In response to the significant increase in the number of HIV and hepatitis A co-infection cases observed recently, the Taiwan Centers for Disease Control (Taiwan CDC) decided to implement the “Expanded Government-funded Hepatitis A Vaccination Pilot Program” on October 1, 2015.　The new target populations include confirmed HIV cases or newly diagnosed cases of syphilis and gonorrhea that were born after January 1, 1977. The target populations are offered one government-funded dose of hepatitis A vaccine. Approximately 25,000 individuals are eligible for the vaccine. Eligible individuals are urged to receive the vaccine at contracted healthcare facilities to lower the risk of infection.

Since June 2015, the acute viral hepatitis A outbreak has continued to escalate. 　 According to the surveillance data compiled by Taiwan CDC, as of September 29, 2016, a cumulative total of 845 cases have been reported, which is the highest during the same period in years. Among them, 56.3% of the cases have reported HIV or other sexually transmitted disease (STD) such as syphilis or gonorrhea. Further studies show that the majority of the HIV and hepatitis A co-infection cases are men aged between 18 and 39 who contracted HIV through unsafe sex. They mostly reside in urban areas in northern and central Taiwan, including 33.8% who reside in New Taipei City, 25.3% who reside in Taipei City, 13.7% who reside in Taichung City and 8.9% who reside in Taoyuan City.

The “Expanded Government-funded Hepatitis A Vaccination Pilot Program” will be implemented during October 1, 2016 and December 31, 2017.The contracted healthcare facilities that offer the hepatitis A vaccination include HIV/AIDS hospitals, STD friendly clinics that are contracted to provide vaccination, and local public health centers. Six months to a year later, the same individuals are advised to receive the second dose at their own expense. Those with insufficient immunity are advised to receive the third dose at their own expense after the physician’s evaluation in order to ensure long-term protection against the virus.

Besides the newly included target populations, the government-funded hepatitis A vaccine also targets children living in mountainous townships, 9 townships adjacent to the mountainous township, Kinmen County and Lianjiang County, and contacts of confirmed acute viral hepatitis A cases. Taiwan CDC reminds the public that hepatitis A vaccination remains the most effective way to prevent hepatitis A. Protection against hepatitis A is achieved in over 95% of the individuals after receiving the first dose. The 2-dose HepA vaccine series spaced 6 to 12 months lasts for over 20 years. High risk individuals and contacts of confirmed cases should be proactive about hepatitis A vaccinations. In addition, other at-risk individuals, including restaurant workers, healthcare workers, caretakers of infants and children, people with chronic liver disease, hemophilia, those who have had liver transplants, people who practice unsafe sex, people who inject drugs, and those planning to visit areas affected by hepatitis A, who do not have hepatitis A antibodies are urged to receive 2 doses of self-paid hepatitis A vaccine in order to prevent infection.

The public is urged to take prevention measures, including paying attention to food hygiene, avoiding the consumption of raw and undercooked food, especially raw bivalves such as oyster and clams, and unboiled water, washing hands properly with soap and water before and after handling food, having meals and using the bathroom, avoiding having multiple sex partners, and avoiding unsafe sex practices, in order to ward off infection. If symptoms develop, please seek immediate medical attention. Additionally, outbreaks of hepatitis A infection among intravenous drug users have been previously reported in other countries. Therefore, drug users are urged not to share needles to prevent infection. For more information, please visit the Taiwan CDC website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Consultation Hotline, 1922 (or 0800-001922).