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Original research
Immunity to hepatitis A among men who have sex with men attending a large sexual health clinic in Melbourne, Australia, 2012–2018
  1. Lenka A Vodstrcil1,2,
  2. Christopher K Fairley1,2,
  3. Deborah A Williamson3,4,
  4. Catriona S Bradshaw1,2,
  5. Marcus Y Chen1,
  6. Eric P F Chow1,2
  1. 1 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  2. 2 Central Clinical School, Monash University, Clayton, Victoria, Australia
  3. 3 Melbourne Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  4. 4 Doherty Applied Microbial Genomics, Department of Microbiology & Immunology, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
  1. Correspondence to Dr Lenka A Vodstrcil, Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC 3053, Australia; lvodstrcil{at}


Background Outbreaks of hepatitis A are being reported more commonly among men who have sex with men (MSM) globally. Australia has also reported a sharp increase in the number of cases of hepatitis A in 2017. This study aimed to determine the level of immunity to hepatitis A among MSM attending a large urban sexual health clinic in Victoria in the lead up to recent outbreak.

Methods This was a retrospective audit of serological testing data from first-time MSM attendees at Melbourne Sexual Health Centre (MSHC) in Australia from 1 January 2012 to 31 December 2018. We determined the proportion of MSM who were tested and who had serological detection of hepatitis A IgG, stratified by age and calendar year. We used univariable and multivariable logistic regression to investigate factors associated with testing for and detection of hepatitis A IgG.

Results There were 16 609 first-time MSM attendees at MSHC over the 7-year period, of which 9718 (59%, 95% CI 58% to 60%) were tested for hepatitis A IgG. There was a 2% annual increase in the proportion of men tested (from 60% in 2012 to 69% in 2018; OR=1.02, 95% CI 1.00 to 1.03, p=0.025). Men born outside of Australia/New Zealand, and younger men <30 years had higher odds of being tested. Of those tested, 44% (n=4304, 95% CI 43% to 45%) had hepatitis A IgG detected at their first visit, with no change over time (OR=1.01, 95% CI 0.99 to 1.03, p=0.210). Detection of hepatitis A IgG was associated with being aged 30 years or older (adjusted OR=2.06, 95% CI 1.89 to 2.24, p<0.001) or being born overseas versus Australia/New Zealand (AOR=1.21, 95% CI 1.11 to 1.31, p<0.001).

Conclusion Hepatitis A immunity among MSM remains below the estimated 70% required to prevent outbreaks. Measures including increased testing and higher vaccination coverage are needed to prevent outbreaks and to limit the number of cases and deaths.

  • hepatitis A
  • gay men
  • vaccination
  • prevention
  • seroprevalence

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  • Handling editor Francesca Ceccherini Silberstein

  • Twitter @lenkavod, @drdebwilliamson, @EricPFChow

  • Presented at Some of the data were presented as part of a poster presentation at the STI & HIV 2019 World Congress in Vancouver, Canada, 14 –17 July 2019

  • Contributors EPFC, CKF and LAV designed the study. LAV conducted the analysis and wrote the first draft of the manuscript. All authors were involved in data interpretation. All authors revised the manuscript critically for important intellectual content and approved the final version.

  • Funding EPFC and CKF received a GSK Immunisation Grant from the Public Health Association Australia on hepatitis A research (number EP000784GSK).

  • Competing interests CKF and CSB are supported by an Australian National Health and Medical Research Council (NHMRC) Leadership Investigator Grant (GNT1172900 and GNT1173361, respectively). DW and EPFC are supported by an Australian NHMRC Emerging Leadership Investigator Grant (GNT1174555 and GNT1172873, respectively).

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from the Alfred Hospital Ethics Committee, Melbourne, Australia (project number 448/18), and the project was registered with the Monash University HREC (project number 17000).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.