Homosexuals At Risk For Hepatitis A

People who receive blood transfusions or blood products can get hepatitis A. These include hemophiliacs, cancer patients and those who receive tainted blood that contains the hepatitis A virus (HAV).

Once such episode published in the Pediatric Infectious Diseases Journal was reported by Dr. Kenneth K. Lee of the Department of Medicine, Kaiser Permanente Medical Center in Sacramento, California.

In 1989, nine nurses at the hospital's obstetrics department contracted hepatitis A within four days. The outbreak was traced to an infant who was discharged earlier.

The infant was delivered in the same hospital by cesarean section and received 40 milliliters of fresh frozen plasma (the fluid portion of the blood with no red and white blood cells). The blood donor was later identified as a 26-year-old woman who didn't have the symptoms of hepatitis A at the time she donated blood but developed jaundice shortly afterwards. She got the disease from her boyfriend.

Since the HAV can remain in stored fresh frozen blood for up to six months, Lee stressed the importance of careful screening of donors to avoid a similar situation in the future.

"A number of reports have described transfusion-acquired hepatitis A, primarily in neonatal and intensive care units. Most episodes of post transfusion hepatitis A developed after transfusion with either whole blood or packed erythrocytes (red blood cells). One previous report described transmission by fresh frozen plasma; the outbreak described in our report is the second,” Lee said.

“Of note is that our patient contracted hepatitis A from transfusion long after the plasma was donated. Transmission to an infant can set the stage for secondary transmission to health care workers who care for that infant, especially if hand-washing and other hygienic techniques are deficient," he added.

Another way of acquiring the disease is through the re-use of contaminated needles and syringes. This means of transmission has not been conclusively established, yet transmission of the HAV is believed to occur with poor hygiene, fecally contaminated drugs or shared needles among infected drug users.

Direct transmission of the virus from person to person remains the most common route. This puts certain individuals at risk. One of these is the gay community.

Higher rates of infection have been observed in homosexuals owing to certain sexual practices, particularly oral - anal sex. This was evident in 1991 in an HAV epidemic in Melbourne, Australia which affected 243 people.

Of that number, 197 were men - 89 of whom were homosexuals. Other similar outbreaks among gays have occurred in Europe, the United States, and New Zealand.

"There has been a genuine and continuing increase in the number of clinical cases in gay men. The public health measures so far employed are being enhanced to control the transmission of hepatitis A in the homosexual community," according to Dr. Tony Stewart of the Victoria Health Department. (Next: Hepatitis A common in soldiers.)

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