Hepatitis A outbreaks among illicit drug users and their contacts in Queensland, 1997

Abstract

Objective To describe five outbreaks of hepatitis A virus (HAV) infection associated with illicit drug use during a statewide outbreak of HAV infection in Queensland. Design Risk factor prevalence survey. Patients and setting All 875 cases of HAV infection notified to Public Health Units in Queensland in the 12 months to 30 November 1997. Main outcome measure Type and prevalence of illicit drug use. Results Risk factor assessment was completed for 804 cases (91.9%). We identified five outbreaks of HAV infection linked to illicit drug use. These outbreaks accounted for 24.6% (215/875) of all notified cases and 39% (190/482) of notified cases in the 15‐34 years age group. The main type of illicit drug use in four of the five outbreaks was injecting drug use (74%; 118/160), while in the other outbreak it was sharing of smoking implements for marijuana (38%; 21/55). Conclusion Illicit drug use may be an under‐recognised risk factor for HAV infection, particularly in young people. Faecal‐oral transmission through poor personal hygiene, including sharing of implements for smoking marijuana, is the most probable route of transmission in these drug‐linked outbreaks. The role of contaminated drug and needle‐sharing remains to be clarified.

An outbreak of hepatitis A virus infection with a high case-fatality rate among injecting drug users

“…Outbreaks among IDUs have been reported more often in low endemic areas, compared to highly endemic areas [4][5][6][7][8][9][10][11][12][13], yet it is not known whether the differences are a result of the efficiency of surveillance systems. It is possible that in highly endemic countries infection occurs early in life and that a low proportion of the population thus remains susceptible in young adulthood, when injecting drug use usually begins.…”

“…In non-endemic countries, both large and small outbreaks of HAV infection among IDUs have occurred [4][5][6][7][8][9][10][11][12][13]. In some outbreaks, the prevalent variant was genotype IA [4,5] or IIIA [7,11]; co-circulation of different strains was also reported [7].…”

“…Nonetheless, the mode of transmission was not determined. HAV is mainly transmitted through the fecal-oral route, which, among IDUs, can be favored by poor hygiene and living conditions [4][5][6][7][8][9][10]. The implication of blood products in HAV transmission [14][15] suggests that the virus can also be transmitted through needle sharing during the viremic period, which can exceed two months [16,17].…”

Sexually acquired hepatitis

“…[4][5][6] Parenteral spread can also occur in injecting drug users, haemophiliacs using contaminated factor VIII, and other recipients of blood products. [7][8][9][10][11] Sexual transmission There are now numerous reports of HAV outbreaks among men who have sex with men (MSM). Infection correlates with visits to saunas and darkrooms, sex with anonymous partners, group sex, oro-anal and digital-rectal intercourse, and number of partners.…”

Hepatitis A in injecting drug users: a national problem

“…Serological human leukocyte antigen (HLA) A and B typing was performed by An epidemic of reactive arthritis in Vanuatu: a descriptive study 1 Cases of hepatitis A among illicit drug users have been reported previously in southeast Sydney.? Despite the reports of hepatitis A outbreaks among illicit drug users nationally'< and internationally," the route of transmission in most cases remains unclear and is probably multifactorial.…”