Hepatitis A virus and injecting drug misuse in Aberdeen, Scotland: a case–control study

Abstract

To describe an epidemiological investigation of an outbreak of hepatitis A virus (HAV) infection among injecting drug users in Aberdeen, Scotland. A case-control study to determine whether transmission was facilitated by poor personal hygiene or through sharing injecting equipment. Cases were more likely to report not washing their hands after using the toilet [odds ratio (OR) = 12.9, 95% confidence interval (CI) = 1.58-105.89] or before preparing food (OR = 4.0, 95% CI = 1.01-15.8), and less likely to have washed their hands prior to preparing drugs (OR = 10.67, 95% CI = 2.14-53.07). Cases were also more likely to report recipient sharing of needles/syringes (OR = 8.27, 95% CI = 1.68-40.57), and to have had injecting contact with someone who was jaundiced (OR = 29.4, 95% CI = 3.18-271.44). The results indicate that the lack of hygiene within the context of individuals gathering to prepare and inject drugs provides ample opportunity for the transmission of HAV. Although the promotion of good hygiene and the avoidance of sharing injecting equipment are important measures in preventing HAV transmission, they are unlikely to effect major behavioural change. Such measures should, therefore, be reinforced by routinely offering HAV vaccine to injectors.

An outbreak of hepatitis A among homeless drug users in Rotterdam, The Netherlands

“…In England, 14 outbreaks were reported in 2002, all involving injecting drug users [Perrett et al, 2003]. Therefore, when sporadic HAV cases are reported among the homeless population, HAV vaccination should be actively offered to this vulnerable group [Roy et al, 2004].…”

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].…”

Prevalence of hepatitis and HIV infections and vaccination rates in patients entering the heroin-assisted treatment in Switzerland between 1994 and 2002

“…The prevalences of HBV and HAV have moderately, but significantly decreased, but were still high at 53.3%, and 41.2% respectively. HAV [24][25][26][27] and HBV infections are transmitted easily in the viremic phase, but since HAV never and HBV (in immune competent adults) only rarely becomes chronic (in about 5-10% of infections), the chance of acquiring the infection by occasional sharing of injection devices is not so high as with HCV. The number of HAV infections could not be determined reliably, however.…”