1
|
Savicka O, Dusacka D, Zeltmatis R, Nikisins S, Azina I, Ivancenko L, Tolmane I, Rozentale B. Hepatitis A virus subgenotypes in Latvia, 2008-2021. J Infect Public Health 2023; 16:1462-1470. [PMID: 37531706 DOI: 10.1016/j.jiph.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/21/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND In Latvia outbreaks of the HAV were observed between 2008 and early 2010 and again in 2017-2018. However, the risks of introducing and spreading infection still exist, as the virus spreads easily when personal hygiene is not followed. METHODS To determine the spread of HAV subgenotypes in the territory of Latvia the VP1/P2A genomic region of HAV was amplified and sequenced for 259 case serum samples. The study carried out a molecular biological investigation and molecular epidemiological investigation. Demographic data (sex, age), disease data (hepatitis symptoms, hospitalization, vaccination) and epidemiology data (part of the outbreak, possible source of infection, recent travel) were collected. Based on the obtained sequences, the phylogenetic tree was built and analyzed for the homology and belonging to different isolated HAV clusters from other countries. RESULTS From the obtained data, it was concluded that HAV subgenotype IA had 13 clusters and 12 sporadic cases, HAV subgenotype IB had eight clusters and 11 sporadic cases, HAV subgenotype IIIA had one cluster and nine sporadic cases. It was found that the sources of infection among the investigated cases were different, they were mostly associated with contact with a patient with HAV, travel, as well as between persons who inject drugs and men who have sex with men, and the prevalence of HAV similar sequences was observed in different years. It was concluded that patients with HAV subgenotype IA had the longest hospitalization duration and averaged 9.3 days, while patients with subgenotype IB - 7.3 days, subgenotype IIIA - 7.7 days. Analyzing the data on vaccination, it was found that mostly all were not vaccinated or had an unknown vaccination status. CONCLUSIONS All of this has led to the conclusion that the application of molecular biological methods of the HAV and a careful analysis of epidemiological data can help to better understand the ways of spreading the infection, investigate local outbreaks, detect cases of imported infection and track the recirculation of the virus.
Collapse
Affiliation(s)
- Oksana Savicka
- Riga East Clinical University Hospital, Laboratory "Latvian Centre of Infectious Diseases", National Microbiology Reference Laboratory, Riga, Latvia; Riga Stradins University, Department of Infectology, Latvia.
| | - Diana Dusacka
- Riga East Clinical University Hospital, Laboratory "Latvian Centre of Infectious Diseases", National Microbiology Reference Laboratory, Riga, Latvia
| | - Reinis Zeltmatis
- Riga East Clinical University Hospital, Laboratory "Latvian Centre of Infectious Diseases", National Microbiology Reference Laboratory, Riga, Latvia
| | - Sergejs Nikisins
- Riga East Clinical University Hospital, Laboratory "Latvian Centre of Infectious Diseases", National Microbiology Reference Laboratory, Riga, Latvia
| | - Inga Azina
- Riga East Clinical University Hospital, hospital "Latvian Centre of Infectious Diseases", Riga, Latvia; Riga Stradins University, Department of Public Health and Epidemiology, Latvia
| | - Ludmila Ivancenko
- Riga East Clinical University Hospital, hospital "Latvian Centre of Infectious Diseases", Riga, Latvia
| | - Ieva Tolmane
- Riga East Clinical University Hospital, hospital "Latvian Centre of Infectious Diseases", Riga, Latvia; University of Latvia, Department of Medicine, Latvia
| | - Baiba Rozentale
- Riga East Clinical University Hospital, hospital "Latvian Centre of Infectious Diseases", Riga, Latvia; Riga Stradins University, Department of Public Health and Epidemiology, Latvia
| |
Collapse
|
2
|
Hofmeister MG, Asher A, Jones CM, Augustine RJ, Burkholder C, Collins J, Foster MA, McBee S, Thoroughman D, Thomasson ED, Weng MK, Spradling PR. Prevalence and Types of Drugs Used Among Hepatitis A Patients During Outbreaks Associated with Person-to-Person Transmission, Kentucky, Michigan, and West Virginia, 2016-2019. JOURNAL OF APPALACHIAN HEALTH 2022; 4:51-60. [PMID: 35769511 PMCID: PMC9200450 DOI: 10.13023/jah.0401.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background People who use drugs are at increased risk for hepatitis A virus infection. Since 1996, the Advisory Committee on Immunization Practices has recommended hepatitis A vaccination for people who use drugs. Since 2016, the U.S. has experienced widespread hepatitis A outbreaks associated with person-to-person transmission. Purpose To describe the prevalence of drug use, route of use, and drugs used among hepatitis A outbreak-associated patients. Methods State outbreak and medical records were reviewed to describe the prevalence, type, and route of drug use among a random sample of 812 adult outbreak-associated hepatitis A patients from Kentucky, Michigan, and West Virginia during 2016-2019. Differences in drug-use status were analyzed by demographic and risk-factor characteristics using the X 2 test. Results Among all patients, residents of Kentucky (55.6%), Michigan (51.1%), and West Virginia (60.1%) reported any drug use, respectively. Among patients that reported any drug use, methamphetamine was the most frequently reported drug used in Kentucky (42.3%) and West Virginia (42.1%); however, opioids were the most frequently reported drug used in Michigan (46.8%). Hepatitis A patients with documented drug use were more likely (p<0.05) to be experiencing homelessness/unstable housing, have been currently or recently incarcerated, and be aged 18-39 years compared to those patients without documented drug use. Implications Drug use was prevalent among person-to-person hepatitis A outbreak-associated patients, and more likely among younger patients and patients experiencing homelessness or incarceration. Increased hepatitis A vaccination coverage is critical to prevent similar outbreaks in the future.
Collapse
Affiliation(s)
| | | | | | | | | | - Jim Collins
- Michigan Department of Health and Human Services
| | | | - Shannon McBee
- West Virginia Department of Health and Human Resources
| | - Douglas Thoroughman
- Centers for Disease Control and Prevention,Kentucky Department for Public Health
| | | | | | | |
Collapse
|
3
|
White AE, Van Tubbergen C, Raymes B, Contreras AE, Scallan Walter EJ. Cannabis-Infused Edible Products in Colorado: Food Safety and Public Health Implications. Am J Public Health 2020; 110:790-795. [PMID: 32298168 PMCID: PMC7204451 DOI: 10.2105/ajph.2020.305601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/04/2022]
Abstract
Cannabis-infused "edibles" are a popular means of cannabis use, and the variety of edible food products available to consumers continues to grow. Although there has been much discussion on dose standardization, childproof packaging, and the prevention of overconsumption, the important topic of food safety has received less attention.We discuss potential food safety hazards associated with cannabis-infused edible food products, drawing on examples from Colorado, and describe edible-associated foodborne illness outbreaks and other contamination events.It is important for public health agencies, particularly environmental health and enteric disease programs, to be familiar with the cannabis industry, including regulatory partners, signs and symptoms of cannabis ingestion, the scope of edible products sold and consumed, and the food safety risks unique to cannabis products.
