Hepatitis A Outbreak Amongst Intravenous Amphetamine Abusers in Finland

Abstract

This article describes a widespread outbreak of hepatitis A virus (HAV) infection amongst drug abusers in Finland. Although attempts to demonstrate the virus in amphetamines failed, the infection was assumed to be linked to intravenous use of the drug. The unusual mode of transmission prompted us to analyse possible atypical clinical features as well as the spread of the virus to the general population, nowadays practically without protective immunity. Serologically verified cases that occurred in Helsinki were interviewed, their hospital records were analysed and their contacts were serology tested. Amphetamine lots, as well as faecal samples from patients, were examined with RT-PCR. Detailed information was obtained from 238 subjects, among whom 131 admitted drug abuse and 67 cases were classified as secondary cases. Phylogenetic analysis of virus strains from HAV-infected cases suggested a common origin, and epidemiological observations linked it with particular lots of amphetamine. Three cases died, and 3 presented with severe clinical disease. Icterus was more common among i.v. drug abusers than others. Infection with hepatitis A virus was probably related to the faecal contamination of amphetamine associated with the transportation of the drugs in the gastrointestinal tract.

Diagnosis of Hepatitis A Virus Infection: a Molecular Approach

“…Outbreaks of HAV infection among injection drug users (IDUs) have been reported in North America and Scandinavia (97,101,143). Several routes of transmission are likely to occur, and these include a combination of personto-person and percutaneous spread.…”

The cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C

“…This high rate of infection is rarely seen in North America except in highly endemic regions such as some Alaskan Native and American Indian communities. 2 Although some patients with HCV, predominantly intravenous drug abusers, may be at an increased risk of acquiring HAV compared with the general population, [8][9][10]13,27 this high rate of infection has not been duplicated in studies of North American patients with HCV. 28 The impact of the epidemiology of HAV infection on this decision model is further highlighted in Fig.…”

“…In this study, 41% of those acquiring HAV developed acute liver failure and 86% of these individuals died, a case fatality rate of 35%. 7 Leino et al, 13 on the other hand, reported no deaths among 75 HCV-infected intravenous drug abusers during an outbreak of HAV in Finland.…”

“…6 Conflicting findings have been reported concerning the course of HAV infection in patients with chronic HCV. [7][8][9][10][11][12][13][14] For example, Vento et al 7 recently reported the course of 427 patients with HCV who acquired acute HAV. In this study, 41% of those acquiring HAV developed acute liver failure and 86% of these individuals died, a case fatality rate of 35%.…”

Genetic Analysis of Hepatitis A Virus Strains That Induced Epidemics in Korea during 2007–2009

“…HAV occurs worldwide, and humans are thought to be its natural host. The virus is transmitted via person-to-person contact, through the fecal-oral route, and by the ingestion of contaminated food and water (18,26,30,31). The virion is a naked, spherical particle with a diameter of 27 to 32 nm.…”