<i>Notes from the Field:</i> Hepatitis A Outbreak Associated with Drug Use and Homelessness — West Virginia, 2018

Wilson, Erica; Hofmeister, Megan G.; McBee, Shannon; Briscoe, Janet; Thomasson, Erica; Olaisen, R. Henry; Augustine, Ryan; Duncan, Eliana; Morris, Sapna Bamrah; Haddy, Loretta

doi:10.15585/mmwr.mm6814a4

Cited by 14 publications

(10 citation statements)

References 3 publications

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“…Seventeen hepatitis A articles conducted among homeless populations fulfilled the eligibility criteria [31, 35, 36, 54-67]. Overall, 10,552 individuals were enrolled between 1991 and 2018.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 10,552 individuals were enrolled between 1991 and 2018. Nine studies were conducted in adults (mean age: 19-45 years, range 16-74 years) [31, 55-57, 59, 61, 62, 64, 65], and eight in populations comprising children and adults (mean age: 25-42 years, range 0-90 years) [35, 36, 54, 58, 60, 63, 66, 67]. Studies were conducted in the USA (n=7) [35, 54, 56-68, 61, 64], Canada (n=4) [36, 55, 65, 66], Brazil [67], the UK [63], Czech Republic [60], The Netherlands [62], Iran [59] and Australia (n=1 per country) [31].…”

Section: Resultsmentioning

confidence: 99%

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Vaccine-preventable diseases other than tuberculosis, and homelessness: A systematic review of the published literature, 1980 to 2020

Castaneda

Hoang

et al. 2020

Preprint

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Background. Homelessness may result in the breakdown of regular health services, including routine vaccination programmes. A literature review was conducted to describe vaccine-preventable diseases (VPD) other than tuberculosis in homeless populations and to summarize vaccination recommendations in homeless people. Methods. We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We searched peer-reviewed literature published in English, French or Spanish reporting the outbreak of VPD or VPD prevalence in both infant and adult homeless populations published between 1980 and 2020, using PubMed/Medline, SciELO, Google Scholar, and Web of Science databases. Relevant information from the studies was charted in Microsoft Excel and results were summarised using a descriptive analytical method. Results. Seventy-five articles were included. A high prevalence of past HBV and HAV infections were observed through serosurveys, mostly in high income countries or high-middle income countries (USA, Canada, France, Iran or Brazil). Nine outbreaks of HAV infection were also reported, with lethality rates ranging from 0-4.8%. The studies discussed numerous risk factors positively associated with HBV infection, including older age, homosexual or bisexual practice, injected drug use (IDU), and, with HAV infection including IDU, having sexual partner(s) with a history of unspecified hepatitis, insertive anal penetration, or originating from a country with a high prevalence of anti-HAV antibody. Eleven outbreaks of pneumococcal infection affecting homeless persons were reported in Canada and USA, with lethality rates from 0-15.6%. Five diphtheria outbreaks were reported. Vaccination status was rarely documented in these studies. Conclusions. The literature suggests that homeless populations generally experience a higher VPD burden and lower immunisation rates. The findings suggest the need for a national vaccination programme and planning for delivering vaccines in this population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Vaccine-preventable diseases other than tuberculosis, and homelessness: A systematic review of the published literature, 1980 to 2020

Castaneda

Hoang

et al. 2020

Preprint

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“…Another increment of HAV cases is expected by surveillance analysts in 2017-2018 due to ongoing multiple outbreaks among persons who use drugs or people who experience homelessness across the country. 28 A study from San Diego identified people experiencing homelessness as being at disproportionally higher risk of HAV infection than the general population. This study indicated that people experiencing homelessness had 3.3 times higher odds of being infected with HAV than the general population, 2.5 times higher odds of being hospitalized and were 3.9 times more likely to die due to HAV infection.…”

Section: Discussionmentioning

confidence: 99%

“…A significant increase in hepatitis A cases in the United States was observed in 2013 and 2016 mainly caused by outbreaks linked to imported foods. Another increment of HAV cases is expected by surveillance analysts in 2017‐2018 due to ongoing multiple outbreaks among persons who use drugs or people who experience homelessness across the country 28 . A study from San Diego identified people experiencing homelessness as being at disproportionally higher risk of HAV infection than the general population.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis A virus survival on drug paraphernalia

Medrzycki

Kamili

Purdy

2020

Journal of Viral Hepatitis

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The ongoing hepatitis A outbreaks in multiple states in the United States have concerned public health authorities since March 2017. The outbreaks have spread throughout 30 states and include primarily persons who use drugs, including persons who inject drugs (PWID) and persons experiencing homelessness. Contaminated drug injection paraphernalia and sharing of these items could potentially aid in transmission of hepatitis A virus (HAV) among these populations. We examined HAV survival on drug paraphernalia frequently shared among PWIDs. The effect of low pH on HAV survival using citric acid, which is frequently used by PWIDs during dose preparation, was investigated. We compared the plaque assay results with those concurrently obtained by qRT-PCR to establish whether HAV RNA levels could be used as surrogates for plaque assay results. HAV suspended in minimal essential media at room temperature infected FRhK4 cells for more than 17 weeks. HAV remained viable in syringes/needles for up to 10 weeks depending on the gauge of the needles and the syringe dead volumes, and on cookers, tourniquets and cotton balls/filter surfaces for up to 4 weeks. HAV retained its infectivity for more than 10 weeks at pH as low as 2. In conclusion, our findings show that HAV survives and remains infective in or on injection drug use equipment for 1 to 10 weeks depending on the type of paraphernalia examined and environmental conditions. These findings suggest that contaminated drug paraphernalia can potentially facilitate the transmission of HAV within populations who share these items.

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“…Another issue is that hepatitis A outbreaks are frequently reported among some special groups including persons experiencing homelessness and MSMs in developed countries. [112][113][114][115][116][117][118] Hepatitis A vaccination has been approved to be effective in controlling these outbreaks.…”

Section: Epidemiological Shift After Hepatitis a Vaccinationmentioning

confidence: 99%

Hepatitis A vaccination

Zhang

2020

Human Vaccines & Immunotherapeutics

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Hepatitis A is an important public health issue worldwide. Hepatitis A vaccine (HepA) was first licensed in 1992. Both inactivated HepA (HepA-I) and live attenuated HepA (HepA-L) are highly immunogenic and well tolerated, and immune protection postvaccination can persist for at least 20 y. HepA is effective for both preexposure and postexposure prophylaxis, especially among children and young adults. The strategy of HepA vaccination varies in different countries and mainly includes vaccination among highrisk populations, regional childhood vaccination and universal childhood vaccination. The incidence of hepatitis A has decreased greatly in many countries in the last 30 y, but hepatitis A outbreaks frequently occur among high-risk populations and those who have not been covered by universal child vaccination programs in recent years. Disease surveillance and serosurveys are suggested to clarify the shift in the epidemiology of hepatitis A. The long-term persistence of immune protection after one dose of HepA should be further studied, as well as the cost-effective evaluation of different strategies of HepA vaccination. Based on this evidence, the recommendation on HepA vaccination should be put forward scientifically and updated in a timely and well-implemented manner.

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Notes from the Field: Hepatitis A Outbreak Associated with Drug Use and Homelessness — West Virginia, 2018

Cited by 14 publications

References 3 publications

Vaccine-preventable diseases other than tuberculosis, and homelessness: A systematic review of the published literature, 1980 to 2020

Vaccine-preventable diseases other than tuberculosis, and homelessness: A systematic review of the published literature, 1980 to 2020

Hepatitis A virus survival on drug paraphernalia

Hepatitis A vaccination

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