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To the Editor: Dore and Kaldor provide valuable guidance on the directions a coordinated national system for surveillance of sexually transmissible diseases (STD) might take.1 They did not attempt to provide an outline of what diseases might fall into this group, or what data should be collected for each disease, although a recent review of a decade of STD surveillance in Victoria examined data on syphilis, gonorrhoea, chlamydia, genital herpes, genital warts, hepatitis B, chancroid, lymphogranuloma venereum and donovanosis.2
However, it would seem timely to draw attention again to hepatitis A as a sexually transmissible disease, at least in some urban populations. The epicentre of a prolonged epidemic of hepatitis A in 1991-92 among homosexual men, was the gay community of the inner Sydney suburbs. A crude incidence of 136 cases per 100,000 population was recorded for 1991 in eastern Sydney, compared to 13 per 100,000 for Australia as a whole.3 The same epidemic was observed in Melbourne4 and simultaneously in other cities around the world.5 A similar, though smaller, epidemic occurred in 1995-96 in Sydney.
At the onset of the 1991-92 epidemic, the then Eastern Sydney Public Health Unit established a standalone hepatitis A database where risk factor information, in particular sexual preference, was kept in de-identified format. Maintenance of the database through subsequent epidemics in other risk groups6-7 has been invaluable in helping direct prevention activities, including education regarding hygiene and appropriate use of normal human immunoglobulin and hepatitis A vaccine. Analysis of the data revealed that during the 1991-92 and 1995-96 epidemics, adult males comprised almost 90% of all cases. This lead to a peak incidence among young males, approaching 500 cases per 100,000 (or 0.5%) per year. Information on sexual preference was recorded in 75% of adult males, and of these, men who have sex with men contributed 80-90% of cases. In Australian cities, hepatitis A appears to behave as a sexually transmissible disease, and its proper surveillance requires collection of comprehensive risk factor data including sexual preference.
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Author affiliationDirector, South Eastern Sydney Public Health Unit, Zetland, New South Wales, Locked Bag 88, Randwick NSW 2031.
References1. Dore GJ, Kaldor JM. Sexually transmissible diseases surveillance in Australia: towards a coordinated national system. Commun Dis Intell 1998;22:49-52.
2. Crofts N, Gertig DM, Stevenson E, et al. Surveillance for sexually transmissible diseases in Victoria, 1983 to 1992. Aust J Public Health 1994;18:433-9.
3. Stokes M-L, Ferson MJ, Young LC. Outbreak of hepatitis A among homosexual men in Sydney. Am J Public Health 1997;87:-39-41.
4. Stewart T, Crofts N. An outbreak of hepatitis A among homosexual men in Melbourne. Med J Aust 1993;158:519-21.
5. CDC. Hepatitis A among homosexual men - United States, Canada and Australia. MMWR 1992;41:155,161-4.
6. Ferson MJ, Young LC, Robertson PW, Whybin LR. Hepatitis A outbreak in a preschool in Eastern Sydney. Commun Dis Intell 1994;18:82-83.
7. Ferson MJ, Young LC. Preliminary report - Hepatitis A in injecting drug users. Commun Dis Intell 1994;18:655.
This letter was published in Communicable Diseases Intelligence Vol 22 No 6, 11 June 1998.