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Historically, however, men who have sex with men MSM have higher risk of HAV infection than the general population and outbreaks have occurred among MSM communities [ 2 ]. Given that MSM were not disproportionately affected in this outbreak, we hypothesized that the HAV seroprevalence was sufficient to offer herd immunity to the local MSM community. Because risk practices and demographics may differ among cultures, our study aimed to establish a benchmark level of HAV immunity for MSM in urban centers in the United States.

Other data used in the analysis came from a question demographic and health survey at the testing center. Each predictor was modeled individually against HAV seropositivity. Interactions between predictors were tested but were not found to ificantly improve model fit. Model diagnostics were performed with a combination of likelihood ratio tests, Akaike information criterion, variance inflation factors, and residual plots.

Participants with missing data among ificant predictors in the final model were excluded from the analysis.

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Study participants had a mean age of 34 years and This could provide a good vaccination benchmark for at-risk communities during HAV outbreaks. Among male cases, 14 3. Among all cases, mortality was high with 20 deaths 3. Of note, the Los Angeles outbreak developed much later September and remains much smaller than the San Diego outbreak 43 vs total cases.

Because the proportion of infected persons was large for MSM in Michigan and Los Angeles, we postulate that HAV seroprevalence sufficient for herd immunity was not present in those communities.

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Our study was limited because we do not know the baseline HAV seroprevalence among people who are homeless or use illicit drugs during the San Diego outbreak that may have predisposed them to infection. It is also important to consider that there may not have been sufficient overlap between MSM and people experiencing homelessness in San Diego or those using illicit drugs; however, 11 of the 14 MSM who did become infected in the San Diego outbreak were either homeless or reported use of illicit drugs.

Additionally, we do not know whether the high HAV seroprevalence among MSM study participants was through vaccination or exposure, although large HAV and hepatitis B virus vaccination awareness campaigns were directed to the local MSM community in — and Further seroprevalence and vaccination data in various risk groups across outbreaks are needed to corroborate our findings. Financial support.

Potential conflicts of interest. All other authors report no potential conflicts. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Hepatitis A outbreak Accessed 21 June Google Scholar. Google Preview. Gorgos L. Sexual transmission of viral hepatitis. Infect Dis Clin North Am ; 27 : — Estimating the critical immunity threshold for preventing hepatitis A outbreaks in men who have sex with men.

Epidemiol Infect ; : — Euro Surveill ; Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases Michigan Health Department. Michigan hepatitis A — outbreak summary Hepatitis A outbreak. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. In. Advanced Search. Search Menu. Skip Nav Destination Article.

Close mobile search Article. Volume Article Contents Abstract. Article. University of California. Correspondence: D. Oxford Academic. Christina Huynh. Adam J Moore. Andrew Frick. Christy Anderson. Magali Porrachia.

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Brianna Scott. Sarah Stous. Robert Schooley. Susan Little. California State University. Select Format Select format. Permissions Icon Permissions. Open in new tab Download slide. Google Scholar Crossref. Search. Advisory Committee on Immunization Practices. Issue Section:. Download all slides. Comments 0. Add comment Close comment form modal. I agree to the terms and conditions. You must accept the terms and conditions.

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Sexual partner concurrency among partners reported by MSM with recent HIV infection