Let It "B"? The role of Hepatitis B universal vaccination among italian problematic drug users

COVID-19 vaccination and drug users: Past, present, and future

Vaccination against COVID-19 is crucial in the attempt of containing the virus’ spread, but facing a viral pathogen with such a high prevalence means that vaccination strategies are facing an unprecedented situation. People that use illicit drugs may have elevated risk of adverse outcomes from COVID-19 given their high prevalence of underlying medical conditions, including respiratory and pulmonary disease, chronic liver disease, cardiovascular and cerebrovascular conditions, diabetes, and compromised immune systems. Despite a widespread distribution on the Italian territory, a large presence of health personnel and a long-standing experience in vaccinations, addiction clinics have yet to be involved in the vaccination campaign against COVID-19. The aim of this study was to investigate the beliefs of drug users attending some Italian addiction clinics, in order to envisage any vaccine administration strategies involving the services themselves. A questionnaire used for the Italian general population to investigate the relative importance of some factors in influencing the propensity to vaccinate against COVID-19, was administrated to drug users in a multicenter survey. The majority of respondents expressed general confidence in vaccines and a good willingness to undergo vaccination. Given strong peer networks, high coverage of treatment and harm reduction interventions, Italian public addiction clinics could play a strategic role in administering the vaccine in this hard-to-reach population, usefully aiding the global campaign against the virus.

Association between universal hepatitis B prison vaccination, vaccine uptake and hepatitis B infection among people who inject drugs

BACKGROUND AND AIMS

In Scotland, hepatitis B virus (HBV) vaccination for all prisoners was introduced in 1999; here, we examine the impact of this programme among people who inject drugs (PWID) in the community. This study aimed to compare rates of HBV vaccine uptake before and after implementation of the prison programme and to estimate the determinants of vaccine uptake, the levels of ever/current HBV infection and the associations between vaccine uptake and ever/current HBV infection.

DESIGN

Data collected via serial cross-sectional surveys were used to compare the proportion who reported being vaccinated over time. For the 2013-14 survey, rates of ever/current HBV infection were calculated and the associations between vaccine uptake and ever/current HBV infection were examined using logistic regression.

SETTING

Services providing injecting equipment and drug treatment and street sites in Glasgow (1993-2002) and throughout Scotland (2008-14).

PARTICIPANTS

More than 10 000 PWID in total were recruited in the surveys.

MEASUREMENTS

Participants completed a questionnaire (all years) to ascertain self-reported vaccine uptake and provided a blood spot (in 2013-14), tested for HBV core antibodies (anti-HBc) and surface antigen (HBsAg).

FINDINGS

Among recent-onset PWID in Glasgow, vaccine uptake increased from 16% in 1993 to 59% in 2008-14 (P < 0.001). Among all PWID in Scotland, uptake increased further from 71% in 2008-09 to 77% in 2013-14 (P < 0.001) and was associated with incarceration [adjusted odds ratio (aOR) = 2.91, 95% confidence interval (CI) = 2.23-3.79]. The prevalence of anti-HBc and HBsAg in Scotland was 2.6 and 0.3%, respectively, among PWID who had commenced injecting in the decade since the programme's introduction. Vaccination was associated with reduced odds of ever (aOR = 0.60, CI = 0.37-0.97) and current (aOR = 0.40, CI = 0.16-0.97) HBV infection.

CONCLUSIONS

In Scotland, uptake of hepatitis B virus (HBV) vaccination among people who inject drugs (PWID) in the community has increased since the 1999 introduction of universal prison vaccination, and current levels of HBV infection among PWID are low compared with other European countries.

Risk and blood-borne virus testing among men who inject image and performance enhancing drugs, Sydney, Australia

INTRODUCTION AND AIMS

Needle and syringe program (NSP) workers have highlighted that people who inject image and performance enhancing drugs (IPED) in Australia are a younger and more culturally and linguistically diverse (CALD) group compared with other groups who inject drugs. Previous research has found riskier injecting practices and faster Hepatitis C acquisition rates among people who are new to injecting drugs and self-identify with CALD backgrounds, compared with their Anglo-Australian counterparts. Given recent indications of increasing IPED prevalence in Australia and elsewhere, this study sought to update knowledge of infection risk among a large group of IPED injectors, as well as explore sub-group differences.

DESIGN AND METHODS

A cross-sectional survey of men who inject IPEDs was conducted from September 2014 to January 2015 at nine NSP sites, across five local health districts in Sydney, Australia.

RESULTS

Six hundred and five people participated. Small proportions reported previous 12month needle or syringe sharing (2.3%), sharing vials (4.6%), injecting psychostimulants (5.1%) or personal needle or syringe reuse (5.2%). Participants from CALD backgrounds were more likely to report sharing needles or syringes (P = 0.004), and participants from Middle Eastern and North African backgrounds were less likely to have ever been tested for blood-borne viruses, compared with Anglo-Australian participants (P = 0.04).

DISCUSSION AND CONCLUSIONS

The findings show that some groups who inject IPEDs may be more vulnerable to blood-borne virus transmission and/or less likely to know their blood-borne virus status. From design to delivery, IPED harm minimisation strategies should pay attention to the needs of CALD groups.

Hepatitis B virus in drug users in France: prevalence and vaccination history, ANRS-Coquelicot Survey 2011-2013

People who use drugs (PWUD) are a key population for hepatitis B virus (HBV) vaccination and screening. We aimed to estimate the seroprevalence of HBs antigen (HBsAg) and self-reported HBV vaccination history in French PWUD attending harm reduction centres using data from the ANRS-Coquelicot multicentre survey conducted in 2011-2013 in 1718 PWUD. Self-fingerprick blood samples were collected on dried blood spots to detect the presence of HBsAg. HBsAg seroprevalence was estimated at 1·4% [95% confidence interval (CI) 0·8-2·5]. It varied between PWUD born in high (7·6%, 95% CI 2·7-19·1), moderate (2·2%, 95% CI 0·8-5·7) and low (0·7%, 95% CI 0·3-1·5) endemic zones. Factors independently associated with HBsAg carriage were being born in a moderate or high endemic zone or reporting precarious housing. Self-reported HBV vaccination history varied from 47·4% in high endemic zones, to 59·3% and 62·6% for moderate and low endemic zones, respectively. Our results suggest that drug use plays a small and substantial role, respectively, in HBsAg carriage in PWUD born in high/moderate and low endemic zones.