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American Journal of Epidemiology Vol. 152, No. 2 : 186-192
Copyright © 2000 by The Johns Hopkins University School of Hygiene and Public Health

ORIGINAL CONTRIBUTIONS

Multiple Modes of Hepatitis A Virus Transmission among Methamphetamine Users

Yvan J. F. Hutin1, Keith M. Sabin1, Lori C. Hutwagner2, Laura Schaben3, Ginger M. Shipp4, Destria M. Lord5, Julius S. Conner4, M. Patricia Quinlisk3, Craig N. Shapiro1 and Beth P. Bell1

1 Hepatitis Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
2 Statistics and Epidemiology Branch, Division of Prevention Research and Analytic Methods, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA.
3 Iowa Department of Public Health, Des Moines, IA.
4 Polk County Department of Public Health, Des Moines, IA.
5 Wapello County Department of Public Health, Ottumwa, IA.

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.

case-control studies; disease outbreaks; epidemiologic methods; equipment contamination; hepatitis A; methamphetamine; substance abuse, intravenous

Abbreviations: CDC, Centers for Disease Control and Prevention; CI, confidence interval; OR, odds ratio


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