An Outbreak of Hepatitis B Virus Infection Among Methamphetamine Injectors: The Role of Sharing Injection Drug Equipment

"Methamphetamine use has become increasingly prevalent in the United States," wrote the authors, who set out to identify risk factors for acute hepatitis B virus (HBV) infection among Natrona County, Wyo., residents who inject the drug.

All participants were self-identified methamphetamine injectors. The researchers identified cases through surveillance and contact tracing. Cases were either symptomatic or confirmed serologically to be acutely infected with HBV between January and August 2003. Controls were susceptible to HBV infection and were tested serologically for acute HBV infection. Participants were surveyed about their risk factors for HBV infection, including sexual behaviors and drug-use practices. The study included 18 case and 49 control participants.

Sharing the water used to prepare injections and/or rinse syringes was associated with HBV infection (94 percent of cases vs. 44 percent of controls; OR=21.9; 95 percent CI: 2.7, 177.8), as was sharing cotton filters (89 percent of cases vs. 52 percent of controls; OR=7.4, 95 percent CI: 1.5, 35.6). Sharing syringes was not statistically associated. Sharing water and cotton remained statistically associated in logistic regression models adjusted for age, sex, and interview site.

"Our findings highlight the need for awareness of risks associated with injection drug use and sharing behaviors," the authors concluded. "Enhanced hepatitis B vaccination programs and educational campaigns that target methamphetamine injectors specifically, including those living in rural areas, should be developed and implemented."

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