Increasing Incidence of Acute Hepatitis B Virus Infection Referrals to the Aberdeen Infection Unit: A Matter for Concern

Abstract

Objectives: To assess the epidemiology and clinical outcomes of acute hepatitis B virus (HBV) infections presenting to a regional Infection Unit over a ten year period - with reference to the issues of injection drug use and strategies aimed at reducing transmission, notably needle exchange and immunisation programmes. Methods: A retrospective casenote review of all patients with acute HBV managed at the Infection Unit in Aberdeen between 1991–2000. Results: One hundred and nineteen (119) patients with acute HBV infection were managed during the period of review. The annual number of patients increased from a mean of 3.3/year during the years 1991–96 to 46 in 2000. The risk factors associated with HBV infection were being an injection drug user (IDU) in 57 (47–9%), heterosexual sex in 22 (18.5%), sex with an IDU in 4 (3.4%), men who had sex with men in to (8.4%), tattooing in 1 (0.8%), a needle stick injury in 1 (0.8%), trauma 1 (0.8%) and unknown in 23 (19.3%). Many of these patients had “dabbled” in drug use. Thirty-one (54.4%) of the IDU patients had previously been hospitalised with drug-related medical problems. Eighteen (31.6%) of the IDUs were receiving methadone at the time of presentation. Conclusions: There is an epidemic of HBV infection in the Grampian region of Scotland currently. Forty-six (65.7%) of the 70 infected patients diagnosed during 2000 were seen at the Infection Unit. The remainder had mild or asymptomatic disease and were managed in the community. This epidemic has occurred despite extensive use of local needle exchange facilities and might reflect missed opportunities to immunise IDUs against HBV infection. A co-ordinated approach is now in place to immunise IDUs and other high-risk groups, but the use of universal immunisation demands consideration.