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

Abstract：

BACKGROUND/AIMS:In 2002, the first reported outbreak of hepatitis A virus (HAV) infection involving mostly intravenous drug users (IDU) occurred in Italy. We attempted a thorough evaluation of the outbreak, including epidemiological, clinical and virological analyses. METHODS:We conducted an epidemiological investigation, including a case-control study, to identify the source and the modes of HAV transmission. Hepatitis B and C (HCV) viruses and human immunodeficiency virus (HIV) coinfections were clinically analysed. Sequence analysis of the VP1/2A junction of the HAV isolates was also performed. RESULTS:Of the 47 symptomatic cases, 35 were IDUs. The only associated risk factor was contact (not related to injecting practices) with a jaundiced person (odds ratio: 5.8; 95% confidence interval: 1.3-29.9). Of the cases, 58% were anti-HCV positive and 4.7% anti-HIV positive. Three individuals died of acute liver failure: 2 were HCV-coinfected alcohol abusers, with underlying liver cirrhosis; 1 was HCV/HIV-coinfected. HAV-RNA was found in 15 of the 24 tested patients: genotype IB (8 cases) and IIIA (7 cases) were detected. CONCLUSIONS:HAV was probably transmitted through the fecal-oral route, although parenteral transmission cannot be excluded. The high fatality rate was probably due to severe underlying liver damage. The occurrence of this outbreak highlights the need for routine HAV vaccination for IDUs.

journal_name

J Hepatol

journal_title

Journal of hepatology

authors

Spada E,Genovese D,Tosti ME,Mariano A,Cuccuini M,Proietti L,Giuli CD,Lavagna A,Crapa GE,Morace G,Taffon S,Mele A,Rezza G,Rapicetta M

doi

10.1016/j.jhep.2005.06.012

subject

Has Abstract

pub_date

2005-12-01 00:00:00

pages

958-64

issue

6

eissn

0168-8278

issn

1600-0641

pii

S0168-8278(05)00442-3

journal_volume

43

pub_type

杂志文章

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