In addition, Bulgaria reported more than 1 000 viral hepatitis cases, and the United Kingdom reported 377 acute viral hepatitis cases in 2017 (online 2016 data were not found). No specific data for hepatitis A were found for these two countries.

In Portugal, 88 % of the 425 cases reported are men. More than half (52%) of the cases were acquired through sexual contact; three quarters (318) occurred in the region of Lisbon and Tagus Valley. The same virus strain was identified in 204 cases.

In Spain, reported hepatitis A cases have been on the increase since mid-2016. The majority of the cases are men between the ages of 18 and 64 years.

In Italy, 85.9% of the 1 410 reported cases are men, and 61% are men who have sex with men (MSM). This represents a significant increase compared with 2015 when MSM accounted for 8% of the cases. Among the reported cases, 154 were confirmed to belong to the three clusters reported in the EU.

Between 1 June 2016 and 26 June 2017, 16 EU countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, the Netherlands, Norway, Portugal, Slovenia, Spain, Sweden and the United Kingdom) reported 1 500 HAV (hepatitis A virus) genotype IA-confirmed cases, belonging to three separate clusters (based on genetic sequencing of HAV), predominantly among adult MSM. In addition to the outbreak confirmed cases, 2 660 hepatitis A cases were reported, probably or suspected to be associated with this outbreak. No deaths have been reported among confirmed cases.

This multi-country outbreak may explain the increase in the total number of hepatitis A cases reported in 2017 compared with the case numbers from previous years as reported by the 14 countries from which data were available (Figure 1). In 2008 and 2009, hepatitis A outbreaks affecting MSM were identified in several EU countries.

Figure 1. Distribution of reported hepatitis A cases, by year of report, 2007–2017, in 14 EU/EEA countries with available data*