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Background/Aims: In 2002, the first reported outbreak of hepatitis A virus (HAV) infection involving mostly intravenous drug users (IDU) occurred in Italy. We attempted a thorough evaluation of the outbreak, including epidemiological, clinical and virological analyses. Methods: We conducted an epidemiological investigation, including a case-control study, to identify the source and themodes of HAV transmission. Hepatitis B and C (HCV) viruses and human immunodeficiency vir us (HIV) coinfections were clinically analysed. Sequence analysis of the VP1/2A junction of the HAV isolates was also performed. Results: Of the 47 symptomatic cases, 35 were IDUs. The only associated risk factor was contact (not related to injecting practices) with a jaundiced person (odds ratio: 5.8; 95%confidence i nterval: 1.3-29.9). Of the cases, 58%were anti-HCV positive and 4.7%anti-HI V positive. Three individuals died of acute liver failure: 2 were HCV-coinfecte d alcohol abusers, with underlying liver cirrhosis; 1 was HCV/HIV-coinfected. H AV-RNA was found in 15 of the 24 tested patients: genotype IB (8 cases) and III A (7 cases) were detected. Conclusions: HAV was probably transmitted through the fecal-oral route, although parenteral transmission cannot be excluded. The hig h fatality ratewas probably due to severe underlying liver damage. The occurrenc e of this outbreak highlights the need for routine HAV vaccination for IDUs.
Background / Aims: In 2002, the first reported outbreak of hepatitis A virus (HAV) infection involving mostly intravenous drug users (IDU) occurred in Italy. We attempted a thorough evaluation of the outbreak, including epidemiological, clinical and virological analyzes. Methods: Hepatitis B and C (HCV) viruses and human immunodeficiency vir us (HIV) coinfections were clinically analyzed. Sequence analysis of the VP1 / The only associated risk factor was contact (not related to injecting practices) with a jaundiced person (odds ratio: 5.8; 95% confidence i Of the cases, 58% were anti-HCV positive and 4.7% anti-HI V positive. Three individuals died of acute liver failure: 2 were HCV-coinfecte d alcohol abusers, with underlying liver cirrh 1 was HCV / HIV-coinfected. H AV-RNA was found in 15 of the 24 tested patients: genotype IB (8 cases) and III A (7 cases) were detected. Conclusions: HAV was probably transmitted through the fecal- oral route, although parenteral transmission can not be excluded. The hig h fatality ratewas probably due to severe underlying liver damage. The occurrenc e of this outbreak highlights the need for routine HAV vaccination for IDUs.