The aim of the study was to investigate present and past morbidity in drug addicts, 25 years after hospitalisation for acute hepatitis B or hepatitis nonA-nonB. The hospital records for 214 consecutively admitted patients were analysed, and a follow-up study on 66 of the 144 patients still alive was performed. At follow-up, 1 of 54 (1.8%) hepatitis B patients was still HBsAg positive. Twelve patients originally diagnosed as hepatitis nonA-nonB were all among 54 found to be anti-hepatitis C virus (anti-HCV) positive, and the total anti-HCV prevalence was 81.8%. Twelve (22.2%) of the HCV cases were unknown before the follow-up examination. Four (6.1%) participants were anti-human immunodeficiency virus positive, only 1 was on antiretroviral therapy, and none had developed AIDS. Other chronic somatic diseases were a minor problem, whereas drug users reported skin infections as a frequent complication. Forty-three patients (65%) had abandoned addictive drugs since the hospital stay. Serious mental disorders were reported by 19 patients (28.8%), and 17 (25.8%) regarded themselves as present (9) and former (8) compulsive alcohol drinkers. A large proportion of the participants were granted disability pension (39%), a majority because of psychiatric disorders, drug and alcohol abuse.
985 episodes of hepatitis representing 98% of all acute hepatitis episodes found in a Swedish city during a 10-year period were analyzed for anti-hepatitis A IgM antibodies and hepatitis B surface antigen. Hepatitis A was diagnosed in 311 episodes (32%), hepatitis B in 494 (50%), simultaneous acute hepatitis A and B in 12 (1.2%), and 168 episodes (17%) were classified as hepatitis non-A, non-B. The majority of the hepatitis A cases were drug addicts (58%), and all were concentrated in 3 outbreaks of 1-2 years duration. 16% of all hepatitis A cases were probably imported. Hepatitis B cases decreased significantly (p less than 0.001) between the first and second half of the study period. 47% were drug addicts. Hepatitis non-A, non-B was also dominated by drug addicts (61%). Approximately 20% of the cases in all 3 types of hepatitis had no identifiable source.
A retrospective study of acute hepatitis B (AHB) during 1995-1996 in G?teborg, Sweden, was carried out to investigate whether the increasing number of hepatitis B virus (HBV) carriers due to immigration in northwestern Europe has influenced the incidence or genotype heterogenicity. 24 cases of AHB were identified, the probable transmission route of which was intravenous drug use (IVDU) in 11 (46%), heterosexual in six (25%), homosexual in one, hemodialysis in two and unknown in four cases. In no case was the source an immigrant with chronic HBV infection. Genotype D was seen in 12 patients, seven being anti-HCV-positive IVD users, two probably infected heterosexually and three with an unknown source. Genotype A was found in six patients: three IVD users, a sexual partner of an IVD user and two dialysis patients. Genotype B was found in one patient infected during travel to Vietnam, and genotype C in one patient, probably infected sexually from a previously identified chronic carrier. In conclusion, genotype D is the main genotype and IVDU still the major risk factor for AHB in Goteborg, while transmission from immigrants appears to be of minor importance despite the fact that this group comprises over 90% of the young, highly infectious carriers.
Serological analysis by radioimunoassay of sera from 297 patients hospitalized with acute non-toxic hepatitis was used for classification according to virus etiology. Radioimmunoassays included tests for hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), antibody to hepatitis A virus (anti-HAV), anti-HAV of IgM class, and antibody against cytomegalovirus (GMV) and Epstein-Barr virus. One patient with a significant rise in anti-CMV antibodies was classified as having CMV hepatitis. Among the 296 remaining patients serological markers indicated hepatitis A in 51 cases (17.2%) and hepatitis B in 208 cases (70.3%). The remaining 37 patients (12.5%) fulfilled criteria for acute non-A, non-B hepatitis. This type of hepatitis had symptoms and signs indistinguishable from those of hepatitis A, except for a slight tendency to milder disease on admission. A considerable proportion of patients with non-A, non-B hepatitis had a history of drug abuse (43.2%) and of recently traveling to endemic hepatitis areas (29.7%). In the remaining 27.1% no particular background was revealed. No case of post-transfusion hepatitis was seen. During the last 6 months of the study a striking change in epidemiology concerning hepatitis A was seen, apparently caused by a steep increase in the incidence of this type of hepatitis among drug addicts. No significant difference in biochemical liver tests was seen in non-a, non-B hepatitis or hepatitis A. In contrast, a marked and statistically significant difference in serum concentrations of IgM was found, with higher values (mean, 7.5 g/1; range, 3.2-13.9 g/1) in hepatitis A than in non-a, non-B hepatitis (mean, 3.3 g/1; range, 0.9-9.4 g/1). This difference may have diagnostic value.
An epidemic of hepatitis B occurring in a rural area of Nova Scotia in 1988 and 1989 was investigated. This epidemic identified injection drug use (IDU) as the major determinant of transmission and was the first highly visible indication of IDU in rural Nova Scotia. Contact-tracing was used to identify 186 injection drug users (IDUs), of whom 153 (82%) were interviewed. Of 133 (72%) IDUs who underwent serological testing, 78 had serological evidence of hepatitis B infection. Using epidemiological criteria, 57 IDUs formed a cluster of hepatitis B infections. Using logistic regression techniques, age (O.R. = 1.1), the total number of IDU-contacts named (O.R. = 1.1), and the number of hepatitis B seropositive IDU-contacts named (O.R. = 1.3), were identified as risk factors predictive of an IDU being a cluster case. The characterization of this epidemic may be useful as a model for the spread of hepatitis B and other viral infections among IDUs in rural areas.