Research shows low rates of hepatitis A and B vaccination among men who have sex with men

Research analyzing data from a European survey of 113,884 men who have sex with men (MSM) and published in Eurosurveillance indicates that although most MSM have a basic understanding of viral hepatitis, only 44% report having been vaccinated against hepatitis A and hepatitis B. The data highlights notable vaccination gaps despite vaccination and available recommendations. Strong public health support and creating an open environment for MSM to follow recommendations will be key to reducing outbreaks among MSM and eliminating hepatitis B.

Men who have sex with men are more likely to be infected with viral hepatitis, with risks exacerbated by stigma and discrimination, which can affect access to health services. While sexual intercourse between men is the second most commonly reported route of acute hepatitis B virus infection in Europe, only three-quarters of European countries (32/42) recommend hepatitis B vaccination. specifically for MSM. Outbreaks of hepatitis A have been reported among MSM worldwide, including a large outbreak in several countries in Europe in 2016–2018. However, just under half of European countries (19/43) recommend hepatitis A vaccination for MSM.

Both studies examined data from 113,884 participants in the WHO European region from the 2017 European MSM Internet Survey (EMIS-2017) with Brandl et al. analyzing vaccination data, and Burdi et al. review basic knowledge about hepatitis A and B. EMIS-2017 was an anonymous, open-access internet survey conducted between late 2017 and early 2018 on the sexual health of MSM. Both studies looked at data from respondents above the age of consent in their country, who identified as cis or trans men, and reported that they were attracted to men and/or had sex with men.

Vaccination data

Brandl et al. examined data on self-reported hepatitis A and B vaccination status by age, education, financial status, household size, openness about sexual orientation, migration history and diagnosis with hepatitis C or HIV. The study also compared these data to information on national vaccination recommendations for hepatitis A and B.

Only 48% of respondents reported being vaccinated against hepatitis A and 53% against hepatitis B, with significant differences in vaccination between countries. Reported vaccination rates for either disease were higher among respondents who were more open about their sexual orientation (“outness”) and in countries where vaccination against that disease was specifically recommended for MSM. Participants were more likely to report having been vaccinated if they were older, lived in larger cities, were more financially secure, or had been diagnosed with hepatitis C and/or or HIV.

Basic knowledge of viral hepatitis

Burdi et al. examined basic knowledge about viral hepatitis and hepatitis vaccination, which may be correlated with a higher vaccination rate. Basic knowledge was defined as correctly identifying at least 4 out of 5 hepatitis-related statements in EMIS-2017. Researchers also collected data on sociodemographic characteristics, history of hepatitis C and/or HIV diagnosis, disclosure of sexual orientation at last sexually transmitted infection (STI) test, and exoticism.

Although two thirds of respondents (68%) demonstrated basic knowledge, there is a significant disparity among MSM in Europe. Respondents who were older, had a history of hepatitis C and/or HIV, were absent, or had disclosed their sexual orientation during their last STI test were more likely to have basic knowledge. Knowledge was also higher among those who had been vaccinated against viral hepatitis or who were immune due to previous infection. Among vulnerable, unvaccinated or immunized respondents, 58% and 62%, respectively, said they had not been offered a hepatitis A or B vaccine.

Although there are national differences, individual factors play a greater role in reported levels of knowledge about viral hepatitis.

Targeted public health action and a supportive environment are very beneficial

Both studies highlight the importance of actively recommending vaccination against hepatitis A and B to MSM, Brandl et al. also highlighting the benefits of national recommendations for MSM and offering vaccines free of charge or with a co-payment. Burdi et al. also suggest improving access to information among young MSM living in smaller localities with lower levels of education and financial resources.

Researchers from both studies highlighted the crucial role of a supportive and tolerant climate in encouraging openness, facilitating targeted public health action, and improving health outcomes for MSM.