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HBV cases increase among IDUs in Appalachian states
The incidence of hepatitis B virus infection appears to have increased in three Appalachian states from 2006 to 2013, especially among injection drug users and those in nonurban areas, according to recent MMWR data.
“Since 2006, the overall U.S. incidence of acute HBV infection has remained stable; the rate in 2013 was 1.0 case per 100,000 persons,” researchers wrote. “Population-based surveillance data from Kentucky, Tennessee and West Virginia indicate a 114% increase in acute HBV infection during 2006 to 2013; this increase occurred after 2009, among whites, aged 30 to 39 years who reported injection drug use.”
The researchers examined data from the CDC’s National Notifiable Diseases Surveillance System for confirmed cases of acute HBV infection in these states. Cases were analyzed by year, demographics, injection drug use and county population, which was used to categorize regions as urban or nonurban. Population estimates from the U.S. Census Bureau were used to estimate annual incidence, and analysis was divided into two time periods: 2006 to 2009 and 2010 to 2013.
The researchers identified 1,243 HBV cases during the first period and 2,062 cases in the later period, demonstrating a marked increase when national incidence rates remained stable.
When comparing the two periods, a significant increase was seen in the proportion of whites (P < .001), persons aged 30 to 39 years (P < .001) and injection drug users (IDU; P < .001) confirmed with HBV.
Among cases in which a classification could be determined, 42% of cases were among those residing in a nonurban county. While incidence grew in both urban and nonurban counties, the trend was only significant among cases in nonurban counties (P < .001).
The researchers wrote that the increase in acute HBV cases is likely the result of an increasing number of IDUs and lower hepatitis B vaccine coverage among young adults, challenges that must be overcome in order to reduce incidence in this region.
“The increase in incident HBV infections has the potential to impede the nation’s hepatitis B elimination strategy,” the researchers wrote. “Evidence-based prevention strategies, including increasing hepatitis B vaccination coverage, testing and linkage to care, and implementing education campaigns that target persons who inject drugs are urgently needed.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.