Investigation of a large community-based outbreak of hepatitis B infection in the United Kingdom

• Published in: Epidemiology and infection Vol. 140; no. 1; pp. 47 - 57
• Main Authors: ANDERSSON, M. I., LOW, N., IRISH, C. J., VERLANDER, N. Q., CARRINGTON, D., HORNER, P., STUART, J. M., HICKMAN, M.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.01.2012
• Subjects: Acute Disease; Adolescent; Adult; Antibodies; Antigens; Biological and medical sciences; Case-Control Studies; Community-Acquired Infections - epidemiology; Community-Acquired Infections - transmission; Community-Acquired Infections - virology; Disease Outbreaks; Drug use; Drug Users - statistics & numerical data; England - epidemiology; Female; Fundamental and applied biological sciences. Psychology; Hepatitis; Hepatitis antigens; Hepatitis B; Hepatitis B - epidemiology; Hepatitis B - transmission; Hepatitis B virus; Human viral diseases; Humans; Hypotheses; Immunization; Infections; Infectious diseases; Injections; Investigations; Laboratories; Male; Medical sciences; Medical syringes; Men; Microbiology; Middle Aged; Multivariate Analysis; Predisposing factors; Public health; Questionnaires; Risk Factors; Risk-Taking; Vaccination; Vaccines; Viral diseases; Viral hepatitis; Virology; Viruses; Workers; United Kingdom; Europe; Western Europe; England; United Kingdom > UK; United States > US; Wales; British Isles, England, Avon; British Isles, England; infectious disease epidemiology; Bloodborne virus transmission; hepatitis B; injecting drug users (IDUs); community outbreaks; Infection; Viral hepatitis B; Digestive diseases; Hepatic disease; Epidemiology; Viral disease
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268811000148

We describe the largest outbreak of hepatitis B virus infection reported to date in the UK. Between July 2001 and December 2005, 237 cases were identified in Avon, South West England. The likely route of transmission was injecting drug use in 44% (104/237) and heterosexual intercourse in 30% (71/237) of cases. A case-control study in injectors showed that injecting crack cocaine [adjusted odds ratio (aOR) 23·8, 95% confidence interval (CI) 3·04–186, P<0·001] and sharing injecting paraphernalia in the year before diagnosis (aOR 16·67, 95% CI 1·78–100, P=0·010) were strongly associated with acute hepatitis B. In non-IDUs number of sexual partners and lack of consistent condom use were high compared to a national sample. We describe the control measures implemented in response to the outbreak. This outbreak has highlighted the problems associated with the low uptake from the national hepatitis B vaccination policy which targets high-risk groups, the difficulties of identifying those at risk of acquiring hepatitis B infection through heterosexual sex, and injecting crack cocaine as a risk factor for hepatitis B.