Search tips
Search criteria 


Logo of jurbhealthspringer.comThis journalToc AlertsSubmit OnlineOpen ChoiceThis journal
J Urban Health. 2002 December; 79(4): 579–585.
PMCID: PMC3456717

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.

Keywords: Hepatitis B, Hepatitis C, Substance use, Surveillance

Full Text

The Full Text of this article is available as a PDF (66K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
1. Contoreggi C, Rexroad VE, Lange WR. Current management of infectious disease complications in the injecting drug user. J Subst Abuse Treat. 1998;15:95–106. doi: 10.1016/S0740-5472(97)00048-2. [PubMed] [Cross Ref]
2. Hagan H. Hepatitis C transmission dynamics in injection drug users. Subst Use Misuse. 1998;33:1197–1212. doi: 10.3109/10826089809062214. [PubMed] [Cross Ref]
3. Chamot E, Saussure P, Hirschel B, et al. Incidence of hepatitis C, hepatitis B, and HIV infections among drug users in a methadone maintenance programme. AIDS. 1992;6:431–432. [PubMed]
4. Ameijden EJC, Hoek JAR, Mientjes GHC, et al. A longitudinal study on the incidence and transmission patterns of HIV, HBV and HCV infection among drug users in Amsterdam. Eur J Epidemiol. 1993;9:255–262. doi: 10.1007/BF00146260. [PubMed] [Cross Ref]
5. Hagan H, McGough JP, Thiede H, et al. Syringe exchange and risk of infection with hepatitis B and C viruses. Am J Epidemiol. 1999;149:203–213. [PubMed]
6. Crofts N, Aitken CR. Incidence of blood-borne virus infection and risk behaviors in a cohort of injecting drug users in Victoria, 1990–1995. Med J Aust. 1997;167:17–20. [PubMed]
7. Alter MJ, Moyer LA. The importance of preventing hepatitis C virus infection among injection drug users in the United States. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(suppl 1):S6–S10. [PubMed]
8. Moyer LA, Mast EE, Hepatitis B. Virology, epidemiology, disease, and prevention, and an overview of viral hepatitis. Am J Prev Med. 1994;10:45–55. [PubMed]
9. Heptonstall J. Strategies to ensure delivery of hepatitis B vaccine to injecting drug users. Commun Dis Public Health. 1999;2:174–177. [PubMed]
10. Margolis HS, Alter MJ, Hadler SC. Viral hepatitis. In: Evans AS, Kaslow RA, editors. Viral Infections of Humans—Epidemiology and Control. New York: Plenum; 1997. pp. 363–418.
11. Robinson WS. Hepatitis B virus and hepatitis D virus. In: Mandel GE, Bennett JE, Dolin R, editors. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill Livingstone; 2000. pp. 1652–1685.
12. Seeff LB. Natural history of hepatitis C. Hepatology. 1997;26(suppl 1):21S–28S. doi: 10.1002/hep.510260704. [PubMed] [Cross Ref]
13. Chang G, Kosten TR. Detoxification. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, editors. Substance Abuse: a Comprebensive Textbook. Baltimore, MD: Williams and Wilkins; 1997. pp. 377–381.
14. Hagan H, Thiede H, McGough JP, Alexander ER. Hepatitis B vaccination among research participants, Seattle, Washington. Am J Public Health. November 2002. In press. [PubMed]
15. Hagan H, Thiede H. Changes in injection risk behavior associated with participation in the Seattle needle exchange. J Urban Health. 2000;3:365–378. [PMC free article] [PubMed]
16. Hagan H, Thiede H, Weiss NS, et al. Sharing of drug preparation equipment as a risk factor for hepatitis C virus incidence. Am J Public Health. 2001;91:42–46. doi: 10.2105/AJPH.91.9.1350. [PubMed] [Cross Ref]
17. Thiede H, Hagan H, Murrill CS. Methadone treatment and HIV and hepatitis B and C risk reduction among injectors in the Seattle area. J Urban Health. 2000;77:331–345. doi: 10.1007/BF02386744. [PMC free article] [PubMed] [Cross Ref]
18. Hanley JA, Lippman-Hand A. If nothing goes wrong, is everything all right? Interpreting zero numerators. JAMA. 1983;249:1743–1745. doi: 10.1001/jama.249.13.1743. [PubMed] [Cross Ref]
19. Annual Communicable Disease Report. Olympia, WA: Washington State Department of Social and Health Services; 1998.
20. Centers for Disease Control and Prevention Summary of notifiable diseases, 1998. MMWR Morb Mortal Wkly Rep. 1999;47:4–7.
21. Gretch DR. Diagnostic tests for hepatitis C. Hepatology. 1997;26(suppl 1):43S–47S. doi: 10.1002/hep.510260708. [PubMed] [Cross Ref]
22. Schroter M, Feucht HH, Schafer P, Zollner B, Polywka S, Laufs R. Definition of falsepositive reactions in screening for hepatitis C virus antibodies. J Clin Microbiol. 1999;37:233–234. [PMC free article] [PubMed]
23. Alter MJ, Mares A, Hadler SC, et al. The effect of underreporting on the apparent incidence and epidemiology of acute viral hepatitis. Am J Epidemiol. 1987;125:133–139. [PubMed]
24. Crofts N, Jolley D, Kaldor J, et al. Epidemiology of hepatitis C virus infection among injecting drug users in Australia. J Epidemiol Community Health. 1997;1:692–697. doi: 10.1136/jech.51.6.692. [PMC free article] [PubMed] [Cross Ref]

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine