CHARACTERIZATION OF AN EPIDEMIC OF HEPATITIS-A VIRUS INVOLVING INTRAVENOUS DRUG-ABUSERS - INFECTION BY NEEDLE SHARING

An epidemic of hepatitis A virus (HAV) among intravenous drug abusers in Oslo involved 144 serologically confirmed cases. Another 26 patient s (non-drug abusers), of whom 14 were derived from a single nosocomial outbreak, were associated with the epidemic. Sequencing of the VP1/P2 A junction revealed that viruses associated with the epidemic were com pletely identical, whereas other HAV samples collected during the same period differed by up to 10 %. HAV was detected in the serum of 48 of 100 patients by a nested PCR. Viremia was observed as early as 25 day s before the onset of clinical hepatitis, and up to 30 days after. The large number of patients within the drug abuser group, and the few se condary cases, raised the question of whether the virus could be trans mitted by the use of needles. To establish whether viral contamination of drugs did contribute appreciably to maintaining the epidemic, we e xamined heroin and amphetamine confiscated during the period, using im munomagnetic separation coupled to nested PCR, but failed to detect an y virus. Antibodies against hepatitis B virus and hepatitis C virus we re common among the HAV infected drug abusers (43% and 81%, respective ly), suggesting widespread sharing of needles. This observation and th e large number of patients with a demonstrable viremia suggest that ne edle sharing may contribute to the dissemination of HAV. (C) 1997 Wile y-Liss, Inc.