Eurosurveillance - Volume 29, Issue 45, 07 November 2024

Hepatitis A and B vaccinations are recommended for men who have sex with men (MSM), given their increased risk of infection. However, data on vaccination programmes are scarce.

To use information on vaccination recommendations and vaccine uptake among MSM in the WHO European Region to guide prevention.

From a large pan-European MSM Internet Survey (EMIS-2017), we analysed data on self-reported hepatitis A and B vaccination status by age, education, financial coping, settlement size, outness (disclosure of sexual behaviour), migration history and diagnosis with hepatitis C or HIV, using multivariable logistic regression. Additionally, we collected information on national hepatitis A and B vaccination recommendations.

We present data of 113,884 MSM, median age 36 years (IQR: 27–47). Vaccination for hepatitis A and B was recommended and free for MSM in 7 and 18 of 43 countries, respectively. Of all respondents, 48% (n = 50,966) reported ever being vaccinated against hepatitis A, and 53% (n = 56,889) against hepatitis B. Odds for being vaccinated against hepatitis A increased with outness (‘out to (almost) all’ aOR: 1.78, 95% CI: 1.72–1.85 vs ‘out to none’) and were higher in countries where vaccination was recommended and free for MSM (aOR: 2.22, 95% CI: 1.29–3.82 vs ‘no recommendation’). Results for hepatitis B were similar (outness: aOR: 1.81, 95% CI: 1.75–1.88 and MSM-specific vaccination recommendation: aOR: 2.44, 95% CI: 1.54–3.85).

Large proportions of MSM in Europe remain vulnerable to hepatitis A and B, despite available vaccination. Implementation of MSM-specific vaccination recommendations and greater efforts to improve the societal climate for MSM are needed to address gaps in vaccine coverage.

Recent hepatitis A virus outbreaks in Europe affecting men who have sex with men (MSM) and ongoing hepatitis B virus transmission among MSM underscore the ongoing need for viral hepatitis prevention in this population.

To describe viral hepatitis knowledge and associated factors among MSM in the WHO European Region to inform targeted prevention.

In the European MSM Internet Survey (EMIS-2017), basic knowledge was defined as correctly identifying at least 4 of 5 statements about viral hepatitis and vaccination. We described basic knowledge by country. In a multilevel logistic regression model, we estimated adjusted odds ratios (aOR) with 95% confidence intervals (CI) for having basic knowledge and explanatory variables: sociodemographic characteristics, history of hepatitis C and/or HIV diagnosis, sexual orientation disclosure at last sexually transmitted infections (STI) test and outness.

Of 113,884 participants across 43 WHO European Region countries, 68% demonstrated basic knowledge, ranging from 50% in Israel to 80% in the Netherlands. Basic knowledge was significantly associated with older age (≥ 40 years vs < 25 years, aOR: 2.9, 95% CI: 2.7–3.0), a history of hepatitis C and/or HIV diagnosis (aOR: 1.8, 95% CI: 1.7–1.9) and sexual orientation disclosure at last STI test (aOR: 1.3, 95% CI: 1.2–1.3), among other factors.

We found a knowledge disparity regarding viral hepatitis and hepatitis vaccination awareness among MSM across Europe, highlighting a need to address these gaps. A non-judgemental, accepting climate that allows individuals attending medical services to safely disclose their sexual orientation is fundamental to enable healthcare professionals to target information and preventative measures more effectively.

Despite widely implemented pneumococcal vaccination programmes, Streptococcus pneumoniae remains a global risk for human health. Streptococcus pneumoniae can cause invasive (IPD) or non-invasive pneumococcal disease (NIPD). Surveillance is mainly focusing on IPD, assessing the full impact of pneumococcal vaccination programmes on pneumococcal disease is challenging.

We aimed to prospectively investigate serotype distribution and antimicrobial resistance (AMR) of S. pneumoniae isolates from patients with NIPD and compare with data on IPD isolates and with a 2007–2008 dataset on NIPD.

Between September 2020 and April 2023, we collected isolates and patient data from patients with NIPD from 23 clinical laboratories in Belgium. Capsular typing was performed by a validated Fourier-Transform Infrared spectroscopic method, and AMR was assessed with broth microdilution, using the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints.

We received S. pneumoniae isolates from 1,008 patients with lower respiratory tract infections (n = 760), otitis media (n = 190) and sinusitis (n = 58). Serotype 3 was the most prevalent serotype among the NIPD isolates. Serotypes not included in the 20-valent pneumococcal conjugate vaccine (PCV20) were significantly more common among the NIPD than among the IPD isolates. Antimicrobial resistance levels were significantly higher among the NIPD isolates (n = 539; 2020–2022) compared with the IPD isolates (n = 2,344; 2021–2022). Resistance to several β-lactam antimicrobials had increased significantly compared with 15 years before.

The NIPD isolates were strongly associated with non-vaccine serotypes and with increased AMR levels. This underlines the importance of continued NIPD surveillance for informed policy making on vaccination programmes.