Collapse
Affiliation(s)
- Alice E White
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Christine Van Tubbergen
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Brianna Raymes
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Alexandra Elyse Contreras
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| | - Elaine J Scallan Walter
- Alice E. White, Christine Van Tubbergen, Brianna Raymes, and Elaine J. Scallan Walter are with the Department of Epidemiology, Colorado School of Public Health, Aurora. Alexandra Elyse Contreras is with the Marijuana Health Monitoring and Research Section, Colorado Department of Public Health and Environment, Denver
| |
Collapse
|
4
|
Stark MM. Infectious Diseases: The Role of the Healthcare Professional. CLINICAL FORENSIC MEDICINE 2020:343-392. [PMCID: PMC7122348 DOI: 10.1007/978-3-030-29462-5_10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
For the healthcare professional dealing with infections presents two main problems. First, managing detainees or police personnel who have contracted a disease and may be infectious or unwell, and second, handling complainants of assault, including police officers, who have potentially been exposed to an infectious disease. This chapter addresses some general principles of infection control and safety in the working environment and then goes on to discuss some infections that may be encountered in police custody and how they can best be managed.
Collapse
Affiliation(s)
- Margaret M. Stark
- Faculty of Forensic and Legal Medicine, Royal College of Physicians, London, UK
| |
Collapse
|
5
|
Ciccozzi M, Lai A, Zehender G, Borsetti A, Cella E, Ciotti M, Sagnelli E, Sagnelli C, Angeletti S. The phylogenetic approach for viral infectious disease evolution and epidemiology: An updating review. J Med Virol 2019; 91:1707-1724. [PMID: 31243773 DOI: 10.1002/jmv.25526] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/24/2019] [Indexed: 12/16/2022]
Abstract
In the last decade, the phylogenetic approach is recurrent in molecular evolutionary analysis. On 12 May, 2019, about 2 296 213 papers are found, but typing "phylogeny" or "epidemiology AND phylogeny" only 199 804 and 20 133 are retrieved, respectively. Molecular epidemiology in infectious diseases is widely used to define the source of infection as so as the ancestral relationships of individuals sampled from a population. Coalescent theory and phylogeographic analysis have had scientific application in several, recent pandemic events, and nosocomial outbreaks. Hepatitis viruses and immunodeficiency virus (human immunodeficiency virus) have been largely studied. Phylogenetic analysis has been recently applied on Polyomaviruses so as in the more recent outbreaks due to different arboviruses type as Zika and chikungunya viruses discovering the source of infection and the geographic spread. Data on sequences isolated by the microorganism are essential to apply the phylogenetic tools and research in the field of infectious disease phylodinamics is growing up. There is the need to apply molecular phylogenetic and evolutionary methods in areas out of infectious diseases, as translational genomics and personalized medicine. Lastly, the application of these tools in vaccine strategy so as in antibiotic and antiviral researchers are encouraged.
Collapse
Affiliation(s)
- Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Alessia Lai
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milan, Italy
| | - Gianguglielmo Zehender
- Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milan, Italy
| | - Alessandra Borsetti
- National HIV/AIDS Research Center, Istituto Superiore di Sanità, Roma, Italy
| | - Eleonora Cella
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marco Ciotti
- Laboratory of Molecular Virology, Polyclinic Tor Vergata Foundation, Rome, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| |
Collapse
|
6
|
Hepatitis A virus infection associated with cannabis use. Can Commun Dis Rep 2017; 43:245-246. [DOI: 10.14745/ccdr.v43i11a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
7
|
Ghosh T, Van Dyke M, Maffey A, Whitley E, Gillim-Ross L, Wolk L. The Public Health Framework of Legalized Marijuana in Colorado. Am J Public Health 2015; 106:21-7. [PMID: 26562117 DOI: 10.2105/ajph.2015.302875] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
On January 1, 2014, Colorado became the first state in the nation to sell legal recreational marijuana for adult use. As a result, Colorado has had to carefully examine potential population health and safety impacts as well as the role of public health in response to legalization. We have discussed an emerging public health framework for legalized recreational marijuana. We have outlined this framework according to the core public health functions of assessment, policy development, and assurance. In addition, we have discussed challenges to implementing this framework that other states considering legalization may face.
Collapse
Affiliation(s)
- Tista Ghosh
- All of the authors are with the Colorado Department of Public Health and Environment, Denver
| | - Mike Van Dyke
- All of the authors are with the Colorado Department of Public Health and Environment, Denver
| | - Ali Maffey
- All of the authors are with the Colorado Department of Public Health and Environment, Denver
| | - Elizabeth Whitley
- All of the authors are with the Colorado Department of Public Health and Environment, Denver
| | - Laura Gillim-Ross
- All of the authors are with the Colorado Department of Public Health and Environment, Denver
| | - Larry Wolk
- All of the authors are with the Colorado Department of Public Health and Environment, Denver
| |
Collapse
|
8
|
Stark MM. Infectious Diseases: The Role of the Forensic Physician. CLINICAL FORENSIC MEDICINE 2011. [PMCID: PMC7138432 DOI: 10.1007/978-1-61779-258-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Infections have plagued doctors for centuries, both in the diagnosis of the specific diseases, and the identification and subsequent management of the causative agents. There is a constant need for information as new organisms emerge, existing ones develop resistance to current drugs or vaccines and there are changes in epidemiology and prevalence. In the twenty-first century, obtaining this information has never been more important. Population migration, and the relatively low cost of flying, means that unfamiliar infectious diseases may be brought into industrialised countries. An example of this was an outbreak of severe acute respiratory syndrome (SARS), which was first recognised in 2003. Despite modern technology and a huge input of money, it took months for the agent to be identified, a diagnostic test to be produced, and a strategy for disease reporting and isolation to be established.
