Rapid transmission of hepatitis C virus among young injecting heroin users in Southern China

BACKGROUND: Hepatitis C virus (HCV) is quickly spread through injection drug use. The prevalence and incidence of HCV in Chinese heroin users has been rarely reported. METHODS: A longitudinal cohort of young injection drug users (IDU) from southern China was established to study the risk factors for blood-borne infections (597 subjects). Individuals underwent analysis for the presence of hepatitis B surface antigen and antibodies to human immunodeficiency virus type 1 (HIV-1), HCV and hepatitis B surface antigen. Using self-reported risk behaviours, multivariate regression analysis was performed for factors associated with HCV prevalence and seroconversion. RESULTS: At baseline, HIV-1 and HCV prevalence was 17% and 72%, respectively. Significant factors associated with HCV seroprevalence included age >25 years (odds ratio [OR] = 1.71) and injection drug use for >2 years (OR = 2.60). HCV prevalence within one year of starting heroin use was 57% for any route of administration, and 80% if restricted to injectors. After two 6-month follow-up visits, 56 out of 159 baseline HCV seronegative individuals (148.9 total person years [py]), underwent seroconversion at an incidence rate of 37.6 per 100 py. Individuals who reported injection drug use were more likely to undergo HCV seroconversion (rate ratio [RR] = 6.59). CONCLUSIONS: HCV infection is rapidly acquired in heroin users who adopt injection in southern China. This study emphasizes the urgent need to implement and expand injection prevention and primary substance abuse prevention programmes in China.     

Sexual transmission of hepatitis C virus infection

The role of sexual transmission in the diffusion of HCV infection, was studied through the seroprevalence of anti-HCV antibodies in the heterosexual habitual partners of 83 anti-HCV positive subjects. The index cases were represented by 10 dialysed subjects, 31 patients with chronic liver disease and 42 healthy carriers. Seroprevalence of anti-HCV positivity reported in partners was 8.43%, with a higher rate in cohabitants of patients with chronic liver disease (16.12% vs 4.76% of carriers); no case was found among partners of dialysed subjects. Laboratory and ultrasonograph signs of chronic hepatitis were reported in 3 cases (3.61%). Control on 70% of the cohabitants' relatives, was negative for HCV infections. These data suggest a possible sexual transmission of HCV infection, even if its prevalence resulted modest, undoubtedly lower than in other disease sexually transmitted.     

Sexual transmission of hepatitis C virus and HIV-1 infection in female intravenous drug users

We examined the relationship between the presence of antibody to HCV and sexually transmitted diseases in 151 female, intravenous drug users aged 17–43 years. Anti-HCV was present in 49 of 66 HIV-1-negative women (74.2%), and 63 of 85 HIV-1-positive women (74.1%). Anti-HCV seropositivity was significantly related to sexually transmitted infections (Ureaplasma urealyticum infections excluded) in HIV-1-seronegative women, but not in HIV-1-positive women. Also, in HIV-1-negative subjects, Trichomonas vaginalis infections (and infections with M. hominis) were significantly related to anti-HCV seropositivity, and a positive relation between the number of sexual partners and the presence of anti-HCV was demonstrated. In HIV-1-positive subjects a shared use of needles and syringes was more likely, and an increased parenteral exposure to HCV may decrease the relative contribution by sexual transmission. However, in HIV-1-negative subjects, sexual transmission of HCV appears to be both a possible and important means of transmission.     

An epidemic of hepatitis B virus infection among intravenous drug users in Iceland

This study describes an outbreak of hepatitis B primarily among intravenous drug users in Iceland which has a population with a very low incidence of hepatitis B virus infection. The incidence of acute hepatitis B is generally low in the Nordic Countries, in the order of one to five cases per 100,000 people per year. Between 1989 and 1992 there was an outbreak of hepatitis B virus infection primarily among the intravenous drug user (IVDU) population in Iceland. At the Department of Medical Virology, University of Iceland there were 44 cases of acute hepatitis B identified during the peak year 1990, an incidence of 16.9 cases of acute hepatitis B per 100,000 people. 63.6% of these were known to be IVDUs. The seroprevalence of the hepatitis B core antibody (anti-HBc) marker was assessed among 1100 randomly selected individuals. The average prevalence of this marker was 2.9% and rose from zero at the age of 15 and younger to 6.5% at the age of 65 and older. Among IVDUs attending a detoxification clinic in 1990 the prevalence of the anti-HBc was 32%. In contrast, those attending the same clinic, due to alcoholism only, did not have a significantly higher prevalence of anti-HBc than the group used for comparison.     

