Outbreak of Hepatitis B among Methamphetamine Injectors

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Outbreak of Hepatitis B among Methamphetamine Injectors

Sharing of equipment for injecting drugs is likely the most common route of hepatitis B virus (HBV) transmission in the United States. Other routes include sexual and mother-to-child transmission; transmission related to healthcare procedures is uncommon now that donated blood is routinely screened and healthcare providers have adopted universal precautions.

While HBV - as well as HIV and hepatitis C virus (HCV) -- infection are often associated with heroin use, injection of other drugs also poses a risk if needles and other injecting equipment are shared.

In the May 2006 issue of Addiction, researchers with the Centers for Disease Control and Prevention reported on an outbreak of hepatitis B among methamphetamine injectors in rural central Wyoming during January-August 2003.In this case-control study, HBV-infected individuals were identified through surveillance and contact tracing. The 18 cases were either symptomatic or confirmed through serological testing to be acutely infected with HBV. The 49 controls were susceptible to HBV infection (i.e., not previously infected or vaccinated). All participants identified themselves as methamphetamine injectors. Subjects were asked to complete a survey about their risk factors for HBV infection, including drug use practices and sexual behavior. Results

Among the 18 infected patients and 49 controls who participated in the study, sharing water used to prepare injections or rinse syringes was associated with HBV infection (94% of infected patients shared water vs 44% of controls; OR 21.9; 95% CI 2.7-177.8). Sharing cotton filters was also associated with infection (89% of infected patients vs 52% of controls; OR 7.4; 95% CI 1.5-35.6). However, sharing syringes was not statistically associated with HBV infection. In logistic regression models adjusted for age, sex, and interview site, sharing rinse water and sharing cotton remained statistically associated with HBV infection.

Conclusion

In conclusion, the authors wrote, "Our findings highlight the need for awareness of risks associated with injection drug use and sharing behaviors." This study adds to the evidence that sharing of water and cotton during injection increases the risk of disease transmission, but it is unusual that needle-sharing itself was not associated with increased risk.The authors recommend that, "Enhanced hepatitis B vaccination programs and educational campaigns that target methamphetamine injectors specifically, including those living in rural areas, should be developed and implemented."8/18/06

http://www.hivandhepatitis.com/hep_b/news/2006/081806_a.html

ReferenceT M Vogt, J F Perz, C K Van Houten, and others. An Outbreak of Hepatitis B Virus Infection Among Methamphetamine Injectors: The Role of Sharing Injection Drug Equipment. Addiction 101(5): 726-730. May 2006.