Collapse
|
9
|
Matheson K, Halperin B, McNeil S, Langley JM, Mackinnon-Cameron D, Halperin SA. Hepatitis A and travel amongst Nova Scotia postsecondary students: evidence for a targeted vs. universal immunization strategy. Vaccine 2010; 28:8105-11. [PMID: 20955828 DOI: 10.1016/j.vaccine.2010.09.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 09/29/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Canadian guidelines recommend hepatitis A virus (HAV) vaccination for high-risk persons, such as travelers to HAV-endemic areas. The US CDC advocates universal immunization. OBJECTIVES To explore whether a universal strategy for HAV immunization rather than the Canadian targeted approach for travelers is justified by measuring compliance of postsecondary students with Canadian guidelines. METHODS A cross-sectional study using an electronic survey method elicited HAV risk factors, immunization history, disease status, and factors affecting immunization status from postsecondary students. Seropositivity was determined by measuring HAV antibodies in saliva from a convenience sample of survey participants within each study group. Statistical analysis used Fisher's exact test and logistic regression. RESULTS We received 2279 completed surveys (10.6% response) and 235 saliva samples (58.7% response). A total of 1380 (60.6%) participants had traveled to HAV-endemic regions and 1851 (81.2%) were planning to do so within the next 5 years. Less than half who traveled to HAV-endemic areas reported a history of HAV vaccination (48.0%). HAV seropositivity rates were higher amongst those who traveled to (63.6%) or were planning to travel to (55.0%) HAV-endemic areas than those who had never traveled or had no plans to travel to such areas (17.4%). Only 8.9% of unvaccinated students were seropositive (5.3% of Canadian-born students). Amongst unvaccinated, seropositive students, there was a nonsignificant trend for higher seropositivity in those who had previously traveled to HAV-endemic areas (14.7%) than those who had not traveled abroad (4.4%), suggesting an exposure to HAV during travel. Nearly all (96.5%) unvaccinated students, who were willing to be vaccinated based on current knowledge or if their doctor recommended it, indicated a willingness to receive vaccine if it were provided free of charge. CONCLUSIONS Current Canadian guidelines for HAV vaccination are not being followed within the postsecondary student population. Given high rates of travel to HAV-endemic areas in this population, a universal approach to HAV vaccination may be warranted.
Collapse
|
10
|
Struve J, Käll K, Stendahl P, Scalia-Tomba G, Giesecke J, Weiland O. Prevalence of Hepatitis B Virus Markers among Intravenous Drug Abusers in Stockholm: Impact of Heterosexual Transmission. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/00365549309169663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
11
|
Embry D, Hankins M, Biglan A, Boles S. Behavioral and social correlates of methamphetamine use in a population-based sample of early and later adolescents. Addict Behav 2009; 34:343-51. [PMID: 19138821 PMCID: PMC2710245 DOI: 10.1016/j.addbeh.2008.11.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 10/04/2008] [Accepted: 11/14/2008] [Indexed: 11/28/2022]
Abstract
This paper reports relationships between methamphetamine use and behaviors and social influences using data from a population-based survey of 8th- and 11th-grade students in Oregon for the 2001-2003 school years. We analyze methamphetamine use within a general problem behavior framework to identify malleable correlates of behavior for future prevention interventions. We specifically test two models of methamphetamine use employing logistic regression analysis: one comprised of behaviors and traits of the individual students and another focusing on peer and parental influences. This study finds adolescent methamphetamine use related to several problem behaviors. However, the specific problems vary by grade and are moderated by gender. Findings indicate the need for tailored interventions targeting gender/grade-specific behaviors or problems such as antisocial activities, risky sex, and depression, as well as social influences such as peers engaging in antisocial behaviors or using drugs and parents favoring drug use or poorly monitoring or setting limits for their children.
Collapse
|
12
|
Abstract
When first introduced in 1992 the hepatitis A vaccine was recommended for individuals at high risk of exposure. This policy was not expected to have a significant impact on disease incidence at population level in view of the epidemiology of the hepatitis A virus (HAV). More recently two countries, Israel and Bahrain, and regions or subpopulations in others (Australia, China, Byelorussia, Italy, Spain, US) have embarked upon more ambitious vaccination programmes that aim to immunize whole birth cohorts. After a brief survey of the virology and epidemiology of HAV, the disease burden it inflicts and a short history of the development of HAV vaccines--both live (in China) and killed vaccines are available--he vaccination programmes introduced in the countries mentioned above are described. The results have been spectacular: disease incidence, not only in the vaccinated cohorts but also in the whole population, have plummeted within a few years of the start of mass vaccination. There is now convincing evidence that the vaccine confers herd immunity if the main spreaders of the virus are targeted for immunization. This finding should encourage other countries to start mass vaccination programmes against HAV, particularly as pharmacoeconomic studies are beginning to show that such a strategy could be a cost-effective way of controlling the disease. It is now even conceivable to eradicate HAV. In fact, this should be easier to achieve than polio eradication as HAV vaccines confer more durable immunity than polio vaccines. However, the global disease burden of HAV is generally thought not to be high enough to justify such an undertaking in the foreseeable future.
Collapse
|
13
|
Fisher DG, Reynolds GL, Jaffe A, Perez MJ. Hepatitis and human immunodeficiency virus co-infection among injection drug users in Los Angeles County, California. J Addict Dis 2007; 25:25-32. [PMID: 16785216 DOI: 10.1300/j069v25n02_04] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined the prevalence of hepatitis A (HAV), B (HBV), C (HCV), and Human Immunodeficiency Virus (HIV) co-infection among Injection Drug Users (IDUs) in Los Angeles County, California, and predictors of multiple infections in this population. Six hundred seventy-nine IDUs were recruited from October 2002 through June 2004. Participants completed questionnaires to elicit demographic, drug and sex risk information, and were tested for hepatitis A, B, C and HIV.A linear regression model predicting the total number of infections (0 to 4 possible) was constructed. Significant associations were found between HAV and HBV infection, HAV and HCV infection, and HBV and HCV infection. Predictors of total co-infections included age of first injection, lifetime years in jail, and Hispanic ethnicity. Latinos had the highest proportion of HAV and HBV co-infection with HCV. The total number of co-infections, especially those co-infected with all three of the hepatitis infections, was unexpectedly high.
Collapse
Affiliation(s)
- Dennis G Fisher
- Center for Behavioral Research and Services, California State University, Long Beach, CA 90813, USA.
| | | | | | | |
Collapse
|
14
|
Cabral GA. Drugs of abuse, immune modulation, and AIDS. J Neuroimmune Pharmacol 2006; 1:280-95. [PMID: 18040805 DOI: 10.1007/s11481-006-9023-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 05/16/2006] [Indexed: 11/29/2022]
Abstract
Illicit drugs such as amphetamines, cocaine, marijuana, and opiates alter immune function and decrease host resistance to microbes in vitro and in experimental animal models. Effects on the immune system may be mediated indirectly as a result of drug interactions in the central nervous system (CNS) or directly through activation of cognate receptors on various immune cell types. For marijuana and opioids, seven-transmembranal G protein-coupled receptors have been identified in the CNS and in the immune system that may play a functionally relevant role in immune modulation. There is accumulating evidence that sigma(1) receptors play a comparable role in cocaine-mediated alteration of immune responses. A mode by which these exogenously introduced substances affects immunity and host resistance may be by perturbing the balance of Th(1) proinflammatory versus Th(2) anti-inflammatory cytokines and lipid bioeffectors. However, while illicit drugs have been documented to alter immune functions in vitro and in animal models, there is a paucity of controlled longitudinal epidemiological studies that definitively correlate immunosuppressive effects with increased incidence of infections or immune disorders in humans, including infection with the human immunodeficiency virus (HIV) or disease progression to AIDS.
