With the widespread availability of smartphones and Internet access, the use of mobile-accessible apps has increased dramatically over the last decade, and geosocial networking apps for MSM facilitating anonymous sexual activities are known as potential drivers of recent outbreaks of syphilis, shigellosis and hepatitis A in Europe. Furthermore, we launched an advertising campaign on dating apps and MSM websites to inform MSM in Berlin, including those seeking anonymous sexual contacts, about the ongoing outbreak and personal prevention measures.
Campaign material was distributed in gay clubs, darkrooms, saunas and other sex-on-premises venues in Berlin. This included the distribution of posters and postcards containing information about the outbreak and the importance of vaccination. The State Office for Health and Social Affairs (SOHSA) in Berlin launched a broad information campaign from 10 March until 31 July 2017 to interrupt transmission among MSM.
A recent study showed that MSM websites and smartphone applications are popular platforms to find sexual partners in particular, Grindr, Scruff and PlanetRomeo are the three most popular apps across Europe. There is evidence that MSM seeking anonymous sexual contacts predominantly use Internet-based communication technologies which may therefore serve as appropriate tools to reach that population. This is of particular relevance for local public health authorities, where staff, money and time resources are often limited.
Tracing of sexual contacts can be challenging when there are multiple and or anonymous sexual partners. In detailed case interviews with a subset of cases, the interviewees often reported having multiple sex partners while they were infective, often anonymously, and facilitated by the use of geosocial networking smartphone applications (dating apps). Enhanced surveillance, including information on sexual contacts, revealed that 78% of them were MSM. The outbreak in Berlin comprised 190 cases, 162 of them male. Berlin was affected by this outbreak from mid-November 2016 to the end of 2017, peaking in early 2017. Īfter the EuroPride festival in Amsterdam in 2016, several European countries were affected by a large hepatitis A cluster, with circulation of three distinct strains of HAV genotype Ia (VRD_521_2016, RIVM-HAV16–090 and V16–25801) that involved more than 4,101 cases in 22 countries in the European Union (EU) until May 2018. The main preventive measure in hepatitis A outbreak control is tracing of household contacts and other close contacts and their subsequent vaccination with a two-dose regimen of inactivated hepatitis A virus within 2 weeks. In Berlin, 35–88 cases were reported annually between 20 (incidence: 0.1–0.4 cases/100,000 residents) with a balanced sex ratio. Similar to other western European countries, Germany is a low-endemicity area and annual hepatitis A incidence was 0.9 cases per 100,000 residents in 2016. In Germany, hepatitis A vaccination recommendations by the Standing Committee on Vaccination include people whose sexual behaviour increases the likelihood of exposure to HAV (including MSM) and this is therefore covered by health insurance. The disease is vaccine-preventable and the vaccine is highly effective. Sexually transmitted hepatitis A outbreaks among men who have sex with men (MSM) have been frequently described. Hepatitis A virus (HAV) is predominantly transmitted from person to person via the fecal–oral route, or through ingestion of contaminated food or water. Hepatitis A is an acute infection of the liver, usually with a self-limiting course.