Hygiene and uncertainty in qualitative accounts of hepatitis C transmission among drug injectors in Serbia

Hepatitis C virus (HCV) infection is a significant cause of mortality and morbidity related to injecting drug use. In Serbia, recent estimates suggest that approximately a third of drug injectors are hepatitis C positive. We undertook the first qualitative study of drug injecting in Serbia with a focus on exploring drug injectors' accounts of hepatitis C risk. Drawing upon 67 qualitative interviews with drug injectors in Belgrade, we explore accounts of hepatitis C risk and its transmission. We find that accounts portray a social context of pervasive risk in relation to hepatitis C. Hepatitis C is characterised as ubiquitous among drug injectors, and as a hardy virus with immense transmission potential. Narratives of hygiene emerge as core to accounts of transmission, in which the virus is linked to dirt, including dirty environments, dirty drugs and dirty injecting equipment. These hygiene narratives not only have symbolic function but also appear to stem from ambiguities in accounts wherein hepatitis C is conflated with the signs, symptoms and transmission routes of hepatitis A. In addition, accounts portrayed hepatitis C risk management as a responsibility of individuals in the absence of secure trust or certainty in knowledge about risk, including in relation to others' disclosed antibody status. Hygiene narratives are a core and symbolic feature of injectors' accounts of hepatitis C transmission. There is an urgent need for health promotion fostering hepatitis C risk awareness and risk avoidance among drug injectors in Serbia.     

Prisoners are at risk for hepatitis C transmission

Objective: Determine the incidence of hepatitis C virus antibodies among a cohort of prisoners. Design: Follow-up study of a random sample of prisoners who participated in a cross-sectional survey in 1996. Setting: 29 correctional centres in New South Wales (Australia). Participants: 181 adult prisoners (163 men and 18 women). Results: The incidence of hepatitis C virus antibody among the 90 inmates who were seronegative at the first test in 1996 was 7.1 per 100 person-years (16 seroconverters). Among the 90 inmates, 37 had re-entered the prison system following release into the community and 53 had been continuously detained. The seroconversion rate was higher among the re-entrants compared with those who had been continuously incarcerated (10.8 vs. 4.5 per 100 person-years, p=0.07). However, when the data was stratified by injecting status, the seroconversion rate in the two groups was similar. Most of the seroconverters had histories of injecting drug users (14/16). The overall incidence among injectors was 19.3 per 100 person years (95% CI: 9.1–29.2). Conclusions: Hepatitis C transmission occurs inside the prison with injecting drug use the likely cause. Among non-injectors, tattooing was the most likely mode of transmission. Harm minimisation measures with proven effectiveness need to be considered for this environment.     

Seroprevalence of HIV, HCV and syphilis in Brazilian prisoners: Preponderance of parenteral transmission

Between November 1993 and April 1994, our physicians' team interviewed and took blood samples of 631 prisoners randomly drawn from the largest prison of South America, which counted about 4700 inmates at that time. The interview consisted of questions related to risk behaviour for HIV infection, and the subjects were asked to provide blood for serological tests for HIV, hepatitis C and syphilis. Our main purpose was to investigate the relationship between HCV and injecting drug use as related to HIV seropositivity. Participation in the study was voluntary and confidentiality was guaranteed. Overall prevalences found were as follows: HIV: 16% (95% confidence interval (CI): 13–19%); HCV: 34% (95% CI: 30–38%), and syphilis: 18% (95% CI: 15–21%). Acknowledged use of ever injecting drug was 22% and no other parenteral risk was reported. Our results, as compared with other studies in the same prison, suggest that HIV prevalence has been stable in recent years, and that the major risk factor for HIV infection in this population is parenteral exposure by injecting drug use.     

A computer model of the spread of hepatitis C virus among injecting drug users

A number of behavioural and clinical parameters influence the transmission of an infectious agent through direct contact between two individuals. The behavioural parameters encountered in such situations are also likely to exhibit an enormous amount of variability. With the spread of hepatitis C among injecting drug users, the parameters associated with injecting behaviour play an important role in the modelling of the transmission process. Computer simulation modelling is an ideal approach to deal with a large number of parameters as well as high levels of variability without excessive simplification. The simulation model presented in this paper is tested on data from a cohort of injecting drug users and the results obtained are very encouraging from a public health perspective. The model clearly indicates that the rate at which HCV spreads through a population of injecting drug users is extremely sensitive to the interaction rate and to the probability of infection through a single contact with an infective. At the same time it shows that rate of spread is not very sensitive to initial prevalence, which is very encouraging from a public health perspective.     

Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995–2004

High hepatitis C virus (HCV) prevalence has been documented among many injecting drug user (IDU) populations worldwide; however, there is limited published data on trends in incidence of infection in these epidemics over time. To address this, we used a novel method of analyzing data collected via repeat, cross-sectional sero-surveys by injection initiation cohorts to investigate trends in HCV seropositivity among a population of needle and syringe program (NSP) attendees in Australia between 1995 and 2004, and thereby infer annual incidence trends. Injection initiation cohorts were defined by their time of entry into the IDU population. We also investigated the associations between HCV antibody seroprevalence and risk factor data, and trends in risk factor data over the decade. Approximately 20,000 NSP attendees participated in the study over the 10-year period. Within each injection initiation cohort, we found an increase in HCV prevalence over time, with prevalence appearing to reach saturation around 90%. There was little indication that the slopes of increase had changed with more recent initiation cohorts. While duration of injecting was most strongly associated with HCV seropositivity in this study, we also found that self-reported history of needle and syringe sharing and imprisonment were independently associated with higher HCV prevalence regardless of duration of injecting, with the exception of IDUs who have 15 or more years injecting experience. In this group, recent risk behavior had no relationship to prevalence. In summary, our findings suggest a persistent HCV epidemic despite significant harm reduction efforts in Australia since the mid-1980s, with HIV incidence effectively constant in successive initiation cohorts. FUNDING SOURCE: Australian Government Department of Health and Ageing     

Prevalence of HIV,syphilis, hepatitis B,and hepatitis C among entrants to Maryland correctional facilities

Although high prevalence of hepatitis C virus (HCV) in correctional institutions has been established, data are sparse regarding the comorbidities of hepatitis B virus (HBV), HCV, and human immunodeficiency virus (HIV), all of which may complicate the management of HCV. This study sought to estimate the prevalence and correlates associated with HCV prevalence among entrants into the Maryland Division of Correction and the Baltimore City Detention Center. Participants included all newly incarcerated entrants between January 28 and March 28, 2002. Excess sera with identifiers removed from samples drawn for routine syphilis testing were assayed for antibodies to HIV and HCV and for HBV surface antigen and surface and total core antibodies. Separately, all HIV-positive specimens were tested using the serological testing algorithm for recent HIV seroconversion. Of the 1,081 immates and 2,833 detainees, reactive syphilis serology was noted in 0.6% of the combined population; HIV seroprevalence was 6.6%; HCV prevalence was 29.7%; and 25.2% of detainees and prisoners had antigen or core or surface antibodies to HBV. A multivariate analysis of predictors of HCV positivity indicated that detainees, women, whites, older age groups, those who were HIV seropositive, and individuals with past or present infection with HBV were significantly more likely to be positive for HCV. These data indicate that hepatitis C remains an important public health concern among entrants to jail and prison and is complicated with coinfections that need to be addressed for effective treatment.     

中国2013-2020年乙型肝炎发病情况估算和病例特征分析

目的:为了解我国乙型肝炎（乙肝）病例的发病特征,为评估我国消除乙肝目标的实现情况,制定乙肝防控规划提供科学依据。方法:对2013-2020年我国高、中、低流行区的全国法定传染病报告系统（NNDRS）中报告的乙肝病例进行调查,分析报告的病例的诊断信息,通过报告信息和诊断信息对2013-2020年的乙肝病例发病情况进行估算...     

Determinants of current HIV risk behaviour among injecting drug users in Warsaw, Poland

Of the injecting drug users (IDUs), 24% had borrowed, and 37% had passed on syringes in the previous 6 months. In logistic regression analysis, current borrowing of syringes was significantly associated with a shorter duration of injecting drug use, a higher number of drug-injecting sex partners in the previous 6 months, and with current lending of syringes. A majority of the IDUs have modified previous HIV risk behaviour but these modifications are insufficient and not sustained over time. Intensified AIDS prevention measures for IDUs in Poland are needed.     

