HEPATITIS-A OUTBREAK AMONGST INTRAVENOUS AMPHETAMINE ABUSERS IN FINLAND

This article describes a widespread outbreak of hepatitis A virus (HAV ) infection amongst drug abusers in Finland. Although attempts to demo nstrate the virus in amphetamines failed, the infection was assumed to be linked to intravenous use of the drug. The unusual mode of transmi ssion prompted us to analyse possible atypical clinical features as we b as the spread of the virus to the general population, nowadays pract ically without protective immunity. Serologically verified cases that occurred in Helsinki were interviewed, their hospital records were ana lysed and their contacts were serology tested. Amphetamine Lots, as we b as faecal samples from patients, were examined with RT-PCR. Detailed information was obtained from 238 subjects, among whom 131 admitted d rug abuse and 67 cases were classified as secondary cases. Phylogeneti c analysis of virus strains from HAV-infected cases suggested a common origin, and epidemiological observations linked it with particular lo ts of amphetamine. Three cases died, and 3 presented with severe clini cal disease. Icterus was more common among i.v. drug abusers than othe rs. infection with hepatitis A virus was probably related to the faeca l contamination of amphetamine associated with the transportation of t he drugs in the gastrointestinal tract.