis A and B.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">As noted by Fortea et al.,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> regardless of the adopted vaccination strategy (vaccination of risk groups exclusively or universal vaccination), it is essential to provide information programs directed at the MSM group that will help raise awareness regarding the vaccine and achieve coverages greater than the 70 % necessary to prevent transmission in this group.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> However, we agree with Lorenzo-Ortega et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> that to control hepatitis A outbreaks in MSM in the long term we need to consider universal vaccination and the vaccination of risk groups.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">Angela Domínguez received funding from the <span class="elsevierStyleGrantSponsor" id="gs0005">Secretary of Universities and Research of the Department of Economy and Knowledge</span> 2017 <span class="elsevierStyleGrantNumber" refid="gs0005">SGR 1342</span>.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Xavier Forns received funding from the Secretary of Universities and Research of the Department of Economy and Knowledge 2017 <span class="elsevierStyleGrantNumber" refid="gs0005">SGR 1753</span>.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">Ángela Domínguez declares that she has no conflicts of interests.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Xavier Forns has consulted for Gilead and Abbvie.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-10-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Domínguez A, Forns X. ¿Es posible el control de los brotes de hepatitis A en hombres que tienen sexo con hombres? Rev Clin Esp. 2020;220:434–436.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Grupo de trabajo vacunación en población adulta y grupos de riesgo de la Ponencia de Programa y Registro de Vacunaciones. Vacunación en grupos de riesgo de todas las edades y en determinadas situaciones. Comisión de Salud Pública del Consejo Interterritorial del Sistema Nacional de Salud. Ministerio de Sanidad, Consumo y Bienestar Social, julio 2018. 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