Illness-related stigma, mood and adjustment to illness in persons with hepatitis C

We examined stigma in persons with hepatitis C and its relationship with mood and adjustment to illness. We studied 87 persons awaiting interferon treatment for hepatitis C at St James's Hospital, Dublin. Stigma was assessed using Fife's Experience of Illness scale. A structured clinical interview was used to establish DSM-IV diagnosis. The Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI) were also used as measures of mood. Factor analysis and clustering around latent variables analysis were used to assess scale structure and reliability. The stigma scale had an overall reliability of 0.94. A strong dimension of fear of disclosure emerged, from item analysis, together with dimensions of social isolation and social rejection. Stigma was higher in those in manual occupations and the unemployed than in those in non-manual occupation. There were high levels in those with disease associated with injecting drug use and iatrogenic disease caused by transfusion or anti-D blood products, and low levels in those who had been treated for haemophilia with contaminated products or whose hepatitis was of unknown origin. Adjusted for confounders, a 1-decile increase in stigma score had an odds ratio of 1.4 for DSM-IV depression and similar associations with depression on the HADS and BDI. Stigma was also associated with poorer work and social adjustment, lower acceptance of illness, higher subjective levels of symptoms and greater subjective impairment of memory and concentration. These associations were replicated in the non-depressed subsample. The results underline the strong link between stigma and well-being in hepatitis C. However, they also suggest that stigma is a complex construct that will require further research to elucidate.     

Prevalence of hepatitis virus infections in Albanian refugees

A sample of 393 Albanian refugees, including both children and adults, was tested for serological HAV, HBV, HDV and HCV markers. A high prevalence of infection with both the hepatitis A and B viruses was found, while HDV and HCV infections were uncommon. The overall prevalence of anti-HAV was 96%; it was very high in children 0-10 years, suggesting that HAV infection is largely acquired during childhood and that poor ambiental conditions influence the spreading of this viral infection.One or more serological markers of HBV infection were found in 295 Albanians (75%), confirming the endemic nature of this virus in the Albanian community. The overall prevalence of HBsAg was 19%, and the carrier rate was higher in males than in females. The high HBsAg prevalence among children suggests that HBV infection is usually acquired in early childhood.The serological data obtained in the Albanian sample examined clearly indicate the urgent need for measures to reduce the incidence of HAV and HBV infections and to avoid the further spread of HDV and HCV infections.Finally, the high prevalence of type B hepatitis indicates the necessity of vaccination against HBV for all risk groups and for all children at birth.     

Risk factors for hepatitis C infection and perception of antibody status among male prison inmates in the hepatitis C incidence and transmission in prisons study cohort,Australia

The objective of this study was to compare the prevalence of risk factors for hepatitis C virus (HCV) infection among male prison inmates enrolling into a prospective cohort in Australia. We tested 121 inmates who were previously untested or were previously known to be anti-HCV antibody negative for anti-HCV antibodies by enzyme-linked immunosorbent assay. HCV-positive inmates were classified as cases (n=25) and HCV-negative inmates as controls (n=96). The study found that cases were less educated than controls and confirmed that prior imprisonment, drug injection, and a longer duration of injecting were risk factors for HCV infection. More than half of those who tested HCV positive perceived that they did not have HCV infection, and 44% were unsure of their HCV status. Those inmates who were incorrect about their HCV status tended to be less educated and were more likely to have been previously imprisoned than those who were correct about their HCV status. Inmates who were unsure of their HCV status were less likely to have been tested for HCV than those who had a clear perception of their HCV status, even if incorrect. Three (12%) inmates who tested positive denied injecting drug use, but reported other risk factors. Prisons are likely to remain an important site for the diagnosis of HCV infection and targeted interventions aimed at risk reduction among inmates with low education levels and a previous imprisonment history. In addition to the authors, the members of the Hepatitis C Incidence and Transmission in Prisons Study (HITS) group at the time of the study are as follows: Michael Levy, Marian Gray, Deanne Wood, Susan Harper (Corrections Health Service, New South Wales); Rosemary A. Ffrench (Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia); Anthony J. Freeman, Charles E. Harvey, George Marinos (Viral Hepatitis Research Unit, Gastrointestinal and Liver Unit, Prince of Wales Hospital, Randwick, Australia); William D. Rawlinson, Peter A. White (Virology Research Laboratory, Department of Microbiology, South Eastern Area Laboratory Services, Randwick, Australia); Patricia Palladinetti (Inflammation Research Unit, Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, Australia); Jenean Spencer (National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney); Sophie DeKantzow, Joanne Micallef (Virology Research Laboratory, Department of Microbiology, South Eastern Area Laboratory Services, Randwick).     

