Programs promoting safe injection drug use practices, drug treatment, and hepatitis A and B vaccination should be key components of viral hepatitis prevention, according to study results published in Clinical Infectious Diseases.1

In 2016, the Centers for Disease Control and Prevention’s viral hepatitis surveillance data indicated that approximately one-third of newly reported cases of acute hepatitis B virus (HBV) infection are in adults with injection drug use history.2 Despite recommendations to vaccinate at-risk groups against HBV and hepatitis A virus (HAV) infection,3,4 coverage in 2016 was estimated at 25% for HBV and 10% for HAV in all adults in the United States, regardless of risk factors. Assessing HAV and HBV immunity in patients with an injection drug use history is pertinent to monitoring immunization adherence.1 Thus, researchers used 2001 to 2006 National Health and Nutrition Examination Survey data to calculate positive antibody to hepatitis B core antigen (anti-HBc+) prevalence in adults with an injection drug use history and in the general US population. They found that during this period anti-HBc+ prevalence was 19.7% in adults with an injection drug use history compared with 4.6% in the general population. In addition, in adults with a history of injection drug use, 19.8% reported prior year injection drug use and 28.5% had hepatitis A immunity.

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The investigators suggest that this was the first study to establish a baseline anti-HBc+ prevalence, indicating previous or ongoing HBV infection in adults with a history of injection drug use.1 “In summary, these data indicate that from 2001 to 2016, one in five US adults aged 20-59 years with IDU history had previous or ongoing HBV-infection, which was over four times higher than the anti-HBc+ prevalence in the general population,” concluded the researchers.

References
1. Shing JZ, Ly KN, Zing J, Teshale EH, Jiles RB. Prevalence of hepatitis B virus infection among US adults aged 20-59 years with a history of injection drug use: National health and nutrition examination survey, 2001-2016 [published online July 27, 2019].  Clin Infect Dis. doi:10.1093/cid/ciz669

2. Surveillance for viral hepatitis-United States, 2016. Centers for Disease Control and Prevention website. www.cdc.gov/hepatitis/statistics/2016surveillance/pdfs/2016HepSurveillanceRpt.pdf. Accessed August 28, 2019.

3. Centers for Disease Control and Prevention. Recommendation of the Immunization Practices Advisory Committee (ACIP) inactivated hepatitis B virus vaccine. MMWR Morb Mortal Wkly Rep. 1982;31(24):317.

4. Centers for Disease Control and Prevention. Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1996;45(RR15):1-30.