Factors associated with fulminant liver failure during an outbreak among injection drug users with acute hepatitis B
✍ Scribed by Richard S. Garfein; William A. Bower; Cherry M. Loney; Yvan J. F. Hutin; Guo-Liang Xia; Jaspaul Jawanda; Amy V. Groom; Omana V. Nainan; James S. Murphy; Beth P. Bell
- Publisher
- John Wiley and Sons
- Year
- 2004
- Tongue
- English
- Weight
- 922 KB
- Volume
- 40
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
Death related to acute hepatitis B occurs in approximately 1% of patients. We investigated an outbreak of hepatitis B virus (HBV) infections among injection drug users (IDUs) resulting in several deaths. We conducted a case-control study of fulminant (case patients) and nonfdminant (control patients) HBV infections. We directly sequenced the entire HBV genome from fdminant and nonfulminant cases. From October 1998 to July 2000,21 acute HBV infections, including 10 fdminant hepatitis B cases, were identified. The median age was 30 (range, 18-49) years, 12 (57%) were female, 20 (95%) were American Indians, and 20 (95%) reported injecting illicit drugs. All patients with fulminant hepatitis B died (casefatality rate = 47.6%). Case patients (n = 5 ) and control patients (n = 9) were similar with respect to age, sex, race, and hepatitis C virus serostatus. All case patients used acetaminophen during their illness compared with 44% of control patients (P = .08). Compared with control patients, 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 included mutations previously described in association with fulminant hepatitis B. In conclusion, a high prevalence of exposure to factors potentiating hepatic damage with acute hepatitis B contributed to the outbreak's high mortality rate; mutations present in the outbreak strain might also have been a factor, Improved vaccination coverage among IDUs has the potential to prevent similar outbreaks in the future. (HEPATOLOGY 2004;40:865-873.) H epatitis B virus (HBV) infection manifests a broad clinical spectrum. Approximately 50% of adults will develop symptoms, characterized by anorexia, malaise, nausea, vomiting, abdominal pain, and jaundice.' In case series, fulminant hepatitis B occurs in approximately 1 % of patients with acute disease2 and carries a mortality rate of up to 80Y0.3 However, hepatitis B