Increasing Hepatitis C Prevalence and Associated Risk Behaviors among Incarcerated Young Adults

This study sought to assess the rate of hepatitis C virus (HCV) infection and associated risk factors in young adults 18–28 years of age who were incarcerated in the Rhode Island Department of Corrections. The majority of participants reported injection drug use and engaged in high-risk behaviors such as needle sharing. Despite having these risk factors and believing themselves to be at risk, the majority of youths reported no prior HCV testing. Correctional facilities present a unique opportunity to detect HCV infection and provide risk reduction education to young adults, the population with the highest rates of new infections in the US. Seventy-two incarcerated individuals with a history of drug use were approached to participate in the study; 68 completed the screening and interview. The rate of HCV infection among adults <30 years of age and incarcerated at the Rhode Island Department of Corrections in 2011 was high (24 %). In 1998, the rate of HCV among inmates <30 years of age at the same facility was only 11.4 %. These data follow the same increase in HCV infection rates among young adults observed in non-incarcerated young adults across the nation. HCV is the leading cause of liver failure and hepatocellular carcinoma in the US. Despite a decline and leveling in HCV incidence nationwide, alarming increases in HCV rates among adolescents and young adults have been reported during the period between the years 1992 and 2005. This disquieting epidemic is attributable to injection drug use amongst young adults.     

门诊乙型病毒性肝病处方调查与点评

目的探讨专科用药的现状,促进专科合理用药。方法根据《处方管理办法》选取2008年1月～2010年1月问题处方进行点评和分析。结果用药不当、联用不当和用法用量不当占有较高比率,分别为26．33％、19．72％和25．56％。结论专科处方亦存在较多不合理用药,应加强督查。     

A longitudinal study on the incidence and transmission patterns of HIV,HBV and HCV infection among drug users in Amsterdam

In the present study data on the incidence of HBV and HCV were used to indicate the prevalence of and trends in risk behavior, assuming that drug users (DUs) who become infected with HBV or HCV are also at risk for infection with HIV. In addition, we determined to that extent the transmission patterns of HIV, HBV and HCV differed. DUs were selected from a cohort study in Amsterdam, had at least one follow-up visit between December 1985 and September 1989 and reported never to have had homosexual contacts. Among 305 DUs, of whom 70% injected recently, the prevalence of HIV, HBV and HCV were 31%, 68% and 65% respectively. These prevalences were strongly interrelated and the same risk factors were found. The cumulative incidence of either HIV or HBV or HCV was 30% among prevalent HIV-negatives. Despite a previously reported reduction in risk behavior, only the HIV incidence tended to decrease initially, and after 1986 the incidences of HIV, HBV and HCV remained disturbingly high and stable (mean: 4, 9 and 10 per 100 person-years, respectively). As at present HBV appears to be transmitted more heterosexually than HIV in our study group and the HIV-epidemic may follow the HBV-epidemic in its transmission patterns, preventive activities targeted at both injecting and sexual behavior should be expanded.     

广州市社区居民病毒性肝炎血清流行病学调查及相关影响因素分析

目的了解社区居民病毒性肝炎的血清流行病学情况,分析乙型肝炎（乙肝）的危险因素,为进一步探索社区居民肝炎综合防治措施提供科学依据。方法以分层随机抽样方法,于2010年在广州市选取3个街道的社区居民为调查对象,采用面对面询问方式问卷调查,收集一般情况、生活史、家族史、乙肝知识、乙肝疫苗注射史等信息。采用ELISA法检测调查对象血样的HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc和抗-HAVIgG、抗-HCVIgG共7项指标。采用logistic回归分析方法分析影响乙肝感染率的因素。结果调查了2015户家庭居民共3511人,其中男性1403人,女性2108人。人群抗-HAVIgG、抗-HCV IgG、HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc阳性率分别为91．83％、0．74％、7．18％、61．75％、0．85％、12．90％和17．23％;HBsAg阳性率峰值出现在31～40岁年龄组（12．80％,43／337）;乙肝疫苗计划免疫策略实施后出生人群HBsAg阳性率为0．30％（1／328）,大幅低于政策实施前出生的人群（7．89％,251／3183）（P〈0．01）;HBV感染率为16．80％（590／3511）。多因素logistic回归分析结果表明,有肝炎家族史是HBV感染的危险因素（OR=33．52）,而接种乙肝疫苗是保护因素（OR=0．56）。结论广州市社区居民甲肝免疫水平较高,通过持续的肝炎防治,乙肝和丙肝的感染率有所降低,乙肝疫苗免费接种有效降低了新生儿和青少年的乙肝感染率,但成年人这一指标仍处于较高水平,建议今后应针对性改进社区居民尤其乙肝患者家属这一高危人群肝炎综合防治措施。     