Epidemiology of hepatitis C virus infection among injecting drug users in Australia.

STUDY OBJECTIVE: To review the epidemiology of hepatitis C virus (HCV) infection among injecting drug users (IDUs) in Australia, and consider needs for further research and prevention policies and programmes. DESIGN: (1) Review of the results of surveillance for HCV; (2) review of published literature on prevalence, incidence, and risk factors for HCV among IDUs; and (3) reconstruction of incidence rates from prevalence studies of HCV in IDUs. SETTING AND PARTICIPANTS: Field and clinic based studies of IDUs in Australia. MAIN RESULTS: HCV has been present at high prevalences (of the order of 60-70%) in populations of Australian IDUs since at least 1971. Duration of injecting and main drug injected were the main predictors of seropositivity, the latter possibly a surrogate for frequency of injecting and both together as surrogate for cumulative numbers of times injected. Risk of infection begins with first injection and continues as long as injecting does. Current incidence is approximately 15 per 100 person years, and up to 40 per 100 person years in some subpopulations. Incidence may have decreased through the 1980s as a result of behaviour change in relation to HIV, as it has for hepatitis B, but not significantly so. CONCLUSIONS: Control of HCV infection in Australia will depend on effectiveness of measures to control HCV spread among IDUs. This will be a greater challenge than the control of HIV in this population has been. Needs identified include improved surveillance, especially for recently acquired infection, better understanding of exact transmission modes, and urgent improvement in prevention strategies.     

注射毒品者丙型肝炎病毒感染率及其危险因素研究

目的了解北京市注射毒品者HCV感染状况及其危险因素,评估注射毒品人群中HIV感染高危行为流行水平,为制定预防和控制艾滋病的策略和措施提供科学依据。方法选择北京市强制戒毒所新收治的注射毒品者和自社区招募的注射毒品者作为研究对象,采用问卷调查的方法进行资料的收集,采集静脉血5ml,实验室检测HCV抗体。资料的分析采用单因素分析、多因素分析。结果北京市注射毒品者的HIV感染率和HCV感染率分别为7.33%和52.59%。多因素分析结果表明HCV感染的危险因素有在强制戒毒所(OR=2.37,95%CI为1.55~5.72)、非北京市户籍(OR=1.94,95%CI为1.05~3.45)和注射次数≥100次(OR=2.60,95%CI为1.54~7.03)。结论北京市注射毒品人群HCV的感染率高达52.59%,标志着HIV感染高危行为在这一人群中广泛存在,应立即采取相应措施控制HIV和HCV感染的进一步扩散。     

Variability in the incidence of human immunodeficiency virus,hepatitis B virus,and hepatitis C virus infection among young injecting drug users in New York City

Cohort studies of young (aged 18-30 years) injecting drug users recruited in 1997-1999 in the Harlem and Lower East Side areas of New York City, New York, were used to assess the incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The authors found that HIV incidence was low at both sites: 0.8/100 person-years at the Harlem site and 0/100 person-years at the Lower East Side site. In contrast, HBV incidence was moderate (12.2/100 person-years) at the Harlem site and high (30.7/100 person-years) at the Lower East Side site. Similarly, HCV incidence was moderate (9.3/100 person-years) at the Harlem site and high (34.0/100 person-years) at the Lower East Side site. Results show that high rates of HBV and HCV transmission do not imply high rates of HIV transmission, even within an area of high HIV seroprevalence.     