Collapse
Affiliation(s)
- Guy A Cabral
- Department of Microbiology and Immunology, Virginia Commonwealth University, School of Medicine, 1101 E. Marshall Street, Richmond, VA 23298-0678, USA.
| |
Collapse
|
15
|
Nainan OV, Xia G, Vaughan G, Margolis HS. Diagnosis of hepatitis a virus infection: a molecular approach. Clin Microbiol Rev 2006; 19:63-79. [PMID: 16418523 PMCID: PMC1360271 DOI: 10.1128/cmr.19.1.63-79.2006] [Citation(s) in RCA: 207] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Current serologic tests provide the foundation for diagnosis of hepatitis A and hepatitis A virus (HAV) infection. Recent advances in methods to identify and characterize nucleic acid markers of viral infections have provided the foundation for the field of molecular epidemiology and increased our knowledge of the molecular biology and epidemiology of HAV. Although HAV is primarily shed in feces, there is a strong viremic phase during infection which has allowed easy access to virus isolates and the use of molecular markers to determine their genetic relatedness. Molecular epidemiologic studies have provided new information on the types and extent of HAV infection and transmission in the United States. In addition, these new diagnostic methods have provided tools for the rapid detection of food-borne HAV transmission and identification of the potential source of the food contamination.
Collapse
Affiliation(s)
- Omana V Nainan
- Centers for Disease Control and Prevention, 1600 Clifton Road, N.E., Mailstop A33, Atlanta, GA 30333, USA.
| | | | | | | |
Collapse
|
16
|
Nainan OV, Xia G, Vaughan G, Margolis HS. Diagnosis of hepatitis a virus infection: a molecular approach. Clin Microbiol Rev 2006. [PMID: 16418523 DOI: 10.1128/cmr.19.1.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Current serologic tests provide the foundation for diagnosis of hepatitis A and hepatitis A virus (HAV) infection. Recent advances in methods to identify and characterize nucleic acid markers of viral infections have provided the foundation for the field of molecular epidemiology and increased our knowledge of the molecular biology and epidemiology of HAV. Although HAV is primarily shed in feces, there is a strong viremic phase during infection which has allowed easy access to virus isolates and the use of molecular markers to determine their genetic relatedness. Molecular epidemiologic studies have provided new information on the types and extent of HAV infection and transmission in the United States. In addition, these new diagnostic methods have provided tools for the rapid detection of food-borne HAV transmission and identification of the potential source of the food contamination.
Collapse
Affiliation(s)
- Omana V Nainan
- Centers for Disease Control and Prevention, 1600 Clifton Road, N.E., Mailstop A33, Atlanta, GA 30333, USA.
| | | | | | | |
Collapse
|
17
|
Abstract
Marijuana and other exogenous cannabinoids alter immune function and decrease host resistance to microbial infections in experimental animal models and in vitro. Two modes of action by which delta9-tetrahydrocannabinol (THC) and other cannabinoids affect immune responses have been proposed. First, cannabinoids may signal through the cannabinoid receptors CB1 and CB2. Second, at sites of direct exposure to high concentrations of cannabinoids, such as the lung, membrane perturbation may be involved. In addition, endogenous cannabinoids or endocannabinoids have been identified and have been proposed as native modulators of immune functions through cannabinoid receptors. Exogenously introduced cannabinoids may disturb this homoeostatic immune balance. A mode by which cannabinoids may affect immune responses and host resistance maybe by perturbing the balance of T helper (Th)1 pro-inflammatory versus Th2 anti-inflammatory cytokines. While marijuana and various cannabinoids have been documented to alter immune functions in vitro and in experimental animals, no controlled longitudinal epidemiological studies have yet definitively correlated immunosuppressive effects with increased incidence of infections or immune disorders in humans. However, cannabinoids by virtue of their immunomodulatory properties have the potential to serve as therapeutic agents for ablation of untoward immune responses.
Collapse
Affiliation(s)
- G A Cabral
- Department of Microbiology and Immunology, Virginia Commonwealth University, School of Medicine, 1101 E. Marshall St., Richmond, VA 23298-0678, USA.
| | | |
Collapse
|
18
|
Roberts RJ, Palmer SR. Exposure to school children as a risk factor in a community outbreak of hepatitis A in young adults: a case control study. Epidemiol Infect 2005; 134:803-7. [PMID: 16316491 PMCID: PMC2870453 DOI: 10.1017/s0950268805005625] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2005] [Indexed: 11/06/2022] Open
Abstract
To investigate risk factors during a community outbreak of hepatitis A we carried out a case- control study of 35 cases and 49 matched controls using an interviewer-administered questionnaire on clinical history, travel, household details including domestic toilet facilities, infectious contacts, and food history. Of 99 cases notified in the city during the outbreak year, 50 (51%) were young adults age 15-34 years. Hepatitis A infection was independently associated with household contact with a case (P=0.0005), and sharing a household with children in primary school (OR 3.4, 95% CI 1.2-9.5, P=0.008) with risk increasing with number of primary-school pupils in the household (chi(2) for linear trend 6.47, P=0.01). We concluded that in a population with a low prevalence of hepatitis A, adults who live in the same household as primary-school-age children are at increased risk of acquiring the infection during community outbreaks.
Collapse
Affiliation(s)
- R J Roberts
- National Public Health Service, Preswylfa, Mold, Flintshire, UK.
| | | |
Collapse
|
19
|
Rey D, Frick-Michot E, Partisani M, Hess-Kempf G, Cheneau C, Priester M, Bernard-Henry C, de Mautort E, Wendling MJ, Meyer P, Lang JM. Séroprévalence de l'hépatite A chez des patients infectés par le VIH. Med Mal Infect 2005; 35:402-6. [PMID: 16139462 DOI: 10.1016/j.medmal.2005.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2005] [Accepted: 05/24/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The authors had for aim to prospectively study the hepatitis A seroprevalence of an HIV-infected population, followed-up in an outpatient clinic (CISIH Strasbourg). DESIGN Blood tests were performed on all patients from September 2003 to March 2004 to screen for hepatitis A (total antibodies with Elisa). RESULTS The overall seroprevalence was 219/514 (56.6%), similar in male and female patients. It increased with age, especially in European patients (P = 0.003). The seroprevalence was lower in European subjects: 46.3% (while it reached 100% in sub-Saharan Africans), the prevalence was similar whatever the HIV risk group (46% in homosexual as well as in heterosexual patients, 44% in intravenous drug users). Hepatitis B or C co-infection did not increase the seroprevalence of hepatitis A. The hepatitis A seroprevalence was similar in various CD4 T cell count categories. CONCLUSIONS Our results stress the utility of hepatitis A serology in HIV-infected patients (more than 50% of European patients are non immune), and the importance of assessing hepatitis A vaccination.
Collapse
Affiliation(s)
- D Rey
- Centre d'information et de soins de l'immunodéficience humaine, clinique médicale A, hôpitaux universitaires, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Wise ME, Sorvillo F. Hepatitis A--related mortality in California, 1989-2000: analysis of multiple cause-coded death data. Am J Public Health 2005; 95:900-5. [PMID: 15855472 PMCID: PMC1449275 DOI: 10.2105/ajph.2003.035485] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We estimated the hepatitis A (HA) mortality rate in California, assessed demographic differences in HA-related mortality, and examined comorbidities listed on death certificates in order to provide information for health policy and planning related to HA vaccination. METHODS We identified HA-related deaths in California from 1989 to 2000 with multiple-cause-of-death files and calculated mortality rates and rate ratios. RESULTS We identified 402 HA-related deaths between 1989 and 2000; the annual age-adjusted HA-related mortality rate was 1.20 deaths per 1 million persons. Older individuals, men, Latinos, and American Indians/Alaska Natives had elevated mortality rates. Liver conditions and non-A viral hepatitis infections were more common among HA-related deaths than among all other deaths. CONCLUSIONS Current immunization practices should be reevaluated and the expansion of current vaccination guidelines for groups that have elevated HA-related mortality rates should be considered.
Collapse
Affiliation(s)
- Matthew E Wise
- Department of Epidemiology, UCLA School of Public Health, 90095-1772, USA.
| | | |
Collapse
|
21
|
Vong S, Fiore AE, Haight DO, Li J, Borgsmiller N, Kuhnert W, Pinero F, Boaz K, Badsgard T, Mancini C, Nainan OV, Wiersma S, Bell BP. Vaccination in the county jail as a strategy to reach high risk adults during a community-based hepatitis A outbreak among methamphetamine drug users. Vaccine 2005; 23:1021-8. [PMID: 15620475 DOI: 10.1016/j.vaccine.2004.07.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Revised: 07/19/2004] [Accepted: 07/26/2004] [Indexed: 01/13/2023]
Abstract
Illicit drug use (IDU) is an important risk factor for hepatitis A, but implementing vaccination programs among drug users is difficult. During January 2001-July 2002, 403 hepatitis A cases were reported in Polk County, Florida; 48% were drug users and of these, 80% were recently in jail. To assess the county jail as a potential vaccination venue, we interviewed 280 inmates and conducted a serologic survey during July--August 2002. Of these, 227 (81%) reported a past IDU history. Previous HAV infection was found in 33%. In communities with illicit drug users at risk for hepatitis A and who are frequently jailed, vaccination programs in jails could be an important component of a community-based strategy to control hepatitis A outbreaks among illicit drug users.
Collapse
Affiliation(s)
- Sirenda Vong
- Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop D-66, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Brunet A, Grabar S, Blanche P, Héripret-Fredouille L, Spiridon G, Calboreanu A, Rollot F, Launay O, Sicard D, Salmon-Céron D, Abad S. Prévalence et facteurs de risque de l'hépatite A au sein d'une population de patients infectés par le virus de l'immunodéficience humaine. Med Mal Infect 2005; 35:73-81. [PMID: 15780896 DOI: 10.1016/j.medmal.2004.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Accepted: 09/07/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND There are common risk factors between hepatitis A virus (HAV) and human immuno deficiency virus (HIV) infections. OBJECTIVES We tried to evaluate if HIV-infected patients could be at risk for HAV. More over, HAV could worsen prognosis of HIV infection and HAV vaccination was then to be considered. Thus we assessed the prevalence and risk factors of HAV infection in an HIV-infected population. PATIENTS AND METHODS Seroprevalence and risk factors for HAV were studied among 154 HIV-positive patients followed in a Parisian hospital (mean age: 42 years, male patients: 70.8%, female patients: 29.2%). They were screened for HAV antibodies and answered a questionnaire on risk factors for HAV and means of HIV contamination. RESULTS The global prevalence was 72.7% [IC95%: 65.7-79.7]. We excluded patients who were born in highly endemic areas where seroprevalence reached 60% [IC95%: 51.2-70]. The HAV seroprevalence was almost 100% in migrants from highly endemic countries and for those born before 1946. The multivariate analysis showed that risk factors were the geographic origin [OR=20.88; IC95%: 2.40-181], age [OR = 2.33; IC95%: 1.24-4.39], and hemophilia [OR = 13.78; IC95%: 1.34-141]. CONCLUSION Our results suggest that a screening test for HAV antibodies should be performed before vaccination, especially in HIV-infected patients born after 1946 or in non-endemic countries.
Collapse
Affiliation(s)
- A Brunet
- Service de médecine interne 2, hôpital Cochin-Saint-Vincent-de-Paul, université René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Syed NA, Hearing SD, Shaw IS, Probert CS, Brooklyn TN, Caul EO, Barry RE, Sarangi J. Outbreak of hepatitis A in the injecting drug user and homeless populations in Bristol: control by a targeted vaccination programme and possible parenteral transmission. Eur J Gastroenterol Hepatol 2003; 15:901-6. [PMID: 12867801 DOI: 10.1097/00042737-200308000-00011] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To study the use of hepatitis A virus (HAV) vaccination in controlling an outbreak of HAV in inner-city Bristol among injecting drug users (IDUs). To study whether hepatitis C virus (HCV) and hepatitis B virus (HBV) co-infection increases morbidity. DESIGN Community-based cohort study. SETTING Avon Health Authority area, UK. PARTICIPANTS All laboratory-confirmed cases of HAV infection notified in 2000. INTERVENTION Administration of a targeted vaccination, education and liaison programme. MAIN OUTCOME MEASURES Number of cases of HAV before and after introduction of HAV vaccination programme. Mortality and number of patients requiring hospital admission. Association of HCV and HBV co-infection with hospital admission. RESULTS Ninety cases of HAV were reported in the first 6 months of 2000, of whom a substantial number were IDUs and/or inner-city hostel residents. In the second 6 months of 2000, following the introduction of a vaccination programme among homeless people, hostel residents, and IDUs, the number of HAV cases fell to 33. Sixteen patients had evidence of HCV co-infection. No patient had chronic HBV infection. Two patients died as a result of HAV, and two subsequently died from drug misuse. Fifty-six per cent of HCV-co-infected patients required admission to hospital compared with 28% non-HCV-co-infected patients. CONCLUSIONS This is the first reported successful use of vaccination to control an outbreak of HAV in a population of IDUs and to prevent transmission to the wider population. HCV co-infection appears to increase the severity of HAV illness, as demonstrated by increased incidence of hospital admission.
