No 40 - 2023

RS virus(RSV) vaccine authorized for use in elderly people above 60 years of age

The Arexvy^® has been authorized by the European Medicines Agency (EMA) for protection against RSV disease in the lower airways in persons aged 60 years or above. A single 0.5 mL dose is given.

Read more about the vaccine in the SSI Vaccine Encyclopaedia (in Danish).

National guidelines on the use of the vaccine have yet to be published. The vaccine does not form part of any vaccination programme, and vaccine costs are therefore defrayed by the person receiving the vaccine.

The vaccine may be ordered at the SSI, using item number 105625.

(Statens Serum Institut)

Hiv 2022

2022 saw a total of 259 notified cases of HIV, including 150 men and 109 women. Among the 259 notified cases, 144 persons (56%) had previously been diagnosed with HIV abroad, including four Danish-born persons and 73 Ukrainians. Seven of the 144 persons known to have HIV were children (2-12 years). No children were notified as having become infected in Denmark.

For a detailed epidemiological description of the 2022 incidence, please see the 2022 Annual HIV report.

• In 2022, a total of 115 persons were notified with newly diagnosed HIV, along with 144 persons who had already been diagnosed abroad. These unusually high numbers are mainly due to refugees from the Ukraine. A total of 84 HIV-positive Ukrainians were notified, among whom 73 were known to have HIV and receiving treatment in their home country. The remaining 11 were newly diagnosed in Denmark.

• Among the newly diagnosed persons, 79 were either Danes who had become infected in Denmark or abroad, or immigrants infected after their arrival to Denmark. The remaining 36 were immigrants who had become infected before their arrival to Denmark. These 36 persons could not have been reached with Danish HIV-preventive measures.

• Among the newly diagnosed persons, 47 were men who have sex with men (MSM), 52 were infected heterosexually (HTX), among whom 23 were men and 29 women. Five of the diagnosed persons were notified as being drug users; and in 11 cases, the mode of transmission was not stated.

• In 70% of the MSM for whom country of infection was stated and in 46% of the HTX for whom country of infection was stated, the infection had been acquired in Denmark.

• Among the newly diagnosed MSM, 40% were immigrants. The corresponding share for HTX was 51%.

• Among MSM, 45% were tested late. The same applied to 68% of the HTX.

• Immigrants and asylum seekers, etc., should undergo HIV testing as quickly as possible after their arrival to Denmark. This facilitates rapid treatment of HIV positives and reduces the risk of transmission of the infection.

• All MSM who have not been diagnosed with HIV should be HIV tested annually. Furthermore, MSM who lead an active sex life and who do not consistently use a condom should be tested for HIV and other sexually transmitted diseases more frequently, e.g. every 3 months. In some cases, this group may be offered pre-exposure prophylaxis (PrEP), i.e. HIV medication taken before exposure.

• Initiation of treatment immediately after the diagnosis means that people who are known HIV positives pose no risk for further HIV transmission as well-treated HIV positives are not infectious.

• Prevention of HIV infection includes:
  o Using condoms
  o TasP (treatment as prevention, i.e. only having unprotected sex with HIV-positive people who are known to be in effective treatment).
  o PrEP (pre-exposure prophylaxis, HIV medication taken before exposure).
  o PEP (post-exposure prophylaxis, HIV medication taken immediately after exposure).

Even though the number of notified HIV cases has increased considerably from last year (from 132 to 259 cases), a significant increase was not recorded among MSM who were born in Denmark or had become infected after their arrival to Denmark. This group constitutes the main target for HIV prevention in Denmark. In 2022, this group only comprised 38 persons, which is the same number as the preceding year. Thus, the preventive measures implemented in Denmark remain a success.

Continued success depends on the continuous offer of PrEP for HIV negative MSM, who do not use condoms consistently. This group may best be contacted at clinics of infections medicine, STI clinics, general practitioners and at the CheckPoints of the Danish AIDS Foundation, when they visit to get tested for sexually transmitted diseases. The preventive treatment is handed out free of charge at clinics of infectious medicine across Denmark.

On the other hand, it causes concern that a large share was tested and diagnosed late, which was possibly due to the COVID-19 pandemic and associated lockdowns. We take this opportunity to stress once more that frequent testing is essential if you are at risk of becoming infected with HIV.

Among the newly diagnosed cases who were tested in the SERO project in the 2019-2022 period, one person had a low level of resistance against TDF and a high level of resistance against FTC. As these drugs constitute PrEP, it is important to remain attentive to the occurrence of resistance among newly diagnosed people. So far, transmitted resistance to both drugs has not been recorded in Denmark. Also, HIV transmission has not been recorded among persons receiving PrEP treatment in Denmark.

(S. Cowan, M. Wessman, Department of Infectious Epidemiology and Prevention, J. Fonager, M.M. Lassaunière, Department for Virus and Microbiological Special Diagnostics)