Hepatitis E Virus among Persons Who Inject Drugs, San Diego, California, USA, 2009–2010

Reena Mahajan

, Melissa G. Collier, Saleem Kamili, Jan Drobeniuc, Jazmine Cuevas-Mota, Richard S. Garfein, and Eyasu Teshale

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R. Mahajan, M.G. Collier, S. Kamili, J. Drobeniuc, E. Teshale); University of California School of Medicine, San Diego, California, USA (J. Cuevas-Mota, R.S. Garfein)

Abstract

Data about prevalence of hepatitis E virus infection in persons who inject drugs are limited. Among 18–40-year-old persons who inject drugs in California, USA, prevalence of antibodies against hepatitis E virus was 2.7%. This prevalence was associated with age but not with homelessness, incarceration, or high-risk sexual behavior.

Serologic evidence of hepatitis E virus (HEV) infection (i.e., IgG against HEV) in the United States has been reported to be ≤21% on the basis of national estimates during 1988–1994 (1). Among marginalized populations, such as persons who inject drugs (PWID) and homeless or incarcerated persons, HEV infection ranges from 5% to 23%, although data have been limited for these groups (2–6). We determined the seroprevalence of and factors associated with IgG against HEV among 18–40-year-old PWID in San Diego, California, USA.

The Study

Methods for the Study to Assess Hepatitis C Risk have been summarized (7). In brief, during March 2009–June 2010, persons 18–40 years of age who were residents of San Diego County, California, and who had injected drugs in the previous 6 months were recruited to participate in this study. Eligibility screening and acquisition of informed consent for potential participants were followed by a behavioral risk assessment and serologic testing.
Data collected included participant demographics, substance use, injection practices, diagnosis with sexually transmitted infections, exchange of sex for money, homelessness, travel to Mexico, and HIV status. Serologic testing included detection of antibodies against hepatitis A virus (HAV), hepatitis B virus core antigen, and hepatitis C virus (HCV) by using the VITROS Immunodiagnostic System (Ortho Clinical Diagnostics, Rochester, NY, USA), and IgG against HEV by using a commercial assay (DSI, Saronno, Italy).