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

Enea Spada, Domenico Genovese, Maria Elena Tosti, Andrea Mariano, Marco Cuccuini, Laura Proietti, Cinzia Di Giuli, Alessandro Lavagna, Giuseppe Edoardo Crapa, Graziella Morace, Stefania Taffon, Alfonso Mele, Giovanni Rezza, Maria Rapicetta

Research output: Contribution to journalArticle

59 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)958-964
Number of pages7
JournalJournal of Hepatology
Volume43
Issue number6
DOIs
Publication statusPublished - Dec 2005

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Hepatitis A virus
Virus Diseases
Drug Users
Disease Outbreaks
Mortality
HIV
Acute Liver Failure
Hepatitis C
Jaundice
Hepatitis B
Coinfection
Liver Cirrhosis
Italy
Sequence Analysis
Case-Control Studies
Vaccination
Odds Ratio
Genotype
Alcohols
RNA

Keywords

  • Genotype
  • Hepatitis A
  • Intravenous drug use
  • Outbreak
  • Risk factors

ASJC Scopus subject areas

  • Gastroenterology

Cite this

An outbreak of hepatitis A virus infection with a high case-fatality rate among injecting drug users. / Spada, Enea; Genovese, Domenico; Tosti, Maria Elena; Mariano, Andrea; Cuccuini, Marco; Proietti, Laura; Giuli, Cinzia Di; Lavagna, Alessandro; Crapa, Giuseppe Edoardo; Morace, Graziella; Taffon, Stefania; Mele, Alfonso; Rezza, Giovanni; Rapicetta, Maria.

In: Journal of Hepatology, Vol. 43, No. 6, 12.2005, p. 958-964.

Research output: Contribution to journalArticle

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 2005, 'An outbreak of hepatitis A virus infection with a high case-fatality rate among injecting drug users', Journal of Hepatology, vol. 43, no. 6, pp. 958-964. https://doi.org/10.1016/j.jhep.2005.06.012
Spada, Enea ; Genovese, Domenico ; Tosti, Maria Elena ; Mariano, Andrea ; Cuccuini, Marco ; Proietti, Laura ; Giuli, Cinzia Di ; Lavagna, Alessandro ; Crapa, Giuseppe Edoardo ; Morace, Graziella ; Taffon, Stefania ; Mele, Alfonso ; Rezza, Giovanni ; Rapicetta, Maria. / An outbreak of hepatitis A virus infection with a high case-fatality rate among injecting drug users. In: Journal of Hepatology. 2005 ; Vol. 43, No. 6. pp. 958-964.
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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.",
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AU - Spada, Enea

AU - Genovese, Domenico

AU - Tosti, Maria Elena

AU - Mariano, Andrea

AU - Cuccuini, Marco

AU - Proietti, Laura

AU - Giuli, Cinzia Di

AU - Lavagna, Alessandro

AU - Crapa, Giuseppe Edoardo

AU - Morace, Graziella

AU - Taffon, Stefania

AU - Mele, Alfonso

AU - Rezza, Giovanni

AU - Rapicetta, Maria

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N2 - 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.

AB - 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.

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KW - Risk factors

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