Collapse
Affiliation(s)
- Naveed A Syed
- Department of Public Health, Avon Health Authority, Bristol, UK.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Ochnio JJ, Patrick D, Ho M, Talling DN, Dobson SR. Past infection with hepatitis A virus among Vancouver street youth, injection drug users and men who have sex with men: implications for vaccination programs. CMAJ 2001; 165:293-7. [PMID: 11517645 PMCID: PMC81329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND In Canada, inactivated hepatitis A vaccines are targeted selectively at those at increased risk for infection or its complications. In order to evaluate the need for routine hepatitis A vaccination programs in Vancouver for street youth, injection drug users (IDUs) and men who have sex with men (MSM), we determined the prevalence of antibodies against hepatitis A virus (HAV) and risk factors for HAV in these groups. METHODS The frequency of past HAV infection was measured in a sample of Vancouver street youth, IDUs and MSM attending outreach and STD clinics and needle exchange facilities by testing their saliva for anti-HAV immunoglobulin G. A self-administered, structured questionnaire was used to gather sociodemographic data. Stepwise logistic regression was used to evaluate the association between presumed risk factors and groups and past HAV infection. RESULTS Of 494 study participants, 235 self-reported injection drug use, 51 were self-identified as MSM and 111 met street youth criteria. Positive test results for anti-HAV were found in 6.3% of street youth (95% confidence interval [CI] 2.6%-12.6%), 42.6% (95% CI 36.2%-48.9%) of IDUs and 14.7% (95% CI 10.4%-19.1%) of individuals who denied injection drug use. Among men who denied injection drug use, the prevalence was 26.3% (10/38) for MSM and 12% (21/175) for heterosexuals. Logistic regression showed that past HAV infection was associated with increased age and birth in a country with high rates of hepatitis infection. Injection drug use among young adults (25-34 years old) was a significant risk factor for a positive anti-HAV test (p = 0.009). MSM were also at higher risk for past HAV infection, although this association was nominally significant (p = 0.07). INTERPRETATION Low rates of past HAV infection among Vancouver street youth indicate a low rate of virus circulation in this population, which is vulnerable to hepatitis A outbreaks. An increased risk for HAV infection in IDUs and MSM supports the need to develop routine vaccination programs for these groups also.
Collapse
Affiliation(s)
- J J Ochnio
- Vaccine Evaluation Center, British Columbia's Children's Hospital and University of British Columbia.
| | | | | | | | | |
Collapse
|
25
|
Abstract
This paper examines barriers to health care utilization and the correlates associated with these barriers. As part of a larger study of health services utilization, the study sample of 1085 including injection drug users, other chronic users of heroin or cocaine, and a demographically similar group who had used neither heroin nor cocaine, was selected based on the criterion of not having received health care for at least one health problem within the previous 12 months. Both categories of chronic drug users were more likely than non-users not to want health care treatment and to put off seeking needed health care.
Collapse
Affiliation(s)
- C B McCoy
- Health Services Research Center, University of Miami School of Medicine, Florida, USA.
| | | | | | | |
Collapse
|
26
|
Staes CJ, Schlenker TL, Risk I, Cannon KG, Harris H, Pavia AT, Shapiro CN, Bell BP. Sources of infection among persons with acute hepatitis A and no identified risk factors during a sustained community-wide outbreak. Pediatrics 2000; 106:E54. [PMID: 11015549 DOI: 10.1542/peds.106.4.e54] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Hepatitis A is a common vaccine-preventable disease in the United States. Most cases occur during community-wide outbreaks, which can be difficult to control. Many case-patients have no identified source. OBJECTIVE To identify foodborne and household sources of hepatitis A during a community-wide outbreak. DESIGN Serologic and descriptive survey. SETTING Salt Lake County, Utah. PARTICIPANTS A total of 355 household contacts of 170 persons reported with hepatitis A during May 1996 to December 1996, who had no identified source of infection; and 730 food handlers working in establishments where case-patients had eaten. MAIN OUTCOME MEASURE Prevalence of immunoglobulin M antibodies to hepatitis A virus (IgM anti-HAV) among household and food service contacts. RESULTS Overall, 70 household contacts (20%) were IgM anti-HAV-positive, including 52% of children 3 to 5 years old and 30% of children <3 years old. In multivariate analysis, the presence of a child <3 years old (odds ratio [OR]: 8.8; 95% confidence limit [CL]: 2.1,36) and a delay of >/=14 days between illness onset and reporting (OR: 7. 9; 95% CL: 1.7,38) were associated with household transmission. Of 18 clusters of infections linked by transmission between households, 13 (72%) involved unrecognized infection among children <6 years old. No food handlers were IgM anti-HAV-positive. CONCLUSION During a community-wide outbreak, HAV infection among children was common, was frequently unrecognized, and may have been an important source of transmission within and between households. Transmission from commercial food establishments was uncommon. Ongoing vaccination of children may prevent future outbreaks.
Collapse
Affiliation(s)
- C J Staes
- Salt Lake City-County Health Department, Salt Lake City, Utah, USA.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Hutin YJ, Sabin KM, Hutwagner LC, Schaben L, Shipp GM, Lord DM, Conner JS, Quinlisk MP, Shapiro CN, Bell BP. Multiple modes of hepatitis A virus transmission among methamphetamine users. Am J Epidemiol 2000; 152:186-92. [PMID: 10909956 DOI: 10.1093/aje/152.2.186] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Methamphetamine users are at increased risk of hepatitis A, but modes of transmission are unclear. The authors conducted a case-control study among methamphetamine users during an outbreak in Iowa in 1997. Twenty-eight reported, laboratory-confirmed, hepatitis A cases did not differ from 18 susceptible controls with respect to age, sex, or number of doses used. When compared with controls in multivariate analysis, case-patients were more likely to have injected methamphetamine (odds ratio (OR) = 5.5, 95% confidence interval (CI): 1.1, 27), to have used methamphetamine with another case-patient (OR = 6.2, 95% CI: 0.95, 41), and to have used brown methamphetamine (OR = 5.5, 95% CI: 0.51, 59). Receptive needle sharing was reported by 10 of the 20 case-patients who injected. Methamphetamine use with another case-patient was also associated with hepatitis A in an analysis restricted to noninjectors (OR = 17, 95% CI: 1.0, 630). During this outbreak, hepatitis A may have been transmitted from person to person among methamphetamine users through the fecal-oral and the percutaneous routes. Methamphetamine users should be vaccinated against hepatitis A and should be given immune globulin if they used methamphetamine with a case-patient in the last 2 weeks. Persons who intend to continue using methamphetamine should be advised about safer practices.