Occupational exposures and risk of hepatitis B virus infection among public safety workers

We conducted a questionnaire and seroprevalence survey to determine the frequency and type of occupational exposures (OEs) and the risk of hepatitis B virus (HBV) infection experienced by public safety workers (PSWs). Of the 2910 PSWs who completed the survey, 6.8% reported at least one OE in the previous 6 months, including needlestick (1.0%), being cut with a contaminated object (2.8%), mucous membrance exposure to blood (0.9%), and being bitten by a human (3.5%). The rate of OE varied by occupation with 2.7% of firefighters, 3.2% of sheriff officers, 6.6% of corrections officers, and 7.4% of police officers reporting > or = 1 OE (P < 0.001). The HBV infection prevalence was 8.6%, and after adjustment for age and race, it was comparable to the overall US prevalence and did not vary by occupation. By multivariate analysis, HBV infection was not associated with any OEs, but it was associated with older age, being nonwhite, and a previous history of a sexually transmitted disease. This study demonstrated that although OEs are not uncommon among PSWs, HBV infection was more likely to be associated with nonoccupational risk factors. Administration of hepatitis B vaccine to PSWs early in their careers will prevent HBV infection associated with occupational and non-OEs.     

Age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus infection among injection drug users admitted to drug treatment in 6 US cities

OBJECTIVES: This study measured age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus (HCV) infection among injection drug users (IDUs) admitted to drug treatment programs in 6 US cities. METHODS: Remnant sera collected from persons entering treatment with a history of illicit drug injection were tested for antibodies to HIV, hepatitis C (anti-HCV), and hepatitis B core antigen (anti-HBc). RESULTS: Prevalence of anti-HBc and anti-HCV increased with age and reached 80% to 100% among older IDUs in all 6 cities. Although overall age-specific HIV prevalence was lower than anti-HCV or anti-HBc, this prevalence was greater in the Northeast than in the Midwest and West. CONCLUSIONS: The need continues for effective primary prevention programs among IDUs specifically targeting young persons who have recently started to inject drugs.     

The hepatitis C virus epidemic among injecting drug users.

Given the economic and health costs of hepatitis C virus (HCV) infection, and the ongoing transmission within the injecting drug user (IDU) population, there is a need for improved understanding of HCV epidemiology within this risk group. We employed a recently developed method based on phylogenetic analysis to infer HCV epidemic history and to provide the first estimates of the rate of spread of subtypes 1a and 3a circulating within injecting drug user populations. The data indicates that HCV subtype 1a entered the IDU population on at least three separate occasions. Both subtypes demonstrate exponential population growth during the 20th century, with a doubling time of 7-8 years. The results provide a baseline for prediction of the future course of the HCV epidemic, and its likely response to transmission control policies.     

深圳市外来务工人群丙型肝炎基因型分布及感染危险因素研究

目的 了解深圳市外来务工人群丙型肝炎病毒(HCV)感染者的基因型分布,并探讨该群体感染HCV的危险因素,为掌握本市外来务工群体HCV流行特点提供科学依据.方法 选取为本地外来务工人员提供体检服务的健康体检门诊2个,选择2014年1月至12月期间诊断出的HCV感染者进行基因型检测分析;并将其作为病例组,选择同时期同门诊中...     

我国吸毒人群中艾滋病病毒与丙型肝炎病毒的感染状况

相对其他人群,我国吸毒人群具有较高的艾滋病病毒与丙型肝炎病毒的感染率以及合并感染率,是影响该人群健康的主要问题之一。本文从地区分布、人群分布方面描述和比较了艾滋病病毒与丙型肝炎病毒在我国吸毒人群面的染GZ中的感染以及合并感染的情况,分析了两种病毒通过相互影响,在病毒传播与致病方面产生的危害,并对相应的防治工作提出了建议。     

Seroprevalence of hepatitis C virus infection and its association with natural infection of hepatitis B virus among preschool children in Taiwan

