O02 Outbreak of acute symptomatic hepatitis B in low prevalence region in Scotland

Abstract

We describe an outbreak of 18 cases of acute symptomatic Hepatitis B (HBV) between Dec 2020- September 2022 in a low prevalence region in Scotland. All initially presented as heterosexual, 15 were male, majority were married, aged 40–70 and from a similar area. We discuss the vital input sexual health (SH) had in identifying the outbreak and liaising with partner agencies. We also review the outreach and difficulties supporting people who may not feel able to disclose risk factors (RF) especially to non SH staff 2 cases of HBV/syphilis coinfection were diagnosed in the hospital in December 2020 with no identified source of infection. When the men attended SH both disclosed male sexual contacts. Concern of a cluster was raised by SH. 9/12 passed and SH were advised of 5 further cases. SH linked with Public Health and an Incident Management Team was created which identified weakness in pathways between services to realise an outbreak. Extensive collaborative work was done to improve communication between departments and training on sexual history taking. All cases were then referred to SH, of those that attended, 5 men newly disclosed male sexual contacts, 2 were wives of cases, 7 still had no identifiable infection source Genotyping was possible for 12, 10 were type A2. This is the most common strain and associated with MSM Several collaborative outreach events were arranged, >80 contacts were made but no new cases were seen and none disclosed RF. Communications were made to general public but due to the concern of inadvertently “outing” people or creating stigma in small communities it was decided to not focus them at MSM. This outbreak highlights SH’s vital importance in supporting patients disclose and reduce infection spread. It also shows the difficulties in targeting support for people who may be unaware/unable to disclose RF.