Collapse
Affiliation(s)
- Y J Hutin
- Hepatitis Branch, Division of Viral and Rickettsial Disease, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
French MT, McGeary KA, Chitwood DD, McCoy CB. Chronic illicit drug use, health services utilization and the cost of medical care. Soc Sci Med 2000; 50:1703-13. [PMID: 10798326 DOI: 10.1016/s0277-9536(99)00411-6] [Citation(s) in RCA: 153] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Few studies have examined the relationships between drug use, health services utilization and the cost of medical care for a community-based sample of drug users. The purpose of this study was to analyze recently collected data on chronic drug users (CDUs), CDUs who were also injecting drug users (IDUs) and non-drug users (NDUs) to determine whether these groups exhibited differences in health services utilization and cost. In addition to descriptive analyses, these relationships were estimated with multivariate regression models. Data were collected in 1996 and 1997 through a standardized self-reported questionnaire administered to individuals who were recruited through community outreach activities in the USA. Annual differences in health services utilization between CDUs, IDUs and NDUs were estimated for three measures: number of times admitted to a hospital, number of outpatient visits and number of emergency room episodes. Results of this study indicate that CDUs and IDUs consumed significantly more inpatient and emergency care, but less outpatient services relative to NDUs. Analyses of total health care costs showed that CDUs and IDUs each generated about $1000 in excess services utilization per individual relative to NDUs. This research is the first study to compare differences in health services utilization and cost among out-of-treatment drug users relative to a matched group of non-users in a community-based setting. The findings suggest that health care providers and managed care organizations should consider policies that promote more ambulatory care and discourage emergency room and inpatient care among drug users. Innovative and culturally acceptable approaches may be necessary to provide incentives without posing unusual financial hardship.
Collapse
Affiliation(s)
- M T French
- Department of Epidemiology and Public Health, University of Miami School of Medicine, FL 33136, USA.
| | | | | | | |
Collapse
|
29
|
Salleras Sanmartí L, Buti Ferret M, Domínguez García A, Navas Alcalá E, Batalla Clavell J, Plans Rubió P, Garrido Morales P, Taberner Zaragozá J, Bruguera Cortada M, Vidal Tort J, Esteban Mur R. Hepatitis A vaccination policy in Catalonia (Spain). ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s1576-9887(00)70186-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
30
|
Shaw DD, Whiteman DC, Merritt AD, el-Saadi DM, Stafford RJ, Heel K, Smith GA. Hepatitis A outbreaks among illicit drug users and their contacts in Queensland, 1997. Med J Aust 1999; 170:584-7. [PMID: 10416427 DOI: 10.5694/j.1326-5377.1999.tb127904.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe five outbreaks of hepatitis A virus (HAV) infection associated with illicit drug use during a statewide outbreak of HAV infection in Queensland. DESIGN Risk factor prevalence survey. PATIENTS AND SETTING All 875 cases of HAV infection notified to Public Health Units in Queensland in the 12 months to 30 November 1997. MAIN OUTCOME MEASURE Type and prevalence of illicit drug use. RESULTS Risk factor assessment was completed for 804 cases (91.9%). We identified five outbreaks of HAV infection linked to illicit drug use. These outbreaks accounted for 24.6% (215/875) of all notified cases and 39% (190/482) of notified cases in the 15-34 years age group. The main type of illicit drug use in four of the five outbreaks was injecting drug use (74%; 118/160), while in the other outbreak it was sharing of smoking implements for marijuana (38%; 21/55). CONCLUSION Illicit drug use may be an under-recognised risk factor for HAV infection, particularly in young people. Faecal-oral transmission through poor personal hygiene, including sharing of implements for smoking marijuana, is the most probable route of transmission in these drug-linked outbreaks. The role of contaminated drug and needle-sharing remains to be clarified.
Collapse
Affiliation(s)
- D D Shaw
- Darling Downs Public Health Unit, Toowoomba, QLD.
| | | | | | | | | | | | | |
Collapse
|
31
|
Hutin YJ, Bell BP, Marshall KL, Schaben CP, Dart M, Quinlisk MP, Shapiro CN. Identifying target groups for a potential vaccination program during a hepatitis A communitywide outbreak. Am J Public Health 1999; 89:918-21. [PMID: 10358687 PMCID: PMC1508638 DOI: 10.2105/ajph.89.6.918] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study sought to identify groups for targeted vaccination during a communitywide hepatitis A outbreak in 1996. METHODS Residents of the Sioux City, Iowa, metropolitan area reported with hepatitis A between September 1995 and August 1996 were sampled and compared with population-based controls. RESULTS In comparison with 51 controls, the 40 case patients were more likely to inject methamphetamine, to attend emergency rooms more often than other health care facilities, and to have a family member who used the Special Supplemental Nutrition Program for Women, Infants, and Children. CONCLUSIONS Groups at increased risk of hepatitis A can be identified that might be [corrected] accessed for vaccination during communitywide outbreaks.
Collapse
Affiliation(s)
- Y J Hutin
- Hepatitis Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
The hepatitis A virus is usually transmitted person-to-person due to fecal-oral exchange of virus. Approximately 30,000 infections are reported each year in the United States, with the actual incidence being much greater. Prophylaxis with immune globulin has had a minimal impact on the overall incidence of hepatitis A. The recent availability and proven efficacy of a hepatitis A vaccine offers the hope that the incidence of infection may be substantially reduced. Pre- and postexposure prophylaxis should be targeted to individuals at increased risk of either acquiring infection, transmitting infection, or developing fulminant hepatitis, or to help control epidemics. This article reviews the current literature and discusses recommendations for pre- and postexposure prophylaxis against hepatitis A virus.
