Corresponding Author

Megan G. Hofmeister


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


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.



Creative Commons License

Creative Commons Attribution 4.0 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.