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

Authors

Megan G. Hofmeister, Division of Viral Hepatitis, Centers for Disease Control and PreventionFollow
Alice Asher, Division of Viral Hepatitis, Centers for Disease Control and PreventionFollow
Christopher M. Jones, National Center for Injury Prevention and Control, Centers for Disease Control and PreventionFollow
Ryan J. Augustine, Division of Viral Hepatitis, Centers for Disease Control and PreventionFollow
Cole Burkholder, Division of Communicable Diseases, Michigan Department of Health and Human ServicesFollow
Jim Collins, Division of Communicable Diseases, Michigan Department of Health and Human ServicesFollow
Monique A. Foster, Division of Viral Hepatitis, Centers for Disease Control and PreventionFollow
Shannon McBee, Bureau for Public Health, West Virginia Department of Health and Human ResourcesFollow
Erica D. Thomasson, Bureau for Public Health, West Virginia Department of Health and Human ResourcesFollow
Doug Thoroughman, CDC/KY DPHFollow
Mark K. Weng, Division of Viral Hepatitis, Centers for Disease Control and PreventionFollow
Philip R. Spradling, Division of Viral Hepatitis, Centers for Disease Control and PreventionFollow

Corresponding Author

Megan G. Hofmeister

lxn7@cdc.gov

Author Affiliations

Author Names: Megan G. Hofmeister, MD, MS, MPH;¹ Alice Asher, PhD;¹ Christopher M. Jones, PharmD, DrPH, MPH;² Ryan J. Augustine, MPH;¹ Cole Burkholder, MPH;³ Jim Collins, RS, MPH;³ Monique A. Foster, MD, MPH;¹ Shannon McBee, MPH;⁴ Erica D. Thomasson, PhD, MPH;^4,5 Douglas Thoroughman, PhD, MS;^5,6 Mark K. Weng, MD, MSc;¹ Philip R. Spradling, MD¹

¹Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA; ²National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; ³Division of Communicable Diseases, Michigan Department of Health and Human Services, Lansing, MI, USA; ⁴Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV, USA; ⁵Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, GA, USA; ⁶Kentucky Department for Public Health, Frankfort, KY, USA

Author Area of Expertise

hepatitis A; viral hepatitis; outbreak investigation

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 χ2 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.

DOI

https://doi.org/10.13023/jah.0401.06

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Hofmeister MG, Asher A, Jones CM, et al. 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. J Appalach Health 2022;4(1):51–60. DOI: https://doi.org/10.13023/jah.0401.06.