Death related to acute hepatitis B occurs in approximately 1%of patients. We investigated an outbreak of hepatitis B virus (HBV) infections among injection d rug users (IDUs) resulting in several deaths. We conducted ...Death related to acute hepatitis B occurs in approximately 1%of patients. We investigated an outbreak of hepatitis B virus (HBV) infections among injection d rug users (IDUs) resulting in several deaths. We conducted a case-control study of fulminant (case patients) and nonfulminant (control patients) HBV infections . We directly sequenced the entire HBV genome from fulminant and nonfulminant ca ses. From October 1998 to July 2000,21 acute HBV infections, including 10 fulminant hepatitis B cases, were identified. The med ian age was 30 (range, 18-49) years, 12 (57%) were female, 20 (95%) were Amer ican Indians, and 20 (95%) reported injecting illicit drugs. All patients with fulminant hepatitis B died (case-fatality rate = 47.6%). Case patients (n = 5) and control patients (n = 9) were similar with respect to age, sex, race, and h epatitis C virus serostatus. All case patients used acetaminophen during their i llness compared with 44%of control patients (P = .08). Compared with control pa tients, case patients lost more weight in the 6 months before illness (P = .04); during their illness, they used more alcohol (P = .03) and methamphetamine (P = .04). All 9 isolates sequenced were genotype D, shared 99.7%homology, and incl uded mutations previously described in association with fulminant hepatitis B. I n conclusion, a high prevalence of exposure to factors potentiating hepatic dama ge with acute hepatitis B contributed to the outbreak’s high mortality rate; mu tations present in the outbreak strain might also have been a factor. Improved v accination coverage among IDUs has the potential to prevent similar outbreaks in the future.展开更多
文摘Death related to acute hepatitis B occurs in approximately 1%of patients. We investigated an outbreak of hepatitis B virus (HBV) infections among injection d rug users (IDUs) resulting in several deaths. We conducted a case-control study of fulminant (case patients) and nonfulminant (control patients) HBV infections . We directly sequenced the entire HBV genome from fulminant and nonfulminant ca ses. From October 1998 to July 2000,21 acute HBV infections, including 10 fulminant hepatitis B cases, were identified. The med ian age was 30 (range, 18-49) years, 12 (57%) were female, 20 (95%) were Amer ican Indians, and 20 (95%) reported injecting illicit drugs. All patients with fulminant hepatitis B died (case-fatality rate = 47.6%). Case patients (n = 5) and control patients (n = 9) were similar with respect to age, sex, race, and h epatitis C virus serostatus. All case patients used acetaminophen during their i llness compared with 44%of control patients (P = .08). Compared with control pa tients, case patients lost more weight in the 6 months before illness (P = .04); during their illness, they used more alcohol (P = .03) and methamphetamine (P = .04). All 9 isolates sequenced were genotype D, shared 99.7%homology, and incl uded mutations previously described in association with fulminant hepatitis B. I n conclusion, a high prevalence of exposure to factors potentiating hepatic dama ge with acute hepatitis B contributed to the outbreak’s high mortality rate; mu tations present in the outbreak strain might also have been a factor. Improved v accination coverage among IDUs has the potential to prevent similar outbreaks in the future.
