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We retrospectively identified patients who were tested positive for HAV-IgM at the Vienna General Hospital form Q1\/2008 to Q3\/2018. Our definition of severe HAV infection was AST and\/or ALT &gt;\u20095 \u00d7 above the upper limit of normal (ULN); and liver dysfunction as (i) hepatic encephalopathy or ammonia &gt;\u2009100\u00a0\u03bcmol\/L, (ii) coagulopathy with INR\u2009&gt;\u20091.5, or (iii) jaundice with bilirubin &gt;\u20095\u00a0mg\/dL. A total of 578 HAV-IgM (+) were identified, including 31 (5.4%) and 38 (6.6%) without and with liver dysfunction, respectively. A proportional increase in severe HAV cases with and without liver dysfunction occurred in 2016\/2017 with (21.5% (vs. 8.0% in the years before; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Thirty-seven (53.6%) patients with severe HAV were hospitalized, 6 (9%) required ICU support, and one patient received liver transplantation within 30\u00a0days. Patients with severe HAV and liver dysfunction were more often male (60.5 vs. 43.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.055) and younger (31.5 vs. 63\u00a0years, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) as compared with other HAV-IgM (+) cases. The observed increase of severe HAV infections in Vienna in 2017 among young males, coincided with a multinational HAV outbreak among MSM. Our data suggests a higher likelihood of severe courses of hepatitis A in MSM. Vaccination against HAV should be recommended for risk groups.<\/jats:p>","DOI":"10.1007\/s10096-020-04028-x","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T15:03:59Z","timestamp":1600355039000},"page":"335-344","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Recent outbreaks of severe hepatitis A virus infections in Vienna"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9363-8518","authenticated-orcid":false,"given":"David","family":"Bauer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Farthofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Chromy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Simbrunner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Steininger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Schmidbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Binter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Trauner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattias","family":"Mandorfer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Mayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidemarie","family":"Holzmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Strassl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4590-3583","authenticated-orcid":false,"given":"Thomas","family":"Reiberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,17]]},"reference":[{"key":"4028_CR1","unstructured":"Hollinger FB TJ (1996) Hepatitis A virus. 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L. Gore & Associates and received travel support from AbbVie, Bristol-Myers Squibb, and Gilead.S.R. none decleared.T.M. received speaker fees from BMS, Falk, Gilead, Intercept and MSD; advisory board fees from Albireo, BiomX, Boehringer Ingelheim, Falk, Genfit, Gilead, Intercept, MSD, Novartis, Phenex, Regulus, and Shire. He further received travel grants from Abbvie, Falk, Gilead, Intercept and Jansen and unrestricted research grants from Albireo, Cymabay, Falk, Gilead, Intercept, MSD, and Takeda.ST.R. none declared.M.F. none declared.H.H. none declared.T.R. received grant support from Abbvie, Boehringer Ingelheim, Gilead, MSD, Philips Healthcare, and Gore; speaking honoraria from Abbvie, Gilead, Gore, Intercept, Roche, and MSD; consulting\/advisory board fee from Abbvie, Bayer, Boehringer Ingelheim, Gilead, Intercept, MSD, and Siemens; and travel support from Boehringer Ingelheim, Gilead, and Roche.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the ethics committee of the Medical University of Vienna (No. 1968\/2018) and conducted in accordance with the Helsinki declaration, as revised 2013 and the guidelines for good scientific practice of the Medical University of Vienna.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}