Title: Hepatitis A Cases Surge in Spain: Catalonia Leads with a 293% Increase
Catalonia detected a total of 114 cases of hepatitis A in 2023, a 293% increase from the 29 cases identified in 2022, according to a report by the Ministry of Health. This rise mirrors the national trend, with Spain recording 894 cases last year, a 166% increase from the 336 cases in 2023. Catalonia is now the third region with the highest hepatitis A incidence, following Andalusia and Madrid.
Hepatitis A is an infectious disease that inflames the liver and often shows no symptoms. When they do appear, they can include fever, malaise, fatigue, loss of appetite, nausea, vomiting, and diarrhea. Unlike hepatitis B and C, hepatitis A is rarely life-threatening and does not cause long-term liver damage. However, the Catalan health department is closely monitoring its increasing incidence, especially as it’s now primarily affecting men aged 15 to 44 who have sex with men, behaving like a sexually transmitted infection (STI).
"Right now, we’re seeing cases in young people, in environments of men who have sex with men," said Robert Güerri, head of Internal Medicine at Barcelona’s Hospital del Mar. He added that the hospital’s HIV and PrEP units are promoting vaccination for users engaging in high-risk sexual behaviors who haven’t been vaccinated yet.
Despite the increase, hepatitis A is not yet a severe epidemiological problem, and the Catalan health department does not plan to implement additional measures at this time. Catalonia, along with Ceuta and Melilla, is the only Spanish region that includes the hepatitis A vaccine in its immunization calendar, offering it to children at 15 months and 6 years of age, with a catch-up program for those who miss the initial vaccination.
The hepatitis A virus is transmitted via the fecal-oral route and affects primarily children. Most carriers are asymptomatic, making the infection hard to trace. While the majority of the population has been immunized via infection during childhood, the recent upsurge appears to be driven by the men-who-have-sex-with-men (MSM) community. A possible hypothesis suggests a link to specific sexual practices.
Living in the "era of STIs", as said by Dr. Güerri, society should be aware of and take precautions against hepatitis A, even if it’s not as alarming as the 2022 monkeypox outbreak. Dr. Joan Caylà, a member of the Spanish Society of Epidemiology, agrees that the MSM community hypothesis is the most plausible, matching earlier hepatitis A outbreaks among MSM in Barcelona.
Although a hepatitis A vaccine has been available for MSM since 1994, Barcelona’s Public Health Agency implemented an immunization campaign in 2004, offering the vaccine at gay saunas. This campaign proved effective and could serve as a model for future public health interventions. However, no further vaccination programs are planned at this time.