Taiwan is a hyperendemic area of hepatitis B virus (HBV) infection where chronic hepatitis B is the most important cause of liver cirrhosis and hepatoma. Since, diagnostic kit for detecting hepatitis C virus (HCV) infection has been developed, HCV was found to be another important etiology of chronic liver disease. In order to study the seroprevalence of HCV infection among preschool children after mass hepatitis B vaccination program in Taiwan, a community-based survey was carried out in 54 kindergartens in 10 urban areas, 10 rural areas, and two aboriginal areas randomly selected through stratified sampling. Serum specimens of 2538 preschool children were screened for the HCV antibodies (anti-HCV) by a commercially available third-generation microparticle enzyme immunoassay and for HBV markers by radioimmunoassay methods. The multivariate-adjusted odd ratios (OR_m) with their 95% confidence intervals (CI) were estimated through the multiple logistic regression analysis. A total of 58 children were anti-HCV seropositive, giving a prevalence of 2.3%. The prevalence of anti-HCV was 1.0% (5 of 484) among aboriginal children, a significantly decreased seroprevalence compared with those among other ethnic groups after multivariate adjustment. Boys had a higher anti-HCV seroprevalence, but not statistically significantly different from girls (OR_m: 1.6; 95% CI: 0.9–2.8; p = 0.08). The seroprevalence of the age group of 3–4 years was lower than that of the age group of 5–6 years (OR_m: 2.2; 95% CI: 1.1–4.2; p = 0.02). After multivariate adjustment, preschool children with natural HBV infection had a higher anti-HCV seroprevalence, but not statistically significantly different from those without natural HBV-infection (OR_m: 2.6; 95% CI: 0.9–7.4; p = 0.08 for HBV-infected vs. uninfected). HCV infection varies with gender, residential area, and natural HBV infection. HCV and HBV might share common transmission routes in Taiwan.     

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.     

维持性血液透析患者感染乙型肝炎和丙型肝炎病毒的危险因素分析

目的分析维持性血液透析患者感染乙型肝炎和丙型肝炎病毒的高危因素,为临床感染的预防和治疗提供借鉴依据。方法选取2014年10月-2015年10月医院临床收治的维持性血液透析患者368例为研究对象,分析维持性血液透析患者的乙型肝炎和丙型肝炎病毒感染情况、导致感染的危险因素及相关临床特点。结果共39例患者发生感染,感染率为10.60%;年龄、住院时间、透析总次数、肝炎病史、透析器复用是导致维持性血液透析患者肝炎病毒感染的独立危险因素(P<0.01);感染患者的血红蛋白、血清白蛋白均低于非感染患者,感染患者C-反应蛋白、丙氨酸转氨酶和天冬氨酸转氨酶均高于非感染患者,感染患者的各项淋巴细胞亚群指标均低于非感染患者,组间上述指标比较,差异均有统计学意义(P<0.05)。结论维持性血液透析患者肝炎病毒感染较为严重,危险因素较多,患者遭受感染后临床特点主要表现为营养状况下降、肝脏受损情况加剧、机体免疫能力低下等。     

Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program.

OBJECTIVES. This case-control study examined the association between syringe exchange use and hepatitis B and C in injection drug users. METHODS. Case patients included 28 injection drug users with acute hepatitis B and 20 with acute hepatitis C reported to the health department in a sentinel hepatitis surveillance county; control subjects were injection drug users with no markers of exposure to hepatitis B or C (n = 38 and 26, respectively) attending health department services during the same period. Data were abstracted from clinic records. RESULTS. Seventy-five percent of case patients with hepatitis B and 26% of control subjects had never used the exchange; similar proportions were found for the hepatitis C case and control groups. After adjustment for demographic characteristics and duration of injecting drugs, nonuse of the exchange was associated with a sixfold greater risk of hepatitis B (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 1.5, 20.4) and a sevenfold greater risk of hepatitis C (OR = 7.3; 95% CI = 1.6, 32.8). CONCLUSIONS. The results suggest that use of the exchange led to a significant reduction in hepatitis B and hepatitis C in the county and may have also prevented a substantial proportion of human immunodeficiency virus infections in injection drug users.     