Hepatitis B and C markers among alcoholics in Israel: High incidence of HCV infection

Patients with alcoholic liver disease have an increased prevalence of viral hepatitis. However, the role of demographic characteristics has not been adequately delineated. Therefore, we examined and compared the seroprevalences of hepatitis B and C in Israeli alcoholic patients to that of blood donors control group by their country of birth and origin. Hepatitis B surface antigen, hepatitis B core antibody and hepatitis C virus antibody testing (second generation ELISA) and a confirmatory recombinant immunoblot assay was performed on 496 alcoholic attending an alcoholic abstinence program and compared to 193,806 randomly non-alcoholic blood donors on the basis of their country of birth. Three hundred twenty-eight alcoholic patients (66%) were immigrants and Israeli born Jews and 168 (34%) were Israeli Arabs. Of the 496 alcoholic patients, 24 (4.8%) were HBsAg positive, 38 (7.6%) were anti HCV positive, and 2 (North African Jews) were positive for both markers. HBsAg was detected in 13 (3.9%) immigrant and Israeli Jews and 11 (6.5%) Israeli Arabs, significantly higher than in the adjusted non alcoholic blood donors (p < 0.01). Anti-HCV was detected in 33 (10%) immigrants and Israeli Jews and 5 (2.9%) Israeli Arabs, significantly higher than in the control group (p < 0.005). In the subgroup alcoholic Jews there was no significant difference in hepatitis B seropositivity among alcoholic that were native Israeli, Eastern Europe and former USSR, and western Europe and American immigrants comparing to the control group. In contrast, anti-HCV recombinant immunoblot assay seropositivity in alcoholic Jews from all subgroups was significantly greater than in non alcoholic blood donors (p < 0.001). Odds analysis of all ethnic groups revealed that alcoholism requiring detoxification have a significant risk factor for hepatitis C more than hepatitis B (p < 0.001). The increased seroprevalence of hepatitis C among Israeli alcoholic patients, regardless their country of birth and origin, suggest that alcoholism is likely to have a predisposing factor for HCV infection.     

河北省某献血村村民丙型肝炎病毒流行状况调查及危险因素分析

丙型肝炎病毒(HCV)主要经血液传播。在我国《献血法》颁布之前的20世纪80—90年代初,农村地区非法卖血现象十分普遍,多地献血人群因此引起严重的血源性HCV感染。     

Case-reporting of acute hepatitis B and C among injection drug users

Although public health surveillance system data are widely used to describe the epidemiology of communicable disease, occurrence of hepatitis B and C virus (HBV and HCV, respectively) infections may be misrepresented by under-reporting in injection drug users (IDUs). This study was carried out to examine the relationship between HBV and HCV incidence and case-reporting of hepatitis B and C in Seattle IDUs. Names of participants in a Seattle IDU cohort study who acquired HBV or HCV infection over a 12-month follow-up period were compared to a database of persons with acute bepatitis B and C reported to the bealth department surveillance unit over the same period. Of 2,208 IDUs enrolled in the cohort who completed a follow-up visit, 63/759 acquired HBV infection, 53/317 acquired HCV infection, and 3 subjects acquired both HBV and HCV. Of 113 cohort subjects who acquired HBV or HCV, only 2 (1.5%) cases were reported; both bad acute bepatitis B. The upper 95% confidence limit for case-reporting of bepatitis C in the cohort was 5.7%, and for hepatitis B, it was 7.5%. In this study, reporting of acute bepatitis in IDUs was extremely low, raising questions regarding the use of community surveillance data to estimate underlying incidence in that population group.