Collapse
Affiliation(s)
- M J Levy
- Division of Gastroenterology, University of South Alabama College of Medicine, Mobile 36617, USA
| | | | | |
Collapse
|
33
|
Healey A, Knapp M, Astin J, Gossop M, Marsden J, Stewart D, Lehmann P, Godfrey C. Economic burden of drug dependency. Social costs incurred by drug users at intake to the National Treatment Outcome Research Study. Br J Psychiatry 1998; 173:160-5. [PMID: 9850229 DOI: 10.1192/bjp.173.2.160] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of illegal drugs is seen as a major social problem. The social costs can be high. METHODS Self-report data from interviews at intake to the National Treatment Outcome Research Study (NTORS) for 1075 drug users and cost data from various sources were used to estimate criminal behaviour and health and addiction service costs for a 12-month period. Multivariate statistical analysis was used to analyse cost variations. RESULTS Total costs for one year for the drug users amounted to over 12 million Pounds, the majority attributable to self-reported criminal behaviour. Social costs were positively related to a variety of factors including instability in living circumstances, amount of heroin used and whether or not drugs were taken intravenously. CONCLUSIONS The study clearly demonstrates the economic and social burden associated with heavy drug users and highlights the need for further investigations into the costs and benefits of policies that can reduce these social costs.
Collapse
Affiliation(s)
- A Healey
- Centre for the Economics of Mental Health, Institute of Psychiatry, London
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Contoreggi C, Rexroad VE, Lange WR. Current management of infectious complications in the injecting drug user. J Subst Abuse Treat 1998; 15:95-106. [PMID: 9561947 DOI: 10.1016/s0740-5472(97)00048-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The diagnosis and management of infectious complications associated with injection drug use (IDU) are among some of the more challenging aspects of working with substance abusing populations. As the population of injection drug users age, we expect the number and severity of these complications to increase. Commonly seen infections, such as bacterial endocarditis and bacterial infections of bones, joints, and soft tissue, are now frequently complicated by concurrent immunodeficiency. Parenterally and sexually transmitted viral hepatitis is responsible for significant IDU morbidity and mortality. The human leukemia/lymphoma virus types I and II are increasing in prevalence in the IDU with uncertain long-term clinical effects. Immune dysfunction has been described in the IDU for decades, but the impact of host immune compromise on the transmission and the course of HIV-1 has yet to be fully appreciated. The integration of the treatment of substance abuse and its concurrent psychiatric disorders with the management of infectious complications, including immunodeficiency, promises to improve patient compliance with possible savings of overall medical costs.
Collapse
Affiliation(s)
- C Contoreggi
- Division of Intramural Research, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA.
| | | | | |
Collapse
|
35
|
|
36
|
Leino T, Leinikki P, Hyypiä T, Ristola M, Suni J, Sutinen J, Holopainen A, Haikala O, Valle M, Rostila T. Hepatitis A outbreak amongst intravenous amphetamine abusers in Finland. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1997; 29:213-6. [PMID: 9255876 DOI: 10.3109/00365549709019029] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This article describes a widespread outbreak of hepatitis A virus (HAV) infection amongst drug abusers in Finland. Although attempts to demonstrate the virus in amphetamines failed, the infection was assumed to be linked to intravenous use of the drug. The unusual mode of transmission prompted us to analyse possible atypical clinical features as well as the spread of the virus to the general population, nowadays practically without protective immunity. Serologically verified cases that occurred in Helsinki were interviewed, their hospital records were analysed and their contacts were serology tested. Amphetamine lots, as well as faecal samples from patients, were examined with RT-PCR. Detailed information was obtained from 238 subjects, among whom 131 admitted drug abuse and 67 cases were classified as secondary cases. Phylogenetic analysis of virus strains from HAV-infected cases suggested a common origin, and epidemiological observations linked it with particular lots of amphetamine. Three cases died, and 3 presented with severe clinical disease. Icterus was more common among i.v. drug abusers than others. Infection with hepatitis A virus was probably related to the faecal contamination of amphetamine associated with the transportation of the drugs in the gastrointestinal tract.
Collapse
Affiliation(s)
- T Leino
- Aurora Hospital, Helsinki, Finland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
French MT, Mauskopf JA, Teague JL, Roland EJ. Estimating the dollar value of health outcomes from drug-abuse interventions. Med Care 1996; 34:890-910. [PMID: 8792779 DOI: 10.1097/00005650-199609000-00003] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES People who abuse drugs suffer from a host of medical problems that impose costs on both the abusers and society as a whole. Drug-abuse treatment and other interventions can help alleviate these medical problems, leading to health status improvements for chronic drug users and reduced social costs. The authors' dual purpose here is to (1) propose a theoretically rigorous yet easy-to-apply methodology for estimating the health-related costs of drug abuse and (2) demonstrate the methodology by estimating the potential dollar value of avoiding adverse health consequences as a result of successful drug-abuse interventions. METHODS The authors' proposed multiattribute quality-adjusted life year methodology for estimating the value of avoiding morbidity and mortality involves eight steps to be followed sequentially. The framework is based on developing a common unit of well-being (i.e., quality-adjusted life year) that can be applied to all types of health conditions. If all health states can be denominated in this common unit, then the process of valuation is straightforward and consistent across all types of illnesses and diseases. The methodology is relatively inexpensive to execute because the estimation procedures are not complicated technically and the data demands are modest. Also, this approach incorporates elements from several disciplines, including psychology, epidemiology, medicine, and economics. Finally, the proposed methodology is flexible enough to cover a wide range of illnesses and diseases so that consistent and comparable estimates can be generated. RESULTS The authors estimate the dollar value of avoiding acute hepatitis B, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hypertension, bacterial pneumonia, sexually transmitted diseases, and tuberculosis for a white male aged 32 years. The authors' results illustrate that estimated avoided morbidity values can vary significantly across the range of health consequences associated with drug abuse. At the upper end of the range, the value of avoiding only the morbidity associated with a single case of HIV/AIDS is approximately $157,811 for the period beginning with transmission of HIV, through late-stage HIV and AIDS, and ending just before death. CONCLUSIONS People who abuse drugs suffer from many medical problems in addition to their addiction. The proposed approach for estimating the dollar value of avoiding adverse health consequences provides policy analysts, evaluators, and researchers a method to calculate theoretically based benefit estimates for use in a benefit-cost analysis of drug-abuse interventions.
Collapse
Affiliation(s)
- M T French
- School of Medicine, University of Miami, FL 33136, USA
| | | | | | | |
Collapse
|
38
|
|
39
|
Affiliation(s)
- A Panà
- Dipartimento di Sanità Pubblica, Università degli Studi di Roma Tor Vergata, Italy
| | | |
Collapse
|
40
|
|
41
|
Harkess JR. Dr. Harkess Responds. Am J Public Health 1989. [DOI: 10.2105/ajph.79.11.1571-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
42
|
|