乙肝疫苗免疫人群乙肝病毒感染和发病状况研究

目的了解上海市儿童乙肝疫苗免疫后乙肝病毒感染和发病情况。方法采用多阶段随机抽样方法,于2000年和2006年共计抽取1 904份接种人群血液标本,用酶联免疫吸附试验（ELISA）检测HBsAg、抗-HBs和抗-HBc。结果新生儿乙肝疫苗接种率和及时率均保持较高水平。20岁以下人群乙肝发病率明显下降;HBsAg携带率降幅为78.34%。儿童乙肝患者中84.35%（124/147）未接种过乙肝疫苗;23例接种乙肝疫苗但患病的儿童中,12例患儿的母亲或父亲HB-sAg阳性。结论儿童接种乙肝疫苗是预防和降低乙肝感染的有效措施。需加强母（父）婴阻断和家庭内传播机制的研究。     

孕妇乙型肝炎病毒宫内感染相关危险因素研究

目的 探讨厦门市孕妇乙型肝炎病毒（hepatitis B virus,HBV）感染情况和HBV宫内感染的影响因素。方法 在1 064名孕妇第一次到医院建立孕产妇保健卡时进行问卷调查并检测其血清乙肝标志物,根据检测结果选择外周血乙型肝炎表面抗原（hepatitis B surface antigen,HBsAg）阳性的产妇179例随访至其分娩,并采集其分娩时的脐血和胎盘组织。对脐血进行HBsAg和HBV DNA的检测,对胎盘组织进行HBsAg的检测。采用χ2检验和非条件Logistic回归分析相关因素与HBV宫内感染的关系。结果 被调查的1 064名孕妇中,HBsAg阳性的孕妇共179名,感染率为16.8%。对179名HBsAg阳性的孕妇的脐血进行检测发现,发生HBV宫内感染的孕妇共34名,感染率为19.0%。孕妇HBV宫内感染的危险因素为胎盘HBsAg阳性、孕妇血清乙型肝炎E抗原（hepatitis Be antigen,HBeAg）阳性、孕前超重,OR分别为5.123（95%CI:1.422~18.413）、4.619（95%CI:1.225~17.534）、3.343（95%CI:1.233~9.092）。结论 对于HBsAg和HBeAg双阳性的超重/肥胖孕妇,其新生儿可能发生HBV宫内感染,应加强自身防护措施,合理规避HBV宫内感染风险。     

肇庆市居民乙肝病毒感染现状及危险因素调查

目的 了解广东省肇庆市居民乙型病毒性肝炎(以下简称乙肝)病毒感染现状及相关危险因素,为相关部门制定和完善免疫规划策略提供科学依据。方法 于2014年6-11月采用分层整群随机抽样方法在肇庆市8个区(县)抽取11个街道居委会和29个乡镇村委会共1716名1~59岁常住居民进行问卷调查和血清学检测。结果 肇庆市1716名1~59岁居民HBsAg阳性率为8.74%,抗-HBs阳性率为72.09%,抗-HBc阳性率为69.23%;不同特征居民比较,不同性别居民HBsAg、抗-HBs和抗-HBc阳性率差异均无统计学意义(均P>0.05),不同年龄居民HBsAg和抗-HBc阳性率差异均有统计学意义(均P<0.05),不同地区居民HBsAg、抗-HBs、抗-HBc阳性率差异均有统计学意义(均P<0.05);肇庆市1716名居民中,与乙肝表面抗原阳性者长期一起生活者占7.11%,与家人共用牙刷者占1.28%,与家人共用过剃须刀者占0.58%,有拔牙、补牙或洗牙等口腔治疗史者占21.50%,有过有偿献血史者占3.44%,有输血史者占1.05%,有手术治疗史者占2.97%,有内窥镜诊疗史者占1.81%,有针灸治疗史者占1.28%,曾与他人共用注射器者占0.06%,曾去理发店修面、修体毛或刮胡须者占17.89%,曾去洗浴场所修脚者占5.07%,曾去美容院做过创伤性美容者占2.86%。结论 肇庆市居民乙肝病毒感染率较高,存在家庭内、医疗性和日常生活感染乙肝病毒的危险性。