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Factors associated with fulminant liver failure during an outbreak among injection drug users with acute hepatitis B
Author(s) -
Garfein Richard S.,
Bower William A.,
Loney Cherry M.,
Hutin Yvan J. F.,
Xia GuoLiang,
Jawanda Jaspaul,
Groom Amy V.,
Nainan Omana V.,
Murphy James S.,
Bell Beth P.
Publication year - 2004
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840400416
Subject(s) - medicine , drug , fulminant hepatitis , outbreak , liver failure , fulminant , acute hepatitis , fulminant hepatic failure , hepatitis b , acute hepatitis b , virology , gastroenterology , hepatitis , intensive care medicine , hepatitis b virus , emergency medicine , pharmacology , liver transplantation , virus , hbsag , transplantation
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 (IDU s ) resulting in several deaths. We conducted a case‐control study of fulminant (case patients) and nonfulminant (control patients) HBV infections. We directly sequenced the entire HBV genome from fulminant and nonfulminant cases. From October 1998 to July 2000, 21 acute HBV infections, including 10 fulminant 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 (case‐fatality 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). 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 IDU s has the potential to prevent similar outbreaks in the future. (Hepatology 2004;40:865–873).