The National Hepatitis A Outbreaks: Experience from the Epicenter

Historically, outbreaks of hepatitis A virus (HAV) have been associated with contaminated food. Through vaccination and sanitation, the annual incidence of HAV had plummeted until the recent outbreak. We investigated the demographic features and clinical course of HAV cases during 2017–2018 in West Virginia. We performed a retrospective chart review on 482 patients confirmed with HAV. We found them to be predominantly Caucasian males with a mean age of 42. Forty-nine percent were intravenous drug users with methamphetamine being the substance of choice (52%). There was evidence of geographic clustering. Two patients with chronic liver disease died of hepatic failure secondary to HAV, and a third patient died of lone HAV. Our data shows a strong association of HAV with illicit substance use, specifically methamphetamine. These persons at risk should be targeted for vaccination. The increased transmission of HAV in drug users warrants investigation.