Spain has registered a “notable increase” in hepatitis cases in 2024. Almost 900 diagnoses have been reported compared to 265 in 2022 and 336 in 2023. The unusually high growth has activated the alarms of the Alert and Coordination Center. Health Emergencies (CCAES), which was prepared at the end of December a report to assess the risk what the virus meant for the population and reported the situation to the European Center for Disease Control (ECDC, for its acronym in English). The agency dependent on the Ministry of Health assumes that it does not have information “sufficiently complete to establish the causes of this increase.”
But it does give some clues that could lead to answers, such as the change in the age groups with the most infections: if in previous years the highest incidences were seen above all in children, 2024 concentrates the highest number of diagnoses in young adults between 25 and 44 years old. “It is essential to reinforce the epidemiological surveillance of this disease and continue characterizing the dynamics of the increase in cases to improve knowledge about possible changes in the epidemiological patterns of transmission or in the profile of the population at highest risk to adapt the recommendations to the best evidence available at all times,” notes the report dated December 20.
Spain already experienced another peak of infections – greater than this, there were almost 4,000 cases – in 2017, but since then the situation pointed to a “slow decline” with specific outbreaks that seem to have been left behind, suggests Javier García Samaniego, head of Hepatology at the La Paz university hospital and Coordinator of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVe).
The CCAES suspects that the growth may be related to an increase in transmission between men who have sex with men (GBMSH), a trend that has already been observed in neighboring countries such as Portugal, as highlighted by the ECDC in a previous report dated 13 December. This document from the European public health agency details that in Spain last year two outbreaks were recorded in daycare centers, which grouped 11 and 13 cases respectively, although most of them occurred in isolation or in small groups of infections in young people. The Spanish communities with the most cases, in absolute numbers, are Andalusia (166), Madrid (161) and Catalunya (114).
The hepatitis A virus affects the liver and is transmitted through the oral-fecal route. Its contagion is “closely related to poor sanitary conditions,” according to the Carlos III Health Institute (ISCIII), but it can also be transmitted through oral-anal sex. Many people pass the viral infection mildly or without obvious symptoms – which makes it more difficult to diagnose it and follow the chains of transmission – but in vulnerable patients, such as chronic liver patients, transplant recipients, immunosuppressed people or elderly people, the virus can trigger complications.
“There are many cases that are gastrointestinal and the virus is eliminated on its own on many occasions, it passes with few or no symptoms and can go away on its own in a few weeks,” explains Diego García, spokesperson for the Spanish Society of Infectious Diseases and Clinical Microbiology. (SEIMC). Is it worrying? “I would say no, I don’t like that word, but we do have to take care of it. The number of serious cases to be expected in a young and healthy population is low, although if the incidence is higher it is easier for it to reach someone who can trigger a more complex condition,” points out the microbiologist, who also includes as part of the difficulties for trace the cases the long incubation period. It can last up to four weeks.
The CCAES evaluation concludes that the risk of infection at this time for the population of gay, bisexual and other men who have sex with men is “moderate” while for the rest it is low. Last year, however, the largest number of cases was concentrated in the 5 to 14 year old group, so, García Samaniego warns, “it is early and we must be cautious to see if this trend is also consolidated in other countries.” ”. The SEIMC also considers the hypothesis that the virus is being detected more because more tests are done in these groups with risky sexual practices, who otherwise might go unnoticed because they are asymptomatic or have signs that can go unnoticed such as diarrhea or vomiting. .
Hepatitis A outbreaks have traditionally been linked to a shortage of hygienic-sanitary measures. In Spain, due to its position in southern Europe, the incidence of the disease has historically been higher than in northern Europe, but “once the country joined the developed world it dropped a lot.” “So there is a lot of immunity in the older cohorts (in people between 50 and 70 years old it reaches 50%, according to seroprevalence studies) but very low rates in people between zero and twenty years old who have not been exposed to the virus because “There is less circulation due to better health measures,” continues García Samaniego.
As these hygiene conditions improve, cases are concentrated in two groups, experts say. On the one hand, outbreaks still occur among children and in closed institutions because they are more “vulnerable to fecal-oral transmission,” justifies the La Paz hepatologist. “Hand hygiene is something that prevents infection and this group does not follow it scrupulously.” On the other hand, in people who have risky sexual practices.
Precisely this fact removed serum against hepatitis A from the universal vaccination schedule for minors. It is currently only included in Ceuta and Melilla, due to their proximity to African countries, and in Catalonia. The experts consulted, and also the Health report, call for strengthening vaccination in the groups for which it is recommended: people at risk of serious disease (chronic liver disease, alcoholism or cirrhosis; or transplant recipients) or with high-risk practices. risk of infection (sex workers, men who have sex with men) and as a post-exposure measure to prevent contacts from becoming infected. Health authorities also recommend giving the vaccine to travelers who travel to places with poor hygienic and sanitary conditions.
Chart Raul Sanchez.
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